Radiation doses and image quality in pediatric chest X-ray for the diagnosis of pneumonia in selected Latin American countries

Full text: Pneumonia and acute lower respiratory infections in general, is the leading cause of child death in developing countries. According to the World Health Organization (WHO), 4 millions of children die annually due to this disease. Despite the growing use of vaccination as an alternate approach to reduce mortality, the increasing antimicrobial resistance and the high costs of vaccines remain important obstacles in the global struggle against the disease. The usual treatment strategy begins with a clinical examination of the patient followed by the prescription of a chest X-ray. Radiography would appear as the best available method for diagnosing pneumonia only if radiologists (and other health professionals such as pediatricians) knew how to interpret the images showed in the radiographs, and these meeting the standards of quality (anatomic structures, image contrast and optical density, and patient dose among other factors). On the other hand, special attention should be paid on patient doses due to children's specific radiosensitivity, repeated and extended use of chest x-ray in all Radiology Departments, and high rejection rate due to both equipment malfunction and to human skills shortcomings. Patient doses of chest X-ray performed to children less than 5 years old in PAHO Sentinel Hospitals for surveillance of bacterial pneumonias in various Latin American countries were estimated using technical parameters and equipment specifications. Image quality was compared to WHO criteria for chest X-rays quality. Results showing differences in patient doses translates on one hand the impact of specific characteristics of the radiological equipment, including equipment limitations and performance of the radiographs and on the other various and divers levels of health professionals skills and training on image quality interpretation and dose optimization. The study concludes that professionals' training and education on chest radiographs image quality constitutes the first stage of the process for early diagnosis of children pneumonia, as well as the implementation of the radiation protection principle of optimization in medical exposures. (author)