A systematic review of incubator-based neonatal radiography – What does the evidence say?

Abstract Objectives This systematic review aimed to explore the impact of incubator design (canopy, mattress, and mattress support) on neonatal imaging in terms of imaging technique, radiation dose and image quality. Key Findings A systematic literature review was performed by searching multiple healthcare databases. Following study selection and extraction, 7 articles were deemed eligible and included within the study. Of these 7 studies, six were experimental phantom based with the remaining one being a retrospective analysis. Four studies reported a percentage reduction in beam attenuation for incubator components ranging from 12% to 72% with one other study reporting a reduction but with no numerical data. This wide variation in radiation beam attenuation from the incubator components was correlated with image quality within five studies, two suggesting reduced image quality when using the incubator tray under the mattress support whilst the other three found no significant difference. Although the seven studies reported that incubator components reduced X-ray beam intensity, there was limited evidence on whether this required an increase in exposure factors. Only one study suggested increasing exposure parameters to accommodate for the increase in beam attenuation when using an incubator tray. Conclusion The literature clearly demonstrates that with existing incubator designs, there is considerable beam attenuation between placing the image receptor directly behind the neonate as oppose to the incubator tray. However, this radiation beam attenuation is not well correlated to neonatal radiation dose or image quality effects and therefore is very confusing when considering clinical implementation. Implications for practice This review highlights the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.