Repeated Pelvic Radiographs in Infants, After Harness Treatment for Developmental Dysplasia of the Hip, Carry Very Low Radiation Risk

Abstract

Objective There are no data on the effect of X-Ray irradiation to the vulnerable pelvic organs of babies during DDH follow-up. This study aims to calculate, for the first time, the radiation exposure to infants during follow-up for DDH harness treatment, and thus quantify the lifetime risk of malignancy. Methods Patients who had completed 5 years’ follow-up following successful Pavlik harness treatment were identified from the hospital DDH database. The radiation dose was extracted from the Computerised Radiology Information System database for every radiograph of every patient. The effective dose (ED) was calculated using conversion coefficients for age, sex and body region irradiated. Cumulative ED was compared to Health Protection Agency standards to calculate lifetime risk of malignancy from the radiographs. Results All radiographs of 40 infants, successfully treated in Pavlik harness for DDH, were assessed. The mean number of AP pelvis radiographs was 7.00 (range: 6–9, mode: 7). The mean cumulative ED was 0.25 mSv (Range: 0.11–0.46, SD: 0.07). This is far lower than the annual ‘safe’ limit for healthcare workers of 20 mSv and is categorised as “Very Low Risk”. Conclusion Clinicians involved in the treatment DDH can be re-assured that the cumulative radiation exposure from pelvic radiographs following Pavlik harness treatment is “Very Low Risk”. Whilst being mindful of any radiation exposure in children, this study provides a scientific answer that help addresses parental concerns.

Radiological long-term follow-up up to 12 years of initially ultrasound unstable hip types D, III and IV after treatment with the Tübingen splint worn as a plaster

“…This can usually be performed by a single pelvic osteotomy while in adolescents or adults more complex types of surgery become necessary (triple pelvic osteotomy or periacetabular osteotomy). The concern of radiation exposure is diminished by the fact that modern X-ray technology with significant lower radiation exposure is used today after the introduction of digital radiography [29]. Here Vogel et al showed a mean cumulative effective dose of 0.25 mSv of anterior-posterior pelvic radiographs.…”

“…In comparison to that, the annual limit for healthcare workers is 20 mSv. The effective dose is classified as at very low risk [29]. In summary the current diagnostic and therapeutic approach shows a significant improvement in the detection and treatment of DDH: earlier and shorter treatment, less surgical interventions and less impairment of the physiological development of the affected child.…”

Acetabular index as an indicator of Pavlik harness success in grade I developmental dysplasia of the hip: A retrospective study

“…They reported a lifetime risk of malignancy of 1 in 50,000, which is classified as "very low risk." 59 In our institute, selective hip ultrasound, in association with clinical examination, is considered a screening protocol for newborns at 6 weeks when risk factors are present. Previous literature has recommended that a neonatologist or pediatrician must examine their hips clinically, and an ultrasound examination should be done for all newborns between 4 and 6 weeks, regardless of the risk factors.…”

“…This protocol leads to delayed diagnosis and increased radiation exposure, especially when having to undergo serial X-rays, even though Vogel et al demonstrated the safety of repeated radiographs in DDH diagnosis and follow-up by calculating the effective radiation dose for infants with DDH that underwent seven serial pelvic X-rays during their treatment course. They reported a lifetime risk of malignancy of 1 in 50,000, which is classified as “very low risk.” 59 In our institute, selective hip ultrasound, in association with clinical examination, is considered a screening protocol for newborns at 6 weeks when risk factors are present. Previous literature has recommended that a neonatologist or pediatrician must examine their hips clinically, and an ultrasound examination should be done for all newborns between 4 and 6 weeks, regardless of the risk factors.…”

Hip and Happening: Current Concepts in the Diagnosis and Management of Developmental Dysplasia of the Hip in 2022

“…In the absence of quality ultrasound, an anteroposterior (AP) radiograph of both hips may serve as a more practical screening tool in infants above the age of 4-6 months. Vogel et al [21] report that the cumulative radiation exposure from pelvic radiographs in infants undergoing harness treatment for DDH carry a very low risk-which will go a long way in reassuring parents on the safety of repeated radiographs in the diagnosis and treatment of DDH.…”