Effect of comfort pads and incubator design on neonatal radiography

Abstract

Comfort pads and tray support devices can have a considerable effect on DEE and image quality, with large variations among different incubator designs. Positioning the image detector directly underneath neonatal patients for radiography is a potential means for patient dose reduction. However, such benefit should be weighed against the risks of moving the patient.

A systematic review of incubator-based neonatal radiography – What does the evidence say?

“…Owing to the above methodological differences, there was a wide variation in recorded attenuation values for incubator components ranging from 12%-72%. These values are influenced by methodology differences but also they are influenced by the make and manufacturer of the incubator, however this was difficult to quantify as only two studies specified the type of incubator used 2,5 . In addition, the studies whom provided attenuation values for various different components of incubator design (individual components and combined) calculated the percentage difference or percentage reduction between a direct exposure (without any attenuator) in comparison to exposures with various different incubator component in-between the X-ray tube and image receptor.…”

“…Jiang et al 2 on the other hand used an objective measure of image quality which was contrast to noise ratio (CNR). CNR has been used successfully as a measure of image quality in various optimisation studies [14][15][16][17] .…”

“…A highly exposed image may have a high SNR but show no useful information on that image 18 . According to the study by Jiang et al 2 , CNR increased by 28-36% when removing the mattress and support tray from the primary beam but whether this increase in CNR would impact visual image quality using human observers is unknown. It must also be remembered that CNR does not include the display and observation steps of the imaging process and therefore does not truly reflect clinical processes.…”

“…Due to the increased sensitivity of newborns to ionising radiation, it is important to reduce the radiation dose where possible without compromising image quality. NICU is one of the most critical areas for dose optimisation, as it has the youngest patients, who often require multiple imaging exams 2 . Neonates are maintained in the incubator and warmer systems to ensure a well-regulated, stable and protective environment, which also reduces the chance of infection.…”

“…It also has potential benefits from an infection control perspective. When the IR is placed within the tray, it makes judgements regarding collimation and alignment more difficult, and also the radiation beam must pass through the extra thickness of the mattress and the IR holder, which reduces beam attenuation and consequently detector dose 1,2,5,6 . A further variable is the presence or removal of the incubator canopy (lid).…”