Imaging the neonate in the incubator: an investigation of the technical, radiological and nursing issues

Abstract

Modern neonatal incubators incorporate an X-ray tray device into the mattress support structure to facilitate patient examination with minimal disturbance and distress. However, the usual method of examination is to place the image plate directly underneath the baby. Users often cite radiological reasons for not using X-ray trays but modern quantitative evidence is lacking. This work looks at the technical and clinical aspects of imaging neonates in incubators and the impact that these may have in determining the imaging protocol. A number of hospitals were surveyed to determine their current method of examination and the reasons for their preference. Experimental measurements of the radiological impact of using (or not using) the X-ray tray were performed for a range of neonatal incubators. The average dose to the image plate was 5.9 microGy (range 5.4-6.4 microGy) for the "plate on mattress" method and 3.0 microGy (2.0-3.8 microGy) when using the tray--a 49% reduction owing to the mattress support materials. However, when using a computed radiography (CR) imaging system, the image quality differences were marginal. Survey results indicated that nurses preferred to use the tray but that radiographers were reluctant. We conclude that incubator manufacturers could do much to improve the radiological performance of their equipment and we offer recommendations. We also conclude that, with appropriate nurse and radiographer training and the advent of CR imaging systems, use of X-ray tray facilities may optimize imaging of the neonate in the incubator.

Optimization of Exposure Conditions for Computed Radiology Exams in Neonatal Intensive Care

“…An analysis of literature on exposure of infants in intensive care [2]- [6], [15]- [25], leads to contrasting conclusions for the choice of optimal exposure parameters and positioning of image device. Concerning the selection of beam quality, some studies [3], [15], [16] advise, in agreement to what indicated in [13], the usage of additional filtering at the output of the X-ray beam: the purpose is sharpening the beam by removing low energy components which don't have a contribution on image formation and actually increase noise while increasing imparted dose. In some studies [4], [17], [20], [21], though, usage of additional filtering is not used.…”

“…The problem is also imaging device related: although the transition to digital imaging is accomplished by several years, there are few papers on it within NICU [16], [20], [26].…”

Affordable medical technologies: bringing Value-Based Design into global health

“…Pharmaceutical companies have developed enantiomers of their compounds to re-patent and sell as superior to the generic choice, though no clinical evidence may exist suggesting improved performance 14. New neonatal incubator models often are sold with added-feature such as X-ray trays, though studies have shown that they may be rarely used or superior in practice 15. These features provide marginal utility at an exponential cost.…”

Imaging neonates within an incubator – A survey to determine existing working practice

“…Opening the incubator to place the IR may also change the internal temperature and cause further problems with neonates being susceptible to noise and vibration. 8 With the above issues in mind, limited evidence is reported within the literature to aid identification of the most optimal techniques for imaging neonates within incubators. Phantom based studies on neonatal incubator imaging have demonstrated that when the IR is placed in the incubator tray, a reduction in detector dose is evident, with attenuation varying between 12% and 72%.…”