Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Diagnostic ionizing radiation exposure in premature patients

Journal of Perinatology volume 34, pages 392–395 (2014)Cite this article

Subjects

Abstract

Objective:

Concern regarding the magnitude and consequences of diagnostic radiation exposure in premature infants in neonatal intensive care units (NICUs) has increased as survival of premature infants has improved. Radiation exposure is not often rigorously monitored in NICU patients. The purpose of this observational study was to quantify the amount of ionizing radiation exposure in infants <33 weeks gestational age and to identify the indications for diagnostic imaging.

Study Design:

We conducted a retrospective review of 215 premature infants who were <33 weeks gestation and who received central venous line (CVL) placement during their NICU stay during the period from 2006 to 2011. Absorbed ionizing radiation was estimated using the method of Puch-Kapst and colleagues (2009) and compared with recommended radiation exposure limits. All infants were 29.2±2.3 weeks (mean±s.d.) and 1262±433 g birth weight.

Result:

Subjects received 15±15 radiographs (4.4±2.9 for CVL placement, 5.7±9.8 for gastrointestinal (GI) evaluations and 5.2±9.3 for respiratory indications). Eleven infants (5.1%) received more than the maximum recommended radiation from radiographs (>1000 μSv). Inclusion of fluoroscopic procedures increased to 26 the number of infants (12.1%) who received more than the maximum recommended 1000 μSv.

Conclusion:

Ionizing radiation exposure that exceeded the recommended maximum in premature infants at high risk for long-term sequelae occurred in 12.1% of infants who were <33 weeks gestation and who were cared for in our NICU over the past 5 years. CVL placement accounted for 22% of this radiation exposure. GI evaluations accounted for the greatest amount of ionizing radiation exposure. We suggest that the increased use of other imaging strategies may reduce total ionizing radiation exposure in this vulnerable population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Ono K, Akahane K, Aota T, Hada M, Takano Y, Kai M et al. Neonatal doses from X ray examinations by birth weight in a neonatal intensive care unit. Radiat Prot Dosimetry 2003; 103: 155–162.

    Article  CAS  Google Scholar 

  2. Avery ME . Neonatology. Pediatrics 1998; 102 (Supple 2): 270–271.

    CAS  PubMed  Google Scholar 

  3. Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013; 346: f2360.

    Article  Google Scholar 

  4. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012; 380 (9840): 499–505.

    Article  Google Scholar 

  5. US Food and Drug Administration. Center for Devices and Radiological Health. Initiative to reduce unnecessary radiation exposure from medical imaging US Food and Drug Administration, 2010 p 1–11 http://www.fda.gov/downloads/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/uCM200087.pdf.

  6. The Alliance for Radiation Safety in Pediatric Imaging. Image Gently. 2011. The Society for Pediatric Radiology http://www.pedrad.org/associations/5364/ig/.

  7. Puch-Kapst K, Juran R, Stoever B, Wauer RR . Radiation exposure in 212 very low and extremely low birth weight infants. Pediatrics 2009; 124: 1556–1564.

    Article  Google Scholar 

  8. Huda W, Vance A . Patient radiation doses from adult and pediatric CT. Am J Roentgenol 2007; 188 (2): 540–546.

    Article  Google Scholar 

  9. International Atomic Energy Agency. Radiation Protection of Patients (RPOP) Fluoroscopy International Atomic Energy Agency: Vienna, 2011.

  10. International Atomic Energy Agency. Safety Reports Series, No 71, Radiation Protection in Paediatric Radiology. International Atomic Energy Agency: Vienna, 2012.

  11. Cheng-Chung Y . Radiation safety in the neonatal intensive care unit: too little or too much concern? Pediatrics Neonatol 2010; 51 (6): 311–319.

    Article  Google Scholar 

  12. Moore CL, Copel JA . Point-of-care ultrasonography. N Engl J Med 2011; 364 (8): 749–757.

    Article  CAS  Google Scholar 

  13. Michel F, Brevaut-Malaty V, Pasquali R, Thomachot L, Vialet R, Hassid S et al. Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters. Resuscitation 2012; 83: 705–709.

    Article  Google Scholar 

  14. Jang TB, Schindler D, Kaji AH . Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J 2011; 28: 676–678.

    Article  Google Scholar 

  15. Kidmas AT, Ekedigwe JE, Sule AZ, Pam SD . A review of the radiological diagnosis of small bowel obstruction using various imaging modalities. Niger Postgrad Med J 2005; 12: 33–36.

    CAS  PubMed  Google Scholar 

  16. Ding W, Shen Y, Yang J, He X, Zhang M . Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest 2011; 140: 859–866.

    Article  Google Scholar 

  17. The International Commission on Radiological Protection. ICRP Publication 60. 1990 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP, 1991; 21 (1–3): Pergamon Press.

  18. National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States. National Council on Radiation Protection Report No. 160. National Council on Radiation Protection and Measurements: Bethesda, MD, 2009.

Download references

Author information

Authors and Affiliations

  1. Boston University School of Public Health, Boston, MA, USA

    M V Scott

  2. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA

    A M Fujii

  3. Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    R H Behrman

  4. Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA

    J E Dillon

Authors
  1. M V Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A M Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R H Behrman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J E Dillon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A M Fujii.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scott, M., Fujii, A., Behrman, R. et al. Diagnostic ionizing radiation exposure in premature patients. J Perinatol 34, 392–395 (2014). https://doi.org/10.1038/jp.2013.141

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2013.141

Keywords

This article is cited by

Search

Advanced search

Quick links