The need for the development of an adjustable radiolucent apparatus to address sub-optimal images in terms of poor collimation on neonatal chest radiographs

Hafsa Essop, Ephraim Ritshuri, Mankgane Manyane, Oliver Balo, Samuel Sebotja, Forgiveness Gobele


Background.  Chest radiographs are commonly used by neonatal ICU nurses and physicians to diagnose and manage neonates. Despite numerous recommendations from studies investigating radiographic techniques in neonatal imaging, collimation practices of these radiographs remain poor, increasing the risk of including radiosensitive anatomical structures such as the thyroid and humeri. The practice of collimation amongst radiographers is explored in terms of resultant radiographic contrast after continuous professional development (CPD) training.

Aim.  To determine whether the literature recommendations of CPD training would improve the quality of neonatal imaging at a large academic hospital. 

Methods.  Collimation and image contrast in 100 pre-processed digital neonatal chest images were measured and analysed following CPD training of radiographers. The scale for collimation was: optimal collimation = 1 cm; over-collimation = < 1 cm; under-collimation = > 1 cm. Radiographic contrast was assessed subjectively.

Findings.  Of the 100 images, 77% were under-collimated, and included non-essential thoracic structures; 2% were over-collimated resulting in clipping of essential thoracic structures; and 26% exhibited significantly reduced contrast. The results indicate that the images were still of sub-optimal quality following CPD training.

Conclusion.  Both incorrect centring and anatomical positioning contributed to improper collimation, resulting in sub-optimal images of the neonatal chests. The intervention of CPD training appeared to be have been unsuccessful: the images remained of poor diagnostic quality. There is a need to explore the use of an adjustable radiolucent apparatus, which can be placed under the area of interest, whereby the beam can be visibly collimated. This should enable a radiographer to confidently and accurately collimate the beam to consistently produce images of optimal quality.


neonate, digital radiography, radiosensitive

Full Text:


The South African Radiographer | ISSN 0258 0241

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.5 South Africa License