Patient X-ray Exposure and ALARA in the Neonatal Intensive Care Unit in Bangladeshi Patterns

X-ray imaging plays a crucial role in diagnosing pre-term infants in neonatal intensive care units (NICUs); however, neonates are particularly sensitive to the risks of ionizing radiation. The As Low As Reasonably Achievable (ALARA) principle seeks to minimize radiation exposure while maintaining the diagnostic quality. In Bangladesh, adherence to ALARA is inconsistent because of insufficient training, outdated equipment, and weak regulatory oversight. This study aimed to assess ALARA implementation in Bangladeshi NICUs by evaluating healthcare professionals’ awareness of radiation safety, analyzing X-ray usage patterns, reviewing safety protocols, and suggesting improvements. A cross-sectional study was conducted at two private hospitals in Dhaka, involving 150 neonates admitted between April and September 2024. Data were collected using structured questionnaires, direct observation of X-ray procedures, and entrance surface dose (ESD) measurements with stratified random sampling to ensure diversity. The results revealed that 69.3% of the neonates were male, with most births falling within the 2.75 kg–3.04 kg weight range. Respiratory distress syndrome (RDS) was the most common diagnosis, followed by low birth weight and preterm birth. ESD measurements showed significant variability, indicating inconsistent radiation management. While some practices followed the ALARA principles, dose regulation remained uneven due to staff oversight and equipment variability. The findings suggest gaps in staff training, inconsistent equipment performance, and absence of standardized safety protocols. Frequent X-ray use under conditions such as RDS underlines the need for stricter radiation control. To improve safety, staff education, regular equipment maintenance, and the adoption of non-radiative imaging methods such as ultrasound are recommended. In conclusion, better adherence to the ALARA principles is essential for safe X-ray practice in NICUs. Continuous monitoring, improved training, and the use of non-radiative alternatives are crucial steps for optimizing neonatal care.