Reduction of Adult Fingers Visualized on Pediatric Intensive Care Unit (PICU) Chest Radiographs after Radiation Technologist and PICU Staff Radiation Safety Education

Tynan, Jennifer R.; Duncan, Meghan; Burbridge, Brent

doi:10.1016/j.carj.2009.06.006

Cited by 5 publications

(7 citation statements)

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“…Also, the current study found that 6% of CXRs showed extraneous adult finger. This finding signals another area warranting quality improvement initiatives related to patient imaged field similar to the work by Tynan et al to reduce rate of appearance of extraneous adult finger which was reported in 15% of films in their study (8).…”

Section: Discussionsupporting

confidence: 68%

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Unintentional Exposure and Incidental Findings during Conventional Chest Radiography in the Pediatric Intensive Care Unit

Temsah

Al‐Eyadhy

Alsohime

et al. 2019

Preprint

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Background: Anatomical overexposure is common in CXRs of pediatric patients. However, overexposure may reveal incidental findings that can help to guide patient management or warrant quality improvement. Objective: To assess the prevalence of overexposure in chest X-ray (CXRs) in pediatric intensive care unit (PICU); and identify the incidental findings within overexposed areas. Materials and methods: Retrospective cohort study of children admitted to PICU. Two independent evaluators reviewed patient’s charts and digital CXRs according to the American College of Radiology standards; to evaluate overexposure of the anatomical parameters and incidental findings. Results: A total of 400 CXRs of 85 patients were reviewed. The mean number of CXRs per patient was 4.7. Almost all (99.75%) CXRs met the criteria for overexposure, with the most common being upper abdomen (99.2%), upper limbs (97%) and neck (95.7%). In addition, 43% of these X-rays were cropped by the radiology technician to appear within the requested perimeter. There was a significant association between field cropping and overexposure (t-test: t=9.8, p<.001). Incidental findings were seen in 41.5% of the radiographs; with the most common being gaseous abdominal distension (73.1%), low-positioned nasogastric tube (24.6%), and constipation (10.3%). Conclusions: Anatomical overexposure in routine CXRs remains high and raises a concern in PICU practice. Appropriate collimation of the X-ray beam, rather than electronically cropping the image, is highly recommended to minimize hiding incidental findings in the cropped-out areas. Redefining the anatomic boundaries of CXR in critically ill infants and children may need further studies and consideration. Quality improvement initiatives to minimize radiation overexposure in PICU are recommended.

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Section: Discussionsupporting

confidence: 68%

“…Unfortunately, anatomical overexposure is very common in CXRs of pediatric and neonatal patients with up to 85% of CXRs including the whole abdomen (6). On the other hand, overexposure may reveal incidental findings that can further help in guiding patient management or warrant quality improvement (7)(8).…”

Section: Introductionmentioning

confidence: 99%

Unintentional Exposure and Incidental Findings during Conventional Chest Radiography in the Pediatric Intensive Care Unit

Temsah

Al‐Eyadhy

Alsohime

et al. 2019

Preprint

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“…As previously noted by Tynan et al [2], in 2009, a number of possible factors contribute to the inappropriate exposure of adult fingers to diagnostic radiation in the PICU setting. Many of these are also relevant to the NICU.…”

Section: Discussionmentioning

confidence: 84%

“…In its Standards of Practice guidelines, the Canadian Association of Medical Radiation Technologists has outlined a set of principles promoting the knowledgeable and professional usage of ionizing radiation in a diagnostic setting [1e3]. MRTs are accountable to their peers in the medical community and are required to communicate effectively to optimize radiation safety for themselves as well as for others in the medical setting [2,3]. In addition, the International Commission on Radiological Protection endorses 3 fundamental principles of protection from radiation, namely, justification of exposure, optimization of protection, and dose limitation when appropriate [4].…”

Section: Discussionmentioning

confidence: 99%

“…In a previous publication, Burbridge [1] revealed a disturbingly high incidence of adult fingers visualized on pediatric intensive care unit (PICU) x-ray films, an example of inappropriate occupational exposure to diagnostic radiation. Subsequently, Tynan et al [2] examined the effects of radiation safety seminars on the incidence of adult fingers on PICU chest radiographs and observed a 66.7% postintervention reduction in exposure. In light of this preliminary evidence that education-based interventions reduce unnecessary occupational radiation exposure [2], we thought that it would be useful to determine the status of occupational x-ray exposure in the neonatal intensive care unit (NICU).…”

Section: R Esum Ementioning

confidence: 99%

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

et al. 2013

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Radiation safety education reduces the incidence of adult fingers on neonatal chest radiographs

Sahota

Burbridge

Duncan³

2014

J. Radiol. Prot.

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A previous audit revealed a high frequency of adult fingers visualised on neonatal intensive care unit (NICU) chest radiographs-representing an example of inappropriate occupational radiation exposure. Radiation safety education was provided to staff and we hypothesised that the education would reduce the frequency of adult fingers visualised on NICU chest radiographs. Two cross-sectional samples taken before and after the administration of the education were compared. We examined fingers visualised directly in the beam, fingers in the direct beam but eliminated by technologists editing the image, and fingers under the cones of the portable x-ray machine. There was a 46.2% reduction in fingers directly in the beam, 50.0% reduction in fingers directly in the beam but cropped out, and 68.4% reduction in fingers in the coned area. There was a 57.1% overall reduction in adult fingers visualised, which was statistically significant (Z value - 7.48, P < 0.0001). This study supports radiation safety education in minimising inappropriate occupational radiation exposure.

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Reduction of Adult Fingers Visualized on Pediatric Intensive Care Unit (PICU) Chest Radiographs after Radiation Technologist and PICU Staff Radiation Safety Education

Cited by 5 publications

References 0 publications

Unintentional Exposure and Incidental Findings during Conventional Chest Radiography in the Pediatric Intensive Care Unit

Unintentional Exposure and Incidental Findings during Conventional Chest Radiography in the Pediatric Intensive Care Unit

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

Radiation safety education reduces the incidence of adult fingers on neonatal chest radiographs

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