Radiological imaging is a cornerstone in diagnosing and managing various medical conditions across all age groups, with particular emphasis on newborns and pediatric patients due to their increased sensitivity to radiation. In Dhaka, Bangladesh, the assessment of radiological findings in this vulnerable population poses distinct challenges. The rapid growth and developmental changes in children require precise imaging techniques that not only ensure diagnostic accuracy but also prioritize patient safety. When it comes to little ones, radiological exams need to be both accurate and safe, because lets face it, theyre not just "small adults." Their developing bodies react differently to X-rays and radiation doses, so its essential to have proper dosimetry in place to protect them from potential risks. The delicate nature of pediatric tissues, along with their heightened susceptibility to ionizing radiation, necessitates stringent measures to minimize radiation exposure, while still obtaining necessary diagnostic information. The importance of radiation safety in pediatric radiology cannot be overstated. Studies have consistently demonstrated that pediatric patients are more vulnerable to the harmful effects of ionizing radiation, necessitating a concerted effort to balance the benefits of diagnostic imaging with the risks of radiation exposure (Novotný Jr, J et al., 2002; Novotný Jr, J et al., 2014). 

International guidelines, such as those from the World Health Organization (WHO) and the International Commission on Radiological Protection (ICRP), emphasize the need for radiation protection protocols specifically tailored for children to ensure that exposure remains as low as reasonably achievable (ALARA) while still providing the necessary diagnostic clarity (Hanson, G et al., 1995). Despite advancements in radiological technology, the challenge of optimizing radiation doses remains, particularly in developing countries like Bangladesh, where resources may be limited and radiation safety standards vary across facilities. Studies conducted in regions like Serbia and Montenegro highlight the importance of monitoring patient dose levels even in routine diagnostic procedures, a practice that aligns with global efforts to enhance radiation safety (Raskob, W et al., 2004; Faisal et al., 2023). 

In Bangladesh, the Code of Safe Practice for the Use of X-Rays in Medical Diagnosis has been instrumental in guiding healthcare providers on how to mitigate radiation risks, but there remains a need for continual updates and adherence to international standards to ensure optimal care for pediatric patients. This study aims to provide a comprehensive clinical perspective on assessing radiological findings in newborns and pediatric patients across Dhaka, Bangladesh, focusing on the critical need to minimize radiation exposure without compromising diagnostic accuracy. By examining current practices, radiation dose measurements, and patient outcomes, this research seeks to contribute to the global dialogue on enhancing pediatric radiology, ultimately striving to improve the safety and quality of care for children in Dhaka. As radiology continues to evolve, especially for pediatric patients, theres a need to continuously update practices and introduce better technologies. This will ensure that kids get the care they need while staying safe from unnecessary radiation exposure. Plus, with international bodies like the ICRP and WHO on board, its clear that a global effort is underway to keep our little ones safe during their diagnostic journeys.

No conflict of interest was declared by the authors that might be seen to prejudice the objectivity of the research submitted.

General Objectives

To assess the radiological findings in newborns and pediatric patients across Dhaka, Bangladesh, with a focus on optimizing diagnostic accuracy.

Specific Objectives

• Evaluate current radiological imaging techniques for newborns and pediatric patients, identifying opportunities to improve safety and accuracy.
• Assess clinical outcomes from radiological exams in neonates and children, focusing on their relationship with appropriate imaging methods.
• Recommend strategies to enhance radiological practices, aiming to reduce unnecessary radiation exposure while ensuring diagnostic finding accuracy.

This study employed a cross-sectional retrospective design to assess the radiological findings of pediatric patients aged 1 day to 12 years who underwent X-ray investigations at a selected hospital. A total sample size of 197 patients was purposively chosen based on the inclusion criteria from the radiology departments database at the study center. 

Data such as the patients age, gender, clinical indications, imaging modalities used, specific examinations conducted, and the radiological findings were collected at the time of the diagnostic procedure. This information was meticulously recorded for each patient who underwent the selected imaging tests. The X-ray machines used complied with the Department of Health and Human Services (DHHS) requirements, with the Portable X-ray machine having a minimum inherent filtration equivalent to 2 mm Aluminum at 125kV, and the departments main X-ray machine offering 0.5 mm Aluminum filtration at 70kV, with a rating of up to 150 kVp.

The Spearmans Correlation test was employed to determine if there was any significant relationship between the age of the subjects and the radiological findings. The collected data were processed using Microsoft Excel 2020 and the Statistical Package for Social Sciences (SPSS) version 20 (IBM Corporation, Chicago, IL, USA). Descriptive statistics, including frequency tables, charts, and percentages, were utilized to summarize the data, while inferential statistics were used to analyze correlations in line with the studys objectives. All patient information collected was treated with strict confidentiality and used solely for the purposes of this research.

This study was conducted at a radiographic center in Dhaka city. The findings are presented in the tables below, detailing patient demographics, including gender and age, along with the types of examinations performed, their frequencies, and percentages. The results also outline the diagnostic X-rays and associated radiological findings for pediatric patients aged 1 day to 12 years, as well as the medical procedures they underwent.

Table 1: Radiological Findings of Chest Examination of Newborn- ages 0 day to 28 days.

N.B.: Sex: M- Male and F- Female; Age: D- Day, M- Month, and Y- Year. 

Table 1 includes the chest examination records of 197 pediatric patients. Among them, 25 were newborns, with 11 males and 14 females. The table presents the radiological findings for patients who underwent chest examinations. The least frequent findings, such as cardiomegaly, pulmonary bay, and consolidation, were observed 1 time each (0.51%). The most frequent finding was respiratory distress syndrome (RDS), which occurred 11 times (5.58%). These findings are also illustrated in the accompanying bar diagram.

Fig. 1: Radiological Findings of Chest Examination of Newborn- ages 0 day to 28 days.

Table 2: Radiological findings of Infant- ages 29 day to 1 year.

N.B.: Sex: M- Male and F- Female; Age: D- Day, M- Month, and Y- Year. 

Table 2 includes chest examination records of 197 pediatric patients, with 26 infants in the group-16 males and 10 females. The table details the radiological findings for these patients. The least common findings, such as accentuated broncho-vascular markings, pleural effusion, pulmonary edema, pulmonary congestion, TOF, and pulmonary bay, were each observed once (0.51%). The most frequent finding was pneumonitis, recorded 7 times (3.55%). These results are further illustrated in the accompanying bar diagram.

Fig. 2: Radiological findings of Infant- ages 29 day to 1 year.

Table 3: Radiological findings of Toddler- ages up-to 1 year to 2 years.

N.B.: Sex: M- Male and F- Female; Age: D- Day, M- Month, and Y- Year. 

Table 3 includes the chest examination records of 197 pediatric patients, with 22 toddlers in the group-12 males and 10 females. The table outlines the radiological findings for these patients. The least common findings, such as lung collapse, pulmonary inflammatory lesion, pulmonary plethora, pulmonary venous hypertension, pneumonitis, and pulmonary hypertension, were each observed once (0.51%). The most frequent finding was pneumonitis, recorded Table 4 (in Supplemental Material Section) presents chest examination records for 197 pediatric patients, including 40 preschoolers-26 males and 14 females. The table highlights the radiological findings from these examinations.  10 times (5.08%). These findings are also depicted in the accompanying bar diagram.

Fig. 3: Radiological findings of Toddler- ages upto 1 year to 2 years.

The least frequent findings, such as prominent right hilar vessels, a left clavicle fracture, pulmonary plethora, and pulmonary hypertension, were each observed once (0.51%). The most frequent finding was pneumonitis, occurring 18 times (9.14%). These results are also illustrated in the accompanying bar diagram.

Fig. 4: Radiological findings of Preschooler- ages upto 2 years to 6 years.

Table 5 (in Supplemental Material Section) contains chest examination records of 197 pediatric patients, including 84 school-aged children-50 males and 34 females. The table outlines the radiological findings for these patients. The least common findings, such as accentuated bronchovesicular markings, a dilated vascular pedicle, pulmonary TB (left) with sequelae, and pulmonary hypertension, were each observed once (0.51%). The most frequent finding was a normal chest exam, recorded 42 times (21.32%). These findings are further illustrated in the accompanying bar diagram.

Table 6 summarizes the radiological findings for 197 pediatric patients across five different age groups: newborns (0 to 28 days), infants (29 days to 1 year), toddlers (1 to 2 years), preschoolers (2 to 6 years), and school-aged children (6 to 12 years). 

Fig. 5: Radiological findings of School aged child- ages upto 6 year to 12 years.

Table 6: Frequency and percentage of pathology (male & female) & normal (male & female) of Radiological findings of five age groups. The distribution is as follows:

The distribution is as follows:

The findings from this study provide a comprehensive overview of radiological findings in pediatric patients across various age groups in Dhaka, Bangladesh. The data reveal important insights into the prevalence and types of abnormalities observed in chest examinations of children from newborns to school-aged individuals. The study results show that the prevalence of specific radiological findings varies significantly across different pediatric age groups. For newborns, the most frequent abnormality was respiratory distress syndrome (RDS), a critical condition that has been widely recognized in the literature as a common issue in this age group (Abiramalatha, T et al., 2021). Similarly, for infants, pneumonitis was identified as the most frequent finding, aligning with other studies that highlight the vulnerability of infants to respiratory infections (Kirks, D. R et al., 1998; Ali et al., 2022).

In toddlers, pneumonitis again emerged as the most common radiological finding, consistent with previous research indicating a high incidence of respiratory issues in this age group (Weston, M et al., 2019). For preschoolers, pneumonitis was the most prevalent finding, reflecting a pattern observed in studies focusing on this developmental stage (Nino, G et al., 2021). In contrast, school-aged children exhibited a higher frequency of normal chest examinations, which could suggest a relatively lower incidence of significant pathologies or improvements in overall health (Yu, J. M., Liao et al., 2008).

The variations in radiological findings across age groups are consistent with findings from other studies. For example, a study by Abiramalatha, T et al. (2021) reported that RDS was frequently observed in newborns and infants, which corroborates our results (Abiramalatha, T et al., 2021). Another study by Kirks, D. R et al. (1998) noted a high incidence of pneumonitis in young children, particularly in the preschool age group, aligning with our findings (Kirks, D. R et al., 1998).

Our study also emphasizes the importance of age-specific considerations in radiological assessments, a point echoed by Alnami, H. A. Y et al. (2024), who highlighted the need for tailored imaging protocols to minimize unnecessary radiation exposure while ensuring diagnostic accuracy (Alnami, H. A. Y et al. 2024). The observed variations in radiological findings across different age groups underline the necessity for age-appropriate imaging strategies and the continuous evaluation of diagnostic practices to optimize patient outcomes. The findings underscore the need for ongoing vigilance in pediatric radiology, particularly in optimizing imaging techniques and reducing radiation exposure. The identification of common pathologies such as RDS and pneumonitis in specific age groups reinforces the importance of early and accurate diagnosis. Clinicians should be aware of these patterns to better guide diagnostic and therapeutic interventions. The studys results also highlight the value of regular updates to radiological practices based on emerging data and trends. This approach aligns with recommendations for incorporating evidence-based practices to enhance patient safety and diagnostic efficacy (Allen, B., et al., 2021).

Limitations

• The study focused on a limited number of pediatric patients (197), which may affect the generalizability of the findings.
• The study was conducted in a single radio-graphic center in Dhaka City, limiting the diversity of the sample population.
• Certain radiological findings were observed infrequently, making it difficult to draw strong conclusions for those specific conditions.
• The age distribution of the participants was uneven, with a higher number of school-aged children compared to other age groups.
• The lack of long-term follow-up data restricts the assessment of the clinical impact of the radiological findings.

This study provides an overview of the radiological findings from chest examinations conducted on 197 pediatric patients across five different age groups, from newborns to school-aged children. The findings highlight the varying prevalence of specific pathologies, with conditions like respiratory distress syndrome (RDS) and pneumonitis being the most frequently observed in younger age groups, while normal findings were more common in older children. These results reflect the common chest pathologies encountered in pediatric patients, underscoring the importance of chest radiography in early diagnosis and treatment planning. Despite the studys limitations, the findings offer valuable insights into the radiological profiles of pediatric patients and suggest the need for broader, multicenter studies to validate these outcomes and improve pediatric care.

Suggestions for Future Study

• Explore larger sample sizes to enhance the statistical significance of pediatric chest examination findings across various age groups.
• Investigate the long-term outcomes of pediatric patients diagnosed with respiratory conditions, particularly focusing on the progression of diseases such as pneumonitis and RDS.
• Examine potential radiation exposure risks in pediatric chest examinations and develop guidelines to minimize radiation doses without compromising diagnostic quality.

This study was conducted in accordance with the ethical standards and guidelines of Bangladesh University of Health Sciences.

Conceptualization and methodology of this study were handled by S.A.; N.T.N.; and M.A.O.; they also contributed significantly to manuscript preparation, data analysis, investigation, and visualization. Valuable guidance and supervision throughout the study were provided by M.A.F.; N.T.N.; and M.A.O.; coordinated the completion of the manuscript through extensive review and editing, in addition to data curation, acquisition of funding, and formal analysis. All authors have read and approved the final manuscript.

We would like to offer our sincere gratitude to the Department of Radiology and Imaging Technology, Bangladesh University of Health Sciences, and the Department of Computer Science and Engineering, Ahsanullah University of Science and Technology (AUST), for their wholehearted support and co-operation. Support and co-operation by these departments were instrumental in facilitating the smooth conduct of this study, and we are truly grateful for it.