Purpose or Case Report: The objective for a low dose imaging protocol was to eliminate patient risks and to reduce radiation doses. Tube placements are confirmed via imaging thereby avoiding utilization of malpositioned tubes. Reduced technical parameters lessen the absorbed skin dose. A limited field of view which includes distal espohagus and airway allows accurate assessment of feeding tube position. The new region of interest eliminates unnecessary exposure to hypersensitive organs including, thyroid and reproductive structures. This coned down view requires a lower image quality thereby allowing a lower dose approach.
Methods & Materials: A multidisciplinary team discussed current workflows, process improvements. and anticipated obstacles. Workflows were mapped out for all patient visit types, providers and services. Exam codes were developed with associated CPT charges. Order panels for providers were updated. Macro templates for the Radiologist were developed and loaded at workstations.
Lucite block and phantom testing were conducted using equivalent sized infant, toddler and adolescent phantoms on dedicated and portable units. Testing concentrated on portable units but table bucky techniques were also established. A 40” source to image distance (SID) was used for table (grid) testing and a 36” SID for portable/tabletop. A 6fr feeding tube was used to simulate placement. Established abdomen techniques were selected for corresponding phantom. The KVP factors were unchanged and mAS settings were decreased to lowest outputs by the units. The lowest mAs 1.25 mAs (table grid) was 0.32 for portable (non-grid). The field of view was mid-chest to iliac crest with proper collimation. Radiologist reviewed images and approved for trial. Exams performed using the new protocol. Image quality remained comparable to phantom testing with same technical factors.
Results: The ongoing trial of portable images reflects optimal for tube confirmation using the lowest mAs setting on unit (0.32 mAs). The abdominal KVP settings remained constant for adequate penetration.
Conclusions: The new protocol has a huge benefit to patients. The objective for chest and abdomen imaging is impressively different than a tube check therefore less dose can be utilized. Full dose images are essential for accurate clinical correlations. Mid chest to crest region reduces potential risk of malpositioned tubes as well as significantly reduces unnecessary dose to hypersensitive organs. This is vital when multiple images are required to confirm tube placements.