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European Guidelines for AP/PA chest X-rays: routinely satisfiable in a paediatric radiology division?

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Abstract

Objectives

Accurate collimation helps to reduce unnecessary irradiation and improves radiographic image quality, which is especially important in the radiosensitive paediatric population. For AP/PA chest radiographs in children, a minimal field size (MinFS) from "just above the lung apices" to "T12/L1" with age-dependent tolerance is suggested by the 1996 European Commission (EC) guidelines, which were examined qualitatively and quantitatively at a paediatric radiology division.

Methods

Five hundred ninety-eight unprocessed chest X-rays (45 % boys, 55 % girls; mean age 3.9 years, range 0–18 years) were analysed with a self-developed tool. Qualitative standards were assessed based on the EC guidelines, as well as the overexposed field size and needlessly irradiated tissue compared to the MinFS.

Results

While qualitative guideline recommendations were satisfied, mean overexposure of +45.1 ± 18.9 % (range +10.2 % to +107.9 %) and tissue overexposure of +33.3 ± 13.3 % were found. Only 4 % (26/598) of the examined X-rays completely fulfilled the EC guidelines.

Conclusions

This study presents a new chest radiography quality control tool which allows assessment of field sizes, distances, overexposures and quality parameters based on the EC guidelines. Utilising this tool, we detected inadequate field sizes, inspiration depths, and patient positioning. Furthermore, some debatable EC guideline aspects were revealed.

Key Points

• European Guidelines on X-ray quality recommend exposed field sizes for common examinations.

• The major failing in paediatric radiographic imaging techniques is inappropriate field size.

• Optimal handling of radiographic units can reduce radiation exposure to paediatric patients.

• Constant quality control helps ensure optimal chest radiographic image acquisition in children.

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Abbreviations

ACR:

American College of Radiology

AEA:

Actual exposed area

AP:

Anteroposterior

DICOM:

Digital Imaging and Communications in Medicine

DR:

Digital radiography

EC:

European Commission

FFD:

Film focus distance

ICC:

Intraclass correlation coefficient

ICRP:

International Commission on Radiological Protection

MaxFS:

Maximal field size

MinFS:

Minimal field size

PA:

Posteroanterior

SD:

Standard deviation

WHO:

World Health Organisation

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Acknowledgments

The scientific guarantor of this publication is Prof. Dr. Erich Sorantin. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Prof. Dr. Erich Sorantin) has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, performed at one institution.

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Authors and Affiliations

  1. Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria

    Sebastian Tschauner, Robert Marterer, Michael Gübitz, Sabine Weissensteiner & Erich Sorantin

  2. Division of Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria

    Peter I. Kalmar

  3. Division of General Radiological Diagnostics, Department of Radiology, Medical University of Graz, Graz, Austria

    Emina Talakic

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  1. Sebastian Tschauner
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Correspondence to Sebastian Tschauner.

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Tschauner, S., Marterer, R., Gübitz, M. et al. European Guidelines for AP/PA chest X-rays: routinely satisfiable in a paediatric radiology division?. Eur Radiol 26, 495–505 (2016). https://doi.org/10.1007/s00330-015-3836-7

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  • DOI: https://doi.org/10.1007/s00330-015-3836-7

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