Medical Groups Join Forces to Improve Cardiac Imaging Use in Children

The Image Gently Alliance, the American Academy of Pediatrics (AAP) and a coalition of pediatric medicine and cardiology organizations have launched the “Have-A-Heart” campaign. This multi-society effort would help providers appropriately use and optimize performance of computed tomography (CT), fluoroscopy and nuclear medicine exams in diagnosing and treating heart disease in children. The effort will also equip providers and parents with resources to help them communicate effectively when imaging procedures may (or may not) be the best option to gain proper diagnosis or guide treatment.  

The “Have-A-Heart” campaign provides tools and resources to:

• Help providers ensure ordering patterns comply with latest evidence-based medical guidelines
• Help providers explain to parents/caregivers why an imaging scan is (or is not) necessary
• Help parents ask questions to inform decision making if their child is prescribed a cardiac imaging exam
• Help imaging professionals understand and optimize exam radiation dose

As part of the Have-A-Heart campaign, Image Gently® — which encompasses more than 100 medical organizations in the United States and worldwide — and 13^* additional leading U.S. medical societies recently endorsed “Radiation Safety in Children With Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimization from the Image Gently Alliance.” The groups urge pediatric imaging stakeholders to review the paper, which was published today in JACC: Cardiovascular Imaging, and factor the content into both their clinical decision making and conversations with patients and providers.

“This Image Gently Campaign is another opportunity for medical professionals to work together to equip providers with the latest information to guide medical decisions and help parents take an active, informed role in their child’s health care. This is an example of what modern medicine is about,” said Donald Frush, M.D., chair of the Image Gently Alliance and Image Gently liaison to the International Atomic Energy Agency (IAEA).

Physicians — If you suspect kids may have heart disease or need imaging to inform heart disease treatment, help families make informed decisions.

• Know when an imaging test is (and is not) necessary
• Explain why a CT scan, fluoroscopy or nuclear medicine exam is (or is not) the right choice
• Discuss the benefits as well as the risks of the scan
• Child-size the imaging radiation dose (where necessary and/or possible)

“Children with congenital and acquired heart disease often require many medical imaging procedures, most of which involve radiation exposure. This exposure poses risks to the patient, including an increased lifetime risk of cancer. Cardiologists and radiologists should consider the risks and benefits of imaging procedures, the patient’s previous radiation exposure, and the family’s wishes when deciding on different imaging modalities,” said Aimee Armstrong, MD, FACC, who leads the American College of Cardiology’s radiation safety initiative within the National Cardiovascular Data Registry IMPACT Registry.

“Experts from many specialties — pediatric and adult cardiologists, radiologists, physicists, imaging technicians and nurses — have come together to help maximize the benefits of cardiac imaging and minimize any risks. Children with heart disease often depend on these procedures, and it’s our collective responsibility to perform them safely and effectively,” said Kevin Hill, MD, co-chair of the Image Gently Have-A-Heart Campaign Committee.

Parents — Be your child’s advocate: Ask these questions if your child is prescribed a cardiac imaging exam.

• How will this exam improve my child’s care?
• What are the benefits of having this test?
• Are there any risks of having this scan?
• What will my child’s experience be before and after the exam?
• Are there alternative tests that don’t use radiation?
• Will the radiation dose in this exam be “child-sized”?

“Medical imaging is a wonder of modern medicine. These procedures help doctors quickly diagnose and treat cardiac conditions every day, but not all situations require imaging. The Image Gently tools help doctors and patients communicate to arrive at the best course of action for a child’s condition and promote more patient-centered care,” said Christopher Snyder, MD, FAAP, chair of the AAP Cardiology and Cardiac Surgery Section.

“Cardiac imaging and interventional procedures play a critical, lifesaving role for children with heart disease. This campaign, developed by a broad range of experts in children’s cardiac care, aims to provide doctors, families and patients with knowledge, tools and awareness to ensure that these procedures are performed in a way that optimizes the benefits of these exams and minimizes any associated risks,” said Andrew Einstein, MD, PhD, co-chair of the Image Gently Have-A-Heart Campaign Committee.

Imaging Providers — Kids with heart disease need special care. And like all children, they are more sensitive to radiation.

So when these kids need imaging:

• When appropriate, choose heart ultrasound, MRI or another exam that does not use radiation
• Child-size CT, fluoroscopy and nuclear medicine exams
• And, during catheterization:
  • Lower the frame rate
  • Manage dose settings
  • Increase image receptor field of view (reduce electronic magnification)
  • Lower the image receptor to the patient
  • Reduce size of X-ray field (collimate)

“As the medical personnel who perform these procedures, radiologic technologists serve a key role in optimizing medical radiation dose by applying correct protocol for size and body type of the patient. This campaign allows us to reinforce technologists with resources to help them continue to provide excellent care,” said Michael Latimer, M.S.R.S., R.T.(R), president of the American Society of Radiologic Technologists (ASRT).  

“Imaging exams provide vital information to help diagnose and treat cardiac conditions — including heart disease.  Providers need a firm understanding of the physics of these technologies to select imaging parameters that optimize radiation dose and minimize any potential risks,” said Bruce H. Curran, MEng, FAAPM, FACMP, chair of the American Association of Physicists in Medicine (AAPM).

The Image Gently Alliance website and Image Gently Parents website contains the latest research and educational materials to aid radiologists, radiologic technologists, medical physicists and other imaging stakeholders in determining the appropriate radiation techniques to be used in the imaging of children and how the radiation received from these exams may affect pediatric patients over time.

Health care providers are urged to visit the Image Gently Alliance site and pledge to do their part to image gently.