Assessment Of The Challenges To Radiographers On Pediatric X-ray Examination In Enugu Metropolis (a Case Study Of Unth, Esuth And Nohe)

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Background: Pediatric x-ray examination involves medical imaging of infants, children, adolescents. It comes with many challenges to the Radiographer whose obligation is to produce quality images for correct informed diagnosis irrespective of the challenges.
Aim: To assess the challenges to Radiographers on pediatric x-ray examination in Enugu metropolis.
Method: A non-experimental prospective survey research approach was adopted. Questionnaires were used for data collection from the respondents - Radiographers.  
Results/Conclusion: Challenges encountered by Radiographers in pediatric patients’ radiography were identified from the study. These includes; Apprehensive nature of pediatrics, restiveness/inability to remain still for their examinations, lack of special dedicated equipment and accessories to keep the child successfully immobilized during the examination, Lack of specialized skills in pediatric radiography, Poor pain tolerance in sick pediatrics. Certain challenges peculiar to some age ranges were also found out. 

Title Page - - - - - - -i
Approval Page - - - - - -ii
Certification - - - - - -iii
Dedication - - - - - -iv
Acknowledgement - - - - - -v
Abstract - - - - - -vi
Table of contents - - - - - -vii
1.0 Introduction - - - - - -1
1.1 Statement of problem - - - - - 6
1.2 Objectives of study - - - - - - - 7
1.3 Significance of study - - - - - - 7
1.4 Scope of study - - - - - -8
2.0 Related Literature review - - - - -9
3.0 Research Methodology - - - - - -16
3.1 Research Design - - - - - - 16
3.2 Population of study - - - - - -16
3.3 instrument of data collection- - - - - - 16
3.4 Method of Data Collection- - - - - - 17
4.0 Data presentation and analysis - - - - 18
5.0 Discussion and implication of results - - - - 32
5.1 Summary of findings - - - - - - 38
5.2 Conclusion --                 -          -        -          -         -          - -40
5.3 Recommendation - - - - - -40
5.4 Limitations - - - - - -41
5.5 Area of further study - - - - - -39

Table 1: Bio-data of Radiographers studied
Table 2: Responses on present state of Pediatrics Radiography in the study area
Table 3: Responses on the challenges in pediatric radiography in the study area
Table 4: Different parts posing greater challenges in pediatric radiography
Table 5: Ability of radiographers to gain pediatric cooperation before examinations
Table 6: Ways used to overcome the challenges in pediatric radiography
Table 7: Immobilization devices available in the radiology departments of study
Table 8: Responses on the ideal educational level for special training on pediatric radiography
Chart 1: Responses on the Age range most difficult in positioning
Chart 2: Responses on the Age range most restive and uncooperative
Chart 3: Responses on the Age range most challenging in choice of exposure factors
Chart 4: Responses on the Age range with greatest need for the parent/guardian assistance
Chart 5: Responses on the Age range requiring convincing explanation most for cooperation.

Pediatric x-ray examination involves the imaging of infants, children, adolescents1. Hence Pediatric radiology can also be regarded as a sub-specialty of radiology that strictly involves radiological investigation of patients that have not attained the age of adulthood2.
However Pediatric radiology comes with many challenges such as children inability to comprehend the changes of the environment, children inability to understand or cooperate with strange faces, the fear of x-ray machine and its accessories etc1. 
In the same vein, children do not all reach a sense of understanding at the same predictable age. This ability varies from child to child, and the radiographer undertaking pediatric examination must not assume that every child will comprehend similarly1. To this end, Goske3 in his study stated that good understanding of pediatrics; level of understanding, their experience and feelings while undergoing the investigation is important to achieve success because they lack understanding of the realities of life even when sick. Adaptation to new environment, especially the hospital environment may not be easy for the children. Therefore, the Radiographer is required to appear in a friendly outfit that depicts a normal environment. This can be achieved by wearing colorful outfit as opposed to a normal hospital uniform. Also sick children follow their instincts by crying and staying close to their parents. This poses a huge challenge for the Radiographer who must try to gain their cooperation. Once cooperation is established there is another challenge of keeping the child still for their radiological investigation.
The challenges posed by pediatric radiography are complex and needs specialized radiographers to handle them to avoid excessive patient dose with its negative consequences. To this note, John4 opined that all Radiographers providing children’s imaging should have specialist training to provide the expertise and judgment required in this demanding specialized area of radiography. It is therefore inappropriate for inexperienced radiographers to undertake unsupervised pediatric radiography.
Other challenges encountered in pediatric radiographic investigations include the needed skills and consequences of use of equipment and exposure settings designed for adults on pediatrics. In this case, manufacturers of medical imaging equipment should design equipment that is dedicated specially for pediatric radiological investigations.
Pediatrics especially neonates are at high risk of infection and exposure to cold radiographic diagnostic rooms remains a danger to their health. The radiographer is hereby challenged to ensure completion of the investigation as fast as possible with high level of hygiene. Antonio6 in his study opined that attending nurses should be available to handle the pediatrics especially those on respiratory aides during their radiographic examinations. 
Some Pediatric radiographic examinations require the administration of intravenous injection of contrast agents. There is a great challenge to immobilize the children for intravenous injection or setting of line for the contrast agent administration due to their inability to endure pains. 
Sometimes sedation is recommended for pediatric radiographic examinations. Sedation for radiologic procedures is commonly administered to prevent excessive patient motion and for problems with claustrophobia7. There is the challenge of justification for application of sedation to achieve immobilization and there is always fear of dosage and possible unfavorable consequences of sedation8.
In pediatric patients, proper bowel preparation for radiographic examinations is not achieved owing to their tender body physiology and inability to skip meals for long periods. This leaves fecal matter and gases that challenges the production of quality diagnostic images.
Identification of vessels and administration of intravenous fluids during pediatric radiographic examinations is likely a challenge for inexperienced radiographers. Pediatric patients have small vessels that are difficult to isolate. They exhibit much fear and inability to endure pains during intravenous administration. Most times these pediatric patients are referred to experienced nurses on pediatric care ward for setting of line to be used in contrast administrations9.  
In addition, there is substantial evidence to suggest that children are more susceptible to the effects of ionizing radiation than adults, which places an added burden(challenge) on both radiographer and radiologist to attain the best possible results every time. The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) have emphasized that risks from exposure to ionizing radiation are dependent on the age at which exposure occurs, and that exposure during childhood results in a likely two- to three-fold increase in lifetime risk for certain detrimental effects compared with that in an adult10. The European Commission11 as well as the Council Directive 97/43/Euratom12 have guidelines suggesting examples of good radiographic technique of common pediatric projections, with the aim of producing high quality images at the lowest possible dose to the patient.
It is not uncommon to encounter pediatric patients undergo repeat X-ray examinations after their initial X-rays are rejected for poor image quality thereby subjecting them to excess radiation exposure and avoidable extra cost.
Successful diagnoses of pediatric conditions require high quality image, thus the production of high quality images depends on the ability of the Radiographers to overcome these challenges of pediatric x-ray examination which may vary from one locality to another. However, the major challenges faced by Radiographers during pediatric x-ray examination have not been documented in our locality.
From review, some challenges in pediatric radiography have been identified. However, these researches were conducted in environments and locations different from our locality. This suggests that these identified challenges may not be ideal or obtainable in our locality. Also there seems to exist some unidentified challenges to pediatric radiography peculiar to Enugu metropolis. To this end, this study is interested in the identification of these prevailing challenges in pediatric radiography in Enugu metropolis. In addition, this study aims not only to document the challenges in pediatric radiography but also to identify the possible ways of overcoming these challenges by Radiographers in Enugu metropolis.
Conclusively, it is hoped that these numerous challenges as seen in the background of study will in the course of this study be overcome and pediatric radiography investigations will then pose little or no challenges to practicing radiographers.
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