Contribution of Swallow Studies to Cumulative Radiation Exposure in Infants in the Neonatal Intensive Care Unit.

PURPOSE: This study aimed to quantify exposure to ionizing radiation in infants undergoing VFSS in a Level III neonatal intensive care unit (NICU) and compare with other common radiographic modalities.

METHOD: Demographic and clinical data were collected from the medical records for infants admitted to the NICU for ≥ 72 hr over a 3-year period (mid-2022 to 2025). Infants were stratified by gestational age (GA) at birth. Total radiographic examinations, mean effective dose (mSv), and proportional exposure by modality were calculated based on established reference values.

RESULTS

Among 2,230 infants, 10,958 procedures of interest were performed, with a mean cumulative radiation exposure of 0.095 mSv per infant. Chest X-rays accounted for both the largest number of exams and the highest contribution to cumulative radiation exposure (63% and 47%, respectively), followed by babygrams (19%; 24%), abdominal X-rays (15%; 14%), and VFSSs (3%; 15%). The subset of infants born below 28 weeks GA underwent the greatest number of exams and had the highest cumulative radiation exposure, primarily from chest and abdominal imaging. In contrast, relative VFSS use was higher in infants born ≥ 37 weeks GA compared to other GA groups within the NICU, though overall radiation exposure was low in this subset.

CONCLUSION

Although VFSS contributed to infant cumulative radiation exposure in the NICU, its relative and actual contribution was minimal; this supports the ongoing use of diagnostic swallow studies safely when clinically indicated.