{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:08:18Z","timestamp":1791234498618,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,10]],"date-time":"2024-02-10T00:00:00Z","timestamp":1707523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. Materials and Methods: This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP\/year, the number of chest X-rays performed per mechanically ventilated patient\/year and the mean radiation dose\/patient\/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. Results: The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; p = 0.03) or 2021 (58.1% vs. 34.5%; p = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; p = 0.032) or 2021 (16.3% vs. 44.8%; p = 0.008). The mean radiation dose decreased from 5.89 Gy \u00d7 cm2 in 2021 to 3.76 Gy \u00d7 cm2 in 2023 (36% reduction). However, there was an increase in the number of ventilated patients with more than one X-ray (11 in 2023 versus 6 in 2021). We also noted a slight annual increase in the mean number of X-rays per patient receiving CPAP followed by mechanical ventilation (from 1.80 in 2021 to 2.33 in 2022 and then 2.50 in 2023), and there was a similar trend in the patients that received only mechanical ventilation without a statistically significant difference in these cases. Conclusions: The quality management project accomplished its goal by obtaining a statistically significant increase in the number of ventilated patients in which chest radiographs were not performed and also resulted in a more than 30% decrease in the radiation dose per ventilated patient. This task was accomplished mainly by increasing the number of patients on CPAP and the use only of lung ultrasound in the patients on CPAP and simple cases.<\/jats:p>","DOI":"10.3390\/medicina60020308","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T04:47:45Z","timestamp":1707713265000},"page":"308","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Use of Lung Ultrasound in Reducing Radiation Exposure in Neonates with Respiratory Distress: A Quality Management Project"],"prefix":"10.3390","volume":"60","author":[{"given":"Alexandra Floriana","family":"Nemes","sequence":"first","affiliation":[{"name":"Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neonatology, Life Memorial Hospital, 010719 Bucharest, Romania"},{"name":"Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Ioan","family":"Toma","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Life Memorial Hospital, 010719 Bucharest, Romania"},{"name":"Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5969-9205","authenticated-orcid":false,"given":"Vlad","family":"Dima","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Filantropia Hospital, 011132 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorina Crenguta","family":"Serboiu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Radiology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea Ioana","family":"Necula","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Life Memorial Hospital, 010719 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Stoiciu","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Life Memorial Hospital, 010719 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru Ioan","family":"Ulmeanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Toxicology, Grigore Alexandrescu Children\u2019s Hospital, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Marinescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coriolan","family":"Ulmeanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Toxicology, Grigore Alexandrescu Children\u2019s Hospital, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s12098-016-2288-7","article-title":"Diagnostic Performance of Point of Care Ultrasonography in Identifying the Etiology of Respiratory Distress in Neonates","volume":"84","author":"Rachuri","year":"2017","journal-title":"Indian J. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/j.chest.2015.12.024","article-title":"Lung ultrasonography to diagnose transient tachypnea of the newborn","volume":"149","author":"Liu","year":"2016","journal-title":"Chest"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ammirabile, A., Buonsenso, D., and Di Mauro, A. (2021). Lung Ultrasound in Pediatrics and Neonatology: An Update. Healthcare, 9.","DOI":"10.3390\/healthcare9081015"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1159\/000528914","article-title":"European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update","volume":"120","author":"Sweet","year":"2023","journal-title":"Neonatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.2214\/AJR.12.8678","article-title":"New exposure indicators for digital radiography simplified for radiologists and technologists","volume":"199","author":"Don","year":"2012","journal-title":"Am. J. Roentgenol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5023","DOI":"10.1088\/0031-9155\/51\/19\/019","article-title":"Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: A clinical and Monte Carlo dosimetry study","volume":"51","author":"Makri","year":"2006","journal-title":"Phys. Med. Biol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1159\/000495911","article-title":"A multicenter lung ultrasound study on transient tachypnea of the neonate","volume":"115","author":"Raimondi","year":"2019","journal-title":"Neonatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e2020030528","DOI":"10.1542\/peds.2020-030528","article-title":"Lung Ultrasound Score Progress in Neonatal Respiratory Distress Syndrome","volume":"147","author":"Raimondi","year":"2021","journal-title":"Pediatrics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3565","DOI":"10.1080\/14767058.2020.1830369","article-title":"Lung ultrasound completely replaced chest X-ray for diagnosing neonatal lung diseases: A 3-year clinical practice report from a neonatal intensive care unit in China","volume":"35","author":"Gao","year":"2020","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s00431-020-03789-z","article-title":"Lung ultrasound features predict admission to the neonatal intensive care unit in infants with transient neonatal tachypnoea or respiratory distress syndrome born by caesarean section","volume":"180","author":"Poerio","year":"2020","journal-title":"Eur. J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2178","DOI":"10.1016\/j.chest.2021.06.076","article-title":"Neonatal Lung Ultrasound and Surfactant Administration","volume":"160","author":"Raimondi","year":"2021","journal-title":"Chest"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Riccabona, M. (2020). Pediatric Ultrasound: Requisites and Applications, Springer. [2nd ed.].","DOI":"10.1007\/978-3-030-47910-7"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1097\/MD.0000000000000197","article-title":"The \u2018Double Lung Point\u2019: An Ultrasound Sign Diagnostic of Transient Tachypnea of the New-born","volume":"91","author":"Liu","year":"2014","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1159\/000493001","article-title":"Lung Ultrasound for the Differential Diagnosis of Respiratory Distress in Neonates","volume":"115","author":"Corsini","year":"2018","journal-title":"Neonatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00134-012-2513-4","article-title":"International evidence-based recommendations for point of care lung ultrasound","volume":"38","author":"Volpicelli","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1159\/000358227","article-title":"Lung Ultrasound Accuracy in Respiratory Distress Syndrome and Transient Tachypnea of the Newborn","volume":"106","author":"Vergine","year":"2014","journal-title":"Neonatology"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Liu, J., Ma, H.-R., and Fu, W. (2022). Lung Ultrasound to Diagnose Pneumonia in Neonates with Fungal Infection. Diagnostics, 12.","DOI":"10.3390\/diagnostics12081776"},{"key":"ref_18","unstructured":"Higgins, J.P.T., Churchill, R., Chandler, J., and Cumpston, M.S. (2017). Cochrane Handbook for Systematic Reviews of Interventions Version 5.2.0 (Updated June 2017), Cochrane."},{"key":"ref_19","unstructured":"Ognean, L. (2023). Managementul Sindromului de Detres\u0103 Respiratorie Prin Deficit de Surfactant, Asocia\u0163ia de Neonatologie din Rom\u00e2nia."},{"key":"ref_20","unstructured":"Boiculese, L.V., and Dascalu, C. (2001). Informatica Medicala, Editura Venus."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e1089","DOI":"10.1542\/peds.2013-3924","article-title":"Use of neonatal chest ultrasound to predict noninvasive ventilation failure","volume":"134","author":"Raimondi","year":"2014","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2174\/157339612802139389","article-title":"Lung ultrasound in the critically ill neonate","volume":"8","author":"Lichtenstein","year":"2012","journal-title":"Curr. Pediatr. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.pedneo.2020.10.009","article-title":"Patient X-ray Exposure and ALARA in the Neonatal Intensive Care Unit: Global Patterns","volume":"62","year":"2021","journal-title":"Pediatr. Neonatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.radi.2023.05.012","article-title":"Establishing weight-based diagnostic reference lev-els for neonatal chest X-rays","volume":"29","author":"Gilley","year":"2023","journal-title":"Radiography"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1259\/bjr.75.895.750590","article-title":"Radiation dose quantities and risk in neonates in a special care baby unit","volume":"75","author":"Armpilia","year":"2002","journal-title":"Br. J. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1542\/peds.2005-0817","article-title":"Cumulative effective doses delivered by radiographs to preterm infants in a neonatal intensive care unit","volume":"117","author":"Donadieu","year":"2006","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S1875-9572(10)60061-7","article-title":"Radiation Safety in the Neonatal Intensive Care Unit: Too Little or Too Much Concern?","volume":"51","author":"Yu","year":"2010","journal-title":"Pediatr. Neonatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.medin.2021.10.001","article-title":"Lung Ultrasound Protocol Decreases Radiation in Newborn Population without Side Effects: A Quality Improvement Project","volume":"47","author":"Benet","year":"2023","journal-title":"Med. Intensiv. (Engl. Ed.)"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.jpeds.2019.04.020","article-title":"Ecography-guided surfactant therapy to improve timeliness of surfactant replacement: A quality improvement project","volume":"212","author":"Raschetti","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/jp.2017.140","article-title":"Neonatal lung ultrasound exam guidelines","volume":"38","author":"Kurepa","year":"2018","journal-title":"J. Perinatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s13052-020-00905-5","article-title":"Italian Inter-Society Expert Panel Position on Radiological Exposure in Neonatal Intensive Care Units","volume":"46","author":"Salerno","year":"2020","journal-title":"Ital. J. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"20220344","DOI":"10.1259\/bjr.20220344","article-title":"Fetal lung MRI and features predicting post-natal outcome: A scoping review of the current literature","volume":"96","author":"Whitby","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1002\/jmri.25394","article-title":"Pulmonary MRI of neonates in the intensive care unit using 3D ultrashort echo time and a small footprint MRI system","volume":"45","author":"Hahn","year":"2017","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1164\/rccm.201711-2287OC","article-title":"Neonatal Pulmonary Magnetic Resonance Imaging of Bronchopulmonary Dysplasia Predicts Short-Term Clinical Outcomes","volume":"198","author":"Higano","year":"2018","journal-title":"Am. J. Resp. Crit. Care Med."},{"key":"ref_35","first-page":"44","article-title":"Imaging in Neonatal Respiratory Disease","volume":"43","author":"Hysinger","year":"2022","journal-title":"Paediatr. Respir. Rev."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/2\/308\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:58:27Z","timestamp":1760104707000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/2\/308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,10]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["medicina60020308"],"URL":"https:\/\/doi.org\/10.3390\/medicina60020308","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,10]]}}}