One of these things doesnt belong: High rate of adult fingers seen on NICU x-rays

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A significant number of adult fingers are exposed to radiation during neonatal intensive care unit (NICU) radiographs, according to an article currently in press in the Canadian Association of Radiologists Journal.

Authors Jordan Russell, MD, and colleagues from Royal University Hospital, Saskatoon, Saskatchewan, Canada, also found that simply examining images on PACS may not tell the whole story as some inappropriately exposed fingers are cropped from the NICU radiograph before the image is sent to PACS.

“Avoiding unnecessary exposure to diagnostic radiation is both a professional standard for medical radiation technologists and an internationally recognized safety requirement, as outlined by the International Commission on Radiological Protection,” wrote the authors.

They explained that at their facility, a nurse typically immobilizes infants by using one hand to stabilize the pelvis and the other to hold the patient’s arms above the head. Through this process, the nurse’s fingers—or possibly the fingers of technologists or family members—are sometimes inappropriately exposed to radiation.

To determine the frequency of this error, Russell and colleagues audited 230 consecutive NICU chest radiographs at their facility between December 2010 and March 2011. Both the raw NICU source x-ray images and the final processed images sent to PACS were checked for visibility of adult fingers.

A total of 30 radiographs (13 percent) contained fingers directly in the x-ray beam and were visible on PACS, according to the authors. An additional 22 radiographs (10 percent) contained fingers that were cropped before being sent to PACS, and 44 radiographs (19 percent) contained fingers within the coned area. In all, 42 percent of images contained extraneous adult fingers in at least one of the three areas, according to the study results.

“A challenging patient population, time constraints, an incomplete understanding of the shielding provided by image coning, and an absence of equipment to aid in the acquisition of portable radiographs in the NICU may all be contributing factors,” speculated the authors. They also suggested that a lack of communication between technologists and nurses and inadequate collimation of the x-ray beam at the time of image acquisition also may be contributing factors.

“We must be diligent about evaluating the raw images acquired in the NICU to unmask this source of occupational radiation exposure. We hope to reduce this exposure with further educational interventions.”