Reducing Radiation Dose for Neonatal Patients During Chest X-Ray

Introduction:
According to Who (2016), the reason behind the rapid increase of radiographic imaging
techniques is the evolution of the advancement of imaging techniques. The most frequently
undertaken radiological examinations are chest radiographs. The National Health Service (NHS
England, 2014) has surveyed that the approximate chest x-rays that are carried out every year in
England is 7.72 million. These chest x-rays are meant for identifying various types of pathology,
even lung cancer too. Recently, the radiography has been considered as the front line diagnosis
tool in the healthcare industry (Whitley et al., 2016). The diagnosis radiography possesses a
significant role evaluating and managing medical conditions of both children and adults
(Polycarp Chukwuemeka and Gregory O, 2013). The optimised image quality is of great
importance as it helps to reduce the misdiagnosis rate of lung cancer and it helps to improve the
survival rates rates (RCR, 2014). Precautions should be taken for various reasons while using the
ionizing radiation in children’s bodies as children have more sensitivity for any type of
malignancy (Louise Chapple, 2009). The risk is comparatively higher in diagnostic radiography
procedures for per unit radiation dose to cancer in infants and kids than adults (Jaramillo Garzon,
Morales Aramburo and Puerta Ortiz, 2015). According to the most recent data by Biological
Effects of Ionising Radiation (BEIR), the risk factor is ten times more for children in comparison
with adults (Louise Chapple, 2009). This is another reason to consider chest radiography as the
most frequently performed examination on children (Whitley et al., 2016). For instance, some
neonatal who have risks to suffer from various cardiac and respiratory diseases, may face
frequent chest x-rays after birth and it may continue for few years of their childhood (Louise
Chapple, 2009). Some children act uncooperatively during x-ray examination, pushing the tests
to be repeated several times (Louise Chapple, 2009). Thus, a special monitoring is essential for

protecting the radiation limit for pediatric radiology. Scrutiny should be conducted in order to
control the radiation dose measures and verifying every parts of the imaging chain (Whitley et
al., 2016). The current work aims to reduce the radiation dose for neonatal patients and focuses
to practice the lower exposure aspects while conducting chest x-ray on children.
Imaging equipment-
The image related data was acquired using DR systems during this experiment. The
advanced digital image receptor (IR) Konica Minolta CS-7 had an aero flat panel locater which
helped to collect images and it was used for landscape orientation. This panel locater or detector
offered a sophisticated image quality even at considerable radiation dose. The image quality was
comparatively better than screen film and phosphor plates (Geijer, Beckman, et al, 2001;
Radiological Society of North America (RSNA), 2018). The ESD was measured using the X2
dosimeter which is ray safe, effieicent, and easy to use (Tootell, Szczepura, & Hogg, 2013). The
IR was a 43 x 35 centimeters array shaped thin film non-tiled transistor, made of unstructured
silicone and caesium–iodide scintillator (Konica Minolta, 2011). To score images, the grading
monitors NEC multisync EA243WM was used. It featured 2.3 megapixels with 0.27 pixel per
width and 94 pixels per inch, offering HD display (NEC, 2016). The exposures were executed by
a Wolverson Acroma X-ray unit which comprise of high frequency generator and VARIAN
130HS standard X-ray tube featuring 3 mm A filtration (Ekpo, et al, 2014). The limitless
repetition of exposures was permitted by GammexR chest phantom of newborn children. It also
used to stimulate clinical conditions (Walker, Allen, Barnside and Small, 2011). The
recommendation of the use phantom by the American Association of Physicists and Medicine
(AAPM), (2006), helped to assure the quality of radiation protection. This is to be noted that

there are limitations to the use of phantom which evidently influence practice but restricts the
validation of this experiment externally.
Pilot Study-
The improvement of the reliability in study, the review of the quality control tests were
done before acquiring the image. This review also helped in complying with the ionized
Radiation Regulation (2017). These comprised of exposure time, tube dose output (appendix 3),
collimation, ray safe calibration, image receptor, and kilo voltage tube output (appendix 4).
During the clinical use, the trolley was situated parallel with the top of table of the x-ray. The
GammexR chest phantom for new born babies was positioned on the image receptor to get an AP
projection (Whittley.et al, 2015). The highlight of the positioning error was done by taking test
images till the achievement of the positioning criteria (figure 2). During the experiment, the
position of the phantom was required to remain constant. The values of (mAs) were changeable
with the values 06, 0.8, 1.0, 1.2, and 1.4. The kVp took values 50, 60, and 70.
Exposure-
The maintenance of the unchangeable fine spot size helped to allow clearer visualization
of the anatomical details than wide focal spot size (Bushong, 2013; Carlton and Adler, 2013).
The analysis of ESD and the image quality effect was done by data acquisition form the
simultaneous change of the mAs and kVp (Polgar and Thomas, 2014). To ignore the distortion of
image quality and artefact, the images were acquired excluding the ray-safe dosimeter.