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Description
Conventional radiography remains essential in pediatric imaging of the chest, skull, paranasal sinuses, pelvis, and abdomen. However, inadequate clinical justification and repeated exposures may increase unnecessary radiation doses in radiosensitive populations. This study evaluated the correlation between clinical indications, repetition rates, and entrance surface air kerma (Ka,e) in pediatric radiography under real clinical conditions. A prospective analysis was conducted on 736 pediatric radiographic exposures distributed by anatomical region (chest: 227; abdomen: 157; skull: 125; pelvis: 116; paranasal sinuses: 111). Technical parameters (kVp 60–120; mAs 2–50; focus-to-detector distance 85–130 cm) and clinical indications were categorized into five major groups. Entrance surface air kerma (Ka,e, mGy) was calculated from X-ray tube output (1.62–3.28 mGy/mAs), and results were analyzed using descriptive statistics (median and interquartile range), stratified by indication and presence of repetition. The most frequent indication category was OTHER (65.4%), followed by COUGH/FEVER (16.8%) and CONTROL/PREOP (9.8%). In chest examinations, COUGH/FEVER accounted for 49.8% of cases, with a median Ka,e of 0.15 mGy (Q3 = 0.42 mGy). Repetitions occurred in 6.5% of all exams, predominantly in chest (13.2%) and abdomen (11.5%) studies. Repeated exposures were associated with increased mAs values and nearly doubled the upper quartile dose in chest examinations. Abdominal exams for NG tube verification showed a 14% repetition rate and a 1.6-fold increase in dose when repetitions occurred.
Although doses for clinically justified indications were generally compatible with national diagnostic reference levels, the high proportion of non-standardized indications and the impact of repetitions highlight significant opportunities for optimization. Targeted technical training and improved justification protocols could reduce total exposure by an estimated 10–15%, reinforcing ALARA principles in pediatric radiology.