Enhancing Radiation Safety and Justification of Imaging in Pediatric Chest Radiography: Insights from a Tertiary Hospital in Tanzania.

Objectives: This study focuses on the critical "Justification and Optimization" principles of radiation protection during pediatric chest X-ray (CXR) examinations, the most common radiographic procedure, to reduce unnecessary ionizing radiation exposure and enhance safety protocols. Given that children are particularly vulnerable to the long-term biological effects of ionizing radiation, such as cancer and hereditary conditions, this research evaluates the application of these principles at a tertiary hospital in Tanzania. Methods: A hospital-based, cross-sectional study was conducted on 320 pediatric patients who underwent AP/PA CXR examinations over six months. The "justification" of CXR requests was assessed by comparing them with the "European Radiology and Nuclear Medicine Pediatric Imaging Referral Guideline." The "optimization" of radiation protection was evaluated using six radiographic criteria: X-ray beam projection, collimation, rotation, console exposure parameters, repeated examinations, and the use of thyroid and abdominopelvic shielding. The study used frequencies, percentages, measures of central tendencies, Pearson Chi-square test, logistic regression, t-tests, and ANOVA for data analysis, with significance set at p<0.05, all conducted using SPSS version 29.0. Results: Among the 320 participants, 57.2% were male, with the majority aged 1-5 years (41.9%), and a mean age of 3.2 years ± 1.6. Clinically unjustified CXR requests accounted for 36.6%, predominantly from outpatient departments (82.9%). Optimization failures were observed in AP projection (79.7%), collimation (69.7%), and rotation (63.8%) of the exams, particularly in children under five years old. Additionally, 11.6% of the CXR exams were unnecessarily repeated, and 36.9% did not meet optimal console exposure settings. No thyroid or abdominopelvic shielding was used in any examination. Conclusion: The findings reveal that approximately one-third of pediatric CXR exams were unjustified, and many were conducted using suboptimal techniques, highlighting the urgent need to strengthen the implementation of justification and optimization principles in pediatric radiography.