MedicalResearch.com Interview with:
Ayesha Rahman, MD
Chief Orthopaedic Surgery Resident
NYU Langone Medical Center.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Children are more vulnerable and susceptible to lifetime adverse events from radiation exposure, caused by imaging . We reviewed literature and found certain pediatric orthopaedic patients are at greater risk for radiation exposure, namely those who have surgery for hip dysplasia, scoliosis, and leg length discrepancy, as they are among those most likely to undergo CT imaging. After reviewing all types of imaging studies performed in orthopedics and how much radiation is involved in each test, we developed several recommendations that pediatric orthopaedic surgeons should follow.
Among those recommendations are: utilize low-dose CT protocols or technology that uses less imaging (like EOS), limit CT scans of the spine and pelvis, know that female patients are more susceptible to adverse risk and plan accordingly, and follow the the “as low as reasonably achievable,”principle to limit exposure to parts of the body that are necessary for diagnosis.
MedicalResearch.com: What should readers take away from your report?
Response: While x-rays are still a necessary and important diagnostic tool in the pediatric population, our goal is to reduce radiation exposure to pediatric patients wherever possible without compromising patient care. By knowing the risks and where the are gaps and disparities are, surgeons can make more informed patient care decisions while reducing this risk. There should be a change in mindset regarding ordering studies: does this study answer a question that will affect the treatment or outcome? If the answer is no, then don’t order it.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research will examine the outcomes of several of these best practices that have been implemented at NYU Langone. Some studies will also look at lower-dose CT scan protocols for diagnosing orthopaedic injuries and musculoskeletal conditions and will test how accurately surgeons can diagnose these conditions compared to typical scans.
MedicalResearch.com: Is there anything else you would like to add?
Response: Our institution values advancements in medical technology as well as maintaining the highest standards of patient care and safety. We have implemented an institution wide orthopedic protocol using low-dose CT scans, which in most instances provides equivalent diagnostic information while drastically reducing radiation exposure for young patients. We recently started using EOS machines which can provide a fraction of the radiation dosages as standard x-rays, and can provide us with more information through bi-planar imaging that standard flat-plate x-rays are not capable of.
Intraoperatively we have also implemented standard use of low-dose protocols on our fluoroscopy machines as well as the laser localizer and inverted configuration for upper extremity cases, which reduces the radiation exposure to both patients as well as physicians and staff in the operating room. We have examined our use of x-rays in different clinical situations and the effect on patient outcomes, and have been able to reduce or eliminate the need for x-rays in many instances including certain post-operative and routine follow-up visits.
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Citation: Abstract presented at the American Academy of Orthopaedic Surgeons 2017 Annual Meeting
Radiation Exposure in the Pediatric Patient: What Every Orthopaedist Should Know
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