Purpose or Case Report: Given the relative sensitivity of pediatric patients to radiation, the need to limit exposure to the region of interest is of the utmost importance in pediatric radiography. This study assesses the practice of acquiring pediatric chest radiographs at a community hospital in which the imaging contract was acquired by a radiology practice with subspecialty-certified pediatric radiologists. Pediatric radiologists in the new radiology practice saw a need for improved collimation of pediatric chest radiographs at the community hospital. Many radiographs exhibited poor collimation and included much of the abdomen. This study examines an initiative to measure and improve radiograph quality.
Methods & Materials: All pediatric chest radiographs (n = 50, average age 5.6 years) obtained at the community hospital during 4 consecutive weeks were reviewed. The following method was employed to assess collimation: a horizontal line was drawn across the image at the level of the inferior border of the lower hemidiaphragm, an “optimal” vertebral body level was assigned by allowing 1 vertebral body height below the line for patients 5 years and younger (0.5 vertebral body heights for patients older than 5 years), and comparing this to the actual lowest vertebral level included in the film. After analysis of the control group was complete, an in-service was provided at the community hospital in which the proper and expected technique was reviewed with the technologists.
Results: In the initial analysis of films in the pre-intervention group, an average of 1.72 extra vertebral levels were included on 49 frontal radiographs analyzed. A single film was excluded due to over-collimation meaning that both costophrenic angles were not included. Of the 39 lateral films obtained in the control period, an average of 1.33 extra vertebral levels were included. Of the lateral films, 2 were excluded due to over-collimation.
Conclusions: Reducing unnecessary x-ray exposure to children through the use of an inservice program is achievable.