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sudershan.kumari

radiation with xrays in nicu

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I came acrross an article that neonates exposed to xray abdomen had 1:500 chance of developing malaignancy later, 3 times more that of c skull.

Xray chest is the most often radiological intervention in nursery, for individual nicu baby, the number increases with ventilation, respiratory failure and development of complictions of ventialation;pneumonia, chronic luhg disesase, and air leak etc.Small size of neonates, a part of abdomen is mostly exposed to radiation.

I would like to know, if there is any method to prevent radiation to abdomen while taking xray chest.Also what about preventing radiation to other babies in nicu. Any studies?

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You have started a nice topic on radiation related safety in the NICU.

Let me start by directing you to this article in Pediatrics (1. Donadieu J, Zeghnoun A, Roudier C, Maccia C, Pirard P, Andre C, et al. Cumulative Effective Doses Delivered by Radiographs to Preterm Infants in a Neonatal Intensive Care Unit. Pediatrics. 2006 Mar 1;117(3):882-888.)

Link to this free article

I quote from this article

"...Considering that the prognosis of highly premature infants has improved dramatically thanks to progress in intensive care, it seems difficult to minimize the number of radiographs in this setting. However, given the uncertainties surrounding the precise radiosensitivity of extremely premature newborns, it seems logical to try to minimize radiograph exposure, notably by limiting the radiograph field or by using shielding techniques. Indeed, a large proportion of the radiographs analyzed here included both the thorax and the abdomen and sometimes were more extensive. Finally, it is also important to recall that the use of CT scans should be minimized in this population."

In the recent issue of Clinics in perinatology, the issue of neonatal safety was discussed in detail.

1. Lai TT, Bearer CF. Iatrogenic environmental hazards in the neonatal intensive care unit. Clinics in Perinatology. 2008 Mar ;35(1):163-81, ix.

Let us put radiation doses in perspective first.

The average annual dose of natural radiation humans are exposed to is 2.4 millisieverts (mSv) with a range of 1 to 10 mSv. Life time doses of greater than 100 mSv are statistically significant as a risk for cancer when studying survivors of the atomic bombs in Japan. The dose of radiation for a neonate from a two-view chest radiograph is around 25 to 60 microSv. About 25 two-view chest radiographs correspond to about 1 mSv, and about 75 two-view chest radiographs are equivalent to 1 year of natural background radiation. Single-view abdominal films have a dose of 10 to 30 microSv, and single-view babygrams have a dose of 20 to 40 microSv. The increased risk of cancer from x-ray studies while in the NICU for a very low birth weight and extremely low birth weight infant is between 1 in 10,000 to 1 in 60,000. CT scans impart a much higher dose of radiation. They account for the major source of medical radiation despite comprising a small number of the procedures performed. The calculated effective dose of radiation for a head CT scan is about 6 mSv and for an abdominal CT scan about 5.3 mSv. A single CT scan of the head carries a dose 200 times that of a single babygram and is about 2.5 times the natural radiation exposure in a year.

(Wilson-Costello D, Rao PS, Morrison S, et al. Radiation exposure from diagnostic radiographs in extremely low birth weight infants. Pediatrics 1996;97(3):369–74.)

(Sutton PM, Arthur RJ, Taylor C, et al. Ionising radiation fromdiagnostic x-rays in very low birth weight babies. Arch Dis Child Fetal Neonatal Ed 1998;78(3):227–9.)

I would like to know, if there is any method to prevent radiation to abdomen while taking xray chest.

Exposing more area while taking a Xray than is required is frequent in the NICU. This is highlighted in this article 1. Bader D, Datz H, Bartal G, Juster AA, Marks K, Smolkin T, et al. Unintentional exposure of neonates to conventional radiography in the Neonatal Intensive Care Units. J Perinatol. 2007 Jul 12;27(9):579-585.

(LINK)

Should you do chest and abdomen Xrays as seperate films or together as a a single thoracoabdomenal film? This article will help you decide...1. Jones NF, Palarm TW, Negus IS. Neonatal chest and abdominal radiation dosimetry: a comparison of two radiographic techniques. Br J Radiol. 2001 Oct 1;74(886):920-925.

LINK to this free article

Some methods of avoiding unnecessary exposure to radiation :

1) Proper x-ray beam collimation allows limiting radiation to only the requested area and avoiding unnecessary organ exposure.

2) Genital shields can be used in larger infants during abdominal films to avoid irradiation of reproductive organs.

3) Care should be taken to avoid repeated x-ray studies due to poor initial film quality.

4) Technicians obtaining radiographs in the NICU should be trained in the proper use of these measures.

5) Physicians can also help to minimize radiation by carefully evaluating each patient and their need for a film.

6) Due to the high amount of radiation exposure from CT scans, physicians need to carefully consider possible alternatives to a CT scan for diagnosis. Both ultrasound and MRI have fewer known side effects when compared with a CT scan. If a CT scan is necessary, limiting the region of the body to be studied and using appropriate shielding when possible decreases the amount of radiation exposure. Specific pediatric parameters can also be designated by the radiologist or CT technologist to limit radiation.

These articles may also interest you:

1. McParland BJ, Gorka W, Lee R, Lewall DB, Omojola MF. Radiology in the neonatal intensive care unit: dose reduction and image quality. The British Journal of Radiology. 1996 Oct ;69(826):929-37.

2. Barcham N, Egan I, Dowd SB. Gonadal protection methods in neonatal chest radiography. Radiologic Technology. 69(2):157-61.

The ideal method of gonadal shielding in the neonatal unit provides the greatest radiation protection while minimizing the potential for cross-infection. This study evaluated two common methods of gonadal shielding used during neonatal chest radiography--direct shielding and shadow shielding. For direct shielding, lead was placed over the gonadal region of a phantom. For shadow shielding, lead was placed on top of the crib. Results showed that direct shielding provided a greater reduction in gonadal dose than shadow shielding.

3. Duggan L, Warren-Forward H, Smith T, Kron T. Investigation of dose reduction in neonatal radiography using specially designed phantoms and LiF:Mg,Cu,P TLDs. The British Journal of Radiology. 2003 Apr ;76(904):232-7.

LINK TO THIS FREE ARTICLE

Also what about preventing radiation to other babies in nicu. Any studies?

I think this is what you were referring to...

"We studied the doses of "scattered" received by neonates in a Neonatal Surgical Unit by placing thermoluminescent dosemeters in various positions expect the direct beam. Doses of "scattered" radiation received by neonates as a results of exposure of their neighbours to X-ray examinations were found to be negligible. Sick neonates need not be moved from their neighbours undergoing exposure to X-rays."-

Iyer KR, Spitz L, Kiely E, Drake DP, Dykes E, Evans K, et al. Scattered radiation in a neonatal surgical unit. European Journal of Pediatric Surgery: Official Journal of Austrian Association of Pediatric Surgery1995 Oct ;5(5):286-7.

I came acrross an article that neonates exposed to xray abdomen had 1:500 chance of developing malaignancy later, 3 times more that of c skull

Could I request you to be more specific about this article, so that we can find it and read it.

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I came acrross an article that neonates exposed to xray abdomen had 1:500 chance of developing malaignancy later, 3 times more that of c skull...

Interesting. Which article did you get this figure from?

I guess you mean an increased risk of childhood malignancy (since I guess the standardized lifetime risk for cancer much-much higher than 1:500)

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Any body using mobile lead partition for taking xrays in nicu to prevent radiation exposure to nearby babies and the technician. 

Kindly See the picture below. Any thing like that or what is your strategy. 

IMG-20190301-WA0001.jpg

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