An Evaluation of Image Acquisition Techniques, Radiographic Practice, and Technical Quality in Neonatal Chest Radiography

Abstract

Background Neonatal chest radiography is a frequently performed diagnostic examination, particularly in preterm infants where anatomical and/or biochemical immaturity impacts on respiratory function. However, the quality of neonatal radiographic images has been criticized internationally and a prevailing concern has been that radiographers (radiologic technologists) fail to appreciate the unique nature of neonatal and infant anatomical proportions. The aim of this study was to undertake a retrospective evaluation of neonatal chest radiography image acquisition techniques against key technical criteria. Methods Hundred neonatal chest radiographs, randomly selected from all those acquired in 2014, were retrospectively evaluated. Inclusion criteria for radiographs acquisition were as follows: anterior-posterior supine; within 30 days of birth; and with all preprocessed collimation boundaries visible. Image evaluation was systematically undertaken using an image assessment tool. To test for statistical significance, Student's t-test, χ2 test, and logistic regression were undertaken. Results Only 47% of the radiographs were considered straight in both upper and lower thoraces. The cranial collimation border extended beyond the upper border of the third cervical vertebra in 30% of cases, and the caudal border extended below the lower border of the first lumbar vertebra in 20% of cases, suggesting high possibility of neonatal overirradiation. Upper thorax rotation was significantly associated with head position (χ2 = 10.907; P < .001) as has been stated in many published textbooks internationally, but arm position had no apparent influence on rotation of the upper thorax (χ2 = 5.1260; P = .275). Birth weight was associated with accurate midline centering of central ray (logistic regression; OR = 1.0005; P = .009; CI, 1.00139–1.000957) with greater accuracy observed in images of neonates with higher birth weight. Conclusion This study has highlighted areas for neonatal chest radiography improvement. Importantly, the findings bring into question commonly advocated radiographic techniques relating to arm positioning and assessment of rotation while confirming the importance of other technical factors. These findings begin the work toward developing the evidence base to underpin neonatal chest radiograph acquisition, but further prospective work and multicenter/multinational data comparison are required to confirm the findings.