1

The Effectiveness of the Image Gently Campaign for Pediatric Radiation Safety
Elizabeth Muha
December 9, 2015

Introduction
The practice of pediatric radiologists has been guided by the general principle of ALARA
(As Low as Reasonably Achievable) when performing CT scans and other procedures on
children.1 However, this standard has required fine-tuning in recent years due primarily to an
almost 800% increase in the number of CT scans performed on children.1 In response to this
important shift came the 2007 creation of the Alliance for Radiation Safety in Pediatric Imaging,
a group of medical professionals intending to increase awareness of radiation safety and
protection for children.2 This literature review will examine Alliances Image Gently, Step
Lightly public service campaign to determine the effectiveness of its efforts to raise awareness
about the importance of child-sizing dosages for pediatric CT scans.
Research Articles
The three research articles discussed in this literature review look at various aspects of
the Image Gently campaign. In their article The Image Gently Campaign: Increasing CT
Radiation Dose Awareness through a National Education and Awareness Program, Goske et al.
provide a comprehensive overview of the past, present, and future of safety in pediatric
radiology, with special attention paid to the historical context of radiology and children.1 Sidhu
et al. focus their article, Image gently, Step Lightly: Promoting Radiation Safety in Pediatric
Interventional Radiology, on the campaigns emphasis on a procedural checklist meant to
standardize CT scans and improve patient care and safety.2 Finally, Goske et al. contribute to this
analysis with their article, Image Gently: A national Education and Communication Campaign
in Radiology using the Science of Social Marketing, which looked at the types of

communication strategies, including the use of social marketing, that can be used to inform and
educate healthcare practitioners about radiation protection.3
Goske et al. do an excellent job of contextualizing the history of radiation safety for
children and the factors which led to the emergence of the Alliance for Radiation Safety in
Pediatric Imaging.1 For example, the authors trace the growing awareness from the 1950s
onwards that children were more at risk of radiation during medical procedures, something
which resulted in a series of ALARA conferences and public education campaigns and was later
followed by the Image Gently campaign in 2008.1 Although the Alliance began with just a
handful of healthcare practitioners, it quickly expanded to include 13 alliance organizations and a
membership of more than 500 000 radiology professionals.1 Using the Image Gently website as
its key educational vehicle, the campaign promoted a simple, basic, and life-saving message:
CT helps us save kids lives! But when you image, radiation matters! So when you image,
image gently.1(267) Promotional material including posters, flyers, and the website also
emphasized childrens increased sensitivity to radiation and the long-term effects of radiation
exposure in children, along with the importance of child-sizing dosages, limiting most exposures
to a single scan, and the need for radiology technicians to only scan the required area of the
childs body.1
Research conducted by Sidhu et al. takes a more specific look at the Image Gently
campaign by outlining the procedural checklist which was designed by Alliance researchers and
heavily promoted amongst radiology professionals. Assets of this campaign include both its
emphasis on the relationship between team collaboration and improved safety as well as the
effectiveness of tools such as the checklist when it comes to ensuring that proper procedure is

understood and followed by all team members.2 Through its website, the campaign provides a
downloadable checklist at no cost which is meant to be used prior to any pediatric radiological
intervention and which focuses on the unique environment of the interventional radiology suite,
encouraging consistency and safety in practice and providing a forum for team communication
before each procedure.2(300) Sidhu et al. also note that the Image Gently campaign provide
additional protocols for radiologists on their website along with educational information for
parents and the general public.2
Finally, the third research report takes a different perspective as Goske et al. evaluate the
methods used by the Alliance to disseminate important information about pediatric radiation
safety to healthcare professionals, parents, and the general public.3
The emphasis of this report is on the power of social marketing, with the authors providing an
overview of the history and science behind social marketing and its effectiveness with campaigns
for mammogram screening and chest x-rays.3 The authors note that social marketing campaigns
must meet criteria which includes understanding the goal and messages of the intervention as
well as the target audience, all of which were followed through on by the Image Gently
campaign. Although the authors note that it can be difficult to determine the effectiveness of
social marketing campaigns because a very large database is generally required, they were able
to determine some positive aspects of the Image Gently campaign including the high traffic to its
website which indicates that the campaigns message is being heard.3
Discussion
The three articles discussed in this literature review offer an in-depth exploration of
pediatric radiology, the Alliance for Radiation Safety in Pediatric Imaging, and the Image Gently

campaign to improve radiation safety for children undergoing CT scans. The greatest challenge
provided by these reports is that they do not provide substantial information about the impact of
the Image Gently campaign on the practices of those in the field of pediatric radiology. For
example, Sidhu et al. does not discuss whether the campaigns procedural checklist and other
informational documents like brochures, posters, and stickers have had any effect on the
collaborative teamwork of those working in pediatric radiology and/or the safety practices of
those performing CT scans on pediatric patients. From the perspective of looking at the
effectiveness of the Image Gently campaign, Goske et als discussion of social marketing is the
only report which contains information about the results of this campaignwhich, although
there is limited data available, appears to be largely positive, with the authors implying that the
campaign has put radiologists on the road towards safer practices.3
Conclusion
The published material available on the topic of Image Gently demonstrates that social
marketing may be a viable tool for spreading important health and safety information. There are
several aspects of the campaign which seem to be especially relevant: specifically, its emphasis
on simple strategies for teaching health care practitioners about radiation and children as well as
its use of a website to disseminate important information, handouts, and checklists to
professionals, parents, and the public. While it remains to be seen whether this campaign will
have a statistical effect on childrens exposure to radiation during CT scans and other procedures,
it appears to be a good start to ensuring that our practices and protocols regarding radiation
safety in pediatrics change for the better.

References
1. Goske MJ, Applegate KE, Boylan J, et al. The image gently campaign: Increasing CT
radiation dose awareness through a national education and awareness program. Pediatr
Radiol, 2008; 38: 265-269.
2. Sidhu M, Goske, MJ, Connolly, B, et al. Image gently, step lightly: Promoting radiation
safety in pediatric interventional radiology. AJR Am J Roentgenol, 2010; 195: 299-301.
3. Goske MJ, Applegate KE, Boylan, J, et al. Image gently: A national education and
communication campaign in radiology using the science of social marketing. J Am Coll
Radiol. 2008; 5: 1200-1205.