title: Optimal exposure parameters for digital radiography of the infant skull: a pilot study.
abstract: OBJECTIVE
  To determine optimal exposure parameters when performing digital skull radiographs in infants with suspected non-accidental injury (NAI).
  
  
  METHODS
  Anteroposterior and lateral post-mortem skull radiographs of six consecutive infants with suspected NAI were made at six exposure levels for each projection. Entrance surface doses ranged from 75-351 microGy. Exposures were made with a Fuji 5000R computed radiography system onto a standard resolution imaging plate. In three patients exposures were repeated using a high-resolution imaging plate. Hard copy images with an edge-enhancement factor of 0.5 were produced. Six observers assessed and scored the radiographs from 1=poor to 5=excellent for visualization of five criteria. The criteria scored included outer table of skull vault, inner table of skull vault, suture margins, vascular markings and soft tissues of the scalp. Radiographs were then ranked in order of overall image quality. Film density and sensitivity values were recorded. Local research committee approval was obtained.
  
  
  RESULTS
  Current parameters give an average entrance surface dose of 253 microGy and 246 microGy for anteroposterior and lateral radiographs, respectively. The study demonstrated no perceived improvement in image quality above an entrance surface dose of 200 microGy (80% of current dose) or by the use of a high-resolution imaging plate.
  
  
  CONCLUSIONS
  The potential exists to reduce radiation exposure in infants. A study has commenced to determine the effects of dose reduction on diagnostic accuracy in suspected NAI.
authors.affiliation: Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Offiah
authors.forename: J
authors.initials: J
authors.lastname: Grehan
authors.forename: C M
authors.initials: CM
authors.lastname: Hall
authors.forename: A
authors.initials: A
authors.lastname: Todd-Pokropek
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D015588:Observer Variation; D010865:Pilot Projects; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods*; D012680:Sensitivity and Specificity; D012886:Skull / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014962:X-Ray Film