Radiograma de tórax em neonatos em ventilação mecânica : uso da projeção em perfil

Abstract

Aims: The aims of the study were to assess the necessity of lateral chest X-rays in newborns on mechanical ventilation in a neonatal intensive care unit, and to estimate the dose of radiation exposure during such exams. Methods: Cross-sectional study performed at the neonatal intensive care unit of a city hospital in Porto Alegre (Brazil). Patients were followed on daily basis, and all chest x-rays were registered while they were on mechanical ventilation, including the first day postextubation. Two experienced neonatologists were included as external observers, to assess, independently, the necessity of having performed each of the lateral views of chest x-rays all newborns had. Results: Sixty five newborns were included. There were 426 chest x-rays requisitions during the study period. Of these, 374 were antero-posterior plus lateral views and 52 were only antero-posterior views. The index of chest x-rays requisitions was of 0,8 x-rays per newborn per day, corresponding to 0,7 antero-posterior and lateral views per newborn per day and 0,1 antero-posterior x-rays per newborn per day. The use of the antero-posterior view associated with the lateral view compared to only the antero-posterior view increases three-fold the exposition of the newborn to ionizing radiation. Conclusion: We noticed the lack of well-defined guidelines on the use of the lateral view of chest x-rays in neonatal intensive care units. Many institutions, including ours, are performing chest-x-rays lateral views at a rate greater than needed. This behavior leads to an elevated exposition of radiation dose to the newborns, potentially leading to future consequences.