Chest X-Ray

for diagnosing neonatal respiratory distress

Diagnostic
Diagnostic
  • PREVENTION
  • DIAGNOSTIC
  • TREATMENT
  • OVERVIEW
  • TECHNOLOGY Characteristics
  • Chest X-Ray
    Representative Product

    GLOBAL ANNUAL DEATHS ASSOCIATED WITH NEONATAL RESPIRATORY DISTRESS

    PERCENT (%)
    NUMBER

    Maternal

    N/A
    N/A

    Neonatal

    20-25%
    765,000

    Stillbirth

    N/A
    N/A

    Condition
    Chest x-rays are widely considered the most useful imaging modality in the assessment of infants with respiratory distress. They may be used to assess aeration, infiltration, edema, or congenital lung malformations. Additionally, they may be used to check the position of cathethers or tubes used in the NICU or to monitor pulmonary inflation when high frequency oscillation is used.

    Mechanism of Action

    X-rays are a form of electromagnetic radiation whose penetration of human tissue varies with tissue density. As they pass through the body, X-rays are differentially absorbed, and the penetrating rays traditionally captured to form an image on photographic film. More recently, medical X-ray equipment has moved to computerized radiology (CR ), using a reusable phosphor receptor plate. This plate, although more costly than film, requires lower radiation exposure, and can be re-used several thousand times to create digital images. Many high-end hospitals have now moved to digital radiology (DR ) which replaces the X-ray receptor plate with a matrix of sensors capture the image much like a digital camera. The X-ray source is typically a vacuum tube which accelerates electrons to the point that they collide with a metallic target, creating an X-ray. Image interpretation may or may not be performed by the same person who administers the X-ray, with the roles often separated.
     

    Current use in High-Resource Settings
    Most high-resource hospitals have a dedicated radiology department and use digital or computerized radiology to complete tests rapidly and share images with multiple departments at once. X-ray may be supplemented with other imaging modalities to aid in particular diagnoses. Hospitals may also have a mobile x-ray system for patients who may not be easily moved to the x-ray room.

    Application in Low-Resource Settings
    Access to x-ray is relatively rare outside urban hospitals. Where x-ray equipment is available, it may be second hand or donated. In response to the scarcity of x-ray, the WHO has approved a design specification known as the World Health Imaging System for Radiology (WHIS-RAD). Since establishing the specification, two companies have sold and installed approximately 1,500 WHO-approved WHIS-RAD systems. Today, less than half of all WHIS-RAD systems remain operational, highlighting maintenance issues. Mobile units pose a somewhat less expensive alternative, although they tend to sacrifice some image resolution, and most are not designed for the harsh usage environments of some low -resource settings.
     

    REPRESENTATIVE DEVICES

    MAKE
    MODEL
    PRICE*
    TECH
    STATUS
    NOTES

    GE

    Revolution XQ/I
    $200,000
    Stationary, Digital
    Marketed
    Refurbished units

    Philips

    WHIS-RAD
    $40,000
    Stationary, Film
    Marketed

    MinXray

    HF120/60HPPWV
    $20,000
    Portable, Digital
    Marketed
    X-ray equipment and cart

    * Prices are approximated. Actual pricing can, and will vary by marketplace and market conditions.

  • CHARACTERISTICS OF REPRESENTATIVE PRODUCT

    TECHNOLOGY CHARACTERISTICS

    OPERATIONAL PARAMETERS

    POTENTIAL OPPORTUNITIES FOR IMPROVEMENT

    SKILLS

    REQUIRED

    Intended end user
    Training required
    Time required per use
    Physician, Nurse, Radiologist
    Weeks
    Hours

    WHIS-RAD devices are still based on photographic film, requiring skilled workers not only to administer and interpret the image, but also to develop the film. Digitization could reduce skill required.

    ENVIRONMENT/ INFRASTRUCTURE

    Power required
    Waste collection
    Complementary technologies required
    Temperature and storage
    Maintenance
    Wall or battery power
    None
    Darkroom, film and processing equipment
    Routine maintenance of X-ray tube, generator, and collector

    COST

    Device Cost (Approx)
    Cost/course (Approx)
    $30,000-$50,000
    $1-$5/ image

    Shift to digital output and reduce cost per use.

    OTHER

    Portability
    Regulatory
    Efficacy
    Stationary
    First line diagnostic for respiratory distress

Sources: R. Arthur. The Neonatal Chest X-ray. PEdiatric Respiratory Reviews (2001) 311-323. B. Álvares, Radiologia Brasileira vol.39 no.6 São Paulo Nov./Dec. 2006. G Shaw, J R Soc Med. 2001 August; 94(8): 391–395. WHITIA World Health Imaging, Telemedicine & Informatics Alliance 2009. The World Health Imaging System for Radiography -WHIS-RAD, 2004. M Hoaglin et al. Integrated Digital X-ray System for the WHIS-RAD, 2006