INTRODUCTION
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Paediatric radiography explores radiographic practice within the content of the modern health service and focus on how our knowledge or understanding of paediatric growth, development and illness can inform and influence radiographic procedures. It includes detailed coverage of specific paediatric techniques and good practice-models, including the role of multi-modality imaging and looks specifically at radiation protection, the chest in the upper airway, the abdomen, neonatal radiography, trauma, orthopaedics and non-accidental injury. Children can be uncooperative and obstructive when undergoing radiography examinations and often challenge the very technique and ability of the imaging staff within whose custody they have been temporarily placed. In addition, there is substantial evidence to suggest that children are more susceptible to the effects of ionizing radiation than adults, which places added burden on both radiographer and radiologist to attain the best possible results every time. The United Nations Scientific Committee on the effects of Atomic Radiation (UNSCEAR) has emphasized that risks from exposure to ionizing radiation are dependent on the age at which exposure occurs, and that exposure during childhood results in a likely two-to three- fold increase in lifetime risk for certain detrimental effects (including solid cancers) compared with in an adult.2
Children therefore, need more careful evaluation with regard to the necessity of examination, and radiographic technique needs to be even more exacting to avoid repeats. The European Commission has recognised the need for special treatment of children in the X-ray department. The guidelines suggest examples of good radiographic technique and present useful image quality criteria for a number of common paediatric projections, with the aim of producing high quality images at the lowest possible dose to the patient. To successfully diagnose a paediatric condition, high quality images are needed to give a diagnosis. To achieve this requires creating environment where a child is comfortable. This is one of the most essential elements to paediatric radiography. For imaging departments which specialise in paediatric radiography, this is very easy as rooms can be tailored to suit a child’s needs to avoid repeats. For example; bright wall designs, visual stimulation and toys. These can be permanent fixtures as the department would not need to cater to any other age range. For departments which only see children occasionally, creating a ‘child friendly’ environment is more difficult. It is usually achieved by creating one room a ‘child friendly room’ where murals/ stencils can be painted on the wall. Modern children’s hospitals are now designed with lots of glass to allow as much as natural light in as possible, the Evelina Children Hospital being one of these.3
Children do not all reach a sense of understanding at the same predictable age. This ability varies from child to child, and the paediatric radiographer must not assume that children will comprehend what is occurring. Generally, however, by the age of 2 or 3 years, most children can be talked through a diagnostic radiographic study without immobilization or parental aid. Most important is a sense of trust, which begins at the first meeting between the patient and the radiographer; the first impression that the child has of the radiographer is everlasting and forges the bond of a successful relationship. Successful radiographic studies to avoid repeats are dependent on two things; the radiographer’s attitude and approach to a child and the Radiographers preparation in the room. At the first meeting, most children are accompanied by at least one parent or caregiver. The following steps are important; Introduce yourself as the radiographer, who will be working with this child, find out what information the attending physician has given to the parent and patient. Explain what you are going to do and what your needs will be.Tears, fears, and combative resistance are common reactions for a young child.The radiographer must take the time to communicate to the parent and the child, in language they can understand, exactly what he or she is going to do. The radiographer must try to build an atmosphere of trust in the waiting room before the patient is taken into the diagnostic room. This includes discussing the necessity of immobilization as a last resort if the child’s cooperation is unattainable. Parent is in room as an observer, lending support and comfort by his or her presence and parent serves as a participator, assisting with immobilization.
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Sometimes children who act fearful and combative in the waiting room with the parent present will be more cooperative without their presence. This is the time when the radiographer’s communication skills are tested. Paediatric patients in general can include infants through children up to ages 12 to 14.5
However, older children can be treated more like adults, except for special care in gonadal shielding and reduced exposure factors because of their smaller size. In general, paediatric radiography should always use as short exposure times and as high mA as possible to minimize image blurring that may result from patient motion. However, even with short exposure times, preventing motion during exposures is a constant challenge in paediatric radiography, and effective methods of immobilization are essential. Reduction of repeat exposures is critical, especially in young children, whose developing cells are particularly sensitive to the effects of radiation. Proper immobilization and high mA, short exposure time techniques will reduce the incidence of motion unsharpness. Accurate manual technique charts with patient body weights should be used. Radiographic grids should be used only when the body part examined is greater than 10 centimetres in thickness. Each radiography department should keep a list of specific routines for paediatric imaging exam, including specialised views and limited examination series, to ensure that appropriate projections are obtained and no unnecessary exposures are made.6
It is not uncommon to encounter paediatric patients undergo repeat X-ray examinations after their initial X-rays are rejected for poor image quality thereby subjecting them to excess radiation exposure and avoidable extra cost. This creates a situation which necessitates the need to explore causes of repeat of X-ray examinations in some tertiary hospitals.
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They also have a longer life expectancy over which they may develop cancer from exposures to ionizing radiation due to high level of repeats.
The aim of this study is to ascertain the causes of repeats in paediatric radiography in three tertiary hospitals in Enugu metropolis.
This study was done in three tertiary hospitals in Enugu Metropolis which include; University of Nigeria Teaching Hospital (UNTH), National Orthopaedic Hospital Enugu (NOHE) and Enugu State University Teaching Hospital (ESUTH) Parklane Enugu.
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Paediatric radiography is a branch of radiography involving the imaging of infants and children with ionizing radiation, and other forms of imaging modalities.
Repeat is a radiograph which is retaken to provide further diagnostic information because the previous one is not of adequate diagnostic value.
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