Optimisation of exposure parameters using a phantom for thoracic spine radiographs in antero-posterior and lateral views.

INTRODUCTION: To investigate the exposure parameters for thoracic spine/(TS) radiography that allows the image acquisition at the lowest dose possible, while maintaining an adequate image quality/(IQ) to identify all relevant anatomical criteria. METHODS: An experimental phantom study was conducted, and 48 different radiographs of TS (24 AP/24 lateral) were acquired. The Automatic Exposure Control/(AEC) with the central sensor was used to select the beam intensity, while Source-to-Detector-Distance/(SDD) (AP:115/125 cm; Lateral:115/150 cm), tube potential (AP:70/81/90 kVp; Lateral: 81/90/102 kVp), use of grid/no grid and focal spot (fine/broad) were manipulated. IQ was assessed by observers with ViewDEX. Effective Dose (ED) was estimated using PCXMC2.0 software. Descriptive statistics paired with intraclass correlation coefficient (ICC) were applied to analyse data. RESULTS: The ED increased with a greater SDD for lateral-view, presenting a significant difference (p = 0.038), however IQ was not affected. For both AP and lateral, the use of grid had a significant effect on ED (p < 0.001). Despite the images acquired without grid had lower IQ scores, the observers considered the IQ adequate for clinical use. A 20% reduction in ED (0.042mSv-0.033 mSv) was observed when increasing the beam energy from 70 to 90 kVp for AP grid in. The observers ICC ranged from moderate to good (0.5-0.75) in lateral and good to excellent (0.75-0.9) for AP views. CONCLUSIONS: The optimised parameters in this context were 115 cm SDD, 90 kVp with grid for the best IQ and lowest ED. Further studies in clinical setting are necessary to enlarge the context and cover different body habitus and equipment. IMPLICATIONS FOR PRACTICE: The SDD impacts on dose for TS; Higher kVp and grid are necessary to better image quality.

[Reading children's temperatures with the tympanic infrared thermometer and the rectal mercury thermometer: equally good results in the emergency room]. / Temperatuurmeting bij kinderen: met de trommelvliesinfraroodmeter en de rectale kwikthermometer even goede resultaten op de spoedeisendehulpafdeling.

OBJECTIVE: To compare the results of reading body temperatures with a tympanic infrared thermometer and a rectal mercury thermometer in children in an emergency department. DESIGN: Prospective comparative study. SETTING: St. Elisabeth Hospital, Tilburg, the Netherlands. METHOD: In children up to 11 years of age seen in the emergency room between 1 January 1994 and 1 April 1994, the body temperature was measured with a rectal mercury thermometer as well as with a tympanic infrared thermometer. Data were collected on temperature read, clinical picture on arrival (not ill, ill, seriously ill) and appearance of the tympanic membrane (signs of acute otitis media, presence of cerumen). For the statistical comparison, the differences between the findings of the two methods were plotted against the means. The sensitivity and specificity of the results of tympanic measurement in relation to the values read rectally were determined. RESULTS: Data were collected on 213 children, of whom 19 were younger than 3 months, 46 between 3 and 12 months, and 148 between 1 and 11 years. The mean temperatures measured with the rectal and tympanic thermometers were 38.01 and 38.03 degrees C, respectively. The mean difference between the rectal and tympanic temperatures was -0.013 degree C. The correlation between the rectal and tympanic temperatures was high (r = 0.86; P = 0.0001). The results were the same in groups differing in age, severity of disease and appearance of the tympanic membrane. The sensitivity of the tympanic measurement for fever (rectal temperature > 38.0 degrees C) was 80.6% with a specificity of 92.5%. The sensitivity was 83.8% when a rectal temperature > 38.5 degrees C was taken as the criterion, with a specificity of 95.9%. CONCLUSION: The tympanic infrared measurement in children in an emergency department gave the same results as rectal measurement using a mercury thermometer.

Children born small for gestational age: do they catch up?

Postnatal growth of 724 (423 premature, 301 full-term) small for gestational age infants (SGA, birth length less than the third length percentile (P3) for gestational age) was studied for the first 2 y of life. The study group consisted of all SGA infants who had been admitted over a period of 8 y at the Departments of Neonatology of three University Hospitals in The Netherlands with exclusion of infants with well defined causes for growth retardation, such as chromosomal disorders, syndromes, severe malformations, or complications during the neonatal period or later on. The aim of the study was to describe postnatal growth of SGA infants and to find predictive factors for catch-up growth > or = P3 during the first 2 y of life. The majority (around 85%) of the healthy SGA infants showed catch-up growth to a height > or = P3 during the first 2 y of life. The percentage of premature SGA infants with catch-up growth > or = P3 at 2 y of age (82.5%) was not significantly different from that of full-term SGA infants (87.5%). Birth length SDS was more sensitive than birth weight SDS in predicting catch-up > or = P3 in premature SGA infants. In contrast, birth weight SDS was the best predictor for catch-up > or = P3 in full-term SGA infants. Gestational age, multiple birth, and sex were not significantly associated with catch-up in height > or = P3.(ABSTRACT TRUNCATED AT 250 WORDS)