Optimized protocol for repeated chest X-ray in a pediatric cardiac intensive care unit

Abstract

BackgroundRadiographic 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. ObjectiveThis 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 methodsAs 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. ResultsThe 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 cm2 for group I and from 7.3 to 6.2 mGy cm2 for group II while effective doses decreased from 5.6 to 5.0 mGy cm2 for group I and from 5.0 to 4.2 mGy cm2 for group II. ConclusionThis 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.