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

Abstract

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.

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

“…In addition, there is limited and potentially confusing evidence within the literature as to the optimal kVp and mAs for different birth weights and acquisition modalities (CR/DR). Many studies still advocate the use of a low kV and relatively high mAs values as standard practice, 3,9,21 although Rizzi et al 9 did conclude after an optimisation study that higher kV and lower mAs can reduce the radiation dose and still provide the same image quality (60 kV/1 mAs). Another attempt was made 22 to systematically search the literature for paediatric radiography exposure techniques and subsequently develop an updated paediatric exposure chart.…”

“…2 These radiological examinations are predominantly chest x-rays (CXR) with the smallest birth-weight neonates potentially receiving multiple examinations to monitor their condition. 3 Due to the increased sensitivity of neonates to long-term risk of radiation exposure, it is important to reduce the radiation dose where possible without compromising image quality. 4,5 Although imaging a neonate within an incubator is a common requirement, 2 limited evidence is present within the literature recommending the most optimal imaging technique.…”

A Facile Magnetic System for Tracking of Medical Devices

“…[ 6,8–11 ] Unfortunately, a large number of survivors of high‐risk preterm births develop respiratory, gastrointestinal, and neurodevelopmental morbidities that require as much as 30 radiographs within the first 6 weeks of life. [ 8 ] As a result, the radiation exposure and its consequences in premature infants has been of increasing concern. [ 8 ] With the risk of exposure to ionizing radiation being well documented, new procedures have been suggested for reducing the patient and healthcare staff exposure, such as mandatory lead protective gear, gonadal shield for neonates, new guidelines for optimal collimation of the X‐ray beam and optimal positioning of the neonates.…”

“…[ 8 ] As a result, the radiation exposure and its consequences in premature infants has been of increasing concern. [ 8 ] With the risk of exposure to ionizing radiation being well documented, new procedures have been suggested for reducing the patient and healthcare staff exposure, such as mandatory lead protective gear, gonadal shield for neonates, new guidelines for optimal collimation of the X‐ray beam and optimal positioning of the neonates. [ 8 ] The implementation of these methods has reduced the exposure to ionizing radiation by 75% in neonatal patients and 100% in healthcare staff.…”

“…[ 8 ] The implementation of these methods has reduced the exposure to ionizing radiation by 75% in neonatal patients and 100% in healthcare staff. [ 8 ] However, the regular use of this method for diagnostic imaging in preterm neonates exposes them to large doses of ionizing radiation during a period when cellular (mitotic) activity and the risk of cancer induction are the highest. [ 12–14 ]…”