[Quality control of thoracic X-rays in children in diagnostic centers with and without pediatric-radiologic...

Radiation protection in pediatric radiology is very important because of the particular sensitivity of radiosensitive organs in younger patients. Optimized image quality supports radiation protection and should be targeted. In our study we examined the quality of pediatric chest X-rays at diagnostic centers (university hospitals and other large clinics). We then evaluated differences in image quality in departments without pediatric competence (R) and departments with pediatric competence (PR).

Our study was based on 313 conventional chest X-rays from 207 patients (192 p. a./a. p. and 121 lateral, 43 from R, 258 from PR and 12 neither from R nor KR) and 38 digital chest X-rays from 26 patients (25 p. a./a. p. and 13 lateral, 1 from R and 37 from PR). All patients (age 0 - 18 years) are from Nephroblastoma-Study SIOP-93/01-GPOH. We examined all initial chest X-rays, which were sent to us for evaluation upon request between 4/3/2002 and 6/14/2002. The examined parameters were: exposure, centering of the X-rays/patient positioning, collimation and sharpness. The X-rays were evaluated on a scale from 1 (best result) to 5 (worst result), resulting in an overall score of A = optimum, B = minor problems, C = major problems, or D = unusable. The optical density, the center of the image and the relative field size were also measured. Statistical tests (Mann-Whitney-U and log regression) were carried out on the conventional images. The study was performed retrospectively. The exposure, sharpness and optical density of the digital X-rays were not analyzed.

In the case of all conventional X-rays, the quality of the centering of the X-rays/patient positioning and collimation was moderate (average scale value: 2.4 and 2.8), and the quality of the exposure and sharpness was good and very good (average scale value: 1.9 and 1.5). The quality of the chest X-rays in departments with additional pediatric radiological expertise was better mainly in the case of younger patients (younger than 5 years) than departments without additional pediatric radiological expertise (average scale value in age group 0 - 1 month: PR = 1.7; average scale value in age group 2 months - 2 years: R = 2.4 and PR = 1.8; average scale value in age group 3 - 5 years: R = 2.5 and PR = 1.8).

Despite the good overall image quality, the quality of the centering of the X-rays/patient positioning and collimation was insufficient in both examiner groups (R and PR). For this reason, some radiation protection requirements could not be fulfilled. X-rays from PR were higher quality than X-rays from R in this special study group. Day-to-day quality checks are necessary for pediatric chest X-rays in order to achieve a high quality standard.