Objective The primary purpose of this study was to ensure that x-rays performed, consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed substandard, would facilitate improvement.

Methods A retrospective, one-week review, of all neonatal x-rays and documentation of clinical information on x-ray requisitions (n = 132) in a tertiary care NICU, by a single observer. X-ray standards were defined a priori based on radiographic principles and medically documented information for correct interpretation. Targeted areas for improvement were addressed through brief educational sessions and printed pamphlets. The review was repeated one month (n = 93) and one year later (n = 76). Changes over time were analyzed by Kruskal-Wallis.

Results Results showed improvements in both the completion of x-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (p = 0.019), completeness of the medical history (p = 0.000), reduced x-ray rotation (p = 0.000), collimation to the specific area of interest (p = 0.000), gonadal shielding (p = 0.000) and decrease in monitor leads or artifacts obscuring views (p = 0.000). These improvements were sustained both one month and one year following the educational sessions.

Conclusions A neonatal x-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists. Structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to implement improvement.