Paediatric Imaging

Introduction: Risk communication related to radiation has become more important during the last decade. Informing patients of benefits, risks, and alternative imaging methods is necessary to make informed decisions. The purpose of this study was to investigate radiographers' knowledge of radiation dose and risk, and their experiences with radiation risk communication. Methods: This study used a qualitative approach using semistructured interviews with clinical radiographers. The participants were presented with three authentic cases describing situations where risk communication is necessary. The interviews were audiorecorded, transcribed, and analyzed in four steps before the transcript interviews were coded and collected in meaningful themes. Participation was voluntary and participants signed an informed consent form. Results: Six radiographers from two hospitals took part in the study. The mean age was 34 years, their work experiences as radiographers varied from 3.5 to 30 years and with an equal number of women and men. The participants provided reflections on the cases, how they managed the patients' need for information, and how they dealt with concerned patients. They also reflected on the knowledge and skills needed to be confident with risk communication. Contributors: All authors contributed to the conception or design of the work, the acquisition, analysis, or interpretation of the data. All authors were involved in drafting and commenting on the paper and have approved the final version.

Supplement 1) revolved around the important topic of patient safety. In their editorial, Nightingale and Snaith open by describing patient safety as "a topic clearly of immense importance to our profession and to the public we serve". 1 This view is not likely to change, and patient-safety related topics will remain a constant in terms of the papers published in Radiography and indeed in all journals linked to the fields of medical imaging/radiology and radiation oncology. There are many ways to define patient safety. The top two definitions, ranked by leading institutions across Europe, involved in radiography education, were: "Reducing the incidence of unnecessary disease, injuries, adverse events and deaths caused to patients through the delivery of therapeutic or diagnostic procedures." and "A safe healthcare environment based on having access to the best technology available, the best trained professionals, the best designed healthcare processes and facilities." 2

The research presented in this paper is taken from a larger study whose aims were to explore adolescents' perceptions of X-ray examinations and more specifically middle adolescents' perceptions of X-ray examinations. Middle adolescents are between the ages of 15 and 17 years and experience many changes in their lives that differentiate them from young and late adolescents. There is limited research available on middle adolescents' perceptions of the X-ray examination process Methodology: 18 adolescents, age range 15e17 years, took part in the research study. This included 9 male and 9 female adolescents from 2 secondary schools in the Dublin area. A self-completion questionnaire was used as the method of investigating their perceptions of the X-ray examination process. The data, which consisted of feelings and opinions, was analysed qualitatively using thematic analysis. Results: Analysis suggested that the adolescents perceived that the 'wait' in the waiting room was long and boring. They expressed an interest in the provision of suitable recreational facilities to distract them from feeling nervous, bored and from the pain they felt. 16 of the adolescents found the X-ray examination interesting, although they appeared to have little knowledge of what was happening. 14 of the adolescents perceived the radiographer to be friendly. More boys than girls complained about the radiographer. Conclusion: The study indicates that middle adolescents are not receiving effective quality care that meets their specific needs when presenting for an X-ray examination. Further research could help in providing the adolescents with the optimum care they need.

Background: The production of a good quality chest radiograph depends on the selection of appropriate kilovoltage and current-time product while keeping the radiation dose to patients as low as possible. This study assessed radiographers' level of compliance to the use of high kV as standard for postero-anterior (PA) chest X-ray in the South South region of Nigeria. Results: Seventy-seven of the 82 questionnaires administered were completely filled and returned giving a response rate of 94%. Of these 77 respondents, only 74% (n = 57) were aware of high-kV technique as the recommended procedure for PA chest X-ray. Departmental protocols (technique chart with exposure factors) were also non-existent in all hospitals/diagnostic centres used in this study. Thirty-one respondents were males (40%); 44% (n = 34) working in public hospitals only and 32% (n = 25) with less than five years of working experience were aware of this technique. On the benefits, more than 50% of the respondents were familiar with the benefits of using high-kV technique as the recommended standard for PA chest X-rays. Responses on the benefits of the technique varied from 77% (n = 59) for patient dose reduction to 51% (n = 39) for better imaging of the airways. The use of high-kV technique for PA chest X-rays showed only 13% compliance. Factors influencing compliance included imaging system (film screen /digital), X-ray tube rating and X-ray unit with preset/manual exposure factors (p < 0.05). Conclusions: The present study revealed low compliance to high-kV technique in this region, suggesting a potential increase in ionizing radiation dose to patients during chest radiography, hence the need to improve adherence to the recommended standard.

Background: The production of a good quality chest radiograph depends on the selection of appropriate kilovoltage and current-time product while keeping the radiation dose to patients as low as possible. This study assessed radiographers' level of compliance to the use of high kV as standard for postero-anterior (PA) chest X-ray in the South South region of Nigeria. Results: Seventy-seven of the 82 questionnaires administered were completely filled and returned giving a response rate of 94%. Of these 77 respondents, only 74% (n = 57) were aware of high-kV technique as the recommended procedure for PA chest X-ray. Departmental protocols (technique chart with exposure factors) were also non-existent in all hospitals/diagnostic centres used in this study. Thirty-one respondents were males (40%); 44% (n = 34) working in public hospitals only and 32% (n = 25) with less than five years of working experience were aware of this technique. On the benefits, more than 50% of the respondents were familiar with the benefits of using high-kV technique as the recommended standard for PA chest X-rays. Responses on the benefits of the technique varied from 77% (n = 59) for patient dose reduction to 51% (n = 39) for better imaging of the airways. The use of high-kV technique for PA chest X-rays showed only 13% compliance. Factors influencing compliance included imaging system (film screen /digital), X-ray tube rating and X-ray unit with preset/manual exposure factors (p < 0.05). Conclusions: The present study revealed low compliance to high-kV technique in this region, suggesting a potential increase in ionizing radiation dose to patients during chest radiography, hence the need to improve adherence to the recommended standard.

To optimise the radiation dose and image quality for chest radiography in the neonatal intensive care unit (NICU) by increasing the mean beam energy. Methods: Two techniques for the acquisition of NICU AP chest X-ray images were compared for image quality and radiation dose. 73 images were acquired using a standard technique (56 kV, 3.2 mAs and no additional filtration) and 90 images with a new technique (62 kV, 2 mAs and 2 mm Al filtration). The entrance surface air kerma (ESAK) was measured using a phantom and compared between the techniques and against established diagnostic reference levels (DRL). Images were evaluated using seven image quality criteria independently by three radiologists. Images quality and radiation dose were compared statistically between the standard and new techniques. Results: The maximum ESAK for the new technique was 40.20 mGy, 43.7% of the ESAK of the standard technique. Statistical evaluation demonstrated no significant differences in image quality between the two acquisition techniques. Conclusions: Based on the techniques and acquisition factors investigated within this study, it is possible to lower the radiation dose without any significant effects on image quality by adding filtration (2 mm Al) and increasing the tube potential. Such steps are relatively simple to undertake and as such, other departments should consider testing and implementing this dose reduction strategy within clinical practice where appropriate.

Introduction: To assess how referrers and practitioners disclose benefit-risk information about medical imaging examinations to paediatric patients and their parents/guardians; to gauge their confidence in doing so; and to seek their opinion about who is responsible for disclosing such information. Methods: This study followed on from a previously published study, with a questionnaire distributed in staggered phases to 146 radiographers, 22 radiology practitioners, 55 emergency physicians and 43 paediatricians at a primary paediatric referral centre in Malta. The questionnaire sought details about referrers' and practitioners' practice of disclosing benefit-risk information, as well as their opinion about their confidence and responsibility to do so. Results: An overall response rate of 63.2% (168/266) was achieved. Most referrers and practitioners would generally explain the purpose of the imaging examination, with fewer providing benefit-risk information. The content and the approach adopted to communicate benefit-risk information varied, at times considerably. While 75% (123/164) felt that the responsibility to provide benefit-risk information was a shared one between referrers and practitioners, only 32.1% (53/165) reported a high level of confidence in their own ability to do so. Conclusions: Our findings highlight potential knowledge and skills gaps amongst local referrers and practitioners. This needs addressing so as to ensure that paediatric patients and their parents/guardians are provided with adequate, reassuring and consistent information. Additionally, we recommend that local referrers and practitioners come together and develop a consensus document that can offer guidance on how to go about discussing the benefits and risks of paediatric imaging examinations.

Objectives: To investigate radiographers' and radiology practitioners' opinion, experience and practice of radiation benefit-risk communication and consent for paediatric imaging examinations. Methods: A cross-sectional survey was conducted amongst radiographers and radiology practitioners working at a primary paediatric referral centre in Malta, so as to acquire information about their interactions with paediatric patients and/or their parents, particularly their opinion and practice of communicating benefit-risk information and seeking consent for imaging examinations. Results: The return of 112 questionnaires provided a response rate of 66.7%. Findings revealed varied practice relating to the provision of benefit-risk information, whereby details concerning examination benefits and potential risks are not always conveyed. For 89% of participants, parental consent was sought for paediatric imaging examinations in their current practice. Only 36.7% of participants indicated that they were highly confident in their ability to communicate benefit-risk information. The study findings also revealed that parents can truly be worried about the associated radiation exposure, with some even refusing an imaging examination as a result of such concerns. Conclusions: The practice of communicating benefit-risk information to paediatric patients and/or their parents is varied. A possible gap in benefit-risk communication education and/or training was identified, which may impact radiographers' and radiology practitioners' confidence in conveying such information. Education/training activities for radiographers and radiology practitioners are therefore necessary to foster improved benefit-risk dialogues and help provide reassurance to parents/guardians about the benefits of appropriately indicated paediatric imaging examinations.

Background: Identifying the level of radiology students and staffs&#39;s awareness of their knowledge of radiation risks and radiation protection and their understanding of radiation dose levels in medical imaging procedures will help global and national lawmakers adjust laws according to the recognized need in studies. The significance of this study is further enhanced when it is considered a lack of radiation awareness may increase the risk of radiation damage to themselves and patients.Method: This Crossectional study is done on 180 participants, including 62 participants were students (radiology residents and technologists), and 118 participants were radiology staff (radiologists and radiographers). For measuring the awareness of participants, a prepared questionnaire which had a total of 22 questions. The poll was divided into three sections of which: Demographics data, Radiation protection awareness, and knowledge of radiologists about dose assessment. The questionnaire reliab...

AIM: CT scanning is a widely utilised effective diagnostic tool. We aimed to establish whether patients are adequately informed prior to undergoing CT investigations. Methods: All adult patients with mental capacity attending the department for a CT study over a week period were invited to fill out a brief questionnaire prior to their scan. Results: 57 patients returned completed questionnaires. Overall 23% of patients were unsure or incorrect about the type of scan scheduled. Of patients attending with a new condition, 46% of them did not know their provisional diagnosis. Only 32 % of patients had insight into how a CT scan worked. This was taken to mean that the patient had included some reference to either x-rays, radiation or cross sectional imaging. Only 23% of patients were aware of potential complications of CT scans. Conclusion: Although written consent prior to CT scan is probably a step too far in providing patients with relevant risks/benefits of their investigation, we propose all patients undergoing CT have prior access to a written information sheet should they wish to be further informed regarding their procedure.

Introduction: The introduction of digital radiography has led to a significant problem in terms of dose creep. To address this problem, manufacturers have established a set of exposure indicators (EI) as a feedback mechanism to safeguard against overexposure. The EI is the measure of incident exposure to the detector that is directly proportional to the signal-to-noise ratio and can be related to image quality. The aim of this study was to evaluate the influence of EI on image quality and radiation dose for the posterior anterior (PA) chest radiography. Material and Methods: This study was conducted in three phases, namely pre-optimization, experimental, and post-optimization. A total of 60 patients that could fulfill the inclusion and exclusion criteria for the PA chest radiography were recruited. The radiographic technical parameters, dose area product, and EI were recorded. Radiographs were printed and evaluated by two recruited radiologists using the modified evaluation criteria...

Introduction: The focus on paediatric radiation dose reduction supports reevaluation of paediatric imaging protocols. This is particularly important in the neonates where chest radiographs are frequently requested to assess respiratory illness and line placement. This study aims to assess the impact of neonatal chest radiographic protocols on patient dose in four hospitals in different countries. Methods: Exposure parameters, collimation, focus to skin distance (FSD) and radiation dose from 200 neonatal chest radiographs were registered prospectively. Inclusion criteria consisted of both premature and full-term neonates weighing between 1000 and 5000 g. Only data from the examinations meeting diagnostic criteria and approved for the clinical use were included. Radiation dose was assessed using dose area product (DAP). Results: The lowest DAP value (4.58 mGy cm 2) was recorded in the Norwegian hospital, employing a high kVp, low mAs protocol using a DR system. The Canadian hospital recorded the highest DAP (9.48), using lower kVp and higher mAs with a CR system, including the addition of a lateral projection. The difference in the mean DAP, weight, field of view (FOV) and kVp between the hospitals is statistically significant (p < 0.001). Conclusion: Use of non-standardised imaging protocols in neonatal chest radiography results in differences in patient dose across hospitals included in the study. Using higher kVp, lower mAs and reducing the number of lateral projections to clinically relevant indications result in a lower DAP measured in the infant sample studied. Further studies to examine image quality based on exposure factors and added filtration are recommended. Implications for practice: Reevaluation of paediatric imaging protocols presents an opportunity to reduce patient dose in a population with increased sensitivity to ionising radiation.

There are currently no National Paediatric Diagnostic Reference Levels (DRLs) for plain radiography paediatric imaging studies in the UK. A multi-centre study was performed to establish and compare Local DRLs between three NHS hospitals.

Data from 3 hospitals was collected for n=62,167 paediatric patients (<17 years old). Data was collected from the Radiology Information Service (RIS) for two sites and a Dose Management System (DMS) for the other. Dose Area Product (DAP) values were analysed for each age group (0,1,5,10 and 15 year olds) using SPSS v.22 for the most frequent examinations (>10 studies per age group). Exposure parameters including kV and mAs were also analysed where available.

From the data obtained from RIS 29% did not include a unit for the DAP value; this were excluded from the final analysis. As expected this was not an issue with data obtained from the DMS. In each age group the median DAP varied from 1.4 to 7.1 cGycm2 for chest; 2.9-8.0 cGycm2 for wrist; 3.7-6.2 cGycm2 for ankle; 2.3-5.1 cGycm2 for knee and 3.1-10.1 cGycm2 for elbow.

The DMS not only provided the data in a more time efficient manner but it was of a superior quality when compared to that obtained from the RIS. National DRLs will be easier to establish across all radiology examinations as more sites across the NHS adopt DMSs. This data will now be compared to values published in literature. Although a mixture of Computed Radiography (CR) and Digital Radiography (DR) systems and vendors are operated across the three sites this audit has demonstrated a need for optimisation and harmonisation.