Stollfuss J, Schneider K, Krüger-Stollfuss I
Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich, Germany; Department of Radiology and Nuclear Medicine, Klinikum Memmingen, Bismarckstr. 23, D-87700 Memmingen, Germany.
Institute for Clinical Radiology, Department of Paediatric Radiology, Ludwig Maximillians Universität München, Lindwurmstr. 4, D-80337 Munich, Germany.
Eur J Radiol Open. 2015 Aug 6;2:118-22. doi: 10.1016/j.ejro.2015.07.002. eCollection 2015.
Unnecessary exposure of the abdomen, arms or head may lead to a substantial increase of the radiation dose in portable chest X-rays on the neonatal intensive care unit. The objective was to identify potential factors influencing inappropriate exposure of non-thoracic structures in two teaching hospitals.
The study analysed 200 consecutive digital chest radiographs in 20 preterm neonates (mean gestation 25 ± 1 weeks). Demographical data, tube settings and exposure parameters were recorded. To grade the collimation, we used a scoring system with a maximum of 12 exposed non-thoracic structures. Length of gestation, age, the radiographer, years of experience in performing X-rays and the number of in situ catheters or lines, were correlated with collimation quality.
There was no significant difference between the rates of optimal images obtained in the two hospitals (0.32 vs 0.39, n.s.). Scores showed that most suboptimal images had only mildly reduced image quality (1.40 ± 1.38 vs 1.20 ± 1.43, n.s.). Length of gestation or presence of surgical drains, catheters and tubes had no obvious effects on the exposure of non-thoracic structures. Large intra-individual variation in optimal collimation (14-86%) was noted for the radiographers in both hospitals; this was unrelated to their respective years of experience.
In our study, the only identifiable factor influencing the collimation of portable chest radiographs in preterm infants was the radiographer's dedication and awareness. There were no apparent differences between the hospitals investigated. Exposure of non-thoracic structures was relatively frequent and mainly involved the proximal humeri.
在新生儿重症监护病房进行便携式胸部X光检查时，不必要地暴露腹部、手臂或头部可能会导致辐射剂量大幅增加。本研究的目的是确定两家教学医院中影响非胸部结构不适当暴露的潜在因素。
该研究分析了20名早产儿（平均孕周25±1周）连续的200张数字化胸部X光片。记录人口统计学数据、管电流设置和曝光参数。为了对准直情况进行评分，我们使用了一个评分系统，最多可记录12个暴露的非胸部结构。孕周、年龄、放射技师、进行X光检查的年限以及体内导管或管路的数量与准直质量相关。
两家医院获得的最佳图像比例之间没有显著差异（分别为0.32和0.39，无统计学意义）。评分显示，大多数次优图像的图像质量仅略有下降（分别为1.40±1.38和1.20±1.43，无统计学意义）。孕周或手术引流管、导管和管路的存在对非胸部结构的暴露没有明显影响。两家医院的放射技师在最佳准直方面都存在较大的个体差异（14 - 86%）；这与他们各自的工作年限无关。
在我们的研究中，影响早产儿便携式胸部X光片准直的唯一可识别因素是放射技师的专注度和意识。所调查的医院之间没有明显差异。非胸部结构的暴露相对频繁，主要涉及近端肱骨。
