Optimisation of radiation dose and image quality in mobile neonatal chest radiography

To optimise the radiation dose and image quality for chest radiography in the neonatal intensive care unit (NICU) by increasing the mean beam energy.

Two techniques for the acquisition of NICU AP chest X-ray images were compared for image quality and radiation dose. 73 images were acquired using a standard technique (56 kV, 3.2 mAs and no additional filtration) and 90 images with a new technique (62 kV, 2 mAs and 2 mm Al filtration). The entrance surface air kerma (ESAK) was measured using a phantom and compared between the techniques and against established diagnostic reference levels (DRL). Images were evaluated using seven image quality criteria independently by three radiologists. Images quality and radiation dose were compared statistically between the standard and new techniques.

The maximum ESAK for the new technique was 40.20 μGy, 43.7% of the ESAK of the standard technique. Statistical evaluation demonstrated no significant differences in image quality between the two acquisition techniques.

Based on the techniques and acquisition factors investigated within this study, it is possible to lower the radiation dose without any significant effects on image quality by adding filtration (2 mm Al) and increasing the tube potential. Such steps are relatively simple to undertake and as such, other departments should consider testing and implementing this dose reduction strategy within clinical practice where appropriate.