Children’s Radiation Exposure

WSHA Hospital Safety & Quality Priorities: Historical Programs 

The WSHA Safety & Quality team is a trusted and collaborative partner supporting Washington hospitals on several key quality and patient safety improvement programs. Historically, WSHA’s initiatives have aligned to support federal programs and support hospitals in achieving national patient safety aims such as: 

When a program achieves milestones, objectives and industry standards of care that are widely adopted in our hospitals, our WSHA Board re-evaluates and re-prioritizes these initiatives. If a program has been successful in reducing patient harm, improving, and sustaining clinical quality outcomes in our hospitals, it may be considered ‘historical’ and no longer a key priority topic area. 

The Safety & Quality team recognizes that tools, resources, and access to materials for these historical programs and are still valuable to our members. 


X-rays and CT (computed tomography) scans are useful diagnostic tools that use radiation to view bone and tissue inside the body. However, repeated exposure to radiation during a person’s life (cumulative exposure) can put them at higher risk for cancer.

CT scans are responsible for more than 40% of the cumulative diagnostic radiation exposures to patients. Medicare radiography costs are over $14 billion dollars a year and it is estimated that 20-50% of the scans are unnecessary.

Although there are times when a CT scan is the best tool to diagnose a medical condition, there are ways to minimize the patient’s exposure to radiation.

WSHA supports efforts to optimize radiation exposure in children by providing training, education, tools and patient education materials, as well as data. Strategies and measures have been developed in strong partnership with the 100K Children Campaign. For more information contact

2017 Children’s Radiation Safety Toolkit


1. Optimizing DLP (Dose Length Product) – ensuring that DLP is appropriate for a patient’s age and that protocols are structured to support imaging exam DLP end-values within acceptable ranges to optimize safety and ensure clinically viable images. WSHA supports Dose Index Registry as a platform.

2. Disseminating PECARN – educating ordering providers around identifying children at low risk for clinically important traumatic brain injuries may reduce unnecessary exams based on the 2009 Kuppermann study, thus optimizing when exams are ordered. WSHA supports R-SCAN as a platform. 

3. Supporting Child-Sized Protocols – adjusting the parameters of an exam to fit the pediatric patient based on age and/or size categories for imaging exam DLP end-values is expected to optimize safety and clinical image quality… noting that one size does not fit all. WSHA supports updating protocols to align with the age categories of the Dose Index Registry (ages 0 to 2, 3 to 6, 7 to 10, 11 to 14 and 15 to 18). Additional categories or subcategories may be determined by a physicist and radiologist.

Measure Definition Sheets

  • DLP Dose Length Product CT Head Radiation Dose (see page 15 of the toolkit)
  • PECARN Utilization (see pages 18 and 19 of the toolkit for a description)

DLP Values from 98,210 Pediatric Head CT Imaging Studies

  • ACR DIR Sample Pediatric Report (page 18, column 2)

Data Set

  • CT HEAD without contrast, DLP, Ages 0 to 2, N=14393 (216, 315, 452)
  • CT HEAD without contrast, DLP, Ages 3 to 6, N=13359 (261, 388, 526)
  • CT HEAD without contrast, DLP, Ages 7 to 10, N=13532 (342, 471, 628)
  • CT HEAD without contrast, DLP, Ages 11 to 14, N=19085 (437, 602, 811)
  • CT HEAD without contrast, DLP, Ages 15 to 18, N=37841 (566, 752, 951)

The above image is a representation of DLP data values from the 2016 July-December American College of Radiology’s Dose Index Registry (DIR) Pediatric Sample Report (page 18, column 2). The DIR was launched in 2011 and, as of July 2016, had data on 30.3 million examinations from 1524 facilities. This extensive participation and totally automated complete capture of all patient examinations enable the development of robust, clinically based national Diagnostic Reference Levels (DRLs) and Achievable Doses (ADs). However, DRLs and ADs have not been established for pediatric populations. These may be identified by 2020. 

Each of three lines above illustrates the 25-quartile (blue), median (green) and 75-quartile (yellow) for DLP values for five age categories. These data are from 98,210 Pediatric Head CT studies conducted nationwide. While the initiative lacks national benchmarks such as DRLs and Ads for pediatric imaging, these data in the image above are our current best estimate for optimal dose-to-image performance, irrespective of CT scanner brand, model or slice. Each trend line (red) displays a linear progression of the radiation typically required to produce viable images as patients’ age or size increase. 

NEMA XR-29 (MITA Smart Dose) Standard

Dose Optimization:

Before using a CT scan, medical staff will be asked to consider alternatives. If they decide a CT scan is necessary, the dose should be adjusted for the size of the patient, including smaller doses for children.

Reduce Unnecessary Exposure – Right Order/Right Scan:

Implement protocols, procedures, algorithms, and guidelines to help your staff and clinicians make safer imaging choices for children.

choosing wisely logo          Logo: NRDR DIR Dose index Registry American college of radiologyimage Gently logo (the alliance for radiation in pediatric imaging)

For information about the availability of auxiliary aids and services, please visit:


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