Transition from screen-film to computed radiography in a paediatric hospital: the missing link towards optimisation

Abstract

In paediatrics, the risks associated with ionising radiation should be a major concern, due to children's higher susceptibility to radiation effects. Measure entrance skin dose (ESD) in chest and pelvis X-ray projections and compare the results with the 'European guidelines on quality criteria for diagnostic radiographer images in paediatrics' in order to optimise radiological practice. ESD values were obtained using an ionisation chamber Diamentor M4 KDK (PTW) in 429 children, who underwent chest X-ray or pelvis X-ray in a Computed Radiography system. In the first phase of the study, data were collected according to protocols used in the department; in a second phase different tube voltage values were used according to patient weight. A third phase was carried out, only for chest X-ray, using the exposure parameters of phase 2, plus activating lateral ionisation chamber. Three paediatric radiologists blindly assessed image quality of chest X-ray, using a validated assessment available in the 'European guidelines on quality criteria for diagnostic radiographer images in paediatrics'. Considering all the patients submitted to chest X-ray, the average ESD was 0.22, 0.16 and 0.08 mGy, for phases 1, 2 and 3, respectively. For pelvis X-ray, the average ESD decreased from 1.18 mGy in phase 1 to 0.78 mGy in phase 2. Dose optimisation was achieved. ESD was reduced 63.6 and 33.9 % in chest and pelvis X-ray, respectively.

Radiation dose optimisation for conventional imaging in infants and newborns using automatic dose management software: an application of the new 2013/59 EURATOM directive

“…This kilovoltage was recommended by GE technical support and is in agreement with the literature 25,26 and with the EC European Guidelines. 11 The last row of Table 7 shows the tube potential selected by Paulo et al 25 to optimise the dose in a CR system with the AEC activated, choosing 77 kV for children 5-10 kg in weight. Children above 5 kg are common up to 1 year of age.…”

“…Although "small" Chest PA/AP is the preferred protocol in our room for newborns and infants, very often the radiographers use the "medium" protocol in thick patients younger than 1 year of age, defined with a tube potential of 76 kV. This kilovoltage was recommended by GE technical support and is in agreement with the literature 25,26 and with the EC European Guidelines. 11 The last row of Table 7 shows the tube potential selected by Paulo et al 25 to optimise the dose in a CR system with the AEC activated, choosing 77 kV for children 5-10 kg in weight.…”

Dose optimisation in paediatric radiography – Using regression models to investigate the relative impact of acquisition factors on image quality and radiation dose

“…Researchers have used different approaches for dose optimisation. Some [4,5] collected X-ray images from hospitals to perform dose optimisation. However, such studies include limitations through variations in weight and age ranges, which raises questions regarding the validity of the their results [6].…”