Related Experiment Video
Updated: Jul 7, 2025
X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
Development and clinical feasibility of a reduced-dose radiograph in children for feeding tube placement
Summer L Kaplan1,2, Mohammad Jalloul3, Erfan Akbari3
1Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. kaplans2@chop.edu.
Insights
A new reduced dose feeding tube radiograph (RDFTR) significantly lowers radiation exposure in children. This method maintains clear visualization of feeding tube tips, addressing concerns about radiation risks.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Radiation Safety
Background:
- Temporary feeding tubes are essential but prone to malposition, leading to complications.
- Radiographs are standard for verification, yet radiation exposure concerns limit their use.
- Developing safer imaging techniques is crucial for pediatric patient care.
Purpose of the Study:
- To develop and evaluate a reduced dose feeding tube radiograph (RDFTR) protocol.
- To assess the safety and efficacy of RDFTR in pediatric patients.
- To minimize radiation dose while ensuring accurate feeding tube placement confirmation.
Main Methods:
- Adapted age-based abdominal radiography using a low mAs setting (0.32 mAs).
- Tested the protocol using line-pair plates and anthropomorphic phantoms.
- Conducted a retrospective clinical review comparing radiation dose (DAP) and assessing tube visibility and findings.
Main Results:
- RDFTR preserved feeding tube tip visibility despite reduced spatial resolution.
- Median dose area product (DAP) was reduced by 72-93% compared to standard abdominal radiography.
- Tube visibility was high (99.1%), with low rates of malposition (airway 0.2%, esophagus 2.3%).
Conclusions:
- RDFTR offers a significant reduction in radiation dose for pediatric patients with feeding tubes.
- The protocol effectively visualizes feeding tube tips, enabling accurate placement assessment.
- RDFTR presents a safer alternative to conventional radiography for feeding tube verification.
Background:
Temporary feeding tubes are commonly used but may lead to complications if malpositioned. Radiographs are the gold standard for assessing tube position, but clinician concern over radiation risks may curtail their use.
Objective:
We describe development and use of a reduced dose feeding tube radiograph (RDFTR) targeted for evaluation of feeding tube position.
Materials And Methods:
Age-based abdominal radiograph was adapted to use the lowest mAs setting of 0.32 mAs with field of view between carina and iliac crests. The protocol was tested in DIGI-13 line-pair plates and anthropomorphic phantoms. Retrospective review of initial clinical use compared dose area product (DAP) for RDFTR and routine abdomen, chest, or infant chest and abdomen. Review of RDFTR reports assessed tube visibility, malpositioning, and incidental critical findings.
Results:
Testing through a line-pair phantom showed loss of spatial resolution from 2.2 line pairs to 0.6 line pairs but preserved visibility of feeding tube tip in RDFTR protocol. DAP comparisons across 23,789 exams showed RDFTR reduced median DAP 72-93% compared to abdomen, 55-78% compared to chest, and 76-79% compared to infant chest and abdomen (p<0.001). Review of 3286 reports showed tube was visible in 3256 (99.1%), malpositioned in airway 8 times (0.2%) and in the esophagus 74 times (2.3%). The tip was not visualized in 30 (0.9%). Pneumothorax or pneumoperitoneum was noted seven times (0.2%) but was expected or spurious in five of these cases.
Conclusion:
RDFTR significantly reduces radiation dose in children with temporary feeding tubes while maintaining visibility of tube tip.
Related Concept Videos
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 I: X-ray and CT
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
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...
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:24X-ray Imaging