Radiation dose reduction in the neonatal intensive care unit. Comparison of three gadolinium oxysulfide screen-film combinations.

Infant radiation exposure in the neonatal intensive care unit was quantitated by thermoluminescent dosimetry in 513 mobile unit roentgen examinations of the chest and abdomen. Three combinations of gadolinium oxysulfide intensifying screens and radiographic films were compared. The skin entrance dose in millirads at the mid-chest, mid-abdomen and symphysis pubis levels was measured. Radiation dose reductions of 52% and 68% were achieved using the intermediate and fast combinations relative to the near par speed standard combination. Comparison of the relative line pair resolution of the three combinations under clinical conditions was done and subjective comparison of image detail and image mottle was made by two radiologists. The standard and intermediate speed combinations were considered very acceptable for general neonatal diagnostic interpretation but the fastest combination was not considered acceptable for general purposes. Because of the decreased radiation dose, the intermediate speed combination is now used for all routine neonatal radiography at our institution. The near par speed combination is now used only occasionally for "high-detail" examinations. The fastest combination has a limited role for frequently repeated, less critical studies, such as tube or catheter placement or routine follow-up examinations.