Paediatric pelvic imaging: improvement in gonad shield placement by multidisciplinary audit

McCarty, Moira; Waugh, Rosalind; McCallum, H.; Montgomery, Richard J.; Aszkenasy, Odet Mark

doi:10.1007/s002470100515

Cited by 17 publications

(12 citation statements)

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“…The reasons why the neonates at our hospital experienced more gonad exposure were the lack of awareness about the effect of radiation on the gonads, the fact that neonates move rapidly, and technicians forgetting to shield the gonads during radiography. One study showed that the dose received by the gonads can be reduced by 30 to 40% if the shield containing lead equivalent material is correctly placed (McCarty et al, 2001). In other words, the "as low as reasonably achievable" principle should be kept in mind, and new landmarks need to be identified to ensure that essential diagnostic information is obtained while the gonads are accurately protected.…”

Section: Discussionmentioning

confidence: 99%

Radiation exposure of very-low-birth-weight infants in neonatal intensive care units in Korea

et al. 2018

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To our knowledge, no study has reported the radiation doses of neonates admitted to neonatal intensive care units (NICUs) in Korea. Therefore, we evaluated the radiation frequency and dose of radiation performed in NICUs using mobile X-ray machines. We retrospectively analyzed the number of radiographs and doses among 290 very low-birth-weight infants (VLBWIs) admitted at our hospital between 2011 and 2016. We compared X-ray frequencies and radiation doses according to clinical characteristics and morbidities. The entrance surface doses (ESDs) were calculated using the non-dosimeter dosimetry formula. The median number of radiographs per infant was 26, and about 25% neonates had over 50 radiographs. The number of radiographs taken was higher for infants with low-birth-weight (LBW), respiratory distress syndrome, bronchopulmonary dysplasia, and longer central venous catheterization duration (p < 0.001 for all). The cumulative ESD was 0.18 to 9.89 mGy, and the ESD per radiograph was 0.049 to 0.069 mGy. The LBW and the more severe the neonates' condition, the greater was the radiation exposure. It is difficult to reduce the number of radiographic examinations, but the quality of examinations must be improved without compromising patient care. Additional studies are needed to minimize the cumulative exposure dose and achieve optimal image quality.

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Section: Discussionmentioning

confidence: 99%

Radiation exposure of very-low-birth-weight infants in neonatal intensive care units in Korea

et al. 2018

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“…The placement of such modern shields is often inaccurate, and an unfortunate consequence of misplacement is obscuration of critical orthopaedic landmarks [12][13][14][15][16]18]. The application of shields can be especially difficult in children.…”

Section: Discussionmentioning

confidence: 99%

“…The application of shields can be especially difficult in children. The audit process and radiographer training reportedly have an inconsistent and disappointing impact on the degree of accuracy, perhaps reflecting, in part, the training challenges faced in large departments with significant staff turnover [13,18].…”

Section: Discussionmentioning

confidence: 99%

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More harm than good? The anatomy of misguided shielding of the ovaries

Fawcett¹,

Gómez²,

Barter³

et al. 2012

The British Journal of Radiology

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Objective: Popular gonad shield designs aim to provide coverage of the true pelvis, which is presumed to be the probable location of the ovaries. Shields are frequently placed inaccurately, especially in children, obscuring important orthopaedic landmarks on pelvic radiographs. We aimed to identify the position of the ovaries and asses how this may vary with age and the degree of bladder filling. We aimed to identify the position of the ovaries and asses how this may vary with age and the degree of bladder filling. Methods: Using MRI examinations of the pelvis in women and children, we located 594 ovaries in 306 female patients aged from birth to 59 years. Results: This study provides new evidence that bladder filling affects ovary position. A lower than expected number of patients had both ovaries within the pelvis if the bladder contained more than a moderate volume of urine. Bladder emptying should be achieved wherever practical if a shield is used. In children under the age of 7 years, more than half (19/37) had at least one ovary outside the true pelvis. There was a significant association between age and ovary position, with the percentage of patients with one or both ovaries outside the true pelvis decreasing with age (x 2 , p,0.0001). Conclusion:The embryological descent of the ovaries into the pelvis would appear to continue after birth, well into childhood. Current popular shield designs are therefore inappropriate for use in young children. Given the high risk of obscuring critical landmarks, coupled with the new evidence that even accurate placement will not necessarily protect the ovaries, the use of pelvic shields in girls should be reconsidered.

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“…The quality assurance program should also perform regular tests to all machinery involved with the delivery of radiation burden, and should organize audits to ensure that DRL are kept regarding diagnostic tests in pediatrics as well as in all imaging procedures involving radiation exposure. All departments can benefit from audits and re-evaluation and standardization of their procedures [28,50,51,52,53].…”

Section: Radiation Protection Considerations During Diagnostic X-ray mentioning

confidence: 99%

Pediatric radiation protection

Raissaki

2004

Eur Radiol Suppl

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Paediatric pelvic imaging: improvement in gonad shield placement by multidisciplinary audit

Abstract: Audit was an effective tool in gaining the resources needed to improve technique and reduce radiation exposure in children. The multidisciplinary approach was vital in the success of this project.

Cited by 17 publications

References 0 publications

Radiation exposure of very-low-birth-weight infants in neonatal intensive care units in Korea

Radiation exposure of very-low-birth-weight infants in neonatal intensive care units in Korea

More harm than good? The anatomy of misguided shielding of the ovaries

Pediatric radiation protection

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