Clinical Fellow Seoul National University Hospital Seoul, Seoul-t'ukpyolsi, Republic of Korea
Background: X-ray examinations are frequently conducted for diagnostic and therapeutic purposes in neonatal intensive care units (NICUs). However, there are emerging concerns regarding the safety of radiation exposure, especially for the vulnerable preterm infants who are at the periods of rapid cellular division. This quality improvement project aimed to reduce the radiation hazard in a level IV NICU. Objective: Our goal was to achieve a 30% reduction in the average monthly cumulative the dose area product (DAP, Gy·cm2) value per patient, calculated by dividing the total monthly DAP from x-rays in the NICU by the monthly average of patient admissions. Design/Methods: We established an "X-ray Prescription Protocol" and educated physicians to ensure that only essential x-rays are taken. Additionally, we discouraged full-body infantograms and emphasized prescribing targeted x-rays, like chest or abdomen x-rays. Furthermore, to reduce the DAP values which act as a surrogate for radiation exposure, we provided training to radiologic technologists on meticulous collimation for each radiography session. Retrospective baseline data were collected for 8 months previously and prospectively for 4 months after interventions. Results: The average monthly x-ray count per patient was 28.3 in the pre-intervension era (October 2022 to May 2023), and decreased to 25.4 at post-intervention era (June 2023 to September 2023), reflecting 10.2% reduction. The average monthly infantogram count per patient showed an 18.0% reduction (25.9 to 21.2), and the proportion of infantograms among the total x-ray counts also decreased from 91.5% to 83.3%. The DAP value per x-ray decreased by 42.6%, from an average of 0.25 to 0.14. The primary outcome, the average monthly cumulative DAP value per patient, showed a substantial reduction of 48.6%, dropping from 7.00 to 3.60. There were no statistically significant differences in the baseline characteristics and shor-term morbidities of patients between the pre-intervention and post-intervention eras.
Conclusion(s): Our quality improvement approach has significantly reduced average monthly radiation exposure in the NICU, benefiting both patients and healthcare workers. Further efforts to reduce the number of x-ray prescriptions are necessary.
