Research demonstrates that children receive twice as much medical radiation from Computed Tomography (CT) scans performed at non-pediatric facilities as equivalent CTs performed at pediatric trauma centers (PTCs). In 2014, AFMC outreach staff educated Emergency Department (ED) staff on appropriate CT imaging utilization to reduce unnecessary medical radiation exposure. We set out to determine the educational campaign’s impact on injured children received radiation dose.

All injured children who underwent CT imaging and were transferred to a Level I PTC during 2010 to 2013 (pre-campaign) and 2015 (post-campaign) were reviewed. Patient demographics, mode of transportation, ED length of stay, scanned body region, injury severity score, and trauma center level were analyzed. Median effective radiation dose (ERD) controlled for each variable, pre-campaign and post-campaign, was compared using Wilcoxon rank sum test.

Three hundred eighty-five children under 17 years were transferred from 45 and 48 hospitals, pre- and post-campaign. Most (43%) transferring hospitals were urban or critical access hospitals (30%). Pre- and post-campaign patient demographics were similar. We analyzed 482 and 398 CT scans pre- and post-campaign. Overall, median ERD significantly decreased from 3.80 to 2.80. Abdominal CT scan ERD declined significantly from 7.2 to 4.13 (P-value 0.03). Head CT scan ERD declined from 3.27 to 2.45 (P-value < 0.0001).

A statewide, CT scan educational campaign contributed to ERD decline (lower dose scans and fewer repeat scans) among transferred injured children seen at PTCs. State-level interventions are feasible and can be effective in changing radiology provider practices.

When patients receive radiation therapy for breast cancer, they need to take off their underwear to avoid build-up effects. However, it is a mental burden for female patients to take off their underwear at every fraction of radiation therapy. The purpose of this study was to investigate whether commercially available thin underwear can be worn during radiation therapy for breast cancer.

In this phantom study, we investigated whether commercially available underwear can be worn during radiation therapy for breast cancer using six thin non-disposable brassieres and one disposable paper brassiere. The dose increase rate (ΔD) was calculated by measuring skin doses with or without each brassiere.

The mean ΔD values of six non-disposable brassieres were 13.5% (9.0–21.8%), whereas that of disposable ones was 2.0%.

Due to the risk of excessive radiation to the skin, wearing commercially available underwear is not recommended during radiation therapy for breast cancer, but a thin disposable paper brassiere may be safe to be used.

Radiation exposure during paediatric cardiac catheterisation procedures should be minimised to “as low as reasonably achievable”. The aim of this study was to evaluate the effectiveness of a modified radiation safety protocol in reducing patient dose during paediatric interventional cardiac catheterisation.

Radiation dose data were retrospectively extracted from January 2014 to December 2015 (Standard group) and prospectively collected from January 2016 to December 2017 (Low-dose group) after implementation of a modified radiation safety protocol. Both groups included five most common procedures: atrial septal defect closure, patent ductus arteriosus closure, perimembranous ventricular septal defect closure, pulmonary valvuloplasty, and supraventricular tachycardia ablation.

Median air Kerma was 48.4, 50.5, 29.75, 149, 218, and 12.9 mGy for atrial septal defect closure, pulmonary valvuloplasty, patent ductus arteriosus closure <20 kg, ventricular septal defect closure <20 kg, ventricular septal defect closure ≧20 kg, and supraventricular tachycardia ablation in Standard group, respectively, which significantly decreased to 18.75, 20.7, 11.5, 41.9, 117, and 3.3 mGy in Low-dose group (p < 0.05). This represents a reduction in dose to each patient between 46 and 74%. Among five procedural types in Low-dose group, dose of ventricular septal defect closure was the highest with median air Kerma of 62.5 mGy, dose area product of 364.7 μGy.m2, and dose area product per body weight of 21.5 μGy.m2/kg, respectively, along with the longest fluoroscopy time of 9.9 minutes.

We provided a feasible radiation safety protocol with specific settings on a case-by-case basis. Increasing awareness and adequate training of a practical radiation dose reduction program are essential to improve radiation protection for children.

The purpose of this study was to investigate variations in surface dose, with and without the use of a Klarity® Mask (Orfit Industries America, Wijnegem, Belgium), using intensity-modulated radiotherapy (IMRT) and 3-D conventional radiotherapy (3D-CRT).

Thermoluminescent dosimeters (TLDs) together with a phantom were used to examine acute skin toxicity during nasopharyngeal cancer treatment. These plans were sequentially delivered to the perspex phantom. Dosimeters were placed in five fixed regions over the skin. A Klarity mask for immobilization was used for covering the head, neck, and shoulder. The phantom was irradiated with and without a Klarity Mask, using IMRT and 3D-CRT, respectively.

The Klarity mask increased the skin doses for IMRT and 3D-CRT approximately 18·6% and 8·6%, respectively, from the prescribed maximum skin dose using treatment planning system (TPS). Additionally, the average percentage dose between IMRT and 3D-CRT received on the surface region was 30·9%, 24·9% with and without Klarity mask respectively. The average percentage dose received on surfaces from the total therapeutic dose 70 Gy, without using the mask was 7·7% and 5·7%, for IMRT and 3D-CRT, respectively. The TPS overestimated the skin dose for IMRT planning by 20%, and for 3D-CRT by 16·6%, compared with TLD measurements.

The results of this study revealed that IMRT significantly increases acute skin toxicity, compared with CRT. Although it is recommended to use Klarity mask as a sparing tool of normal tissue, it increases the risk of skin toxicity. In conclusion, skin dose is an important issue of focus during radiotherapy.

Iterative reconstruction has been reported to reduce radiation dose in CT, while preserving and even improving image quality. The purpose of this study was to evaluate the effects of sinogram-affirmed iterative reconstruction (SAFIRE) on radiation dose reduction and image quality for noncontrast adult head CT and to compare SAFIRE with conventional filtered back-projection (FBP) reconstruction.

Institutional review board approval was obtained for this retrospective analysis of head CT scans reconstructed with SAFIRE and/or FBP for 107 patients. Radiation dose parameters were recorded from scanner-generated CT dose reports. Signal-to-noise and contrast-to-noise ratios (SNR, CNR) were calculated from gray and white matter (GM, WM) attenuation measurements. Image noise, artifacts, GM-WM differentiation, small structure visibility, and sharpness were graded by two readers. Statistical analysis included the independent-samples t test for quantitative data, the related samples Wilcoxon signed-rank test for qualitative data, the coefficient of repeatability for intraobserver variation, and κ statistics for interobserver agreement.

Mean effective dose was significantly reduced with SAFIRE from 2.0 to 1.7 mSv (p<0.0001). SAFIRE also significantly improved GM SNR, WM SNR, and GM-WM CNR (p<0.0001). Significant reductions in image noise and posterior fossa artifact as well as improvements in GM-WM differentiation, small structure visibility, and sharpness were noted with SAFIRE (P<0.005).

SAFIRE for noncontrast adult head CT reduces patient radiation dose by 15% for the settings employed at our institution, while significantly improving multiple quantitative and qualitative measures of image quality.