title: European Guidelines for AP/PA chest X-rays: routinely satisfiable in a paediatric radiology division?
abstract: OBJECTIVE
  Accurate collimation helps to reduce unnecessary irradiation and improves radiographic image quality, which is especially important in the radiosensitive paediatric population. For AP/PA chest radiographs in children, a minimal field size (MinFS) from "just above the lung apices" to "T12/L1" with age-dependent tolerance is suggested by the 1996 European Commission (EC) guidelines, which were examined qualitatively and quantitatively at a paediatric radiology division.
  
  
  METHODS
  Five hundred ninety-eight unprocessed chest X-rays (45% boys, 55% girls; mean age 3.9 years, range 0-18 years) were analysed with a self-developed tool. Qualitative standards were assessed based on the EC guidelines, as well as the overexposed field size and needlessly irradiated tissue compared to the MinFS.
  
  
  RESULTS
  While qualitative guideline recommendations were satisfied, mean overexposure of +45.1 ± 18.9% (range +10.2% to +107.9%) and tissue overexposure of +33.3 ± 13.3% were found. Only 4% (26/598) of the examined X-rays completely fulfilled the EC guidelines.
  
  
  CONCLUSIONS
  This study presents a new chest radiography quality control tool which allows assessment of field sizes, distances, overexposures and quality parameters based on the EC guidelines. Utilising this tool, we detected inadequate field sizes, inspiration depths, and patient positioning. Furthermore, some debatable EC guideline aspects were revealed.
  
  
  CONCLUSIONS
  • European Guidelines on X-ray quality recommend exposed field sizes for common examinations. • The major failing in paediatric radiographic imaging techniques is inappropriate field size. • Optimal handling of radiographic units can reduce radiation exposure to paediatric patients. • Constant quality control helps ensure optimal chest radiographic image acquisition in children.
authors.affiliation: Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria. sebastian.tschauner@medunigraz.at.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Tschauner
authors.affiliation: Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Marterer
authors.affiliation: Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Gübitz
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
authors.forename: Peter I
authors.initials: PI
authors.lastname: Kalmar
authors.affiliation: Division of General Radiological Diagnostics, Department of Radiology, Medical University of Graz, Graz, Austria.
authors.forename: Emina
authors.initials: E
authors.lastname: Talakic
authors.affiliation: Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Weissensteiner
authors.affiliation: Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
authors.forename: Erich
authors.initials: E
authors.lastname: Sorantin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011786:Quality Control; D013902:Radiography, Thoracic / Q000592:standards*; D015203:Reproducibility of Results
keywords: Paediatrics; Radiation protection; Radiographic image enhancement; Standards; Thoracic radiography