The chest is the most frequently evaluated region of the body in children. In this issue of Radiologic Clinics the various applications and benefits of chest imaging are detailed. The majority of thoracic diagnostic imaging involves modalities that depend on ionizing radiation, consisting of “conventional” radiography (film screen, computed radiography [CR], and direct/digital radiography [DR]), fluoroscopy, angiography, multidetector computed tomography (MDCT), and nuclear imaging. While radiography has been a mainstay for chest imaging across the pediatric population, computed tomography (CT) is the second most commonly used modality, with an established record for improving care for both diagnosis and management strategies. In particular, with the availability of isotropic datasets with thin detector array technology combined with high-quality 2-dimensional and 3-dimensional reconstruction MDCT images, evaluation of the cardiovascular system and airway has been a particular advantage in children. CT angiography, including electrocardiogram gating CT angiography, has been especially helpful in evaluation, reducing the risks associated with conventional catheter-based angiography. Paralleling these broadening applications are advancements in radiation protection through technical advancements as well as improved protocols. For CT, these technical advances include automatic tube current modulation and, more recently, iterative reconstruction as well as in-plane breast shielding. For fluoroscopic evaluation, pulsed fluoroscopy substantially decreases radiation exposure in children. CR and DR, when used appropriately, also have the potential for dose reduction in pediatric imaging. These improvements in reducing radiation exposure risk, when matched with appropriate use strategies, are essential for safe and effective health care in thoracic imaging in children.
