Image Gently, Step Lightly: Increasing Radiation Dose Awareness in Pediatric Interventions through an International Social Marketing Campaign Manrita K. Sidhu, MD, Marilyn J. Goske, MD, Brian J. Coley, MD, Bairbre Connolly, MB, FRCPC, John Racadio, MD, Terry T. Yoshizumi, PhD, Tara Utley, MRT, and Keith J. Strauss, MSc In the past several decades, advances in imaging and interventional techniques have been accompanied by an increase in medical radiation dose to the public. Radiation exposure is even more important in children, who are more sensitive to radiation and have a longer lifespan during which effects may manifest. To address radiation safety in pediatric computed tomography, in 2008 the Alliance for Radiation Safety in Pediatric Imaging launched an international social marketing campaign entitled Image Gently. This article describes the next phase of the Image Gently campaign, entitled Step Lightly, which focuses on radiation safety in pediatric interventional radiology. J Vasc Interv Radiol 2009; 20:1115–1119 CHILDREN AND RADIATION SAFETY IN March 2009, the National Council on Radiation Protection and Measurement released a critical report (1) indicating that radiation dose exposure to the United States population had increased dramatically since the early 1980s. This report disclosed that US citizens had ex- perienced a sevenfold increase in radia- tion dose, with computed tomography (CT) scans and nuclear medicine being the two largest contributors to medical radiation. Fluoroscopy used during in- terventional procedures is the third larg- est contributor of medical radiation to the public in the United States, account- ing for 14% of the medical radiation dose (1). Although children undergo medical imaging and intervention in smaller numbers than adults, they are more sensitive to radiation effects and have a longer lifespan during which to manifest possible changes as a result of radiation exposure. In addition, some children who undergo interventional procedures may have chronic illnesses and receive a higher lifetime cumulative dose as a result of repeat procedures and exposure (2– 6). There is controversy among medical physicists and medical experts as to whether lower doses of medical radia- tion cause cancer (7–9). However, ex- trapolation from atomic bomb data, us- ing the linear no-threshold model, suggests that even low doses have led to a small but increased incidence of can- cer within that study population (10). It therefore behooves the medical commu- nity to act responsibly and conserva- tively by promoting radiation protection for children and health care workers during fluoroscopy. The purpose of this communication is to inform the inter- ventional radiology community of sim- ple strategies that may be readily imple- mented locally to decrease radiation dose during interventional radiology procedures. The Image Gently Step Lightly campaign is a grassroots effort of the Alliance for Radiation Safety in Pediatric Imaging and is supported by its partner, the Society of Interventional Radiology (SIR). By using the educa- tional tools provided on the Web site (www.imagegently.com), interventional radiologists can minimize radiation dose to themselves, their medical col- leagues in the interventional radiology suite, and most importantly, their pedi- atric patients. IMAGE GENTLY In 2006, spurred by the tremendous growth in CT scanning and increasing medical and public concern about radi- ation dose in children, a small group of health care professionals started the Al- liance for Radiation Safety in Pediatric Imaging. The founding members of the Alliance were the Society for Pediatric Radiology (SPR), the American Associ- ation of Physicists in Medicine, the American College of Radiology, and the American Society of Radiologic Tech- nologists. In 2008, the Alliance, working entirely through volunteer efforts, launched the national education/ From the Department of Radiology (M.K.S.), Seattle Children’s Hospital, University of Washington; Se- attle Radiologists (M.K.S.), 1229 Madison Street, Suite 900, Seattle, WA 98104; Departments of Radi- ology (M.J.G., J.R.) and Pediatrics (J.R.), Cincinnati Children’s Hospital Medical Center, Cincinnati; De- partments of Radiology and Pediatrics (B.J.C.), Na- tionwide Children’s Hospital, Columbus, Ohio; Di- vision of Image Guided Therapy (B.C., T.U.), The Hospital for Sick Children, Toronto, Ontario, Can- ada; Department of Radiology (T.T.Y.), Duke Uni- versity Medical Center, Durham, North Carolina; and Department of Radiology (K.J.S.), Children’s Hospital Boston and Harvard Medical School, Bos- ton, Massachusetts. Received July 8, 2009; accepted July 12, 2009. Address correspondence to M.K.S.; E-mail: msidhu@searad.com None of the authors have identified a conflict of interest. © SIR, 2009 DOI: 10.1016/j.jvir.2009.07.021 Special Communication 1115