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Su YT, Chen YS, Yeh LR, Chen SW, Tsai YC, Wu CY, Yang YN, Tey SL, Lin CH. Unnecessary radiation exposure during diagnostic radiography in infants in a neonatal intensive care unit: a retrospective cohort study. Eur J Pediatr 2023; 182:343-352. [PMID: 36352243 PMCID: PMC9829594 DOI: 10.1007/s00431-022-04695-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
UNLABELLED Unnecessary radiation exposure (URE) during radiographic examination is an issue among infants in neonatal intensive care units (NICUs). The causes of URE have not been fully explored. This study investigated the incidence and identified the causes of URE in infants during diagnostic radiography in a NICU. This was a retrospective cohort study. We retrieved and analysed requests and radiographs taken at a tertiary NICU between September and November 2018. URE was defined as the rate of discordance between requests and images taken (DisBRI) and unnecessary radiation exposure in irrelevant regions (UREIR) during radiography. We compared the rates of URE between very low-birth-weight (VLBW, birth weight < 1500 g) infants and non-VLBW infants. A total of 306 radiographs from 88 infants were taken. The means ± standard deviations (SDs) of gestational age and birth weight were 35.7 ± 3.6 weeks and 2471 ± 816 g, respectively. Each infant underwent an average of 3.5 radiographs. The DisBRI rate was 1.3% and was mostly related to poor adherence to requests. The UREIR rates in thoraco-abdominal babygrams were 89.6% for the head, 14.8% for the elbows and 18.4% for the knee and were mainly related to improper positioning of and collimation in infants while performing radiography. The UREIR rates for the head, knee and ankle were higher in VLBW infants than in non-VLBW infants (94.6% vs. 85.6%, 27.0% vs. 11.5% and 5.4% vs. 0.7%, respectively, p < 0.05). CONCLUSIONS URE during diagnostic radiography is common in sick infants and is mainly related to improper positioning and collimation during examinations. Adherence to protocols when performing radiographic examination or using ultrasonography may be a solution to reduce URE in infants in NICUs. WHAT IS KNOWN • The risk of unnecessary radiation exposure (URE) during radiography has been a common and important issue in sick infants in neonatal intensive care units (NICUs). • The new point-of-care ultrasound (POCUS) technique decreases the need for chest films and prevents radiation exposure in neonates. WHAT IS NEW • In the NICU, URE is still a common issue in critically ill infants during radiographic examinations. The causes of URE during diagnostic radiography are mainly due to improper positioning and collimation during examinations. • The incidence of URE in irrelevant regions is higher in very low-birth-weight (VLBW) infants than in non-VLBW infants.
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Affiliation(s)
- Yu-Tsun Su
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Shen Chen
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Lee-Ren Yeh
- Department of Radiology, E-Da Hospital, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Wen Chen
- Department of Nursing, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Cheng Tsai
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chien-Yi Wu
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yung-Ning Yang
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Leei Tey
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chyi-Her Lin
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan.
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.
- Department of Pediatrics, National Cheng-Kung University Hospital, Tainan, Taiwan.
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