Radiation Risks in Pediatric Chest X-rays

This article discusses the risks of radiation exposure in pediatric chest x-rays and how to minimize them. It covers the different diseases that infants are vulnerable to, the use of chest x-rays in diagnosis and monitoring, and the reasons why infants are at a higher risk of developing malignancies. The article also suggests different strategies to reduce the harmful nature of radiations, such as reducing exposure time and using the AP view during chest x-rays.

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HEALTH SCIENCE
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HEALTH SCIENCE
Children of up to one year in age are vulnerable to different diseases that can alter the
normal functioning of the respiratory as well as the cardiovascular system. Some of the notable
forms of the diseases include respiratory distress syndrome, the post-delivery acquired
pneumonia, pneumothorax and finally the congenital heart failures(Daldrup-Link and Goodling,
2010;).in most of the cases, admission to the pediatric intensive care unit abbreviated as PICU is
the end result. To further extent, the infants go through extended duration under incubation,
pressure ventilation as well as the oxygen administration processes (Daldrup-Link and Goodling,
2010).Since all these procedure involves insertion of tubes and catheters, chest x-rays are
recommended to ensure they are placed at the right place. Besides the chest x-rays, chest
radiographs are also carried out so as to effectively study the configuration of the chest as well
its aeration and the general appearance of the heart and its vessels and to further monitor how the
patient is recuperating from the respiratory condition. Erect post anterior is the best radiograph
recommended for infants unless they are unable to sit up on their own when erect AP or AP are
used.
X-rays are however known to be a risk factor in the development of cancer. It is
estimated that exposure to 0.5 and 120msv of the dose rate increases the chances of developing
cancer. Since the rate at which cells divide in infants is very rapid, infants are prone to
carcinogenesis than adults. Another reason as to why infants are at a higher risk of
carcinogenesis is the fact that the cumulative effects of radiation. It is widely believed that the
younger the age of the age is inversely proportional to carcinogenesis in case they are exposed to
radiation (Zammit-Maempel, Chapple, & Leslie, 2006). Since cancer takes a lot of time to

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develop, infants are prone to cancer since they have a longer lifespan. According to research, the
chances of developing malignancy after exposure to radiation during the first ten years is higher
than above thirty years.
There are other reasons why malignancies are very severe in children. One other reason is
that since children are uncooperative during the chest X-ray procedure, there is a likelihood of
repeated x-rays so as to achieve the desired outcome (Seegenschmiedt, 2008, p. xx). Children are
thought to be very frightened whenever during the chest x-rays and this is known to have a
negative impact on the quality of the image to be processed. In attempts to overcome this
hurdles, the radiographers are forced to widen or rather expound on the field of the radiation or
opt to use the AP projection. It is however the AP projection method that is known to expose the
thyroid gland to radiations leading to higher risks of malignancy since the thyroid is the most
radiosensitive part in the body(Okoye and Avwiri, 2013; Karami et al., 2016).. With this
repeated exposure, the dose rate increases significantly leading to higher risks of malignancies.
Another reason is that most chest x-rays in children are performed through the AP view. With
this procedure, the chances of radiation hitting the thyroid gland are very high.
Another significant reason as to why infants are at a higher risk of developing
malignancies than adults is the fact that they have smaller body size. With these small bodies,
they are chances of radiation going past untargeted organs like the thyroid gland. It is the thyroid
gland according to research, the most radiosensitive organ in younger children.
Since there is no threshold dose limit in pediatric radiography, radiation protection is
essential especially in the pediatric radiography to minimize on potential risks. Infants should
therefore be protected from the harmful stochastic effects during the radiographic examinations.
The best way to achieve this is through justification and optimization as stressed upon by IR

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regulations. Different strategies can be used to reduce the harmful nature of radiations like the
cardinal principles of protection.
One such principle is reducing exposure time to the radiations. This is an effective
method coupled with the projection method during particular examination. The best practical
aspect for example is the use of PA projections instead of the AP projection when examining the
eyes since in AP projections the lens of the eyes receive more dose than PA(Nightingale, 2016).
Another key strategy is the use of AP view during chest x-rays as this method reduces the dose
subjected to different radiosensitive organs or tissues such as the breast and the thyroid. Besides,
using the wall of Bucky with the PA erect position incase an infant is able to sit or stand gives
room for longer focus and skin distance to be employed which can cut on the radiation dose of
the infant. Several studies have indicated during the pelvis, lumbar as well as the clavicle x-rays,
the gonads can receive less radiations when using PA projection as compared to the AP
projection.

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References
Daldrup-Link, H. E., & Newman, B. (n.d.). Preface. Pearls and Pitfalls in Pediatric Imaging,
xi-xi. doi:10.1017/cbo9781139084239.001
Nightingale, J. (2016). Radiography research – Embedding a European perspective.
Radiography, 22(1), 1-2. doi:10.1016/j.radi.2015.12.004
Ogunmefun, G., Hardy, M., & Boynes, S. (2016). Is magnetic resonance imaging a viable
alternative to ultrasound as the primary imaging modality in the diagnosis of
paediatric appendicitis? A systematic review. Radiography, 22(3), 244-251.
doi:10.1016/j.radi.2016.01.001
Paediatric Radiography. (2003). doi:10.1002/9780470776070
Seegenschmiedt, M. H. (2008). Morbus Dupuytren/Morbus Ledderhose. Radiotherapy for
Non-Malignant Disorders, 161-191. doi:10.1007/978-3-540-68943-0_9
Zammit-Maempel, I., Chapple, C., & Leslie, P. (2006). Radiation Dose in Videofluoroscopic
Swallow Studies. Dysphagia, 22(1), 13-15. doi:10.1007/s00455-006-9031-x