Organ doses in preterm and full-term neonates and infants — a retrospective study on 1,064 chest radiographs

Abstract

Background Chest radiography is the most frequent X-ray examination performed in the neonatal period. However, commonly used dosimetric entities do not describe the radiation risk sufficiently. Objective The aim of this study was to investigate selected organ doses and total body dose of chest radiographs in preterm and full-term neonates and infants. Materials and methods In this retrospective study, we evaluated 1,064 chest radiographs of 136 preterm and 305 full-term babies with respect to field size and centering. We calculated the entrance dose from the dose–area product. Upper and lower field borders referred to the corresponding vertebrae. We calculated individual organ doses of the thyroid, the breast, the liver and active bone marrow for each chest radiograph using the neonatal PCXMC program, a Monte Carlo program for calculating patient doses in medical X-ray examinations. Results The median field size of chest radiographs ranged from 90 cm2 in preterm neonates at birth to 290 cm2 in full-term infants at the age of 6 months. Median values of entrance dose varied, depending on age, from 15 μGy to 25 μGy. The median organ doses ranged 1–20 μSv for the thyroid, 3–30 μSv for the breast, 2–20 μSv for the liver and 0.5–3.5 μSv for the bone marrow in preterm and full-term neonates and infants, respectively. Conclusion The analysis of chest radiographs in preterm and full-term neonates and infants revealed high variability in field size. By contrast, the entrance dose varied to a minor extent. Organ dose calculations using the PCXMC program might be a valuable tool to calculate the individual radiation risk in neonates and infants.

Neonatal and Infant Lung Disorders

“…In line with the ALARA (as low as reasonably achievable) principle, radiographic technique should be optimized to minimize exposure to ionizing radiation while maintaining diagnostic accuracy, including proper collimation (especially given the small size of neonates and infants), and standardized exposure indices to minimize “dose creep” phenomenon in digital radiography 1,2 . Radiation doses vary across facilities, but Kammer and colleagues in 2022 recently concluded that the mean entrance dose to neonates and infants remains in a low range between 15 and 25 µGy 3–5 . Contrary to the standard posteroanterior and lateral view protocol for outpatients, single portable anteroposterior view radiographs are most commonly obtained in the NICU.…”

“…1,2 Radiation doses vary across facilities, but Kammer and colleagues in 2022 recently concluded that the mean entrance dose to neonates and infants remains in a low range between 15 and 25 µGy. [3][4][5] Contrary to the standard posteroanterior and lateral view protocol for outpatients, single portable anteroposterior view radiographs are most commonly obtained in the NICU. Additional projections can be considered based on the clinical question or prior imaging: for example, a lateral view may be helpful for the assessment of pleural effusions or pneumothoraces, and lateral decubitus views and/or expiratory images can be evaluated for air trapping.…”