An evaluation of paediatric projection radiography in Ireland

Abstract

PurposeThis study investigated common paediatric radiography examinations in Ireland and analysed any potential for improvement by considering compliance with requirements for justification, the range of doses delivered and potential Diagnostic Reference Levels, and technique approaches that enhance optimisation. MethodReferral information, Dose Area Product (DAP) dose, technique details and patient data were gathered from 568 paediatric examinations performed across several hospitals. The examinations were mobile infant chest (n = 66), chest (n = 266), abdomen (n = 96), lumbar spine (n = 14), full spine (n = 5), pelvis (n = 151) and skull (n = 28). Data were analysed to allow comment on the adequacy of justification, the range of doses being delivered and possible Diagnostic Reference Levels (DRLs), and the potential for optimisation of radiographic technique. Results/conclusionsResults indicate that the principle of justification is generally applied well in paediatric practice.Dose results indicate that age-related doses are generally comparable to published data, although dose variations exist within and between hospitals. Although differences between minimum and maximum DAP values were substantial, differences between the first and third quartile values were rarely greater than a factor of three. With regard to DRLs, age-related, 75th centile DAP values are presented for five paediatric X-ray examinations. While DAP DRLs stated as a function of age are a pragmatic approach to preliminary DRL values, size related DRLs are acknowledged as a better approach and the necessity of objective paediatric patient size measurement is emphasised.With regard to potential for optimisation, small samples limited analysis of factorial influences on DAP. However, trends indicate that objective consideration of kVp and mAs, careful collimation, and matching of exposure to baby weight in neonates and to measured patient depth in children could all contribute to better optimisation. These factors are all within the radiographer's control, thus highlighting the pivotal role of the radiographer in ensuring that the principle of optimisation is attained.