CHALLENGES OF RADIOGRAPHERS IN PEADIATRIC XRAY EXAMINATION

CHALLENGES OF RADIOGRAPHERS IN PEADIATRIC XRAY EXAMINATION

Abstract

Paediatric radiography is a challenging procedure from the perspective of radiation dosage. Children are approximately ten times more sensitive to radiation-induced cancer than middle-aged adults and three times more sensitive than the population average.

A total of 100 patients were enrolled in this study. ESDs were evaluated for the chest postero-anterior (PA) projection and abdomen antero-posterior (AP) projection. For each studied examination, patient anthropometrical data (sex, age, weight, and height) and technical parameters used (kVp, mAs, and FSD) were collected at the time of the examination on a self-designed data collection sheet. The ESD was assessed by the indirect method, with data on the radiation output of the X-ray tube and exposure factors (kVp, mAs, and FSD). The image quality for each examination was also assessed using quantitative techniques. The result of the study revealed that the mean ± SD for ESDs were found to be (0.11 ± 0.03 mGy) and (0.41 ± 0.15 mGy) for PA chest and abdomen, respectively. The maximum ESD for the abdomen (0.723 mGy) was observed at the maximum kV_p (62 kVp), which emphasises the significant correlation between kVp and ESD; no correlation was found between patient age or weight and ESD. Image resolution in terms of information entropy was optimal and correlated with selected Kvp and mAs.

The study is considered an attempt to evaluate the ESDs received by digital radiographic x-ray machines for children aged between 1 and 8 years old, taking into consideration a number of other variables. The mean ESD values obtained are found to be within the standard reference. It may provide guidance on where efforts on dose reduction will need to be directed to fulfil the requirements of the optimisation process and serve as a reference for future research. 

 

 

Chapter one

Introduction

1.1 Introduction:

Paediatric radiography is a challenging procedure from the perspective of radiation dosage. Because it is well known that the dose of radiation is an extremely important issue in children, who are significantly more radiosensitive and more likely to manifest radiation-induced changes over their lifetimes (Guo et al., 2013),. Children are approximately ten times more sensitive to radiation-induced cancer than middle-aged adults and three times more sensitive than the population average (Brenner et al., 2001). More people are exposed to ionising radiation for medical practice than any other human activity, and in many cases, individual doses are the highest. Exposure to radiation in medicine involves people undergoing diagnostic radiography, interventional procedures, or radiation therapy. Diagnostic radiology examinations lead to higher risks per unit dose of radiation for cancer in infants and children compared with adults.

The International Commission on Radiological Protection (ICRP) asserted that the use of an effective dose is actually not recommended for assessing the risks of stochastic effects in retrospective situations for exposures in patients; however, this quantity can be of value for comparing the use of similar technologies and procedures in different hospitals and countries as well as the use of different technologies for the same medical examination (2007).

The entrance skin dose (ESD) is defined as the absorbed dose into the air where the X-ray beam intersects the skin surface of the patient, including the backscatter (Alm-Carlsson et al., 2007). The reasons for evaluating ESD is that the physical parameter recommended for monitoring the Diagnostic Reference Levels (DRLs) in conventional radiography was the ESD and the dose is greatest at the surface where radiation enters the body of the patient; therefore, the skin is the main organ for which there is a possibility of deterministic effect, i.e., skin burn (Sharifat and Oyeleke, 2009) Another reason the organ equivalent dose can be estimated from the ESD is that it is very important, especially in cases where the part of the body being imaged contains sensitive organs to the effect of radiation.

DR has been shown to provide good resolution with no significant difference in diagnostic quality at reduced radiation doses. Volk’s study suggested that dose reductions of approximately 50–75% had no significant impact on image quality. However, a more efficient detector on its own is not sufficient to ensure a consistent low-dose operation in routine clinical practice (Völk et al., 2004).  The knowledge of the relationship that links image quality and radiation dose is a prerequisite to any optimisation of medical diagnostic radiology because, according to the ALARA concept, the dose received by the patient during a radiological examination should be kept ‘as low as reasonably achievable’. The image quality and dose required for a successful and reliable diagnosis depend on physical parameters such as contrast, resolution, and noise, the constitution of the patient, the viewing conditions, and also on the characteristics of the observer that assesses the image (Al-Kinani and Mohsen, 2014).

This study was aimed at estimating the ESD for paediatric patients undergoing diagnostic X-ray examinations of the chest and abdomen in a paediatric hospital in Khartoum, Sudan, to help in the optimisation of radiation protection for the patients.

1.2 Problem of Study:

Children with increased mitotic activity and a longer life expectancy are more radiosensitive than middle-aged adults by a factor of up to 10.

 

 

1.3 Objectives of the study:

• 1General:

The main objective of this study was to estimate the radiation dose for paediatric patients undergoing X-ray examinations of the chest and abdomen.

1.3.2 Specific:

• To measure the absorption dose for paediatrics during chest and abdomen imaging.
• To optimise the exposure factors, those that give good image quality don’t exceed the radiation dose.
• To measure the effective dose for paediatrics during chest and abdomen.
• To compare the estimated dose with published works and internationally established diagnostic reference levels.

1.4 Thesis layouts:

This study falls into five chapters, where chapter one deals with the introduction, problem of the study, objectives, definition of the entrance skin dose, and thesis layout. Chapter two will highlight a theoretical background and a literature review; chapter three includes methodology; chapter four discusses results; and chapter five presents discussion, conclusion, and recommendation.

CHALLENGES OF RADIOGRAPHERS IN PEADIATRIC XRAY EXAMINATION

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