Paediatric pelvic imaging: improvement in gonad shield placement by multidisciplinary audit

Background. In 1996, there were local reports of poor gonad protection for paediatric pelvic radiographs. Objectives. To investigate the nature of the problem and make necessary imp rovements. Materials and methods. A retrospective audit of 218 paediatric pelvic radio graphs was undertaken in 1997. Each radiograph was assessed for the presenc e of a gonad shield, appropriateness of the device and its position. A mult idisciplinary team was formed with representation from radiology, radiograp hy, orthopaedics and medical physics to investigate ways of improving techn ique and reducing patient dose. These included radiographer training and th e introduction of digital fluoroscopy as an alternative imaging technique i n follow-up patients. There were further rounds of data collection in 1998 and 1999. Results. In round 1, a gonad shield was present in 77.9% of boys' films and 76% of girls' films where one should have been, increasing to 85.2% and 85 .4% respectively by round 3 of the audit (P<0.05). Only 31.6% of boys' devi ces and 21.9% of girls' devices were correctly positioned in round 1, incre asing to 78.3% and 94.3%, respectively, by round 3 of the audit (P<0.05). A fter round 1, no inappropriate devices were used. Conclusion. Audit was an effective tool in gaining the resources needed to improve technique and reduce radiation exposure in children. The multidisci plinary approach was vital in the success of this project.