In recent years due to the technological advances in imaging techniques, which have undoubtedly
improved diagnostic accuracy and resulted in improved patient care, the utilization of ionizing
radiation in diagnostic imaging has significantly increased. Computed tomography is the major
contributor to the radiation burden, but fluoroscopy continues to be a mainstay in paediatric radiology.
The rise in the use of ionizing radiation is of particular concern with regard to the paediatric population,
as they are up to 10 times more sensitive to the effects of radiation than adults, due to their increased
tissue radiosensitivity, increased cumulative lifetime radiation dose and longer lifetime in
which to manifest the effects. This article will review the estimated radiation risk to the child from diagnostic
imaging and summarise the various methods through which both the paediatrician and radiologist can practice
the ALARA (As Low As Reasonably Achievable) principle, which underpins the safe practice of radiology. Emphasis is
on the justification for an examination, i.e. weighing of benefits versus radiation risk, on the appropriate utilization of
other, non-ionizing imaging modalities such as ultrasound and magnetic resonance imaging, and on optimisation of a
clinically indicated examination. It is essential that the paediatrician and radiologist work together in this decision making
process for the mutual benefit of the patient. The appropriate practical application of ALARA in the workplace is crucial
to the radiation safety of our paediatric patients.
Keywords: ALARA principle, diagnostic imaging, paediatric imaging, radiation exposure, radiation protection, radiation risks.
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