Related Experiment Video
Updated: Aug 18, 2026
X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
Reduce the rads: a quality assurance project on reducing unnecessary chest X-rays in children with asthma
1Gosford General Hospital, Gosford, New South Wales, Australia. abuckmaster@doh.health.nsw.gov.au <abuckmaster@doh.health.nsw.gov.au>
Insights
An educational program significantly reduced unnecessary chest X-rays (CXRs) in children with asthma. This initiative lowered the rate of unindicated CXRs and decreased hospital admission rates, improving patient care.
Area of Science:
- Pediatric Emergency Medicine
- Radiology Optimization
- Healthcare Quality Improvement
Background:
- Unnecessary chest X-rays (CXRs) are frequently performed in pediatric asthma cases.
- High rates of unnecessary imaging contribute to increased healthcare costs and radiation exposure.
- Standardized guidelines are needed to optimize imaging practices in pediatric asthma management.
Purpose of the Study:
- To quantify the rate of unnecessary chest X-rays (CXRs) in children presenting with asthma.
- To implement and evaluate an educational program aimed at reducing these unnecessary CXRs.
- To assess the impact of the intervention on both imaging rates and hospital admission rates.
Main Methods:
- Retrospective review of medical records for children (1-15 years) with asthma who underwent CXR.
- Implementation of a staff education program with guidelines on appropriate CXR indications.
- Comparison of CXR rates and admission rates before and after the educational intervention in two general hospitals.
Main Results:
- The percentage of children with asthma receiving an unnecessary CXR decreased significantly from 45.3% to 28.4% (P=0.00005).
- The overall rate of unnecessary CXRs dropped, with 81.1% deemed unnecessary pre-intervention and 78% post-intervention.
- Hospital admission rates for pediatric asthma patients also decreased from 46% to 31% following the education program.
Conclusions:
- A high proportion of chest X-rays (CXRs) in pediatric asthma cases were unnecessary.
- A simple educational intervention effectively and significantly reduced the number of unnecessary CXRs.
- Ongoing education and additional strategies are recommended to further improve imaging appropriateness in pediatric asthma care.
Objectives:
To quantify and then reduce the number of unnecessary chest X-rays (CXR) being performed on children presenting with asthma.
Methods:
A retrospective review of case notes of all children, aged 1-15 years, who presented with asthma and had a CXR performed. The setting was two General Hospitals that see all children presenting to an emergency department in the region. The period of review was before and after the development and implementation of a simple guide for staff, with an education programme, outlining when CXR were deemed unnecessary (known asthmatic, primary diagnosis asthma, improving with treatment, pneumothorax not suspected, and not in Intensive Care Unit).
Results:
In the 12 months prior to the education programme, 466 children presented with asthma: 260 had a CXR, of which 211 (81.1%) were unnecessary. During the 6 month period following implementation of the programme 197 presented with asthma: 72 had a CXR, of which 56 (78%) were deemed unnecessary. However the percentage of all children presenting with asthma who had an unnecessary CXR fell from 45.3% (211/466) to 28.4% (56/197): P = 0.00005. There was also a decrease in the admission rate from 46% before to 31% after the period of education.
Conclusion:
This study determined that an unacceptably high rate of unnecessary CXR was being ordered in children presenting to hospital with asthma. It also showed how a clinically and statistically significant reduction in the overall number of CXR could be achieved, through a simple and easy to implement educational programme. Further measures are needed in addition to ongoing education in order to improve on this achievement.
Related Concept Videos
01:30Radiological Investigation I: X-ray and CT
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like asthma or COPD,...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
01:30Asthma-IV: Nursing Management
First, in...