Patient X-ray exposure and ALARA in the neonatal intensive care unit: Global patterns

Abstract

A literature review was conducted to determine norms for practice in neonatal intensive care units (NICU) around the world, given the harmful risks associated with radiation exposure at a very young age; risk of radiation-induced harm later in life increases with every X-ray image taken, more so for younger premature babies. Empirical studies including a measurement of radiation dose in a NICU, published after the year 2000 in a peer-reviewed journal, were collected. Measured doses to patients or X-ray phantoms, number of X-rays per stay and conclusions with recommendations made in response to these values were compared for 25 studies from around the world. The number of X-rays a patient underwent during a NICU stay ranged from 0 to 159. Younger, lower birth weight patients consistently had the greatest number of Xrays per stay. Recommended action based on measured dose ranged from extensive (to minimize risk to neonates) to minimal (to reduce risk) to none (because imaging benefits outweigh patient risk), with no consistent pattern linking recommended action with dose quantity. This demonstrates a broad range of interpretations of the As Low As Reasonably Achievable (ALARA) concept. These findings indicate a disparity in the response to neonatal X-ray dose concerns on a global scale, posing a public health risk to this particular neonatal population. More up-todate imaging protocols and dose limits specifically for the NICU environment with standardized dose monitoring would help minimize this risk to achieve the public health goals of prevention and harm reduction.

Delayed presentation of a malpositioned central venous access device (CVAD) in a neonate

“…Like many others, our institution previously relied on single plane AP confirmation of lower limb PICC tip position. This approach is a common practice in neonatology and is in keeping with the ‘As Low As Reasonably Achievable’ internationally recognised principle to try to protect neonates from the harmful effects of ionising radiation 5 7 8. This case highlights the importance of not relying on a single AP radiograph to confirm line tip position of a lower limb CVAD, radiographic confirmation in two planes or an AP film in conjunction with ultrasound is advised.…”

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

“…Until now, no consensus has existed among neonatologists, medical physicists, and pediatric radiologists as to which dosimetric quantity defines the radiation risk most appropriately. Research groups have used the dose–area product, the entrance air kerma, the entrance surface dose or the entrance dose [ 3 , 8 , 10 , 12 , 16 , 22 – 24 ] to describe radiation exposure. Other authors have preferred the effective dose [ 10 , 21 , 25 , 26 ] to calculate the radiation risk using conversion factors provided by Rosenstein et al [ 27 ].…”

Lung Ultrasound in Neonates: An Emerging Tool for Monitoring Critically Ill Infants

“…1,5,[16][17][18][19][20][21][22] Compared to chest radiographs, LUS is more convenient as it can be readily available at the bedside, is safer as there is no radiation exposure, and has the potential to improve care by allowing quick interpretation and repeated testing to monitor the course of disease and response to therapy. 22,[23][24][25][26][27][28][29][30][31][32] Ultrasound can help evaluate the response to recruitment maneuvers during high-frequency ventilation. [33][34][35][36] There may be less inter-observer variability, and consequently, higher reliability.…”