Imaging Gently: Penn State Children’s Hospital Leads the Way in Reducing Radiation Exposure Risk

MRI images showing two axial views of retrocecal appendicitis (the second with fat saturation to make the inflammation more easily seen). The appendicitis is located at the posterior aspect on the right of the patient (reader’s lower left).
MRI images showing two axial views of retrocecal appendicitis (the second with fat saturation to make the inflammation more easily seen). The appendicitis is located at the posterior aspect on the right of the patient (reader’s lower left).

Sharing in the mission of the Alliance for Radiation Safety in Pediatric Imaging to improve “safe and effective imaging care of children worldwide,”1 Penn State Children’s Hospital has become a national leader in utilizing Magnetic Resonance Imaging (MRI) to diagnose pediatric appendicitis. By using MRIs instead of conventional computerized tomography (CT), physicians at Children’s Hospital are limiting their patients’ exposure to potentially harmful radiation.

The Alliance for Radiation Safety in Pediatric Imaging, sponsor of the Image Gently® campaign, has grown quickly to a coalition of health care organizations, including Penn State Children’s Hospital, “dedicated to providing safe, high quality pediatric imaging worldwide.”2

Michael Moore, MD, associate professor of radiology and pediatrics, elaborates, “Previously, the most common method of diagnosing pediatric appendicitis was via CT scan. There is exposure to a small amount of ionizing radiation in CT scans; that exposure elevates the risk of developing cancer later in life. This risk is quite small, but when millions of CTs are being done in the U.S. each year, even small risks can add up. It’s vital to look for alternative imaging modalities.”

Several articles in well-known academic journals have detailed the Penn State Children’s Hospital program.3 “An analysis in an implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis” in Pediatric Surgery demonstrated a resultant high degree of diagnostic accuracy (sensitivity 96.8 percent, specificity 97.4 percent), and also showed excellent clinical and surgical outcomes.4 Most recently, Children’s Hospital Pediatric Radiology and Surgery groups wrote a systematic review encompassing the experiences of all 10 hospitals that have published data in this area to help advise other institutions beginning their own MRI programs.5

Although pediatric MRIs have increased, barriers remain. Access to magnets can be limited, especially on an emergency basis. Fortunately, Children’s Hospital is a part of Penn State Health Milton S. Hershey Medical Center, which offers 24/7 MRI access, even for cases entering through the emergency department. Finally, despite the higher direct cost, many clinicians believe the long-term cost-effectiveness will be significant. “In any setting where we use radiology imaging,” concludes Dr. Moore, “we practice in accordance with the Image Gently® guidelines and national standards, as we endeavor to provide the best possible care to our patients, while ultimately keeping them safe.


Michael M. Moore, MDMichael M. Moore, MD
Associate Professor of Radiology and Pediatrics
Pediatric Radiologist
PHONE: 717-531-7054
E-MAIL: mmoore5@pennstatehealth.psu.edu
CARE PHILOSOPHY: “I believe that we can advance the care of children through the use of medical imaging.”


References:

  1. http://imagegently.org/. Accessed May 23, 2016.
  2. http://www.imagegently.org/About-Us/The-Alliance. Accessed May 23, 2016.
  3. Moore MM, Gustas CN, Choudhary AK, et al. (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42:1056–1063.
  4. Kulaylat AN, Moore MM, Engbrecht BW, et al. (2015) An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis. J Pediatr Surg 50:1359–1363.
  5. Moore M, Kulaylat A, Hollenbeak C, et al. Magnetic resonance imaging in pediatric appendicitis: a systematic review. Pediatr Radiol (2016) 46:928–939.

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