Paediatrics

As children’s bones are still growing, different techniques are employed for the reduction and fixation of fractures in children than those used in adults. For all paediatric procedures, radiation protection is of paramount significance. This is best achieved by using dose reduction settings on the image intensifier, good collimation to avoid excessive irradiation, and judicious use of Pb shielding on or around the patient. This chapter covers a selection of orthopaedic procedures for paediatric patients, covering manipulation under anaesthesia, K-wiring, and elastic nailing or flexi-nailing for long bone injuries. Each procedure includes images that demonstrate the position of the C-arm, patient, and surgical equipment, with accompanying radiographs demonstrating the resulting images.

RADIATION HAZARDS IN DIAGNOSTIC RADIOLOGY

THE MOST pressing current problem in pediatric radiology is the reduction of hazard to the patient from exposure to ionizing radiations. Pediatric radiologists must become deeply interested in the problems of better protection for their patients because fetuses, infants and children are the most vulnerable of all humans to injury by ionizing radiation, for several reasons. First, young patients are all potential parents. Second, they have the longest expectancy of survival which provides longer life spans for the development of leukemia and for additional, possibly excessive, irradiation. Third, their reticulum cells are more abundant and probably more labile, which makes them more prone to wild growth (leukemia). Fourth, in routine radiologic procedures relatively larger parts of their smaller bodies are usually exposed. Fifth, frightened youngsters often move during exposures and additional exposures must be made to get satisfactory films. Sixth, in small patients the gonads are nearer the central rays in all types of examinations, save when the gonads are exposed directly in adults. Seventh, currently the bones of younger children contain 3 to 4 times more radioactive strontium-90 per gram of calcium than the bones of adults.