Abstract
ObjectiveThere are no data on the effect of X-Ray irradiation to the vulnerable pelvic organs of babies during DDH follow-up. This study aims to calculate, for the first time, the radiation exposure to infants during follow-up for DDH harness treatment, and thus quantify the lifetime risk of malignancy.MethodsPatients who had completed 5 years’ follow-up following successful Pavlik harness treatment were identified from the hospital DDH database. The radiation dose was extracted from the Computerised Radiology Information System database for every radiograph of every patient. The effective dose (ED) was calculated using conversion coefficients for age, sex and body region irradiated. Cumulative ED was compared to Health Protection Agency standards to calculate lifetime risk of malignancy from the radiographs.ResultsAll radiographs of 40 infants, successfully treated in Pavlik harness for DDH, were assessed. The mean number of AP pelvis radiographs was 7.00 (range: 6–9, mode: 7). The mean cumulative ED was 0.25 mSv (Range: 0.11–0.46, SD: 0.07). This is far lower than the annual ‘safe’ limit for healthcare workers of 20 mSv and is categorised as “Very Low Risk”.ConclusionClinicians involved in the treatment DDH can be re-assured that the cumulative radiation exposure from pelvic radiographs following Pavlik harness treatment is “Very Low Risk”. Whilst being mindful of any radiation exposure in children, this study provides a scientific answer that help addresses parental concerns.
Highlights
Developmental dysplasia of the hip (DDH) is common, with up to 1% of newborns treated in most countries [1,2,3]
There was a prescriptive follow-up regime, with the first radiograph occurring at 12 months of age and each patient with a normal clinical and radiographic examination of their hips being discharged at 5 years of age
This study has found that the radiation exposure to infants during routine follow-up of DDH after Pavlik harness treatment carries ‘Very Low Risk’ of lifetime malignancy [17, 26]
Summary
Developmental dysplasia of the hip (DDH) is common, with up to 1% of newborns treated in most countries [1,2,3]. In order to make a diagnosis, ultrasound scans (USS) are used to confirm clinical suspicion, after which abduction splinting is used in the first instance for management [4, 5]. Specific risks include avascular necrosis of the femoral head, femoral nerve palsy and failure to achieve reduction [9]. As such, both clinical and radiological monitoring of progress is essential [10]. Whilst initial diagnosis and monitoring are via USS, as the infant grows and the ossific nucleus develops, the clarity of hip morphology seen on USS decreases [3]. Radiographs become essential to monitor further development of the infant hips, usually beyond the age of
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