Radiology in the neonatal intensive care unit: dose reduction and image quality

Area of Science:

• Medical Physics
• Pediatric Radiology
• Radiation Protection

Background:

• Diagnostic radiation is essential for neonatal intensive care (NICU) but carries risks.
• Optimizing radiation dose is crucial for minimizing long-term health effects in neonates.
• Previous studies highlight the need for dose reduction strategies in pediatric imaging.

Purpose of the Study:

• To prospectively evaluate diagnostic radiation doses from a representative technique versus a low-dose technique in a NICU.
• To compare entrance skin dose (ESD), energy imparted (EI), and mean whole body dose between the two techniques.
• To assess the impact of dose reduction on image quality and estimate associated cancer risks.

Main Methods:

• Prospective study of 363 anteroposterior (AP) chest and abdominal films from 77 neonates.
• Measured ESD, EI, and mean whole body dose for a conventional and a low-dose technique (CEC-recommended).
• Used a 400 speed film-screen combination for both techniques; performed blind image quality comparison.

Main Results:

• The low-dose technique showed an 18% reduction in mean ESD (16.4 vs. 20.0 μGy) and a 20% reduction in mean whole body dose (3.5 vs. 4.4 μGy).
• A statistically significant 10% reduction in mean EI was observed after adjusting for field dimensions.
• Estimated excess childhood cancer mortality risk per chest radiograph decreased from 1.40 x 10⁻⁷ to 1.11 x 10⁻⁷.

Conclusions:

• A low-dose radiological technique significantly reduces radiation exposure in neonates without compromising diagnostic image quality.
• The findings support the adoption of lower radiation doses in neonatal imaging to minimize potential risks.
• Radiation dose and energy imparted correlate with neonate size, suggesting tailored approaches may be beneficial.