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

Elisa Rizzi, Silvia Emanuelli, Simonetta Amerio, Diego Fagan, Francesca Mastrogiacomo, Paola Gianino, Federico Cesarani

Department of Health Physics, Cardinal Guglielmo Massaia Hospital, Asti, Italy.
Pediatrics Division, Cardinal Guglielmo Massaia Hospital, Asti, Italy.
Radiology Division, Cardinal Guglielmo Massaia Hospital, Asti, Italy.
Radiology Institute of University, Città della Salute e della Scienza, Torino, Italy.

DOI: 10.4236/ojrad.2014.41009                

Abstract

This paper performs a review of existing literature about neonatal imaging in intensive care; we notice that the multiplicity of approaches results in different and sometimes conflicting solutions to optimize acquisition technique of X-ray images. European Guidelines still refer to screen-film combinations used in past decades, current usage of digital technology requires an additional effort to reduce dose to infants and to optimize the sensor’s response exploiting their properties. In this work we investigate response changes of digital medium (computed radiography plates), due to alterations of the beam through incubators components. All combinations in use in our Hospital were tested for evaluating dosimetry and image quality and new exposure solutions were devised to optimize radiology exams, taking into account solutions suggested by the equipments makers. Dose measured was compared with dose levels suggested by European Guidelines, evaluating radiation-induced risk too. Image quality was evaluated in a double-blind comparison by radiologists. An easily repeatable optimization procedure is proposed intended to reduce delivered dose well below European guidelines. The proposed study allowed us to instruct the technologists on the most appropriate methodology for performing the radiology exam, by standardizing the approach to Neonatal Intensive Care Units. We have demonstrated also to radiologic technologists reluctant to use the X-ray tray, as it may optimize imaging in the incubator. We were also able to reduce dose—and radiation-induced risk too—of 37% - 67% depending on the previously used operating mode.

Keywords

Neonatal Intensive Care Units; Dose Reduction; Image Quality; Computed Radiography

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Samei, E. and Flynn, M.J. (2002) An Experimental Comparison of Detector Performance for Computed Radiography Systems. Medical Physics, 29, 447-459. http://dx.doi.org/10.1118/1.1449873
[2]	Donadieu, J., Zeghnoun, A., Roudier, C., Maccia, C., Pirard, P., Andre, C., et al., (2006) Cumulative Effective Doses Delivered by Radiographs to Preterm Infants in a Neonatal Intensive Care Unit. Pediatrics, 117, 882-888. http://dx.doi.org/10.1542/peds.2005-0817
[3]	Faulkner, K., Barry, J.L. and Smalley, P. (1989) Radiation Dose to Neonates on Special Care Baby Unit. The British Journal of Radiology, 62, 230-233. http://dx.doi.org/10.1259/0007-1285-62-735-230
[4]	Armpilia, C.I., Fife, I.A.J. and Croasdale, P.L. (2002) Radiation Dose Quantities and Risk in Neonates in a Special Care Baby Unit. The British Journal of Radiology, 75, 590-595.
[5]	Dougeni, E.D., Delis, H.B., Karatza, A.A., Kalogeropoulou, C.P., Skiadopoulos, S.G., Mantagos, S.P. and Panayiotakis, G.S. (2007) Dose and Image Quality Optimization in Neonatal Radiography. The British Journal of Radiology, 80, 807-815. http://dx.doi.org/10.1259/bjr/77948690
[6]	Slade, D., Harrison, S., Morros, S., Alfaham, M., Davis, P., Guildea, Z. and Tuthill, D. (2005) Neonates Do Not Need to Be Handled for Radiography. Pediatric Radiology, 35, 608-611. http://dx.doi.org/10.1007/s00247-005-1414-x
[7]	International Commission on Radiological Protection (ICRP) (1991) 1990 Recommendation of the International Commission on Radiological Protection. Annals ICRP, Publication 60, 21.
[8]	Appleton, M.B. and Stephen, C.R. (1984) Radiation Protection in a Neonatal Intensive Care Unit: A Practical Approach. Radiography, 50, 137-141.
[9]	Hart, D., Wall, B.F., Shrimpton, P.C., Bungay, D.R. and Dance, D.R. (2000) Reference Doses and Patient Size in Paediatric Radiology. NRPB-R318, Chilton, UK.
[10]	International Atomic Energy Agency (IAEA) (2013) Radiation Protection in Paediatric Radiology. Safety Report Series, No. 71.
[11]	International Commission on Radiological Protection (ICRP) (2013) Radiological Protection in Paediatric Diagnostic and Interventional Radiology. Annals ICRP, Publication 121, 42.
[12]	National Radiation Protection Board (NRPB) (2002) Doses to Patients from Medical X-Ray Examinations in the UK. NRPB-W14, Chilton.
[13]	European Commission (1996) European Guidelines on Quality Criteria for Diagnostic Radiographic Images in Paediatrics. EUR16261.
[14]	Decreto Legislativo (2000) Attuazione della Direttiva 97/43/EURATOM in Materia di Protezione Sanitaria delle Persone Contro i Pericoli delle Radiazioni Ionizzanti Connesse ad Esposizioni Mediche. Gazzetta Ufficiale, Supplement, No. 157.
[15]	Puch-Kapst, K., Juran, R., Stoever, B. and Wauer, R.R. (2009) Radiation Exposure in 212 Very Low and Extremely Low Birth Weight Infants. Pediatrics, 124, 1556-1564. http://dx.doi.org/10.1542/peds.2008-1028
[16]	Mutch, S.J. and Wentworth, S.D.P. (2007) Imaging the Neonate in the Incubator: An Investigation of the Technical, Radiological and Nursing Issues. The British Journal of Radiology, 80, 902-910. http://dx.doi.org/10.1259/bjr/88577258
[17]	Ono, K., Akahane, K., Aota, T., Hada, M., Takano, Y., Kai, M. and Kusama, T. (2003) Neonatal Doses from X-Ray Examinations by Birth Weight in a Neonatal Intensive Care Unit. Radiation Protection Dosimetry, 103, 155-162. http://dx.doi.org/10.1093/oxfordjournals.rpd.a006127
[18]	McParland, B.J., Gorka, W., Lee, R., Lewell, D.B. and Omojola, M.F. (1996) Radiology in Neonatal Intensive Care Unit: Dose Reduction and Image Quality. The British Journal of Radiology, 69, 929-937. http://dx.doi.org/10.1259/0007-1285-69-826-929
[19]	Brindhaban, A. and Al-Khalifah, K. (2004) Radiation Dose to Premature Infants in Neonatal Intensive Care Units in Kuwait. Radiation Protection Dosimetry, 111, 275-281. http://dx.doi.org/10.1093/rpd/nch338
[20]	Frayre, A.S., Torres, P., Gaona, E., Rivera, T., Franco, J. and Molina, N. (2012) Radiation Dose Reduction in a Neonatal Intensive Care Unit in Computed Radiography. Applied Radiation and Isotopes, 71, 57-60. http://dx.doi.org/10.1016/j.apradiso.2012.04.015
[21]	Olgar, T., Onal, E., Bor, D., Okumus, N., Atalay, Y., Turkyilmaz, C., Ergenekon, E. and Koc, E. (2008) Radiation Exposure to Premature Infants in a Neonatal Intensive Care Unit in Turkey. Korean Journal Radiology, 9, 416-419. http://dx.doi.org/10.3348/kjr.2008.9.5.416
[22]	Wraith, C.M., Martin, C.J., Stockdale, E.J.N., McDonald, S. and Farquhar, B. (1995) An Investigation into Techniques for Reducing Doses from Neo-Natal Radiographic Examinations. The British Journal of Radiology, 68, 1074-1082. http://dx.doi.org/10.1259/0007-1285-68-814-1074
[23]	Yu, C.C. (2010) Radiation Safety in Neonatal Intensive Care Unit: Too Little or too Much Concern? Pediatrics & Neonatology, 51, 311-319. http://dx.doi.org/10.1016/S1875-9572(10)60061-7
[24]	Duggan, L., Warren-Forward, H., Smith, T. and Karon, T. (2003) Investigation of Dose Reduction in Neonatal Radiography Using Specially Designed Phantoms and LiF:Mg, Cu, P TLDs. The British Journal of Radiology, 76, 232-237. http://dx.doi.org/10.1259/bjr/79291075
[25]	Jones, N.F., Palarm, T.W. and Negus, I.S. (2001) Neonatal Chest and Abdominal Radiation Dosimetry: A Comparison of Two Radiographic Techniques. The British Journal of Radiology, 74, 920-925.
[26]	Hufton, A.P., Doyle, S.M. and Certy, H.M.L. (1998) Digital Radiography in Paediatrics: Radiation Dose Considerations and Magnitude of Possible Dose Reduction. The British Journal of Radiology, 71, 186-199.
[27]	Attix, F.H. (1986) Introduction to Radiological Physics and Radiation Dosimetry. John Wiley & Sons Ltd, New York, 20-34. http://dx.doi.org/10.1002/9783527617135
[28]	Tapiovaara, M. and Siiskonen, T. (2008) PCXMC 2.0. User’s Guide. STUK-TR 7, Helsinki.
[29]	International Commission on Radiological Protection (ICRP) (2007) Recommendations of the International Commission on Radiological Protection. Annals ICRP, Publication 103, 37.