Customised shadow shielding solution developed to optimise entrance skin dose for chest and abdominal mobile neonatal radiographs

Abstract

Introduction: Neonates receive frequent diagnostic imaging due to pathological conditions. Their sensitivity to radiation and frequency of imaging validate the application of the diagnostic radiation protection principle of keeping exposures to radiation as low as possible. Due to underdeveloped immune systems, neonates are susceptible to infections, which hinders radiation protection measures. This requires nursing professionals to keep the neonate in near isolation. There is a need for a customised shadow shielding solution to optimise radiation dose while simultaneously conforming to infection prevention measures. Aim and objectives: The study aimed to optimise the entrance skin dose of neonates through a customised shadow shielding solution, that also had to be aligned with infection prevention measures. The objectives identified were that the requirements of such a shielding solution needed to be determined and translated into parameters. The parameters were simulated to determine the combination with an optimised dose. After optimisation, the shielding solution was implemented and authenticated for neonatal entrance skin dose. The views for its suitability for neonatal radiography were explored. Methods: This was a prospective sequential embedded mixed method study conducted in South African tertiary/regional academic government hospitals. The study population included neonates, radiologists, paediatricians, radiographers, and nursing professionals. The study was conducted in four phases. Phase one was a survey to establish the relationship between infection prevention and radiation protection. Phase two involved an experiment to test the possible parameters of the shadow shielding solution. The shielding solution was developed with consideration of Phase one and two results. The developed shielding solution was named the Baby Cone. Phase three involved implementation and authentication of the Baby Cone during neonatal examinations. Entrance skin dose values were calculated, and logbook data collected. Phase four involved interviews to explore the suitability of the Baby Cone for neonatal radiography. Results: The Baby Cone was successfully designed and developed by considering radiation protection requirements and infection prevention measures. The entrance skin dose values for 120 neonatal radiographs were found to be significantly optimised by the Baby Cone. Logbook results showed that the Baby Cone was practical to implement with a reject rate of 8%. Conclusion: The Baby Cone allowed for a novel, unique field of view that was aligned with the anatomy of a neonate to exclude structures irrelevant to the requested radiograph. The radiographers, radiologist and paediatricians consider the Baby Cone as a form of secondary collimation that enhanced the main radiation beam collimation. A patency application (2023/09787) for the Baby Cone has been filed with the South African National Intellectual Management office. Key terms: diagnostic accuracy, dose optimisation, neonate, radiation protection, restricted field of view, secondary collimation, shadow shielding