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Pediatric chest radiography in Fukushima prefecture: a multicentre organ dose assessment and optimization analysis
Yoshiaki Hirofuji1, Hazuki Manome2, Koyo Sugai3
1Department of Radiological Sciences, Faculty of Health Sciences, Fukushima Medical University, Fukushima, Japan.
Insights
Pediatric chest X-ray radiation doses vary widely between facilities, highlighting a need for optimization. Implementing standardized techniques and projections can significantly reduce patient exposure and improve radiation safety.
Area of Science:
- Medical Imaging
- Radiation Dosimetry
- Pediatric Radiology
Background:
- Pediatric patients exhibit high radiosensitivity, making radiation dose variations in chest radiography critical.
- Fukushima Prefecture faces unique challenges including post-disaster radiation concerns and declining pediatric imaging expertise due to demographic shifts.
Purpose of the Study:
- To assess and quantify the inter-facility variation in radiation doses for pediatric chest radiography.
- To evaluate the impact of different imaging projections on organ and effective doses in pediatric patients.
Main Methods:
- Utilized a 5-year-old anthropomorphic phantom equipped with 50 radiophotoluminescent dosimeters.
- Directly measured organ absorbed doses and entrance surface air kerma (ESAK) across 22 facilities.
- Calculated effective dose using ICRP Publication 103 guidelines, with outlier exclusion for robust analysis.
Main Results:
- Significant variation in ESAK (9-fold) and effective dose (28-fold) was observed across facilities, even after outlier exclusion.
- Median effective dose exceeded international reference values, and 23.8% of facilities surpassed Japan DRLs 2025 for ESAK.
- Anterior-posterior (AP) projection resulted in significantly higher breast and effective doses compared to posterior-anterior (PA) projection.
Conclusions:
- Substantial opportunities exist for dose optimization through increased use of PA projection, optimized source-to-image distance (SID), and precise milliampere-second (mAs) control.
- Radiation protection in pediatric imaging, particularly in regions with limited experience, necessitates integrated technical, educational, and societal support.
Abstract:
Pediatric patients are highly radiosensitive, and technical variation in chest radiography can substantially affect dose. Fukushima prefecture also faces persistent post-disaster radiation concerns and declining pediatric imaging experience due to demographic change. A 5 year-old anthropomorphic phantom with 50 radiophotoluminescent dosimeters was examined at 22 facilities. Organ absorbed doses and entrance surface air kerma (ESAK) were directly measured, and effective dose was calculated using International Commission on Radiological Protection Publication 103 tissue weighting factors. One statistical outlier identified by Tukey's extreme outlier criterion was excluded from outlier-excluded analyses. Across 22 facilities, ESAK ranged from 0.03 to 1.25 mGy (median 0.12 mGy) and effective dose from 3.4 to 180.1μSv (median 27.3μSv). After exclusion of one outlier, ESAK ranged from 0.03 to 0.26 mGy (median 0.12 mGy; 9-fold variation) and effective dose from 3.4 to 94.2μSv (median 27.2μSv; 28-fold variation). The 75th-percentile ESAK was 0.137 mGy, 2.5% below Japan diagnostic reference levels 2025 (0.14 mGy), although 5 of 21 facilities (23.8%) exceeded this level. Median effective dose was 1.4-fold higher than the international reference value (20μSv). Compared with posterior-anterior (PA) projection, anterior-posterior projection showed higher breast dose (151.8 ± 74.3 vs 18.6 ± 10.7μGy;p= 0.0011) and higher effective dose (55.9 ± 29.6 vs 21.7 ± 11.5μSv;p= 0.0059); the stomach dose difference was exploratory (p= 0.025), whereas the thyroid dose difference was not statistically significant (p= 0.050). Tube current-time product correlated positively with effective dose (r= 0.67,p< 0.001). Marked inter-facility variation indicates substantial opportunities for optimization through greater use of PA projection, appropriate source-to-image receptor distance extension, and careful mAs adjustment. In post-disaster regions with declining pediatric imaging experience, radiation protection may require integrated technical, educational, and societal support.
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