Optimizing Pediatric Radiation Dose – 1 CE Credit

Optimizing Pediatric Radiation Dose

Optimizing Pediatric Radiation Dose

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  • Understand Digital Radiography Perfusion and its advantages over FS Analog and computed radiography
  • Identify the standardized terminology in Digital Radiography
  • Understand the importance of estimating patient dose
  • Provide guidelines and recommendations for reducing the pediatric dose
  • Identify the Noise level and answer on some clinical questions
  • Develop the Quality Assurance and Quality Control Programs
  • Understand the importance of using a safety checklist in pediatric Digital Radiography


The purpose of this module is to introduce users to the Pediatric Digital Radiography basics, how to estimate pediatric dose and how to reduce the radiation exposure. It also highlights the image characterization in addition to the patient safety and quality control program. Pediatric X-ray imaging represents 85% of the ionizing exposure in children. Chest X-ray is the most common examination performed, followed by extremity imaging and spinal and abdominal examinations. Given that the children’s radiation sensitivity is high, radiation dose reduction in pediatric X-ray imaging is very important. This article is accredited by the ASRT for 1 Category A CE Credit.

Discipline Major content category & subcategories CE Credits provided
RAD-2017 Safety
Radiation Protection 0.25
RAD-2017 Image Production
Image Acquisition and Technical Evaluation 0.25
Equipment Operation and Quality Assurance 0.25

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Over the past 20 years, digital radiographic technology has developed rapidly and has largely replaced film-screen (FS) radiography in the majority of hospitals. When comparing pediatric digital radiographs exposure to computed tomography (CT), fluoroscopy, and nuclear medicine studies, pediatric patient’s radiation is and shall be lower.

So how does the radiation absorptivity vary between pediatric and adult patients?

Pediatric patients are more sensitive to radiation than adults. Radiation absorptivity is increased in young people due to their low body fat and smaller body size. In addition, babies and younger children have high radiosensitive red bone marrow especially in long bones. Therefore, it is very important to reduce the exposure in children by applying the ALARA principle (As Low as Reasonably Achievable).

As mentioned before, it is a must to apply the ALARA principle to reduce radiation exposure. Moreover, there are many practices that should be applied, including:

  • Proper immobilization: There has long been need for a device which would immobilize the child adequately, be safe, simple, and quick to use, permitting the radiography of various parts of the body in proper positions
  • Addressing family concerns: To ensure that pediatric patients and their families are fully informed of the benefits and risks of a procedure
  • Communication and instructions: Technologists play a central role in the radiology department, and many of their responsibilities depend on the effective communication with the patients: taking histories, verifying patients’ identity and the procedure to be performed, screening for safety, providing instructions and ensuring that patients understand all instructions, answering questions promptly and accurately, explaining post-examination care, and coordinating patient care with efficient and effective use of resources
  • The use of shielding: used for patients who have not passed the reproductive age defined as ages 45 and below, during radiographic procedures in which the gonads are in the useful beam
  • The use of lead aprons and half shields: Lead aprons are used in medical facilities to protect workers and patients from unnecessary X-ray radiation exposure from diagnostic radiology procedures
  • Applying a short exposure time: resulting from high kVp technique based around increasing kVp and decreasing mAs
  • Applying limited views through a proper usage of the collimator: Proper collimation is one of the aspects of optimizing the radiographic imaging technique. It prevents unnecessary exposure of anatomy outside the area of interest, and it also improves image quality by producing less scatter radiation from these areas

In this context, a campaign was launched in 2008 to raise awareness about methods to reduce radiation dose during pediatric medical imaging exams.

This campaign called “Image Gently campaign” is an initiative of the Alliance for Radiation Safety in Pediatric Imaging, a coalition founded by the Society for Pediatric Radiology, the American Society of Radiologic Technologists, the American College of Radiology and the American Association of Physicists in Medicine. The campaign has produced open source modules for all stakeholders regarding CT, fluoroscopy, nuclear medicine, interventional radiology, digital radiography and dental imaging. The philosophy of the Image Gently steering committee is to collaborate, to share information freely, to keep messaging simple and to commit to lifelong learning.

Digital Radiography Basics

Before we go any further in that discussion, we need to understand a little more about the Digital Radiography basics.

Digital radiography is a form of radiography that uses X-ray–sensitive plates to directly capture data during the patient examination, immediately transferring it to a computer system (electronic image) without the use of an intermediate cassette. This data is then digitized and the image will be shown on a computer.

Computed Radiography (CR) and Direct Digital Radiography (DDR) are the commonly used terms for DDR detectors. Now let’s take a look at this comparison of Computed Radiography and Direct Radiography:

  • In terms of image receptors: In Computed Radiography, the image receptors are Photostimulable phosphor plate, Europium-Activated Barium, Fluor Halide or a needle Phosphor Plate. The most commonly used receptors are the Fluor Halide. Whereas in Direct Digital Radiography, we find two types of image receptors depending on the X-ray to Image conversion method: The Direct or the indirect conversion. The Direct conversion is processed through Selenium receptor (mostly) which converts the X-rays to an electrical charge (the radiological image), and the Indirect conversion is processed through Csl and Gadolinium Oxysulfide (mostly) that convert X-ray into light at first, and then light into electrical charge (the radiological image)
  • In terms of readout process: The readout process in Computed Radiography is conducted through a separate laser reader and the whole process takes about 30 to 40 seconds. Whereas in Direct Digital Radiography, a Thin Film Transistor (TFT) layer is bonded to the image receptor and processes the radiological image in less than 10 seconds
Table 1. Comparison of Computed Radiography and Direct Radiography
Image receptors Computed Radiography Direct Digital Radiography
Photostimulable phosphor plate Europium-activated barium fluorohalide (BaFX:Eu2+) most common needle phosphor plate (CsBr) Two types, depending on method of converting X-ray to image. Two types, depending on method of converting X-ray to image, Direct which converts X-rays to electrical charge and Indirect which converts X-rays to light, which then produces electrical charge
Readout process Separate laser reader from the image receptor (creates digital image) Readout availability in 30-40 seconds Thin-film transistor layer bonded with image receptor (integrated circuits) Readout availability in <10 seconds

So why is DR now mostly used, and what are its advantages compared to the FS and CR techniques?

To begin with, the digital radiography has several and major advantages over the analog FS radiography:

  • The DR presents a rapidity and efficiency in image processing and storage: during the FS era, the images required chemical processing (longer time) and physical storage rooms (huge physical space needed), whereas today with the DR technology, the image processing is quasi-instantaneous and all it takes is a larger hard-disk space for storage
  • It provides the ability to manipulate the digital image when viewed and accordingly the need for exam repetition is highly decreased; resultantly the pediatric radiation dose is reduced
  • The images retrieval is much easier with DR; no more loss of the films
  • Since with DR we have got a digital image, Teleradiology is now widely used for second opinions and/or for remote diagnosis. Therefore, with DR we have a better-quality diagnosis and a wider coverage for remote areas even with the shortage of Radiologists personnel
  • And finally, the hazardous chemicals risk in films processing is now completely eliminated with the DR technology, presenting a much safer environment for the Radiologic Technologists

Now let’s do the same comparison between the Digital Radiography and the Computed radiography CR.

With the new detectors in DR, the image quality and resolution are significantly better and resultantly, a lower dose of exposure can be applied compared to the CR system. Moreover, nowadays the whole exam process is now much faster with DR. The Radiologic Technologist doesn’t have to put in and take out the cassette anymore; and since DR is a real time exam, the throughput of patients is greater as there is no intermediate read out phase. Like everything else, advantages come a cost and in this case the DR systems are known to be of higher investment and maintenance when compared to the CR systems.

Now let’s talk a little bit more about the DR systems’ image quality.

The performance of a digital imaging system is characterized by its spatial resolution: Sharpness, Modulation Transfer Function [MTF], and noise level (Noise Power Spectrum [NPS]). The resolution and the noise level determine the efficiency of the system in converting X-rays into an image: this efficiency is described as the Detective Quantum Efficiency (DQE) which is related to the object’s size. The sharpness, is defined by the ability of a radiograph to define an edge precisely within the object being imaged, and is directly related to resolution.

The modulation transfer function (MTF) is the spatial frequency response of an imaging system or a component. In other words, it is the contrast at a given spatial frequency relative to low frequencies.

Now let’s address the two image characteristics: Noise and NPS.

The Noise refers to the unwanted image details that interfere with the visualization of an abnormality of interest and with the interpretation of an image.

The NPS reflects the variance of noise within an image divided among various spatial frequency components of the image.

As mentioned previously, the Resolution and the Noise level determine the efficiency of the system in converting X-rays into an image. This efficiency is described as the Detective Quantum Efficiency (DQE). The higher the DQE is, the less radiation is needed to achieve identical image quality. Therefore, by increasing the DQE while keeping a constant radiation exposure, the image quality will improve. For reference, the optimal DQE is equal to 1.

This short summary on digital radiography presented throughout this chapter is quite essential. By understanding the strengths and weaknesses of each detector, and assimilating the optimal exposure factors, you will be able to apply lower radiation dose in pediatric radiology while producing optimal image quality.

Digital Radiography and Feedback

Now let’s take a look at some feedback on digital radiography.

A digital image consists of pixels. For a grayscale image, each pixel is assigned a grayscale level that presents luminance of the pixel. The Grayscale is a range of monochromatic shades from black to white, therefore, a grayscale image contains only shades of gray. Film screen radiography provides direct feedback on both overexposed (too black) and underexposed (too white) images, the optical intensity is specifically coupled with the exposure technique. However, with Digital Radiography, optical density feedback is missing. Image processing provides appropriate grayscale images of the correct brightness despite over or underexposure. Images that are underexposed have fewer X-rays absorbed by the detector, resulting in a noisy/grainy appearance. Increasing the exposure reduces the noise, and provides a more pleasing image, but results in needless exposure and potential harm to the patient.

43% of pediatric digital radiographs are overexposed due to inadequate high radiographic technical factors. Resulting in unnecessary and additional radiation dose to the patient. As seen on the below image, the overexposed image is too dark, while the underexposed one is too bright.

Overexposed and underexposed images should be avoided; therefore, the technologist shall perform adjustments in radiographic techniques to achieve an optimal image with the lowest radiation exposure possible.

Standardized Terminology

We have covered, so far, a little bit of history relating to radiography, then we have covered the basics of digital radiography and compared it to previous technologies. Now let’s cover the standardized terminology that we commonly use before we move deep into the core subject of radiation dose for pediatrics.

The terminology we will introduce was developed by the IEC (International Electrotechnical Commission) and the AAPM (The American Association of Physicists in Medicine) which are both standard-writing bodies.

Standardized terminology is designed to eliminate the propriety methods of manufacturers for estimating exposure to image receptors. Here below are the three main index:

  • The Exposure Index (EI) is the amount of exposure obtained by the image receptor, it depends on the type of examination, the image processing and the exposure
  • The Target Exposure Index (EIT) is the reference exposure when the image is optimally exposed. It depends on the body part, the projection, the procedure and the image receptor
  • And the Deviation Index DI quantifies how much the actual EI is different from the EIT, and provides immediate feedback on the adequacy of exposure

The Exposure Index EI depends on factors specific to each patient and others depending on the radiography system. As concerns the patient, the EI depends on the selected body portion and the thickness of the body part.

As concerns the system, the EI (Exposure Index) depends on the Kilovoltage Peak (kVp), the X-ray beam filtration, and the type of the detector. When increasing KVp, the penetration capacity is increased enabling lower mAs settings for a shorter exposure time.

However, the EIT (Target Exposure Index) is the optimal exposure to the image receptor and shall be defined for each anatomical analysis and type of imaging equipment. It can be set either by the manufacturer or by the hospital/clinic facility. Maintaining a historical database of these values definitely serves for a much-enhanced dose management.

The DI (Deviation Index) shows how much the EI from the imaging study deviates from the EIT , and is determined using the following equation: DI = 10 x log10 (EI / EIT).

Therefore, DI is an indication of adequate exposure and provides the technologists with input on the appropriateness of the techniques. The body portion and radiographic parameters shall be defined in such a way that correct EIT value is used to measure the DI.

Deviation Index % of Target
3 ~ 100% too high
2 ~ 58% too high
1 ~ 26% too high
0 Correct
-1 ~ 21% too low
-2 ~ 37% too low
-3 ~ 50% too low

In fact, when the EI is equal to the EIT, the deviation index DI is equal to zero, this indicates 100% accurate exposure based on the body part thickness. But if the EI is higher than the EIT, an overexposed image is produced and the DI is positive. On the other hand, if the EI is lower than the EIT, the DI will be negative and the image is underexposed.

Always keep in mind that target values should be chosen to minimize patient exposure.

Estimating Patient Dose

Now, let us move to one of the most important topics in our module. In this section, we will discuss how to correctly estimate the patient dose in pediatric digital radiography.

Pediatric effective doses can be measured for any radiologic examination using the selected radiographic technique factors (kV and mAs), the patient mass, and the exposure geometry.

Please note, that using published radiographic projection-specific ratios, along with a correction applied for the mass, the values of energy imparted can easily be converted to an effective dose.

As mentioned earlier, for optimal estimation of the patient dose, many other variables shall be taken into consideration.

  • The strength of the X-ray beam at the surface entrance which is related to the KVp and the applied total filtration
  • The entrance skin exposure which can be directly measured using thermoluminescent dosimeters or estimated from different measurements using an ionization chamber
  • The distance from source: for your reference, increasing Film-Focus Distance (FFD) from the traditional 100 cm is an effective method of reducing dose while maintaining image quality
  • The use of a grid: grids are used to absorb the scatter radiation emitted by different body tissues before reaching the film/IP plate which will increase the image contrast
  • The organ of interest and the area of the entrance beam covering this organ
  • The depth of the organ of interest: it is well known that the greater the bit depth, the greater the number of tones (grayscale or color) that can be represented
  • The thickness of the non-soft-tissue structures overlaying the organ of interest
  • The Backscatter Factor (BSF): it is closely related to the entrance surface dose. The BSF is generally considered as the ratio between a dose quantity measured at the outer surface of an object along the central axis of the primary X-ray beam and the equivalent dose quantity at the same position free in air
  • And finally, the patient’s age: pediatric or adult

Some imaging departments record generator technique factors in the DICOM header and then compare these technique factors with the dose area product (DAP) to estimate the appropriate dose.

Reducing Radiation Exposure

Moving forward, we will now discuss the different techniques applied to reduce the radiation exposure in pediatrics.

Let’s start by the exposure technique charts and the measurements of body part thickness.

Exposure Technique Charts

One of the methods used to minimize exposure to radiation is the Automatic Exposure Control (AEC) systems.

These systems are designed to adjust the exposure time in order to obtain an image of diagnostic quality. They measure the amount of radiation at the image receptor level, and adjust the dose rate to the patient accordingly, in order to assure that sufficient photons are reaching the image receptor. In other words, the aim of AEC systems, is to deliver accurate and reproducible exposures across a wide range of anatomical thicknesses, tube potentials, and imagers. The AEC systems turn off the x-ray generator when an appropriate level of exposure is reached at the image receptor.

To work well, the system must be correctly calibrated, and the body part of interest must be precisely positioned over the active AEC region.

In order for the AEC to be effective, the patient positioning must be properly maintained and no material, of a different density than the tissue being imaged, should be contained within the sensitive area of the AEC device.

AEC detectors are energy dependent and they sometimes require calibration at multiple kVp values to function properly over a wide range of patient sizes. It is important to note that AEC sensors, commonly used in adults, cannot be used in children especially, if the body part of the patient (child) is smaller than the three AEC sensors.

However, AEC can be used for children if the center sensor is activated and the child’s body part is positioned to completely cover the entire sensor. Now, in case the imaged area is smaller than the single central sensor, then manual techniques are needed.

Manual techniques should be based on pediatrics-specific technique charts that are developed by radiologists, radiologic technologists and medical physicists, to appropriately size the tube current–exposure time product and tube voltage settings for each patient.

The exposure technique charts are usually provided by the equipment manufacturer, taking into consideration the variability in the response of the image receptor due to variations in the sensitivity of the scatter, the use of grids with different grid ratios, collimation, beam filtration, the choice of kVp, source-to-image distance and the size of the image receptor.

Therefore, adjusting the procedure on the basis of specific patient needs, allows noise reduction to be better suited for diagnosis. It reduces patient dose where higher noise levels are appropriate, and decreases patient artefacts.

Also, the implementation of scientific charts and a robust quality assurance system (QA) reduces the exposure in pediatric patients through collecting and analyzing data, and investigating the results according to the acceptance levels. Whenever fault conditions are identified, they are added to what we call the “fault tree” in order to define actions that shall be taken.

Measuring Body Part Thickness

How do body part thickness measurements help reduce dose exposure? The default radiographic parameters (reflecting the radiation exposure level) are decided on the basis of the tissue thickness of the average patient at a specific age for each projection. Therefore, changes to the default radiographic parameters are needed when the patient is younger or older than the average age basis.

Definitely, an understanding of the body part thickness will be more appropriate for tube voltage configuration, filtration and exposure time.

The body exposure optimization approach can be used for projections including the trunk, the humeral head and the femur. The trunk and head contain organs with moderately high radio sensitivity: the lungs, the colon, the breast, the gonad, the stomach, the thyroid and the eyes.

This approach for optimization is important. At the same time, this optimization technique is crucial for reducing the patient dosage and improving image quality.

Here is a common approach to remember: by increasing the KVp, the required mAs (current-time tube product) to achieve constant exposure will be lower. Therefore, the intake and effective dose of the skin will be less which will provide a lower image contrast and a higher scattered radiation. Whereas, by reducing the kVp, the exposure dose will automatically be lower and the image contrast will be higher.

Finally, to add a Recommendation for measuring body part thickness, use the highest kVp within the optimal range for the position and body portion coupled with the lowest amount of mAs required to supply a satisfactory exposure to the picture receptor.

Use of Grids

In addition to what was developed earlier, grids and collimation assist in dose reduction. The grids are positioned between the patient and the X-ray film to minimize scatter radiation and improve the contrast of the image. Scatter radiation is raised in “thicker” patients and in greater field sizes following the interaction of the primary radiation with the patient’s body.

When should the grid be used?

Structures, such as the chest, which are more than 12 cm thick and contain air, can be successfully imaged without grids. Whereas, when imaging a solid body portion, such as the abdomen, pelvis or spine, we can benefit from the use of a grid (whenever the body part is thicker than 12 cm).

However, as per the guidelines, grids should be used sparingly in pediatric patients and should not be used regularly for extremity function and body section thickness of less than 10 to 12 cm.

When eliminating Grids, the sensitivity of the patient to radiation is decreased and lower kVp is used for bones studies.


Collimation is used to remove exposure to certain parts of the body or organs that are not relevant for clinical diagnosis. By using the collimation, we decrease the exposure area and reduce the dose to the patient while improving the quality of the image.

In addition, in Digital Radiography, we are in a position to electronically collimate images after processing, but please keep in mind that it is very necessary to immobilize the patient and to collimate correctly before exposure, rather than afterwards, to minimize the patient’s exposure.

Practical Tips

Finally, we will provide you with some practical tips that can help you as a technologist to minimize dose exposure, particularly in pediatric patients.

To begin, here is a tip regarding the image projection.

With the Anterior Projection (AP), the dose given to internal structures or organs is relatively high. More precisely, it is high for internal organs such as the breasts, colon, liver, small intestine, stomach and bladder. Contrarily, Posterior Projection (PA) lowers the dose applied to these structures. Thus, the PA projection can minimize radiation exposure to all radiosensitive tissues, with the exception of the bone marrow. Moreover, it decreases the dose exposure during some other exams. When it comes to conducting Scoliosis analysis, the image receptor must provide an effective method for generating images up to 36 inches in length without doubling the dose in some areas. Therefore, in this case, routine protocols are useful for the detection of bone anomalies seen in nontraumatic extreme hip pain (NAHP), late osteomyelitis and neoplasm.

Moving to the child’s chest X-ray, the popular approach is that a child’s chest has many different dynamic ranges when compared to an adult’s chest. Therefore, it is highly important to configure the parameters relatively to the patient’s size, the existence of orthopedic implants and whether gonadal shielding is being used or not.

Unfortunately, in most cases, while conducting chest X-ray exams for children and primarily babies, we are obliged to apply the AP procedure. However, with adult patients, we can and we should always use the PA procedure to apply lower dose and avoid inappropriate breast projection.

Noise Level and the Clinical Question

To proceed, we will cover the Noise level, an important characteristic of the image.

As we mentioned earlier, Noise is defined as the information that is not part of the desired signal. It is important to get familiar with the Exposure Index (EI) related to your equipment and to understand the relationship between EI and the visual appearance of noise on the image.

Assessing the appropriateness of the image acquired is based on the level of image noise and DI. By making this assessment, the Radiologic technologist will be able to reduce patient’s dose in future examinations.

Practically, noise has less effect on the visualization of high-resolution objects such as bones, endotracheal tubes and chest tubes. Whereas, while imaging soft tissues, noise can highly affect the diagnosis of the clinical case.

Quality Assurance and Quality Control Programs

Now let’s take a look at quality assurance and quality control programs.

The evaluation of the image quality at a properly managed dose for pediatric patients involves the creation of imaging standards. Also, testing and monitoring EI reduce and reverse the creeping exposure. Analyzing the percentage of images that fall inside and outside of an acceptable range can provide assistance to teaching staff and reduce variety when promoting image quality objectives.

Besides that, the National Diagnostic Reference Levels (DRL) must be consulted to help the departments assess their automated radiographic techniques.

The ACR (American College of Radiology) provides a Dose Index Registry (DIR) software for which the DR registry has been accepted. Such DRL are actually and continuously developed using a database related to the type of detector, the body part and the thickness.

The use of DRL has been shown to decrease the average dosage and dose range found in clinical practice. Furthermore, a continuous quality control system (QC) must be developed. Key aspects of continuous QC include implementation analysis, rejected picture investigation and artifact recognition, which are tracked annually by the medical physicist.

Nonetheless, day-to-day and month-to-month assessments of equipment performance are important to ensure that what is actually chosen for use is what the pediatric patient is receiving.


The recommendations for dose reduction in pediatric digital radiography are as follows:

  • Use Higher kV
  • Use lower mAs procedures and shorter exposure time
  • Apply high DQE
  • Avoid unnecessary repeated exposure and exams duplication
  • Ideally use non-ionizing methods/exams whenever possible

The application of the pediatric features that should be considered for x-ray imaging equipment includes:

  • Use of specific preset pediatric control settings which are designed to alert the radiologic technologist of potential critical pediatric issues
  • Display and record the patient dosage or dose index while conducting the exam
  • Apply the AEC procedure that is developed and validated for a wide range of pediatric patient sizes
  • Refer to technical charts and guidelines that are designed to reduce exposure to radiation while maintaining an image quality of reasonable clinical value

Safety Checklist

Now let’s take a look at the safety checklist created to reduce the dosage of exposure.

The Image Gently alliance has issued a checklist designed for the radiologic technologists, to help them decrease errors and improve safety while performing pediatric DR procedures. It involves the four main phases: Prior to starting the exam, Image capture during the exam, image quality check, and post-processing.

Prior to starting the Exam

  • Patient name selected from the worklist
  • Patient properly identified
  • Appropriateness of request checked
  • Explained the exam to patient/parent
  • Verified LMP/pregnancy if appropriate

Image Capture During the Exam

  • Beam-body part image receptor aligned, SID checked, use of grid determined
  • Patient positioned and body part measured, cassette positioned if applicable
  • Beam collimated
  • Technical factors selected
  • Shielding and markers placed
  • Final adjustment of tube and settings made
  • Breathing instructions given
  • Exposure taken

Image Critique

  • Cassette transported to and processed in reader, if applicable
  • Images displayed and reviewed, identification confirmed
  • Image quality reviewed
  • Exposure indicator/index checked, deviation index compared to target exposure index
  • Image reprocessed or repeated as necessary

Following Completion of the Exam

  • Post-processing performed only if necessary
  • Exam verified and images archived to PACS for reporting

The use of this checklist has many benefits: minimizing the dosage of pediatric exposure, improving the safety of the patient, and the quality of the image.


ALARA principles should be followed in every pediatric DR. Also, only the specified region or organ should be targeted and the grids should not be used unless necessary depending on the thickness of the organ. Therefore, it is very important to know the body part thickness before starting the exam. Collimation is preferred to reduce the region of exposure and exclude extraneous body parts before imaging.

Nevertheless, DR imaging now has new possibilities for optimization of dosage and image quality, and Digital Detectors have a wide dynamic range that increases image quality, allowing images to be taken at different exposure levels. Digital imaging systems currently integrate image processing to freely change contrast and brightness and to find the ideal balance between the contrast-to-noise ratio within the image and the patient dosage applied.

In addition, with proper training and quality control, and by applying the QA system to monitor the EI, radiologic technologists can achieve the optimal reduction in pediatric radiation exposure.

This concludes this course on Optimizing Pediatric Radiation Dose. Before taking the quiz, please re-read the course’s objectives to verify that you are good to go. If needed, review the relevant parts to make sure you did not miss anything.

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