Adult Fingers Visualized on Neonatal Intensive Care Unit Chest Radiographs: What You Don't See

Russell, Jordan T.; Burbridge, Brent; Duncan, Meghan; Tynan, Jennifer R.

doi:10.1016/j.carj.2012.04.004

Cited by 5 publications

(6 citation statements)

References 2 publications

(6 reference statements)

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“…We observed that the NICU staff needs to be much closer than 1 m during radiation exposure to hold the neonate, often without lead protective gear and their hands may inadvertently fall within the primary beam. Previously published studies have shown 4 that 15%–40% of NICU films had at least one adult finger visible in the images.…”

Section: Problemmentioning

confidence: 97%

Reducing radiation hazard opportunities in neonatal unit: quality improvement in radiation safety practices

et al. 2017

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AimGuided by the ALARA - “As Low As Reasonably Achievable” principle in radiation safety, a quality improvement project to optimise the bedside diagnostic imaging process to the best standards of care was conducted over a six month period. The goal was too reduce the radiation hazard opportunities in the neonatal intensive care unit by at least 75% from the existing level at Q2/2015, within 6 months.MethodsThe existing bedside imaging process was critically analysed and the following quality improvement initiatives were implemented namely, mandatory lead protective gear to healthcare staff, gonadal shield for neonates, guidelines for optimal collimation of X-ray beam and optimal positioning of neonates. Radiation dosimetry results, regular staff awareness sessions and strong collaboration between neonatologists, radiologists, radiographers and neonatal nurses helped to ensure compliance to the revised imaging process. Radiation hazard opportunities were measured by analysing all radiographs done during the period under baby exposure and healthcare staff exposure categories.Summary of resultsRadiation hazard opportunities were reduced by 100% to healthcare staff and 75% to neonates, and the overall reduction was 83%. The rate of discordance between radiograph request forms and images taken was measured as a surrogate marker for compliance to the project initiatives and it declined by 77%. Mandatory orientation of staff to the revised policy on the standardised diagnostic imaging process, regular radiation awareness talks and staff feedback sessions are among several measures taken to sustain the project.

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Section: Problemmentioning

confidence: 97%

Reducing radiation hazard opportunities in neonatal unit: quality improvement in radiation safety practices

et al. 2017

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“…(11) A recent study suggests that unintentional exposure of adults to radiation from radiographic procedures in the NICU is underestimated. (12) Estimating the Dose of Radiation and the Limitations Table 2 lists the estimated highest and lowest dose of radiation for various procedures from multiple studies. Dosimetry studies are old, and the techniques of radiologic studies and the equipment to perform these studies have evolved.…”

Section: What Is Known So Far?mentioning

confidence: 99%

Neonatal Radiation Exposure

Vachharajani

Najaf

2013

NeoReviews

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Najaf have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/ investigative use of a commercial product/ device. AbstractDiagnostic radiology is essential in the care of neonates. Survival of extremely preterm neonates and neonates with multiple birth defects inevitably results in a number of diagnostic radiologic procedures being performed in modern neonatal intensive care units (NICUs). Harmful effects of radiation are well known. The number of radiographs performed on preterm neonates is described in several studies over the years. There is no estimate of the number of radiographs performed on neonates of all gestational ages admitted to a NICU. There are multiple dosimetry studies describing the radiation doses from plain chest and abdominal radiographs in preterm neonates. Some of the studies measure the doses imparted by contrast studies in neonates, not preterm neonates. Background natural radiation is estimated to be higher than the radiation from plain radiographs. The radiation from the contrast studies is not known. The article describes the units used to describe doses of radiation, the effects of radiation, and our experience with diagnostic radiographic procedures in neonates of all gestational ages.

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“…Neonatal intensive care unit staff are often required to be within 2 m of the X-ray source to hold the neonate, with their hands sometimes inadvertently being caught within the primary X-ray beam. A study by Russell et al [ 23 ] showed that 15–40% of mobile radiographic examinations conducted in the NICU had at least one adult finger visible on the resultant image. In addition to direct radiation exposure, staff and patients in the NICU may also be exposed to secondary scatter radiation.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of ultrasound for localising peripherally inserted central catheter tips in infants in the neonatal intensive care unit: a systematic review and meta-analysis

et al. 2022

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Background Chest radiography after peripherally inserted central catheter insertion in infants is the reference standard method for verifying catheter tip position. The utilisation of ultrasound (US) for catheter placement confirmation in the neonatal and paediatric population has been the focus of many recent studies. Objective In this systematic review we investigated the diagnostic accuracy of US for peripherally inserted central catheter tip confirmation in infants in the neonatal intensive care unit (NICU) Materials and methods We conducted a systematic literature search of multiple databases. The study selection yielded eight articles, all of which had acceptable quality and homogeneity for inclusion in the meta-analysis. Sensitivity and specificity values were reported together with their respective 95% confidence intervals (CI). Results After synthesising the eligible studies, we found that US had a sensitivity of 95.2% (95% CI 91.9–97.4%) and specificity of 71.4% (95% CI 59.4–81.6%) for confirming catheter tip position. Conclusion Analyses indicated that US is an excellent imaging test for localising catheter tip position in the NICU when compared to radiography. Ultrasonography is a sensitive, specific and timely imaging modality for confirming PICC tip position. In cases where US is unable to locate malpositioned PICC tips, a chest or combined chest–abdominal radiograph should be performed.

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Adult Fingers Visualized on Neonatal Intensive Care Unit Chest Radiographs: What You Don't See

Abstract: A significant number of adult fingers are being exposed to radiation during the acquisition of NICU radiographs. Cropping NICU radiographs before sending them to PACS can conceal a significant source of occupational radiation exposure.

Cited by 5 publications

References 2 publications

Reducing radiation hazard opportunities in neonatal unit: quality improvement in radiation safety practices

Reducing radiation hazard opportunities in neonatal unit: quality improvement in radiation safety practices

Neonatal Radiation Exposure

Diagnostic accuracy of ultrasound for localising peripherally inserted central catheter tips in infants in the neonatal intensive care unit: a systematic review and meta-analysis

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