Performing Chest X-Rays at Inspiration in Uncooperative Children: The Effect of Exercises with a Training Program for Radiology Technicians

Objective. It is difficult to acquire a chest X-ray of a crying infant at maximum inspiration. A computer program was developed for technician training. Method. Video clips of 3 babies were used and the moment of deepest inspiration was determined in the single-frame view. 12 technicians simulated chest radiographs at normal video speed by pushing a button. The computer program stopped the video and calculated the period of time to the optimal instant for a chest X-ray. Demonstration software can be tested at website online. Every technician simulated 10 chest X-rays for each of the 3 video clips. The technicians then spent 40 minutes practicing performing chest X-rays at optimal inspiration. The test was repeated after 5, 20, and 40 minutes of practice. Results. 6 participants showed a significant improvement after exercises (collective 1). Deviation from the optimal instant for taking an X-ray at inspiration decreased from 0.39 to 0.22？s after 40？min of practice. 6 technicians showed no significant improvement (collective 2). Deviation decreased from a low starting value of 0.25？s to 0.21？s. Conclusion. The tested computer program improves the ability of radiology technicians to take a chest X-ray at optimal inspiration in a crying child. 1. Introduction In pediatric radiology especially, quality control such as the improvement of chest X-ray examinations is very important [1]. In addition to the technical parameters of quality, the timing for taking an X-ray during breathing is very important for diagnostic evaluation. The main focus in conventional chest X-ray examinations in children is the exclusion or proof of pneumonic infiltration. In particular, chest X-ray examinations in babies and young children demonstrate characteristic changes like infiltration only at deep inspiration [2]. Babies and small children are not able to follow breathing commands. A good chest X-ray examination depends among other things on the ability of the technician to take the X-ray of a potentially crying child at an optimal instant (deep inspiration). The moment for taking an X-ray is very short. The respiratory frequency in an adult is 16 breaths per minute and increases to 80 breaths per minute in an ill infant. That means that the diaphragm moves up and down in less than a second [3]. The goal of this study was to evaluate a training program using a self-developed video game practicing the taking of a chest X-ray at the optimal moment. The improvement of the reaction time using the training program was demonstrated in an earlier study [4]. This study examined how