Improving Radiation Quality and Safety in the NICU Through the Implementation of a Standardized X-Ray Protocol

Abstract

Background: Diagnostic radiology is used for the diagnosis and management of neonatal disorders in neonatal intensive care units. Although it is currently a necessary component for proper care, increased exposure to radiation is associated with healthcare risks. Neonates are the most vulnerable population to radiation. On average, a neonate will be exposed to 0.3-1.24 mSV of radiation during a NICU stay, exceeding the recommended limit. Despite current x-ray standards, poor quality x-rays continue to be an existing problem, leading to increased radiation exposure and unnecessary manipulation of lines and tubes, including endotracheal tubes (ETTs).|Purpose: The purpose of this project is to implement a standardized x-ray protocol to improve the quality of x-rays and decrease ETT manipulations in a NICU.|Methods: This project took place in a 7-bed specialty unit for neonates born less than 29 weeks and admitted before 32 weeks. Phase 1 was a retrospective review of patient charts over a 15 week period. Data collected included total number of x-rays, x-ray quality, and number of ETT manipulations. A safety checklist was developed and placed at each patient bedside after staff education was completed. Post implementation data was collected over a 12 week period with the same criteria as phase 1.|Results: A total of 40 patients and 801 x-rays were included in this project. After implementation of the x-ray protocol, there was improvement seen in all measured outcomes. Average x-ray quality score improved by 11.7% with improvement seen in all 4 quality measures. Head positioning compliance improved by 11% and arm positioning compliance improved by 10%. Artifact and rotation compliance showed improvement but remained below 50% post implementation. There was a decrease seen in ETT repositioning and average number of x-rays per patient, despite a lower mean gestational age in the post implementation group.|Conclusion: Education and safety checklists are effective methods to improving x-ray quality and safety in a NICU. Improvement in x-ray quality can decrease overall radiation exposure and decrease ETT manipulations. It is necessary to continue exploring best practices when performing and measuring the quality of neonatal images.