Entrance surface dose measurements in pediatric radiological examinations

Abstract

A survey of pediatric radiological examinations was carried out in a reference pediatric hospital of the city of São Paulo, in order to investigate the doses to children undergoing conventional X-ray examinations. The results showed that the majority of pediatric patients are below 4 years, and that about 80% of the examinations correspond to chest projections. Doses to typical radiological examinations were measured in vivo with thermoluminescent dosimeters (LiF: Mg, Ti and LiF: Mg, Cu, P) attached to the skin of the children to determine entrance surface dose (ESD). Also homogeneous phantoms were used to obtain ESD to younger children, because the technique uses a so small kVp that the dosimeters would produce an artifact image in the patient radiograph. Four kinds of pediatric examinations were investigated: three conventional examinations (chest, skull and abdomen) and a fluoroscopic procedure (barium swallow). Relevant information about kVp and mAs values used in the examinations was collected, and we discuss how these parameters can affect the ESD. The ESD values measured in this work are compared to reference levels published by the European Commission for pediatric patients. The results obtained (third-quartile of the ESD distribution) for chest AP examinations in three age groups were: 0.056 mGy (2–4 years old); 0.068 mGy (5–9 years old); 0.069 mGy (10–15 years old). All of them are below the European reference level (0.100 mGy). ESD values measured to the older age group in skull and abdomen AP radiographs (mean values 3.44 and 1.20 mGy, respectively) are above the European reference levels (1.5 mGy to skull and 1.0 mGy to abdomen). ESD values measured in the barium swallow examination reached 10 mGy in skin regions corresponding to thyroid and esophagus. It was noticed during this survey that some technicians use, improperly, X-ray fluoroscopy in conventional examinations to help them in positioning the patient. The results presented here are a preliminary survey of doses in pediatric radiological examinations and they show that it is necessary to investigate the technical parameters to perform the radiographs, to introduce practices to control pediatric patient's doses and to improve the personnel training to perform a pediatric examination.