小児整形外科診療における放射線被ばく低減

Skills to reduce radiation dose in pediatric orthopedic imaging

小児整形外科領域では胸部・腹部写真に加え，全身骨が撮影対象である。診断価値を損なわずに被ばくを低減する放射線防護の最適化が肝要だが，“小児は大人を小さくしたものではない” といわれ，特殊なスキルが要求される。本稿では，小児整形外科領域における放射線被ばく低減法を3つ紹介する。

Pediatric orthopaedic surgeons require X-ray examinations to discuss treatment options or conditions with the guardians and pediatric patients. Then, it is imperative to reduce radiation dose to patients while maintaining the image quality in the ALARA（As Low As Reasonable Achievable）philosophy.

I would like to show my three ideas to reduce the radiation dose without sacrificing the image quality.

1．Keeping the stable radiation output of the conventional X-ray systems. Then, measuring the radiation output is helpful for the determination of radiation dose to pediatric patients and appropriate x-ray parameters.

2．Communication among the guardians, patients, and medical staff is paramount for reducing the radiation dose, taking high quality images, and preventing accidents.

3．Gonadal shielding is effective to reduce the radiation dose in hip X-ray examinations, however, the skill is especially required for female pediatric patients. Recently, the relation between multiple diagnostic X-rays for spine deformities and risk of breast cancer has been reported. We have empirically applied the dedicated breast shielding, and it deserves attention to reduce the radiation dose to the breast.