Unintentional exposure of neonates to conventional radiography in the Neonatal Intensive Care Units

Objective: To evaluate the extent of unintentional exposure to X- rays performed during routine diagnostic procedures in the Neonatal Intensive Care Units ( NICUs). Study Design: During a 1- month period, 157 consecutive neonates from five level- III NICUs were recruited for this study. The mean birth weight was 1747 +/- 911 g ( range: 564 - 4080 g), and gestational age was 31.6 +/- 3.6 weeks ( range: 24 - 41 weeks). A total of 500 radiographs were performed including chest ( 68%), abdomen ( 17%) and combined chest and abdomen ( 15%). The average number of radiographs taken per infant was 4.2 +/- 3.6 ( range: 1 - 21). Unintentional inclusion of body regions other than those ordered was determined by comparing the areas that should be included in the radiation field according to International recommendations, to those that appeared in the actual radiograph. Result: A comparison of the recommended borders to the actual boundaries of the radiographs taken show an additional exposure to radiation in all three procedures: 85% of chest radiographs also included the whole abdomen, 64% of abdomen radiographs included both thigh and upper chest and 62% of chest and abdomen radiograph included the thigh. ( The range in all procedures was from ankle to upper head.) Between 2 and 20% of the relevant targeted body tissues were not included in the exposed fields resulting in missing data. The gonads of both sexes were exposed in 7% in all chest X- rays. Among male infants, the testes were exposed in 31% of plain abdomen radiographs and 34% of chest and abdomen radiographs. Conclusion: In the NICUs participating in the study, neonates are currently being exposed to X- ray radiation in nonrelevant body regions. Higher awareness and training of the medical teams and radiographers are required to minimize unnecessary exposure of newborns to ionizing radiation.