Dose optimization, review and standardization of radiological protocols for abdomen and chest imaging: workflow, results and experience of a pediatric hospital

Abstract Thoracic and abdominal radiographies are standard X-ray examinations often performed to diagnose a wide range of traumas and diseases. These practices inherently involve exposure to ionizing radiation which must be kept as low as reasonably achievable (based on the ALARA principle). Consequently, the optimization of imaging examinations is a critical requirement for all diagnostic practices, especially for those addressed to pediatric patients. In this work, a methodology for protocol optimization applied to young patients has been developed. The main aim is to reduce the dose delivered to patients maintaining good diagnostic image quality and investigate the strengths and weaknesses experienced during the workflow definition. The study evaluates the dose-area product (DAP) and image quality data in 12,919 abdominal and 82,873 thoracic X-ray examinations conducted in a specialized pediatric hospital. Images were acquired using direct digital radiography equipment. Analysis was performed on patients below 18 years of age. Results showed that the strategy for the protocols standardization can be applied with excellent outcomes in the clinical routine. The process can be slow and complex, particularly when applied to pediatric patients, because it requires an adequate number of examinations and organized efforts by healthcare professionals. Nevertheless, the findings demonstrated an improvement in dose standardization and radiological safety aligning with diagnostic reference levels for this vulnerable population.