Related Experiment Video
Updated: Aug 6, 2026
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Optimal exposure parameters for digital radiography of the infant skull: a pilot study
A C Offiah1, J Grehan, C M Hall
1Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
Insights
Digital skull radiographs in infants with suspected non-accidental injury (NAI) can be performed with reduced radiation exposure. Optimal imaging quality is achieved at lower doses, suggesting current parameters are excessive.
Area of Science:
- Medical Imaging
- Pediatric Radiology
- Forensic Radiology
Background:
- Digital skull radiography is crucial for diagnosing non-accidental injury (NAI) in infants.
- Current exposure parameters may deliver higher radiation doses than necessary.
Purpose of the Study:
- To identify optimal exposure parameters for digital skull radiographs in infants with suspected NAI.
- To evaluate the impact of radiation dose on image quality for NAI detection.
Main Methods:
- Post-mortem anteroposterior and lateral skull radiographs were obtained from six infants at varying exposure levels.
- Image quality was assessed by six observers based on specific anatomical criteria.
- Standard and high-resolution imaging plates were utilized, and hard copy images were produced.
Main Results:
- No significant improvement in image quality was observed above an entrance surface dose of 200 microGy.
- This dose represents approximately 80% of the current average dose for both anteroposterior and lateral radiographs.
- Using a high-resolution imaging plate did not enhance perceived image quality.
Conclusions:
- Radiation exposure during infant digital skull radiography for suspected NAI can potentially be reduced.
- Further studies are underway to assess the diagnostic accuracy of reduced radiation doses.
Aim:
To determine optimal exposure parameters when performing digital skull radiographs in infants with suspected non-accidental injury (NAI).
Method:
Anteroposterior and lateral post-mortem skull radiographs of six consecutive infants with suspected NAI were made at six exposure levels for each projection. Entrance surface doses ranged from 75-351 microGy. Exposures were made with a Fuji 5000R computed radiography system onto a standard resolution imaging plate. In three patients exposures were repeated using a high-resolution imaging plate. Hard copy images with an edge-enhancement factor of 0.5 were produced. Six observers assessed and scored the radiographs from 1=poor to 5=excellent for visualization of five criteria. The criteria scored included outer table of skull vault, inner table of skull vault, suture margins, vascular markings and soft tissues of the scalp. Radiographs were then ranked in order of overall image quality. Film density and sensitivity values were recorded. Local research committee approval was obtained.
Results:
Current parameters give an average entrance surface dose of 253 microGy and 246 microGy for anteroposterior and lateral radiographs, respectively. The study demonstrated no perceived improvement in image quality above an entrance surface dose of 200 microGy (80% of current dose) or by the use of a high-resolution imaging plate.
Conclusion:
The potential exists to reduce radiation exposure in infants. A study has commenced to determine the effects of dose reduction on diagnostic accuracy in suspected NAI.
