Improving the quality of positioning and reducing the rotation factor during pediatric portable chest radiography using infant immobilizer

Alireza Mahmoudabadi, Majid Sadeghi Moghadam , Moosa Sajjadi, Majid Shams, Leila Ameri

Alireza Mahmoudabadi
Assistant Professor of Radiology, Medical Physics Department, Faculty of Medicine, Gonabad University of Medical Science, Gonabad, Iran.

Majid Sadeghi Moghadam
Msc of Medical Physics, Medical Physics Department, Faculty of Medicine, Gonabad University of Medical Science, Gonabad, Iran.. Email: majid.sadeghimoghadam@chmail.ir

Moosa Sajjadi
Assistant Professor of Nursing, Department of Medical-Surgical Nursing, Faculty of Nursing & Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran.

Majid Shams
Radiologist MD, Bohlool Hospital, Gonabad University of Medical Science, Gonabad, Iran.

Leila Ameri
Radiologist MD, Qaem Hospital, Mashhad University of Medical Science, Mashhad, Iran
Online First: August 08, 2018 | Cite this Article
Mahmoudabadi, A., Sadeghi Moghadam, M., Sajjadi, M., Shams, M., Ameri, L. 2018. Improving the quality of positioning and reducing the rotation factor during pediatric portable chest radiography using infant immobilizer. Bali Medical Journal 7(2). DOI:10.15562/bmj.v7i2.737

Background: The portable chest X-ray in infants hospitalized in neonatal intensive care units is one of the most common diagnostic procedures. Every child during hospitalization period may be incurred over a number of portable chest radiography examinations. Optimization of the infant position for radiography results in the improved diagnostic quality of radiographs.

Objective: To evaluate rotation factor during pediatric portable chest radiography; the present study examined the effect of two different methods to stabilize infant position during radiography on the incidence of rotation.

Materials and methods: This is an interventional study with nonequivalent groups in which rotation factor was evaluated on 250 portable chest radiography on fields of newborns admitted to NICUs (in two intervention and control groups), by comparing the length of posterior ribs on both sides of the chest. In this study, 176 radiographs were related to infants from three university hospitals so that sandbags or patients accompany had been used to stabilize the position of the patient, and 74 radiographs were for infants referred to an academic center whose positions had been stabilized during X-ray using body immobilizer.

Results: The mean difference between the length of right and left posterior ribs in infants stabilized with the usual method (sandbags or patients accompanies) was obtained 6.51±5.05 mm. This statistical index for the second group of infants whose positions had been stabilized through body immobilizer was 2.87±2.15mm. Independent t-test showed a significant difference between the two groups in terms of the difference in the quantity of rotation. In this study, the difference in the length of posterior ribs over 5 mm was found as detectable rotation in the images.

Conclusion: The infant position during radiography can be improved considerably by using proper body immobilizer, and repeating the tests can be avoided due to the inappropriate position. By means of such an instrument, there is no need for the help of accompanies or personnel to stabilize infant position, and their exposure will be prevented.


Yu C-C. Radiation safety in the neonatal intensive care unit: too little or too much concern? Pediatrics & Neonatology. 2010;51(6):311-9.

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. Radiation protection dosimetry. 2003;103(2):155-62.

Donadieu J, Zeghnoun A, Roudier C, Maccia C, Pirard P, André C, et al. Cumulative effective doses delivered by radiographs to preterm infants in a neonatal intensive care unit. Pediatrics. 2006;117(3):882-8.

Toossi MTB, Malekzadeh M. Radiation dose to newborns in neonatal intensive care units. Iranian Journal of Radiology. 2012;9(3):145-9.

D.Frank PWBE. Merrill atlas radiographic positions & radiographic procedures. 2003;One.

Foos DH, Yankelevitz DF, Wang X, Berlin D, Zappetti D, Cham M, et al. Improved visualization of tubes and lines in portable intensive care unit radiographs: a study comparing a new approach to the standard approach. Clinical imaging. 2011;35(5):346-52.

Dougeni E, Delis H, Karatza A, Kalogeropoulou C, Skiadopoulos S, Mantagos S, et al. Dose and image quality optimization in neonatal radiography. The British journal of radiology. 2014.

Willis CE. Optimizing digital radiography of children. European journal of radiology. 2009;72(2):266-73.

Soboleski D, Theriault C, Acker A, Dagnone V, Manson D. Unnecessary irradiation to non-thoracic structures during pediatric chest radiography. Pediatric radiology. 2006;36(1):22-5.

Russell J. Radiation Protection in Pediatric Radiology NCRP Report No. 68.

Hall EJ. Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatric radiology. 2002;32(10):700-6.

Suleiman OH. Radiation doses in pediatric radiology: influence of regulations and standards. Pediatric radiology. 2004;34(3):S242-S6.

Aldrich JE, Duran E, Dunlop P, Mayo JR. Optimization of dose and image quality for computed radiography and digital radiography. Journal of digital imaging. 2006;19(2):126-31.

Golan A, Marco R, Raz H, Shany E. Imaging in the newborn: infant immobilizer obviates the need for anesthesia. IMAJ-Israel Medical Association Journal. 2011;13(11):663.

Reilly L, Byrne AH, Ely E. Does the use of an immobilizer provide a quality MR image of the brain in infants? Journal of radiology nursing. 2012;31(3):91-6.

European Union. European Commission. Directorate-General XII-Science R, Development. European guidelines on quality criteria for diagnostic radiographic images in paediatrics: Office for Official Publications of the European Communities; 1996.

Cook J, Pettett A, Shah K. Guidelines on Best Practice in the X-ray Imaging of Children. A Manual for all X-ray Departments. 1998.

Goske MJ, Applegate KE, Boylan J, Butler PF, Callahan MJ, Coley BD, et al. The Image Gently campaign: working together to change practice. American Journal of Roentgenology. 2008;190(2):273-4.

Cook J, Kyriou J, Pettet A, Fitzgerald M, Shah K, Pablot S. Key factors in the optimization of paediatric X-ray practice. The British journal of radiology. 2001;74(887):1032-40.

No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0