소아촬영의 방사선 피폭과 저감화 방법 = Medical radiation exposure in children and dose reduction

다국어 초록 (Multilingual Abstract)

Medical imaging is an indispensible diagnostic tool in modern medicine enabling fast and accurate diagnosis. However, recent technological advances in medical equipment and increased utilization of the imaging modality have resulted in a significant increase in the exposure to ionizing radiation. The risk from radiation must be carefully considered in all examinations using ionizing radiation, especially in children. The risk of cancer in children from radiation exposure is higher than adults because pediatric patients are more radiosensitive and have more years ahead in which cancerous changes might occur. Therefore, pediatric protocols specifically designed for children must be used. However, many exams are still conducted using inappropriate adult protocols, which can result in excessive radiation. The most efficient way to reduce radiation is to avoid the examination if not justified. It has been suggested that one third to one half of pediatric CT exams are unnecessary or replaceable by other imaging modalities. If the exam is justified, then the parameters must be optimized to the imaging indication, scan area, body size, age, or weight of the patient according to the “as low as reasonably achievable”(ALARA) principle. The physician should always assess the radiation risk-benefit for each patient before ordering an examination using radiation.

참고문헌 (Reference)

1 Grattan-Smith JD, "urography in children: how we do it" 38 (38): S3-S17, 2008

2 Dorfman AL, "Use of medical imaging procedures with ionizing radiation in children: a population-based study" 165 : 458-464, 2011

3 Korley FK, "Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007" 304 : 1465-1471, 2010

4 Newman B, "Ultrasound body applications in children" 41 (41): 555-561, 2011

5 Nazarian LN, "The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI" 190 : 1621-1626, 2008

6 National Institute of Food and Drug Safety Evaluation, "Technical standard for the performance of pediatric radiography" National Institute of Food and Drug Safety Evaluation 2010

7 McCollough CH, "Strategies for reducing radiation dose in CT" 47 : 27-40, 2009

8 Sidhu M, "Step Lightly: promoting radiation safety in pediatric interventional radiology" 195 : W299-W301, 2010

9 Larson DB, "Rising use of CT in child visits to the emergency department in the United States, 1995-2008" 259 : 793-801, 2011

10 Goo HW, "Regional and whole-body imaging in pediatric oncology" 41 (41): S186-S194, 2011

11 "Radiological protection and safety in medicine. A report of the International Commission on Radiological Protection" 26 : 1-47, 1996

12 Sidhu M, "Radiation safety in pediatric interventional radiology: Step Lightly" 40 : 511-513, 2010

13 Lee CH, "Radiation dose modulation techniques in the multidetector CT era: From basics to practice" RADIOLOGICAL SOC NORTH AMERICA 28 : 1451-1459, 200809

14 Strouse PJ, "Pediatric appendicitis: an argument for US" 255 : 8-13, 2010

15 Hernanz-Schulman M, "Pause and pulse: ten steps that help manage radiation dose during pediatric fluoroscopy" 197 : 475-481, 2011

16 Muhogora WE, "Paediatric CT examinations in 19 developing countries: frequency and radiation dose" 140 : 49-58, 2010

17 Schilham A, "Overranging at multisection CT: an underestimated source of excess radiation exposure" 30 : 1057-1067, 2010

18 Yu L, "Optimal tube potential for radiation dose reduction in pediatric CT: principles, clinical implementations, and pitfalls" 31 : 835-848, 2011

19 Nievelstein RA, "Multidetector CT in children: current concepts and dose reduction strategies" 40 : 1324-1344, 2010

20 Leyendecker JR, "MR urography: techniques and clinical applications" 28 : 23-46, 2008

21 National Council on Radiation Protection and Measurements, "Ionizing radiation exposure of the population of the United States" National Council on Radiation Protection & Measurements 2009

22 Ron E, "Ionizing radiation and cancer risk: evidence from epidemiology" 32 : 232-237, 2002

23 Goo HW, "Individualized volume CT dose index determined by cross-sectional area and mean density of the body to achieve uniform image noise of contrast-enhanced pediatric chest CT obtained at variable kV levels and with combined tube current modulation" 41 : 839-847, 2011

24 Chong AL, "Imaging in pediatric patients: time to think again about surveillance" 55 : 407-413, 2010

25 Goske MJ, "Image gently: a web-based practice quality improvement program in CT safety for children" 194 : 1177-1182, 2010

26 Strauss KJ, "Image gently: Ten steps you can take to optimize image quality and lower CT dose for pediatric patients" 194 : 868-873, 2010

27 Goske MJ, "Image Gently: providing practical educational tools and advocacy to accelerate radiation protection for children worldwide" 31 : 57-63, 2010

28 National Research Council, "Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2" National Academies Press 2006

29 Kim DS, "Guideline for diagnostic reference level of the radiation exposure of CT examination" National Institute of Food and Drug Safety Evaluation 2009

30 김지은, "Evaluation of a Radiation Dose Reduction Strategy for Pediatric Chest CT" AMER ROENTGEN RAY SOC 194 (194): 1188-1193, 201005

31 Brenner D, "Estimated risks of radiation-induced fatal cancer from pediatric CT" 176 : 289-296, 2001

32 Strauss KJ, "Estimated pediatric radiation dose during CT" 41 (41): 472-482, 2011

33 Yakoumakis E, "Effective dose variation in pediatric computed tomography: dose reference levels in Greece" 97 : 595-603, 2009

34 Jung AY, "Dose reduction strategies in pediatric CT" 18 : 1-4, 2011

35 Ahmed BA, "Cumulative effective doses from radiologic procedures for pediatric oncology patients" 126 : e851-e858, 2010

36 Brenner DJ, "Computed tomography: an increasing source of radiation exposure" 357 : 2277-2284, 2007

37 Mettler FA Jr, "CT scanning: patterns of use and dose" 20 : 353-359, 2000

38 Verdun FR, "CT radiation dose in children: a survey to establish age-based diagnostic reference levels in Switzerland" 18 : 1980-1986, 2008

39 Callahan MJ, "CT dose reduction in practice" 41 (41): 488-492, 2011

40 McCollough CH, "CT dose reduction and dose management tools: overview of available options" 26 : 503-512, 2006

41 Frush DP, "CT dose and risk estimates in children" 41 (41): 483-487, 2011

42 Brody AS, "American Academy of Pediatrics Section on Radiology. Radiation risk to children from computed tomography" 120 : 677-682, 2007