title: Relative distribution of pertinent findings on portable neonatal abdominal radiographs: can we shield the gonads?
abstract: BACKGROUND
  Shielding of the gonads is a dose-saving strategy in pediatric radiography and its use is the law in New York and the majority of other states. However, routine use of gonadal shields is controversial because of concerns that important diagnostic information can be obscured.
  
  
  OBJECTIVE
  The purpose of this study was to assess the frequency and spatial distribution of key findings on portable neonatal abdominal radiographs.
  
  
  METHODS
  We reviewed the 2,544 portable neonatal intensive care unit anteroposterior abdominal radiographs performed in 2010 at a university medical center, of which 962 were inadequately shielded. These 962 radiographs were reviewed by pairs of pediatric radiologists for the presence of findings in different regions, including bowel abnormalities, pneumatosis, free air, inguinal hernias, osseous abnormalities, and catheter/tube tips.
  
  
  RESULTS
  The fewest pertinent findings were present below the level of the sacrosciatic notches (n = 181, 18.8%). Of the 853 abnormalities below the level of the iliac crests in our cohort, six were isolated to these regions, whereas others had concomitant abnormalities more superiorly. Of 35 radiographs with pneumatosis or suspected pneumatosis in the pelvis, 33 had pneumatosis in more superior regions. Suspected free air was never isolated to the pelvis. Osseous abnormalities were only present in the pelvis below the sacrosciatic notch, and 37.5% of lower extremity catheters terminated below the level of the sacrosciatic notches.
  
  
  CONCLUSIONS
  Pertinent findings on neonatal intensive care unit abdominal radiographs are rarely isolated to the pelvic regions.
authors: Department of Radiology, New York University-Langone Medical Center, 550 1st Ave., New York, NY, 10016, USA.
authors: Matthew
authors: M
authors: Winfeld
authors: Naomi
authors: N
authors: Strubel
authors: Lynne
authors: L
authors: Pinkney
authors: Shailee
authors: S
authors: Lala
authors: Sarah
authors: S
authors: Milla
authors: James
authors: J
authors: Babb
authors: Nancy
authors: N
authors: Fefferman
mesh_terms: D005260:Female; D006066:Gonads / Q000528:radiation effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D015997:Neonatal Screening / Q000706:statistics & numerical data*; D009518:New York / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011835:Radiation Protection / Q000706:statistics & numerical data*; D011860:Radiography, Abdominal / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
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