Pediatr Radiol (2006) 36: 823–832 DOI 10.1007/s00247-006-0170-x ORIGINAL ARTICLE Karen E. Thomas . June E. Parnell-Parmley . Salwa Haidar . Rahim Moineddin . Ellen Charkot . Guila BenDavid . Connie Krajewski Assessment of radiation dose awareness among pediatricians Received: 5 October 2005 / Revised: 14 February 2006 / Accepted: 6 March 2006 / Published online: 13 May 2006 # Springer-Verlag 2006 Abstract Background: There is increasing awareness among pediatric radiologists of the potential risks associated with ionizing radiation in medical imaging. However, it is not known whether there has been a corresponding increase in awareness among pediatricians. Objective: To establish the level of awareness among pediatricians of the recent publicity on radiation risks in children, knowledge of the relative doses of radiological investigations, current practice regarding parent/patient discussions, and the sources of educational input. Materials and methods: Multiple-choice survey. Results: Of 220 respondents, 105 (48%) were aware of the 2001 American Journal of Roentgenology articles on pedi- atric CT and radiation, though only 6% were correct in their estimate of the quoted lifetime excess cancer risk associated with radiation doses equivalent to pediatric CT. A sustained or transient increase in parent questioning regarding radiation doses had been noticed by 31%. When estimating the effective doses of various pediatric radiological investiga- tions in chest radiograph (CXR) equivalents, 87% of all responses (and 94% of CT estimates) were underestimates. Only 15% of respondents were familiar with the ALARA principle. Only 14% of pediatricians recalled any relevant formal teaching during their specialty training. The survey response rate was 40%. Conclusion: Awareness of radiation protection issues among pediatricians is generally low, with widespread underestimation of relative doses and risks. Keywords Pediatrician survey . Radiation dose awareness . ALARA principle Introduction Ionizing radiation in medical imaging is undoubtedly one of the most powerful diagnostic tools in medicine. Yet, as with all medical interventions, there are potential risks in addition to the clear potential benefits. The cancer risks associated with radiation exposure have long been known. Its potential for harm has been demonstrated by the deaths of early radiation workers [1], fetal radiation exposure [2], follow-up studies of patient groups exposed to repeated or high-dose radiological investigations [3–5], case control studies [6, 7] and data extrapolated from Japanese A-bomb victims exposed to high radiation doses [8, 9]. In February 2001, three papers were published in the American Journal of Roentgenology regarding radiation doses in pediatric CT that had a significant impact on both the radiological community and the public. Brenner et al. [10] estimated the lifetime cancer mortality associated with the radiation doses commonly involved in pediatric CT, using recently published data from the Japanese A-bomb survivors exposed to similar radiation levels [11]. They suggested that a young child undergoing CT has an increased lifetime risk of fatal cancer of approximately 1 in 1,000 (0.18% for CT abdomen, 0.07% for CT head). The importance of adjusting CT technical parameters when performing pediatric examinations was emphasized by Paterson et al. [12] and Donnelly et al. [13] in two other papers published in the same issue. There was much attention in both the radiological literature and the lay press [14], with coverage on multiple television news programs [15]. The level of awareness concerning this issue has certainly increased among pediatric radiologists. But what about pediatricians? Studies from the UK [16, 17] Presented at ESPR, Heidelberg, Germany, 2004. K. E. Thomas (*) . J. E. Parnell-Parmley . E. Charkot . G. BenDavid . C. Krajewski Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada e-mail: Karen.thomas@sickkids.ca Tel.: +1-416-8135823 Fax: +1-416-8137591 S. Haidar Department of Radiology, Mubarak Al-Kabeer Hospital, Salmiya, Kuwait R. Moineddin Department of Family and Community Medicine, University of Toronto, Toronto, Canada