Current Events

In the News


11/14/2017:  Brain MRI findings in pediatric patients post ECMO

Neurologic complications can occur with ECMO due to several factors. Prior studies identified neonates as having unique risk factors and neuro-imaging findings post-ECMO. The aim of this study is to describe brain MRI findings of pediatric patients treated with ECMO. We conducted a retrospective study of non-neonatal pediatric patients who underwent a comprehensive brain MRI after ECMO, between January 2000 and July 2015. We identified 47 pediatric patients in the study cohort with a median age of 8 months (IQR 3-170mo) and a median ECMO run duration of 7.15 days (IQR 3.8-10.3d). Among indications for ECMO cannulation, 12(25.5%) were cardiac, 23(48.9%) were respiratory and 12(25.5%) were ECPR cannulations. There were 33(70.2%) VA cannulations of which 14(42%) were transthoracic cannulations. There were 13 patients (27.7%) with an overall incidence of stroke: 8 patients had exclusive ischemic strokes, 2 had hemorrhagic strokes and 3 with mixed types of stroke. The number of strokes in patients on VA ECMO was significantly decreased in patients undergoing transthoracic cannulation compared to peripheral cannulation (7% vs 42%, p=0.05). Further study will be used to identify risk factors for neurological injury after ECMO and to look for outcome predictors based on neuro-radiologic findings.

Copyright (C) 2017 by the American Society for Artificial Internal Organs,

Pinto, Venessa L.; Pruthi, Sumit; Westrick, Ashly C.; Shannon, Chevis N.; Bridges, Brian C.; Le, Truc M.

ASAIO Journal | April 6, 2017 b| 


To determine the changes of diffusion-tensor imaging (DTI) and tractography in the distal femur and proximal tibia related to age, sex, and height.

Following institutional review board approval, with waiver of consent and with HIPAA compliance, the authors retrospectively analyzed DTI images of the knee in 151 children, 73 girls (median age, 14.1 years; range, 6.5–17.8 years) and 78 boys (median age, 16.6 years; range, 6.9–17.9 years), studied from January 2013 to October 2014. At sagittal echo-planar DTI (20 directions, b values of 0 and 600 sec/mm2), regions of interest were placed in the tibial and femoral physes. Using a fractional anisotropy threshold of 0.15 and an angle threshold of 40°, the authors performed tractography and measured apparent diffusion coefficient (ADC) and tract length and volume. Changes related to age, sex, and height were evaluated by using fitted nonlinear polynomial functions on bootstrapped samples.

Femoral tract volume and length increased and then decreased with age (P < .001); the peaks of femoral tract volume are consistent with the growth spurt, occurring earlier in girls (10.8 years) than in boys (13.0 years) (P < .001). Girls had smaller tract volumes in comparison to boys (P = .013). ADC peaks 2 years earlier than tract volume (girls at 9.3 years, boys at 11.0 years). Girls with greater than 50th percentile of height had longer tracts and greater tract volumes compared with girls with less than 50th percentile (P < .020). DTI parameters of boys do not correlate with percentile of height (P > .300).

DTI of the physis and metaphysis shows greater tract length and volumes in subjects who are at ages when the growth is fastest. ADC and tract length and volume have an earlier and smaller peak in girls than in boys. Femoral tract length and volume are larger in taller girls. | July 2017


Optimizing Medical Imaging for Children of All Sizes 

A proposed framework balances quality and safety of computed tomography protocols across a range of body sizes in pediatric populations.       By:  Janelle Weaver of

2 October 2017

Pediatric patients come in many sizes, from newborns to teenagers, and the wide range poses an ongoing challenge for medical imaging. In a study published in August in the Journal of Medical Imaging, researchers set out to formulate a systematic, evidence-based method to minimize radiation dose while maximizing the diagnostic performance of computed tomography (CT) imaging for young patients. According to the authors, their model could be used to optimize individual scan parameters and provide for consistent diagnostic performance across the broad range of body sizes in children.  Continue reading....


New Guidance for Pediatric CT by AAPM Alliance for Quality Computed Tomography 


Two new pediatric CT protocols have been created by the American Association of Physicists in Medicine (AAPM) Alliance for Quality Computed Tomography.  There are now a total of three pediatric exam protocols available:  routine head, routine chest, and routine Abdomen/pelvis.  These protools account for the spectrum of pediatric patient size (from neonatal to 18yrs), and the protocols are specified for 37 common CT makes and models.

Find the protocols here:

New Children's ERs choosing ultrasound over CT for tummy pain; general ERs encouraged to follow suit

Dave Pearson of reports that after rising for nearly a decade, findings show that CT for children leveled off - and the momentum of #Image Gently is credited!

18 September 2017

Pediatric patients with nontraumatic abdominal pain are less likely to receive CT scans—and more likely to be imaged with ultrasound instead—in pediatric emergency departments than their peers taken to general emergency departments (EDs).

And overall use of abdominal CT for children and adolescents has leveled off across the board since 2007, when the orders hit a high-water mark after rising for nearly a decade (and when the Image Gently campaign began building momentum).

These are the key findings turned up by a review of data reflecting more than 20 million pediatric ED visits conducted at George Washington University in the nation’s capital and published online Sept. 15 in Pediatrics.

Lauren Niles, MPH, Joanna Cohen, MD, and colleagues used data from the CDC’s National Hospital Ambulatory Medical Care Survey. Their primary interest was in identifying trends in utilization of ultrasound versus CT in pediatric-specific and general ED settings.

Performing multivariable logistic regression to measure the strength of the association of ED type, and adjusting for potential confounding variables, the team additionally found that, in both settings combined, 14.6 percent of patients received CT only, 10.9 percent received ultrasound only, and 1.9 percent had both.

Overall use of CT and ultrasound did not significantly change over the study period, 2007 through 2014.

“CT imaging for pediatric patients with nontraumatic abdominal pain has plateaued since 2007 after the steady increase seen in the preceding nine years,” the authors write. “Among this population, an increased likelihood of CT imaging was demonstrated in general EDs compared with pediatric EDs, in which there was a higher likelihood of ultrasound imaging.”

Niles et al. call for wider dissemination of pediatric imaging protocols to general EDs as a way to keep radiation exposure top of mind for children no matter where they’re taken for emergency care.


New app assesses radiation dosage in pediatric imaging

SPIE Journal of Medical Imaging article reports on ‘big step forward' via tablet-based 3D modeling app

22 August 2017


BELLINGHAM, Washington, USA, and CARDIFF, UK — A new Java-based application for Android tablets that provides neurosurgeons with the ability to manipulate 3D models of pediatric patients’ neuroanatomy and accurately tailor radiation doses for imaging has been hailed as “a big step forward” by editors of the Journal of Medical Imaging. The advance is reported in an article published today by SPIE, the international society for optics and photonics.

The Journal of Medical Imaging publishes papers on advances in early detection, diagnostics, and therapy of disease as well as in the understanding of normal. The journal is published in the SPIE Digital Library, at

Ideally, a size-specific protocol is defined based on diagnostic accuracy for a particular procedure, and a targeted balance is calculated between image accuracy requirements and patient dose.

With the wide range of size from newborns to teenagers, size is a particularly dominant factor for pediatric patients in computed tomography imaging of tissues and structures inside the body, note the authors.

However, designing an approach tailored to patient size is possible only if the three-way dependency of quality, dose, and size is known, and current technologies have not provided this ability.

The study by Ehsan Samei and Donald Frush of Duke University Medical Center and Xiang Li of the Cleveland Clinic offers a new methodology to determine the interdependency of these data across the range of pediatric sizes. The work is reported in “Size-based quality-informed framework for quantitative optimization of pediatric CT.”

“This is really a big step forward in imaging brain tumors and other issues in young patients,” said Journal of Medical Imagingassociate editor Christoph Hoeschen of Otto-von-Guericke Universität. “This methodology can serve as an advanced strategy to analyze the accuracy-dose tradeoff for other imaging systems, imaging technologies, or clinical tasks.”

Based on two prior foundational studies by the authors, radiation dosage was assessed for organ doses, effective dose, and risk index within nine pediatric age-size groups. The cases, supplemented with added noise and simulated lesions, were assessed in terms of nodule detection accuracy. The resulting continuous accuracy-dose relationships were used to optimize individual scan parameters for each patient category.

The resulting model can be used to optimize individual scan parameters and provide for consistent diagnostic performance across the broad range of body sizes in children, the authors reported.

#ImageGently #DonaldFrush #ImageGentlyAlliance #PediatricImaging #RadiationDosage


8th Annual Medical Technology Showcase

The Academy for  Radiology & Biomedical Imaging Reseach (Academy) held its Eight Annual Medical Technology Showcase on March 28th 2017. 


April 10, 2017 

Sarah McKenney, PhD, Image Gently Steering committee joined others at the X-ray Dose Reduction booth. Read more about the Showcase here

May 26, 2015 - During the 68th World Health Assembly a side event entitled " Imaging for Saving Kids - the Inside Story about Patient Safety in Pediatric Radiology" was held. Image Gently chair, Donald Frush, MD, opened the first session, encouraging healthcare practitioners to educate and provide informational material to patients and to instill a sense of engagement and accountability in healthcare providers by spreading amongst them a positive and resonating message, that of improving the imaging care of children, such as through catch words "when imaging kids, Image Gently". Read more here.....

Eighteen education specialists from six companies from the Medical Imaging Technology Alliance met with Dr. Marilyn Goske, chair of the Image Gently Alliance and Mr. Keith Strauss, Medical Physicist and Image Gently Steering Committee member at RSNA 2014.

2/11/15:  AXIS (formerly Imaging Economics) interviewed Keith Strauss on the joint MITA and Image Gently position paper on interventional X-ray equipment for pediatric patients. Listen to the podcast here.

1/20/15:  MITA And Image Gently Release Joint Position Paper On Interventional X-Ray Equipment For Pediatric Patients

The position paper offers essential questions and insights for engineers and designers of interventional X-ray imaging technologies for pediatric patients (from neonate to 21 years of age) to consider when developing such equipment, with the ultimate goal of improving patient outcomes, enhancing image quality and managing radiation dose.

 Click here to access the press release.

May 14, 2014 - Under the leadership of Dr. Richard Barth, 2013-2014 President of The Society for Pediatric Radiology, the SPR's Board of Directors and other leaders within the SPR went to Capitol Hill to advocate for improved child safety in radiation protection through the Image Gently® campaign and to thank the legislators for their role in the repeal of the sustainable growth rate (SGR) bill. Dr. Matthew Lungren (left), a fellow in pediatric interventional radiology and Dr. Brian Coley, President of SPR, 2014-2015, both from Cincinnati Children’s Hospital, visited the office of Senator Sherrod Brown and Robert Portman as part of the advocacy of the Alliance for Radiation Safety in Pediatric Imaging and the SPR.


On January 31, 2014 the New York Times published an op-ed piece entitled "Are we giving ourselves cancer?" by Drs. Rita Redburg and Rebecca Smith Bindman. Please see the response from the Image Gently Steering committee below: 

To the editor:

The Jan. 30 op-ed "We Are Giving Ourselves Cancer" presents an unbalanced view that CT scans are doing more harm than good — unnecessarily alarming parents of children who need CT scans. While the authors raise some legitimate issues, they offer no constructive suggestions and minimize existing safety efforts. The Alliance for Radiation Safety in Pediatric Imaging, via the Image Gently campaign (, has adopted a responsible and balanced approach to managing medical imaging dose. Seventy-eight medical and dental societies and agencies worldwide have joined the Alliance, pledging to use the lowest effective radiation dose, to ensure that imaging procedures are necessary and appropriate, to raise awareness, to educate the public and to advocate for child safety in imaging. CT scans save lives every day. Far greater risk is posed to patients from avoiding a necessary exam than that from the scan itself. We strongly urge parents to discuss with their doctor any imaging exam prescribed, but not to forego necessary exams due to the sensationalistic opinions expressed by the authors of the op-ed.

on behalf of the Alliance for Radiation Safety in Pediatric Imaging:

Marilyn J. Goske, MD, Chair, Alliance for Radiation Safety in Pediatric Imaging
Professor of Radiology and Pediatrics, Cincinnati Children’s Hospital
Office: 513 6365240 - Email:
Kimberly E. Applegate, MD, Professor of Radiology and Pediatrics
 Director of Practice Quality Improvement - Department of Radiology and Imaging Sciences
Emory University School of Medicine


Image Gently Responds to article in Lancet

The leaders of the Alliance would like to help answer any questions that you may have.  If you have additional questions or concerns after reviewing the Image Gently website and the letter below, please contact us at  Please click here to access related articles release in response to the Lancet article:

AAPM Task Group Releases Dose Report

The AAPM Task group 204 document that now provides an estimate of patient dose within 10 - 20 percent for body CT by patient body habitus.  Click here to read Size Specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations.

IAEA:  Use of social media to achieve interaction with the public on medical radiation protection

The International Atomic Energy Agency (IAEA) hosted a video Q & A to provide parents answers to their radiation questions. Access the video here.

Diagnostic Imaging promotes Image Gently

Physicist Keith Strauss was interviewed by Diagnostic Imaging to discuss the monitoring of CT doses at adult focused facilities.  The article refers readers to the Image Gently website for more informaiton.  Click here for the article written by Deborah Abrams Kaplan.

Imaging Gently:  A Call for Awareness

Please read Dr. Sue Kaste's article "Imaging Gently:  A Call for Awareness" that in the Journal of the American Ostepopatic Association in March 2012.  You may view this article in a full text version or a pdf version. 

Choose Wisely

Choose Wisely is a new initiative of the ABIM foundation and the American College of Radiology - Five things physicians and patients should question.  Click on the logo here to find out more...

CT Scans:  Balancing Health Risks and Medical Benefits

Dr. Marilyn Goske, Chair for the Alliance for Radiation Safety in Pediatric Imaging is quoted in this Environmental Health Perspectives article, March 2012.

The Seesaw Effect

From Health Imaging, February 17, 2012 - Study:  The seesaw effect - Pediatric CT dips; Ultrasound nudges up.  This article disusses the relation of a decrease in CT to an increase in Ultrasound due to education.  Please click here to read the article. 

Radiation is an Essential Part of Our Life

The International Atomic Energy Agency (IAEA) has written this article to provide the public with information with regard to radiation.  Please click here to read the article

TJC Sentinel Event Alert

The Joint Commission has issued a Sentinel Event Alert on the radiation risks of diagnostic imaging.  The Image Gently website was designed to include protocols and training modules to assist health care professionals to reduce radiation dose and risk to pediatric patients.  Download The Joint Commission document that details their requirements and use our website to learn ways to comply with them.

Radiation Research Podcast

December 2011:  Image Gently an initiative of the Alliance for Radiation Safety in Pediatric Imaging.  The December edition of the Radiation Research Podcast features Dr. Marilyn Goske, Chair of the Alliance for Radiation Safety in Pediatric Imaging.  This podcast is an interview of Dr. Goske describing the Image Gently campaign.  Please click here to listen to her interview.

IMAGE GENTLY Is the Overuse of CT Scans in the ED Harming Our Children?

Dr. Karen Frush writes this informative article to help us "Learn what efforts are being made to make sure that the exams are necessary and safe".  Please access her article in Contemporary Pediatrics here.

Kids' CT Scan Risk

An article appeared on the USA Today website quoting Dr. Marta Hernanz Schulman.  Dr. Hernanz-Schulman is a leader in Pediatric Radiology and is a member of the Image Gently Steering Committee. Click here to access the article.

AAPM releases CT Terminology Lexicon

The American Association of Physicists in Medicine has released a CT Terminology Lexicon. This provides CT acquisition and reconstruction terms between different manufacturer's systems. Please use the following link to access this remarkable tool.Access the CT Terminology Lexicon