Effective doses for common paediatric diagnostic general radiography examinations at a major Australian paediatric hospital and the communication of associated radiation risks

Conventional Radiography Assessment of the Pediatric Knee: Pearls and Pitfalls

Knee pain is one of the most common indications for radiography in the evaluation of musculoskeletal disorders in children and adolescents. According to international guidelines, knee radiographs should be obtained when there is the suspicion of an effusion, limited motion, pain to palpation, inability to bear weight, mechanical symptoms (such as "locking"), and persistent knee pain after therapy. When indicated, radiographs can provide crucial information for the clinical decision-making process. Because of the developmental changes occurring in the knee during growth, the assessment of knee radiographs can be challenging in children and adolescents. Radiologists unfamiliar with the appearance of the knee on radiographs during skeletal maturation risk overcalling or overlooking bone lesions. Image acquisition techniques and parameters should be adapted to children. This article describes the most common challenges in distinguishing pathology from the normal appearance of knee radiographs in the pediatric population, offering some pearls and pitfalls that can be useful in clinical practice.

X-ray Doses in Relation to Body Mass, Indication, and Substrate During Pediatric Electrophysiological Procedures on the Heart

The main goal of this study is to determine typical values of dose area product (DAP) and difference in the effective dose (ED) for pediatric electrophysiological procedures on the heart in relation to patient body mass. This paper also shows DAP and ED in relation to the indication, the arrhythmia substrate determined during the procedure, and in relation to the reason for using radiation. Organ doses are described as well. The subjects were children who have had an electrophysiological study done with a 3D mapping system and X-rays in two healthcare institutions. Children with congenital heart defects were excluded. There were 347 children included. Significant difference was noted between mass groups, while heavier children had higher values of DAP and ED. Median DAP in different mass groups was between 4.00 (IQR 1.00-14.00) to 26.33 (IQR 8.77-140.84) cGycm2. ED median was between 23.18 (IQR 5.21-67.70) to 60.96 (IQR 20.64-394.04) µSv. The highest DAP and ED in relation to indication were noted for premature ventricular contractions and ventricular tachycardia-27.65 (IQR 12.91-75.0) cGycm2 and 100.73 (IQR 53.31-258.10) µSv, respectively. In arrhythmia substrate groups, results were similar, and the highest doses were in ventricular substrates with DAP 29.62 (IQR 13.81-76.0) cGycm2 and ED 103.15 (IQR 60.78-266.99) µSv. Pediatric electrophysiology can be done with very low doses of X-rays when using 3D mapping systems compared to X-rays-based electrophysiology, or when compared to pediatric interventional cardiology or adult electrophysiology.

Comparison of typical radiation doses and risks using an anthropomorphic 'bone fracture' phantom for commonly performed X-ray projections in a 5-year-old

INTRODUCTION

Diagnostic reference levels (DRLs) are typical dose levels for medical imaging examinations for groups of standard-sized patients or standard phantoms for broadly defined types of equipment used as a tool to aid optimisation of protection for medical exposures. Currently, there are no paediatric DRLs for conventional radiography (i.e. general X-rays) published in Australia. The aim of this study was to establish typical radiation doses and risks that are representative of those delivered for commonly performed X-ray projections for a 5-year-old/20 kg child using a 5-year-old anthropomorphic 'bone fracture' phantom in three dedicated paediatric radiology departments in Victoria.

METHODS

A total of 20 projection images were acquired for a standard 5-year-old/20 kg phantom using digital radiography X-ray equipment. The air kerma-area product (KAP) measured at each centre by a KAP metre, which was calibrated to a national primary standard, was considered to represent the median value for that centre for each X-ray projection. Organ doses and effective dose were estimated using PCXMC software, and risks of radiation-induced cancer and radiation-induced death were calculated based on the BEIR VII report.

RESULTS

The typical doses for the individual X-ray projections ranged from 3 mGy•cm2 to 86 mGy•cm2 , whilst the effective doses ranged from 0.00004 to 0.07 mSv. The radiation risks were 'minimal' to 'negligible'.

CONCLUSION

The estimation of typical radiation doses and associated risks for a 5-year-old/20 kg phantom study provides reference values for guidance and is a first step in assisting optimisation at other institutions until national DRLs, based on patient data from the clinical setting, are published.

Radiographers' perceptions on the quality of managing general radiographic paediatric examinations through the use of a reflective tool

INTRODUCTION

Paediatric patients are a vulnerable population that require additional care by healthcare professionals. Quality managing these examinations ensures that effective and quality care is provided to individual patients, whilst encouraging consistency within the medical imaging department. This study explored radiographers' perspectives on quality management strategies of general radiographic paediatric examinations using a paediatric imaging reflective checklist.

METHODS

A quantitative descriptive research design with qualitative questions was used through a purposive sampling method from both public and private Australian diagnostic imaging qualified radiographers who had experience in paediatric imaging examinations. The paediatric imaging service reflective tool consisted of 65 items in total. Data analysis entailed Microsoft Excel version 16.16.6 and Jamovi version 2.3.21 for the closed-ended questions and for the open-ended responses a thematic analysis.

RESULTS

The participation rate was 13.2% and the most significant findings were: lead shielding was still being used at their organisation, despite recent recommendations to suspend its use; access to paediatric patient related information resources is limited; there was no involvement of families and communities regarding policy development or quality improvement measures as advocated in literature; and there was a need for enhanced specialised paediatric education, training and protocols.

CONCLUSION

Using the paediatric patient-centred imaging reflective checklist, radiographers had an opportunity to identify quality improvement indicators as well as issues that could further enhance best practice principles. Further studies could inform on the validity of this reflective tool.

Optimizing Communication of Radiation Exposure in Medical Imaging, the Radiologist Challenge

Since I started my residency program in Radiology, I have been committed to promoting radiation protection, paying particular attention to the justification and optimization of the examinations [...].