Flouroscopy controlled voiding cystourethrography in infants and children: Are the risks trivial?
ABSTRACT The purpose of this study was to determine the gonadal dose, effective dose and relevant radiogenic risks associated with pediatric patients undergoing voiding cystourethrography (VCUG). Exposure parameters were monitored in 118 consecutive children undergoing VCUG. The entrance surface dose (ESD) was determined by thermoluminescent dosimeters (TLDs). For male patients, the gonadal dose was determined by TLDs attached on the anterior scrotum. For female patients, the gonadal dose was estimated by converting ESD to the ovarian dose. ESD-to-ovarian dose conversion factors were determined by thermoluminescence dosimetry and physical anthropomorphic phantoms representing newborn and 1-, 5- and 10-year-old individuals. The effective dose was estimated by using ESD and data obtained from the literature. The mean fluoroscopy time and number of radiographs during VCUG were 0.73 min and 2.3 for female and 0.91 min and 3.0 for male pediatric patients, respectively. The gonadal dose range was 0.34-5.17 mGy in boys and 0.36-2.57 mGy in girls. The corresponding ranges of effective dosage were 0.12-1.67 mSv and 0.15-1.45 mSv. Mean radiation risks for genetic anomalies and carcinogenesis following VCUG during childhood were estimated to be up to 15 per million and 125 per million, respectively. Radiation risks associated with pediatric patients undergoing VCUG should not be disregarded if such a procedure is to be justified adequately.
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ABSTRACT: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a considerable radiation exposure for patients and staff. While optimization of the radiation dose is recommended, few studies have been published. The purpose of this study has been to measure patient and staff radiation dose, to estimate the effective dose and radiation risk using digital fluoroscopic images. Entrance skin dose (ESD), organ and effective doses were estimated for patients and staff. Fifty-seven patients were studied using digital X-ray machine and thermoluminescent dosimeters (TLD) to measure ESD at different body sites. Organ and surface dose to specific radiosensitive organs was carried out. The mean, median, minimum, third quartile and the maximum values are presented due to the asymmetry in data distribution. The mean ESD, exit and thyroid surface dose were estimated to be 75.6 mGy, 3.22 mGy and 0.80 mGy, respectively. The mean effective dose for both gastroenterologist and assistant is 0.01 mSv. The mean patient effective dose was 4.16 mSv, and the cancer risk per procedure was estimated to be 2 × 10(-5). ERCP with fluoroscopic technique demonstrate improved dose reduction, compared to the conventional radiographic based technique, reducing the surface dose by a factor of 2, without compromising the diagnostic findings. The radiation absorbed doses to the different organs and effective doses are relatively low.Saudi Journal of Gastroenterology 01/2011; 17(1):23-9. DOI:10.4103/1319-3767.74456 · 1.12 Impact Factor
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ABSTRACT: Over recent years there has been increasing concern over the level of radiation exposure to the population from diagnostic radiology, and this is particularly the case for paediatric radiology. In addition, many regulatory authorities place particular importance on the optimization of exposures to paediatric patients. This lecture aims to review and summarise the existing guidance for radiation protection in paediatric radiology and recent developments in technology and methodology. Guidelines on technique and dose in paediatric radiology have been produced by the CEC and by departments in the UK, among others, and these will be discussed along with the most recent surveys of radiation dose and diagnostic reference levels for paediatric patients. The varying attitudes to paediatric radiation protection between centres will be explored. There are a variety of equipment issues affecting dose reduction in paediatric radiology, and those to be discussed include tube filtration, automatic exposure control devices, anti-scatter grids and pulsed fluoroscopy. Choice of technique plays a big part in radiation dose, and exposure factors need to be scaled down for smaller patients. Other technique issues include neonatal chest/abdomen radiography, the use of a well collimated radiation beam and the use of lead shielding to protect radiosensitive organs. Optimization of computed tomography examinations for children is of particular concern, and some proposals for dose reduction will be presented and discussed. One of the most effective ways of reducing dose from an x-ray examination is to prevent the need for a repeat exposure – a common occurrence with scared or reluctant paediatric patients. Some practical suggestions and examples of easy measures that can be taken in this regard will conclude the lecture, along with a brief mention of the associated radiation protection issues for staff and carers involved in paediatric radiology.
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ABSTRACT: Die Ultraschalluntersuchung wird bei der Frage nach Obstruktion, Nierenbeteilung oder Vorliegen eines Refluxes beim Harnwegsinfekt (HWI) als primre Bildgebung eingesetzt. Fortschritte in der Ultraschalltechnologie (hoch auflsender Schallkopf, Harmonic Imaging) und der Ultraschallkontrastmittel sowie eine systematische Darstellung ermglichen eine qualitativ gute Beurteilung des Harntrakts. Eine Refluxprfung sollte nach der Antibiotikatherapie und damit frher als empfohlen durchgefhrt werden. Eine Refluxuntersuchung mit Blasenkatheterisierung oder -punktion kann einen unangenehmen Erfahrungswert haben, daher sollte bei Bedarf sediert werden. Hierzu haben sich Midazolam intranasal, fr die lokale Ansthesie bei Blasenpunktion EMLA Pflaster gut bewhrt. Die kontrastverstrkte sonographische Refluxprfung, die Miktionsurosonographie, ist ein alternatives Verfahren und hat im Vergleich zur Miktionszystourethrographie eine hhere Sensitivitt in der Refluxdetektion bei fehlender Strahlenexposition. Die MRT bietet bei HWI gegenber der DMSA-Szintigraphie eine hhere diagnostische Sicherheit.The primary role of US in the diagnostic work-up of urinary tract infection is to provide information regarding obstruction, renal parenchymal involvement and reflux. Advances in US technology (high resolution transducer, harmonic imaging) and US contrast media coupled with systematic examination will provide a high quality evaluation of the urinary tract. The reflux examination should be carried out at the end of antibiotic therapy, contrary to what has been recommended in the past. A reflux examination with bladder catheterization or suprapubic puncture can be a traumatic experience for the child. Thus whenever necessary sedation should be used. The intranasal administration of Midazolam and the use of local anesthesia (EMLA plaster) for suprapubic puncture have proved to be valuable. The contrast-enhanced sonographic reflux examination – voiding urosonography [VUS], is an alternative diagnostic modality for reflux examination and compared to voiding cystourethrography [VCUG] has higher sensitivity in reflux detection without utilising ionizing radiation. Further diagnostic imaging modalities for UTI should incorporate primarily MRI as it offers a higher diagnostic accuracy compared to DMSA scintigraphy.Monatsschrift Kinderheilkunde 02/2007; 155(3):215-227. DOI:10.1007/s00112-007-1468-y · 0.23 Impact Factor