Optimized protocol for repeated chest X-ray in a pediatric cardiac intensive care unit. (February 2021)

• Record Type: Journal Article
• Authors: Polito, C.; Genovese, E.; Longo, M.; Cassano, B.; Donatiello, S.; Secinaro, A.; Magistrelli, A.; Tomà, P.; Cannatà, V.
• Is Part Of: Radiation physics and chemistry. Volume 179(2021)
• Publication Date: 2021-02
• Subjects: Children -- Patient dose -- Pediatric cardiac intensive care unit -- Radiographs optimization -- Chest X-ray examinations; Radiation chemistry -- Periodicals; Radiometry -- Periodicals; Radiation -- Periodicals; Chimie sous rayonnement -- Périodiques; 539.2
• DOI: 10.1016/j.radphyschem.2020.109255
• Languages: English
• ISSNs: 0969-806X

Abstract

Abstract: Background: Radiographic examinations are crucial to diagnosis and management of young patients hospitalized in a pediatric Cardiac Intensive Care Unit (CICU). Since these infants are often subject to a large number of repeated X-ray examinations in order to follow up their clinical situation, special attention must be paid to use protocol aimed to dose reduction. Objective: This work was aimed to perform a radiological survey of children undergoing chest X-ray examinations in a CICU. The study was focused on the evaluation of collimation, Dose-Area-Product (DAP) and Effective doses (E) to patients subjected to repeated examinations with optimized protocols. Materials and methods: As suggested by the European Guidelines on Diagnostic Reference Levels (DRLs) for Pediatric Imaging, patients have been stratified in two groups (group I included newborn having weight < 5 kg while group II applied to infants with weight ranging from 5 to 15 kg). The study has involved 128 children undergoing chest X-ray examinations both with a standard (operator dependent) technique and with a proposed optimized protocol. Results: The integrated system DAP chamber has been validated. Data are related to examinations performed both with a standard technique (exposure parameters manually set by operators) and with an optimized protocol. The adoption of the optimized protocol resulted in a decrease of DAP and E for both weight groups. The median DAP values obtained with standard and optimized protocols respectively decrease from 4.0 to 3.4 mGy cm 2 for group I and from 7.3 to 6.2 mGy cm 2 for group II while effective doses decreased from 5.6 to 5.0 mGy cm 2 for group I and from 5.0 to 4.2 mGy cm 2 for group II. Conclusion: This work has shown that DAP and E values obtained with the optimized protocol were relatively low compared to previous literature. Particularly, DAP and E decrease up to 15% and 16% respectively using the optimized protocol. These results are particularly relevant for patients undergoing a great number of repeated X-ray examinations. Highlights: Radiation dose to children in a cardiac intensive care unit was evaluated. Children in an intensive care unit are exposed to a large number of repeated exams. An optimized protocol for pediatric chest X-ray was proposed to reduce exposure. Cumulative DAP and effective dose were evaluated with the optimized protocol.