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Introduction Given the high radiation tissue sensitivity of pediatric patients, it is necessary to monitor their received dose in order to optimize radiation protection. The first aim of this study was to evaluate of the entrance surface dose (ESD) in pediatric patients undergoing chest x-ray at the main hospital of Dezful, Iran. The second aim was to compare our results with the established dose reference levels (DRL). Materials and Methods The studied population included 204 pediatric patients less than 15 year who were referred to chest x-ray. A calibrated dose area product meter (DAP-meter) with permanent installation on x-ray unit was used to radiation dose measurements. For each patient, the demographic data, exposure parameters and the dose read by DAP-meter were recorded and ESD was calculated using standard mathematical formula. Results The average value of ESD was 119 μGy in patients less than 15 years. This value was 51.3, 122.3, 131.5 and 171.2 μGy for the age groups less than 1 year, 1 to 5 year, 5 to 10 year and 10 to 15 year, respectively. A statistical significant difference was seen between ESD values in different age groups (P<0.001), whereas no statistical difference was seen between ESD values in girls and boys (P =0.993). Conclusion Pediatric patients in hospital investigated (except age group less than 1 year) are subjected to unnecessary radiation exposure, especially due to use of non-optimize x-ray protocols.
An 81-year-old male presented to the Emergency Department with urinary retention, subsequent to passing blood clots. A three-way catheter was inserted for continuous bladder irrigation. 48 hours later he deteriorated, with worsening tachypnea and hypoxaemia. Clinical examination and chest x-ray suggested pulmonary odema, managed with intravenous furosemide, and non-invasive ventilation. His irrigation circuit-chart showed he had received 10 litres Normal Saline via the afferent limb, but only 3 litres recorded at the efferent limb. It was suspected the catheter was adjacent to a vascular-cystic interface, however an urgent contrast CT revealed the irrigating catheter perforating the bladder, being situated in the abdominal cavity (see 3 images). His arterial blood-gas analysis demonstrated the expected normal anion-gap academia, however his Strong Ion Difference calculations, sodium-chloride difference of 13 and a normal albumin level, perfectly demonstrated the expected calculated BE of -13. The catheter was withdrawn, and the patient made a full recovery.