This content has been downloaded from IOPscience. Please scroll down to see the full text.

Download details:

IP Address: 168.176.5.118This content was downloaded on 07/04/2014 at 04:39

Please note that terms and conditions apply.

Radiation safety education reduces the incidence of adult fingers on neonatal chest

radiographs

View the table of contents for this issue, or go to the journal homepage for more

2014 J. Radiol. Prot. 34 333

(http://iopscience.iop.org/0952-4746/34/2/333)

Home Search Collections Journals About Contact us My IOPscience

J. Radiol. Prot. 34 (2014) 333337

Society for Radiological Protection Journal of Radiological Protection

doi:10.1088/0952-4746/34/2/333

Radiation safety education reduces theincidence of adult fingers on neonatalchest radiographs

N Sahota1, B E Burbridge1 and M D Duncan21 Department of Medical Imaging, Royal University Hospital, 103 Hospital Road,Saskatoon, Saskatchewan, S7N 0W8, Canada2 626 Mulvey Ave, Winnipeg, MB, R3M 1H4, Canada

E-mail: nas229@mail.usask.ca

Received 16 July 2013, revised 21 December 2013Accepted for publication 14 January 2014Published 4 April 2014

AbstractA previous audit revealed a high frequency of adult fingers visualisedon neonatal intensive care unit (NICU) chest radiographsrepresenting anexample of inappropriate occupational radiation exposure. Radiation safetyeducation was provided to staff and we hypothesised that the education wouldreduce the frequency of adult fingers visualised on NICU chest radiographs.Two cross-sectional samples taken before and after the administration of theeducation were compared. We examined fingers visualised directly in the beam,fingers in the direct beam but eliminated by technologists editing the image,and fingers under the cones of the portable x-ray machine. There was a 46.2%reduction in fingers directly in the beam, 50.0% reduction in fingers directlyin the beam but cropped out, and 68.4% reduction in fingers in the conedarea. There was a 57.1% overall reduction in adult fingers visualised, whichwas statistically significant (Z value 7.48, P < 0.0001). This study supportsradiation safety education in minimising inappropriate occupational radiationexposure.Keywords: radiation safety, neonatal, radiation exposure, chest radiograph,digital imaging

(Some figures may appear in colour only in the online journal)

1. Introduction

A previous publication, by Russell et al, revealed a high frequency of extraneous adult fingersvisualised on neonatal intensive care unit (NICU) chest radiographs [1]. This represented anexample of inappropriate occupational radiation exposure. Furthermore, many of the adultfingers were concealed by cropping of the digital imaging prior to it being sent to the picture

0952-4746/14/020333+05$33.00 c 2014 IOP Publishing Ltd Printed in the UK 333

J. Radiol. Prot. 34 (2014) 333 N Sahota et al

archiving and communication system (PACS)signifying a hidden source of occupationalradiation exposure.

Avoiding unnecessary exposure to diagnostic radiation is a cornerstone principle promotedby both the International Commission on Radiological Protection (ICRP) and the professionalstandards of practice from the Canadian Association of Medical Radiation Technologists(CAMRT) [2, 3]. The ICRP encourages the ALARA principle (as low as reasonably achievable)to guide both patient and health care staff exposure to diagnostic radiation [2]. The CAMRTpractice standards focus on the knowledgeable and professional use of ionising radiation, whichincludes the following highlight, The MRT [medical radiation technologist] will provide thebest possible health outcome for the patient while minimising exposure to risk of harm [3].As a result, we administrated radiation safety educational seminars to the MRTs and NICUstaff. We hypothesised that the education would reduce inappropriate occupational radiationexposure of adult fingers when performing NICU chest radiographs.

2. Methods

This study was approved by our local Research Ethics Board. Two cross-sectional samplesof consecutive NICU chest radiographs, taken before and after the administration of radiationsafety education, were compared and statistically assessed. There was no significant changein equipment or staff turnover between the audits. Based on the first audit where 230 chestradiographs were examined from December 2010 and March 2011, it was determined that asample size of 375 chest radiographs was required; this would allow the post-educational auditto detect a statistically significant decrease in fingers seen on the subsequent radiographs, withan alpha of 0.05 and a power of 0.80.

Multiple radiation safety presentations with question and answer sessions were given toboth MRTs and NICU staff in June 2012; safety reminder posters were placed in the NICUand remained up after the audit was concluded. The PowerPoint presentations reinforced themessage of safe imaging practices in the NICU setting and focused on (1) proper technique forrestraining the infant and eliminating occupational radiation exposure; (2) general radiationeducation; and (3) a discussion of factors that contribute to the inappropriate exposure todiagnostic radiation. These factors have been explored in-depth in the previous publicationby Russell et al [1].

After the presentations, the subsequent and consecutive 408 chest radiographs from July2012 to November 2012 were audited. The auditor examined the original anteroposterior (AP)portable NICU chest radiographs for the presence of adult fingers, including the area that wouldbe cropped before the image was sent to PACS. Radiographs analysed were of the chest andchest/abdomen combined that were captured as a single digital image. Extraneous adult fingersvisualised on the chest radiographs were reported as binary (yes/no) and grouped as either (1)fingers directly in the beam and visible on PACS; (2) fingers in the direct beam but eliminatedby technologists editing the image before being sent to PACS; or (3) fingers partially shieldedunder the coned area of the image, which is produced by the shielding collimation device ofthe portable x-ray machine. The 95% confidence interval for the incidence of extraneous adultfingers was calculated for each of the previously described groups and statistical significancebetween the two cross-sectional samples was determined using z-scores.

3. Results

After the implementation of the educational intervention, 408 total radiographs were audited.There was a total of 72 extraneous adult fingers visualised, 28 fingers directly in the beam,

334

J. Radiol. Prot. 34 (2014) 333 N Sahota et al

Figure 1. The percentage of total NICU chest radiographs with extraneous fingers, thepercentage in the direct beam, the percentage in the direct beam but cropped beforesent to PACS and the percentage in the coned area, before and after the radiation safetyeducation intervention.

20 fingers directly in the beam but cropped out and 24 fingers in the modality coned area.In comparison to the pre-intervention sample, administration of radiation safety educationwas associated with a statistically significant reduction (Z value 7.48, P < 0.0001) ininappropriate occupational radiation exposure (table 1). There was a 57.1% overall reduction inextraneous adult fingers visualised, with a 46.2% reduction in fingers visualised directly in thebeam, 50.0% reduction in fingers visualised directly in the beam but cropped out, and 68.4%reduction in fingers visualised in the coned area (figure 1).

4. Discussion

Our study showed that the administration of radiation safety education seminars was associatedwith a statistically significant reduction in the total number of extraneous adult fingersvisualised on NICU chest radiographs. These findings are comparable with other studiesexamining educational interventions to reduce occupational radiation exposure. In 2007, Sheynet al observed a significant change in radiation safety practices after the implementationof a focused education initiative [4]. Examples of changes in practice included an increasein physician use of lead eyeglasses and decreased fluoroscopy time for uncomplicatedperipherally inserted central catheters (PICC) procedures. From our own institution, Tynanet al noted a 66.7% reduction in the incidence of extraneous adult fingers on paediatric intensivecare unit (PICU) chest radiographs after the implementation of radiation safety education [5].

The effective radiation dose to staff from inappropriate exposure during the imageacquisition of NICU chest radiographs is relatively small. Per examination, it representsa negligible lifetime additional risk of cancer and is equivalent to a few days of naturalbackground radiation exposure [6]. However, the frequency of adult fingers in NICU chestradiographs at our institution was alarmingly high pre-intervention and staff experience acumulative effect from the repeated occupational exposure to ionising radiation. As such, itis prudent to reduce overall occupational radiation exposure, especially from inappropriatesources.

An issue that was uncovered during the previous audit was that many of the adult fingerson the NICU chest radiographs were being concealed by the MRTs. They would crop outthe adult fingers on the original images before sending them to PACS for interpretation. Thisraises an ethical dilemma with respect to hidden occupational radiation exposure. Before this

335

J. Radiol. Prot. 34 (2014) 333 N Sahota et al

Tabl

e1.

Stat

istic

alco

mpa

riso

nof

extr

aneo

usad

ultfi

nger

son

NIC

Uch

estr

adio

grap

hsbe

fore

and

afte

rthe

radi

atio

nsa

fety

educ

atio

nin

terv

entio

n.

Tota

lrad

iogr

aphs

audi

ted

Tota

lfing

ers

obse

rved

Fing

ers

indi

rect

beam

and

visi

ble

onPA

CSa

Fing

ers

indi

rect

beam

butc

ropp

edbe

fore

bein

gse

ntto

PAC

SFi

nger

sin

the

cone

dar

ea

Bef

ore

inte

rven

-tio

n(%

ofto

tal)

230

96(4

2%)

30(1

3%)

22(1

0%)

44(1

9%)

95%

CIb

(3

5.6%

,48.

4%)

(8.7

%,1

7.3%

)(6

.1%

,13.

9%)

(13.

9%,

24.1

%)

Aft

erin

ter-

vent

ion

(%of

tota

l)

408

72(1

8%)

28(7

%)

20(5

%)

24(6

%)

95%

CI

(1

3.9%

,21.

3%)

(4.4

%,9

.3%

)(2

.8%

,7.0

%)

(3.6

%,8

.2%

)Z

valu

e

7.4

82

.77

2.5

85

.07

Pva

lue