HSS’s ‘Image Lightly’ Approach Means Safer X-Rays for Kids

No one enjoys going in for an X-ray or CT Scan. And an MRI? Forget about it. But that anxiety often gives way to dread when it’s your child who’s undergoing the imaging. If you’re not worrying about sending them off into a darkened room by themselves, then you’re fretting over the radiation exposure — and how it could affect your child in the years to come.

Though the amount of radiation used in a diagnostic treatment is very small, a parent’s concern is understandable. After all, your son or daughter is still growing, and you don’t want anything to interfere with that.

Neither do the pediatric orthopedists at the Hospital for Special Surgery Lerner Children’s Pavilion. They take patient care very seriously and only subject patients to radiation when absolutely necessary, thereby keeping exposure to a minimum. Likewise, the HSS Department of Radiology and Imaging adheres to an ‘Image Lightly’ approach aimed at getting the best diagnostic image with the lowest possible dose of radiation. This sounds deceptively simple. In reality, HSS pediatric radiologists rely on a finely honed set of skills, years of experience working with children and teenagers, and some of the most advanced equipment available.

Low-dose Technology

In fact, one of the biggest ways they cut down on exposure is with EOS. This powerful, low-dose X-ray system decreases radiation in up to 90 percent of routine imaging, says Dr. Eric A. Bogner, a board-certified radiologist and chief of MSK Computed Tomography at the HSS Lerner Children’s Pavilion. “Having something like this is helpful, especially for kids with spine deformities, like scoliosis, that need to be evaluated constantly to look for progression of disease,” he adds.

Even the way the diagnostic image is formed is done with your child’s safety in mind. Whenever possible, the radiologists will use an innovative post-process called iterative reconstruction to form an image based on the data received during the testing. Since it uses less energy on the front end, doctors are able to decrease the dose of radiation by 20-30 percent.

Radiation-free Techniques

Thanks to their specialized knowledge, HSS pediatric radiologists also use ultrasound and MRI on young patients whenever possible. (Neither technique relies on radiation.) It’s a workaround that’s only possible thanks to the highly specialized team of doctors interpreting the images. "We can do it because we have radiologists who are terrific at reading MRIs and ultrasounds,” Dr. Bogner explains. “In fact, we have radiologists who specialize in reading only bone and joint imaging. That expertise lets us do things that obviate the need for a CT scan, thereby eliminating the radiation dose altogether."

Limiting the Evaluation Area

That wealth of knowledge and experience in diagnosing children and teenagers is also useful when deciding the best (and safest) imaging choice. “We know the radiosensitive organs of the body,” Dr. Bogner says. “So we’re always asking ourselves: what do we need to scan and how can we avoid radiosensitive areas to the best of our ability?”

That said, the radiologists work in tandem with the pediatric orthopedic surgeon to zero in on a precise (read: smaller) target area to image. For example, if a teen comes in with a stress fracture in the spine, Dr. Bogner and his team will evaluate only the part that’s broken. “We look at the area but not anywhere superfluous,” he says. “We do more tailoring than other radiologists.”