Adult fingers visualized on neonatal intensive care unit chest radiographs: what you don't see

In a previous publication, it was revealed that a disturbingly high incidence of adult fingers were seen on pediatric intensive care unit radiographs, an example of inappropriate occupational exposure to diagnostic radiation. The present study examined adult fingers seen on neonatal intensive care unit (NICU) radiographs to assess the frequency of this occupational radiation exposure. During this study, we encountered an unexpected issue. The inappropriately exposed fingers appeared on the raw images but were sometimes cropped during technologist image processing before being sent to the picture archiving and communication system (PACS) for interpretation. Our audit describes the frequency of cropping adult fingers from images before display on PACS, with the intent of unmasking this source of occupational radiation exposure, of which quality assurance personnel may not be aware.

At the x-ray workstation, the raw NICU source x-ray images were analysed for the visibility of adult fingers and then were compared with the final processed images sent to PACS by the x-ray technologist.

Of 230 radiographs audited, 30 (13%) contained fingers directly in the x-ray beam that remained visible on PACS, 22 (10%) contained fingers in the direct beam that were cropped before being sent to PACS for analysis, and 44 (19%) contained fingers in the coned area.

A significant number of adult fingers are being exposed to radiation during the acquisition of NICU radiographs. Cropping NICU radiographs before sending them to PACS can conceal a significant source of occupational radiation exposure.