In medicine, knowledge is power and the information and knowledge gained from medical imaging have transformed the way medicine is practiced in less than a generation. Advances in X-ray imaging have evolved dramatically and span simple projection X-ray examinations to sophisticated 3-D techniques (computed tomography or 'CT') to fluoroscopy, which features dynamic images helpful in both diagnosing and treating certain conditions.
These advances mean that we can find problems earlier, when a treatment is most likely to be successful. As a pediatrician and a cardiologist, I have relied upon these increasingly accurate tests, and seen firsthand their life-saving benefits among my patients.
With these technological gains, however, comes a cost. X-ray exams use ionizing radiation, and CT and fluoroscopy require a relatively higher dose than plain X-rays. This radiation, if excessive, has been associated with an increased risk of cancer. This risk is slight – and is far outweighed by the benefits for a patient in need of a diagnosis or effective treatment plan. But it is real and compels us to be proactive about reducing patients' exposure as much as possible, without jeopardizing the diagnostic quality of the exam.
Nowhere is this responsibility more important than in children. Children have a higher sensitivity to radiation dose, and a longer lifetime over which the risk of cancer can accumulate. Thus, it is imperative that clinicians use X-ray procedures only when necessary, and at settings that ensure the dose is 'right sized' for these smaller patients.
On Nov. 28, 2017, FDA published a final guidance titled "Pediatric Information for X-ray Imaging Device Premarket Notifications." This guidance recommends that manufacturers include dose reduction features in their equipment designs and pediatric resources when they develop and manufacture X-ray equipment.
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