Unintentional exposure of neonates to conventional radiography in the Neonatal Intensive Care Units

Abstract

Objective: To evaluate the extent of unintentional exposure to X-rays performed during routine diagnostic procedures in the Neonatal Intensive Care Units (NICUs).Study Design: During a 1-month period, 157 consecutive neonates from five level-III NICUs were recruited for this study. The mean birth weight was 1747±911 g (range: 564-4080 g), and gestational age was 31.6±3.6 weeks (range: 24-41 weeks). A total of 500 radiographs were performed including chest (68%), abdomen (17%) and combined chest and abdomen (15%). The average number of radiographs taken per infant was 4.2±3.6 (range: 1-21). Unintentional inclusion of body regions other than those ordered was determined by comparing the areas that should be included in the radiation field according to International recommendations, to those that appeared in the actual radiograph.Result: A comparison of the recommended borders to the actual boundaries of the radiographs taken show an additional exposure to radiation in all three procedures: 85% of chest radiographs also included the whole abdomen, 64% of abdomen radiographs included both thigh and upper chest and 62% of chest and abdomen radiograph included the thigh. (The range in all procedures was from ankle to upper head.) Between 2 and 20% of the relevant targeted body tissues were not included in the exposed fields resulting in missing data. The gonads of both sexes were exposed in 7% in all chest X-rays. Among male infants, the testes were exposed in 31% of plain abdomen radiographs and 34% of chest and abdomen radiographs. Conclusion:In the NICUs participating in the study, neonates are currently being exposed to X-ray radiation in nonrelevant body regions.Higher awareness and training of the medical teams and radiographers are required to minimize unnecessary exposure of newborns to ionizing radiation.

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

“…The median ESD value (0.06 mGy) was higher than those proposed by the National Radiological Protection Board (50 mGy) (Hart et al, 2000) for neonatal chest X-ray examination, but lower than those proposed by the guidelines of the European Commission (80 mGy, European Commission, 1996). Our findings showed that the median ESD values or the number of X-ray procedures performed for each neonate were higher than those reported previously (Sutton et al, 1998;Ono et al, 2003;Donadieu et al, 2006;Bader et al, 2007;Baert et al, 2008;Puch-Kapst et al, 2009). Although low voltage-high tube current time product combination shows good image quality, it could lead to high ESD (Frayre et al, 2012;Porto et al, 2014).…”

“…Therefore, mathematical equations have been suggested by several studies to calculate the radiation dose from radiographic examinations, and some reports have shown that the calculated value corresponds to direct measurement value in radiographic examinations (Ishiguchi et al, 2000;Kim et al, 2005). Since we use a mobile X-ray machine that cannot measure DAP, we calculated the ESD using the nondosimeter dosimetry method developed by Mori (Ibaragi Radiological Technologists Association et al, 1996) and compared our findings with those of other studies and reference values (Sutton et al, 1998;Ono et al, 2003;Donadieu et al, 2006;Bader et al, 2007;Baert et al, 2008;Puch-Kapst et al, 2009). The non-dosimeter dosimetry-M equation calculates the ESD according to the rectification method of the photographic equipment.…”

“…Thus, the amount of radiation infants receive and the effect of diagnostic radiation must be carefully considered. The number of X-ray examinations performed on preterm neonates has been described in several studies (Ono et al, 2000(Ono et al, , 2003Datz et al, 2004;Donadieu et al, 2006;Bader et al, 2007;Puch-Kapst et al, 2009;Yu, 2010). Donadieu et al (2006) reviewed all preterm infants (gestational age < 34 weeks) in a NICU and found that the cumulative doses received were within the range of environmental ionizing radiation received over a similar period (United Nations Scientific Committee on the Effects of Atomic Radiation, 2000).…”

Childhood exposure to external ionising radiation and solid cancer risk

“…Correction of this situation does not require investment of resources. By simply raising awareness among the staff with better guidelines regarding exposure to IR, these issues can be resolved (Bader et al, 2007).…”

Dose versus diagnosis: iatrogenic radiation exposure by multidetector computerised tomography in an academic emergency department with measurement of clinically actionable results and emergently treatable findings

“…The usage of lead screening may also limit radiation to sensitive tissues such as thyroid, breast and ovaries. In many neonatal ICU centres extra parts of the patient were exposed, for example in 85% of chest x rays the abdomen was also irradiated 11. Protocol-driven process change would limit unnecessary exposure.…”