McCarty M, Waugh R, McCallum H, Montgomery R J, Aszkenasy O M
South Cleveland Hospital, Marton Road, Middlesbrough, Cleveland, UK.
Pediatr Radiol. 2001 Sep;31(9):646-9. doi: 10.1007/s002470100515.
In 1996, there were local reports of poor gonad protection for paediatric pelvic radiographs.
To investigate the nature of the problem and make necessary improvements.
A retrospective audit of 218 paediatric pelvic radiographs was undertaken in 1997. Each radiograph was assessed for the presence of a gonad shield, appropriateness of the device and its position. A multidisciplinary team was formed with representation from radiology, radiography, orthopaedics and medical physics to investigate ways of improving technique and reducing patient dose. These included radiographer training and the introduction of digital fluoroscopy as an alternative imaging technique in follow-up patients. There were further rounds of data collection in 1998 and 1999.
In round 1, a gonad shield was present in 77.9 % of boys' films and 76 % of girls' films where one should have been, increasing to 85.2 % and 85.4 % respectively by round 3 of the audit (P < 0.05). Only 31.6 % of boys' devices and 21.9 % of girls' devices were correctly positioned in round 1, increasing to 78.3 % and 94.3 %, respectively, by round 3 of the audit (P < 0.05). After round 1, no inappropriate devices were used.
Audit was an effective tool in gaining the resources needed to improve technique and reduce radiation exposure in children. The multidisciplinary approach was vital in the success of this project.
1996年，当地有报道称儿科骨盆X光检查对性腺的保护不佳。
调查问题的本质并进行必要的改进。
1997年对218例儿科骨盆X光片进行了回顾性审核。对每张X光片评估性腺防护装置的有无、装置的适用性及其位置。组建了一个多学科团队，成员包括放射科、放射照相科、骨科和医学物理方面的代表，以研究改进技术和减少患者剂量的方法。这些方法包括对放射技师进行培训以及引入数字荧光透视作为后续患者的替代成像技术。1998年和1999年又进行了几轮数据收集。
在第一轮中，应使用性腺防护装置的男孩X光片中77.9%有该装置，女孩X光片中76%有该装置，到审核的第三轮时分别增至85.2%和85.4%（P<0.05）。在第一轮中，男孩装置只有31.6%位置正确，女孩装置只有21.9%位置正确，到审核的第三轮时分别增至78.3%和94.3%（P<0.05）。第一轮之后，未使用不当装置。
审核是获取改进技术和减少儿童辐射暴露所需资源的有效工具。多学科方法对该项目的成功至关重要。
