Children sized Radiology: formulating an optimized procedure for chest radiography in accordance with contemporary radioprotection measures

Abstract

Objective: the aim of this study was to formulate an optimized radiological technique exposing children in their first 5 years of age to chest radiation.

Materials and methods: the physical quantity used for dosimetry was the Entrance Skin Dose (ESD), measured for each patient through indirect calculations. In the first phase of the study, data from the radiographic exposure of 131 children under 5 years old (control group) undergoing chest x-ray was collected. After taking into account different patient's variables, a connection between the plate's Exposure Index and the weight of the child was postulated. This hypothesis was then tested collecting data on a sample of 41 patients. A mathematical protocol was developed based on such data, linking a certain radiographic exposure to a corresponding weight range. Using this protocol, 40 examinations (experimental group) were performed. Technical, dosimetric and images' quality assessments were made by comparing the experimental group with the control group; the former being exposed according to the protocol, so on the basis of each patient’s weight, the latter being exposed following the usual radiological routine.   

The quality of the images produced was evaluated, following the double-blind method, by two Medical Radiologists specialized in pediatric imaging, referencing the ‘European Guidelines on Quality Criteria for Diagnostic Radiographic Images in Paediatrics’.

The Mann-Whitney U Test (p<0.01) was finally used for comparative analysis of the two groups' results.

Results: the newly-devised protocol has led to a 44% reduction of dose. Despite such a reduction, no image quality difference was registered between the two groups studied.

Conclusions: the present study has developed a scientific model to manage pediatric radiation doses in chest radiography which is directly linked to an easily quantifiable datum: the weight of the patient. This has led to a considerable reduction in the dose of radiations to which patients are exposed to. It has also led to the standardization of the radiological procedure, allowing a greater reproducibility of the method and increasing the awareness of specialised practitioners with regards to children radiology while maintaining the required quality of results to achieve an accurate diagnosis.