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In Memoriam of James G. Kereiakes: Designing Pediatric Imaging to Achieve the Best Benefit/Risk for Our Patients

S Thomas1*, L Wagner2*, S Brady3*, F Fahey4*, K Strauss5*, (1) ,Cincinnati, OH, (2) UT McGovern Medical School, Houston, TX, (3) Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (4) Children's Hospital, Boston, MA, (5) Children's Hospital Medical Center, Cincinnati, OH


(Wednesday, 8/1/2018) 10:15 AM - 12:15 PM

Room: Room 202

James G. Kereiakes, one of the early leaders of the AAPM served as its 11th president in 1970. Among Jim’s numerous awards, he was the 10th recipient of the AAPM Coolidge Award in 1981 and received the RSNA gold medal in 1988 representing the highest honor given by each of those organizations. In addition to his many professional leadership activities on the national stage, Dr. Kereiakes was one of the first medical physicists to recognize the unique nature and requirements of pediatric imaging. This session will begin with a brief review of Dr. Kereiakes’ personal and professional life and his impact on the field of Medical Physics. Four presentations focused on pediatric imaging will follow in honor of his concerns and passion involving the imaging children.

Benefit and Risk in Pediatric Imaging:
Our professional society exclaims on their website: “Improving Health Through Medical Physics�. And yet evidence exists in published literature and other resources, both pediatric and otherwise, that a substantial underlying current of thought emphasizes risk from medical ionizing radiations with only casual and non-specific reference to ample health benefit. This presentation will disclose several pathways of this phenomenon with proposals on how to more inclusively keep the focus of our profession on optimizing benefit/risk as opposed to just emphasizing the management of risk.

Pediatric CT:
Setting up protocols for imaging pediatric patients in CT can be one of the most complex tasks facing medical physicists. A misconception about imaging pediatric patients is that all pediatric patients are small babies. The reality facing most pediatric CT clinics is that at any hour of the day, the scanner will be required to scan patients as small as premies to as large as bariatric sized adults. This presentation will discuss a methodology for establishing CT protocols for varying patient sizes while optimizing the four pillars of pediatric CT: image quality, radiation dose, IV contrast, and sedation.

Pediatric Imaging in Nuclear Medicine:
The third presentation will discuss the optimization of pediatric nuclear medicine procedures by balancing the benefits as well as any potential risks. The dosimetry associated with pediatric nuclear medicine will be briefly discussed as well as efforts towards protocol standardization.

Pediatric Fluoroscopic Imaging:
The final presentation will focus on the challenges of altering the configuration of fluoroscopic equipment to better manage the radiation dose while maintaining image quality. This is best achieved by teamwork between radiologists, technologists, a qualified medical physicist, and appropriate technical representatives of the vendor of the imaging equipment. The presentation will close with a couple examples of fundamental configuration changes that significantly impact the quality of pediatric patient care during imaging.

Learning Objectives:
1. With respect to benefit and risk in pediatric imaging:
-Cite examples of how correlation of adverse effects and medical ionizing radiations does not translate to causation
-Delineate examples of how casual discussion of benefit/risk can subliminally overemphasize risk or more realistically express benefit/risk.
-Explain the difference between AHARA and ALARA

2. With respect to pediatric CT:
-Demonstrate the need to establish size based image protocols
-Demonstrate techniques to optimize image quality, radiation dose, and IV contrast
-Discuss methods to reduce sedation rates

3. With respect to imaging in pediatric nuclear medicine
-List three factors that affect the radiation dose
-Describe two approaches to dose reduction
-Discuss the benefits and potential risks

4. With respect to pediatric fluoroscopic imaging:
-Describe the size range of pediatric patients and its impact on the automatic exposure control of the fluoroscope
-Describe the team members and challenges to effective teamwork during reconfiguration of a fluoroscope
-Identify and describe three fundamental configuration changes which improve pediatric fluoroscopic imaging



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