Reducing radiation exposure
from medical imaging is the responsibility of all users of imaging equipment.
As a member of the Image Gently Alliance, we adhere to the recommendations of the Pause and Pulse campaign.
Radiation dose reduction is one of the
primary concerns of the Connecticut
Children’s Medical Center (CCMC)
Radiology Department in Hartford,
Connecticut. As a recipient of the AHRA
& Toshiba Putting Patients First grant,
CCMC was able to purchase two laser
targeting systems that were retrofitted
onto existing C-arm units.
Mobile image intensifier systems
(C-arms) are used frequently at CCMC in
the operating room for a variety of surgical
procedures such as central line placement,
treatment of orthopedic injuries, and
urological procedures. C-arm systems are
able to provide both spot imaging as well
as fluoroscopic imaging, which allows the
generation of real time images. It is very
important to consider the radiation dose
to both the patient and to the operating
room personnel from the modality.
Every strategy for decreasing radia-
tion dose should be thoroughly evaluated
for effectiveness and ease of use includ-
ing pulsed fluoroscopy, last image hold,
and collimation. The hypothesis of this
study is that having a laser localizer sys-
tem will also decrease the radiation dose
by eliminating unintentional radiation
prior to localizing the area of interest.
While it is important to decrease radiation doses to all populations, the pediatric population is the most sensitive to
the stochastic effects of radiation. A significant source of radiation accumulation in the pediatric population is from
fluoroscopy, particularly in children with
chronic medical problems who need
frequent evaluations and image guided
procedures. Pediatric patients in particular are at the highest risk for radiation induced cancers. It is estimated that
without dose reduction techniques, one
minute of fluoroscopy is equivalent to
approximately ten chest radiographs. It
is therefore imperative that all techniques
for reducing radiation doses be utilized.
Techniques for dose reduction that
were already in use at CCMC included
pulsed fluoroscopy, last image hold, and
collimation. Laser targeting devices were
also already in use, but there is very little
research/evidence to show that the targeting systems actually reduce fluoroscopy times.
A CCMC pediatric radiology resident conducted a performance quality
improvement project to determine if
having a laser targeting system would
decrease the radiation dose by eliminating unintentional radiation prior to
localizing the region of interest.
By Kellie Schenk, MD and Lynne Johnston, RT(R)(M), CRA
Laser Targeting with C-arm
Fluoroscopy: Effect on Radiation
Exposure for Pediatric Patients
• The primary purpose of obtaining laser
targeting devices for C-arm fluoroscopy
was to attempt to reduce radiation to
the pediatric population in Connecticut
Children’s Medical Center’s commitment to Imaging Gently.
• Fluoroscopy times for placing central
lines in the operating rooms were documented for two months prior to the
installation of the lasers and then for
twenty procedures after installation and
training on the devices.
• Fluoroscopy times trended down 25%
calculated by a simple mean and standard deviation.