Contents lists available at ScienceDirect Radiation Physics and Chemistry journal homepage: www.elsevier.com/locate/radphyschem Dose evaluation in paediatric patients undergoing chest X-ray examinations F. Piantini a , H.R. Schelin a, ⁎ , V. Denyak a,b , A.P. Bunick a , A. Legnani a , J.A. Ledesma a , D. Filipov c , S.A. Paschuk c a Pelé Pequeno Príncipe Research Institute, Av. Silva Jardim, 1632, Curitiba, PR 80250-060, Brazil b National Science Center ‘Kharkov Institute of Physics and Technology’, Akademicheskaya 1, Kharkiv 61108, Ukraine c Federal University of Technology, Av. Sete de Setembro, 3165, Curitiba, PR 80230-90, Brazil ARTICLE INFO Keywords: Dosimetry Paediatric chest radiography Patient anthropometric characteristics ABSTRACT This study aimed to estimate the incident air kerma in chest X-ray examinations, for lateral (LAT) and anterior– posterior (AP) (together with posterior–anterior (PA)) projections, in one of the largest paediatric hospitals in Brazil, and to compare these with the results obtained in a general hospital of the same city. The dosimetric results were analysed along with the patient characteristics and radiographer strategies. The examinations of 225 (119 male and 106 female) patients were studied and 389 X-ray scans (200 AP/PA projections and 189 LAT projections) of paediatric patients were acquired. For analysis of the results, the patients were divided into the following age groups: 0–1 y, 1–5 y, 5–10 y, and 10–15 y. Patient's thickness can be determined from age, height or weight with an uncertainty of 20–30%. In different hospitals, the difference in patient's thicknesses between the same age groups can reach 25–55%. A minimal correlation between the patient dose and thickness was observed, with a 4-fold difference in the dose for patients of the same thickness. By standardizing radiological protocols, it should be possible to keep the dose within intervals of 50–100 μGy for LAT projection and 40– 80 μGy for AP/PA projection. 1. Introduction The radiation dose to which children are exposed from diagnostic radiology examinations has become of great concern over the past three decades, mostly because of its growing contribution to overall radiation exposure, and also because X-ray equipment is not optimized for paediatrics use. Other essential factors with an impact on such investigations are the longer life expectancy of children, relative to adults, which increases the associated radiation risk, and the elevated radiosensitivity. Another new risk factor is the digital nature of modern image receptors, which has significantly increased the upper limit of the detector and, consequently, possible patient exposure. In the late 1980s, intensive studies led to the creation of European diagnostic reference levels (DRLs) and a number of national DRLs (UNSCEAR, 2013; IAEA, 2013). In Brazil, such investigations started in the early 2000s (Khoury, 2001; Mohamadain, 2003), and have been performed in a few hospitals to date. Considering the fact that DRLs are subject to change as radiographic equipment and technique improve, achievement in dose-reduction is of constant interest, parti- cularly in paediatric hospitals. Chest radiography is the most frequently used paediatric X-ray examination. The aim of this study was to estimate the incident air kerma (K i ) in chest X-ray examinations, in lateral (LAT) and anterior– posterior (AP) (together with posterior–anterior (PA)) projections, in one of the largest paediatric hospitals in Brazil and to compare these findings with the results obtained in the general hospital of the same city (Porto et al., 2014). The dosimetric results are discussed along with a detailed analysis of the patient characteristics and radiographer strategies. 2. Materials and methods The study was performed at the Pequeno Príncipe Hospital, one of the largest paediatric hospitals in Brazil. The project was approved by the ethics committee of the hospital that is linked to the Brazilian Federal Government. All patients’ parents received information and approved the survey. The examinations of 225 (119 male and 106 female) patients were studied. In 94% of these examinations, the LAT projection was requested together with the AP/PA projection. The indications for the examinations were cough, fever, and suspicion of bronchitis or pneumonia. In this study, 389 X-ray examinations (200 AP/PA projections and 189 LAT projections) of paediatric patients were acquired. Only the http://dx.doi.org/10.1016/j.radphyschem.2017.01.026 Received 30 September 2016; Received in revised form 23 January 2017; Accepted 25 January 2017 ⁎ Corresponding author. E-mail address: schelin2@gmail.com (H.R. Schelin). Radiation Physics and Chemistry (xxxx) xxxx–xxxx 0969-806X/ © 2017 Elsevier Ltd. All rights reserved. Please cite this article as: Piantini, F., Radiation Physics and Chemistry (2017), http://dx.doi.org/10.1016/j.radphyschem.2017.01.026