Radiological protection in the Neonatal Intensive Care Units (NICUs): a retrospective and observational audit at two teaching hospitals

Vahid Karami, Mansour Zabihzadeh, Atefeh Isavand-Faraji, Hosein Karampour


Introduction: Portable chest and abdomen x-rays are the most common x-ray procedures performed during hospitalization in the Neonatal Intensive Care Units (NICUs). These x-rays contribute to radiation exposure to several radiosensitive tissues, causing increased concerns about patients’ safety. This study aims to assess the status of radiological protection in the NICUs at two teaching hospitals supervised by Dezful University of Medical Sciences (DUMS), Dezful, Iran.

Methods: A retrospective and observational study was performed at two teaching hospitals of DUMS comprising three NICUs. Six radiologic technology students were invited and agreed to participate in this audit. The students were asked to attend as observers in the NICUs and record the radiation safety principle observances specified in the checklist. We also supplemented data from an observational study with a retrospective survey of the images at the picture archiving and communication system (PACS) database.

Results: 230 neonatal chest and abdomen x-rays from 65 hospitalized neonates were investigated during 57 work shifts in the observational survey. In all, 90.1%, 80% and 13% of the chest, abdomen and chest/abdomen x-rays had unsatisfactory beam restriction, respectively. The protective shielding tools were available; however, they were not commonly applied to the patients. Most of the personnel used fixed exposure parameters of 42 kVp and 3.2 mAs. In the retrospective study, 498 portable x-rays were retrieved from the PACS database, in which only 17.5% and 0.4% of images have adequate beam restriction and evidence of shielding, respectively.

Conclusion: Our study is commensurate with previous literature and emphasizes that neonates in the investigated hospitals are receiving avoidable excessive radiation exposure, mainly due to inappropriate beam restriction.


neonate; radiation protection; chest; abdomen; x-ray exposure; NICU

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