Comparison Between Photofluorography and Standard Fluoroscopic Voiding Cystourethrography in Evaluating Vesicoureteral Reflux in Children With Urinary Tract Infection

Radiology Department, Dr Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Nephro-urology monthly 06/2012; 4(3):541-4. DOI: 10.5812/numonthly.3562
Source: PubMed


Imaging of the urinary system is considered to be responsible for significant radiation in children.
This study was conducted to measure and compare the radiation dose in spot films with photofluorography voiding cystourethrography (VCUG) in children.
111 [222 Kidney Urinary Unit (KUU)] pediatric patients, aged 1 month to 5 years, with symptomatic urinary tract infection were enrolled in the study. Peak tube voltage (kVp), exposure setting (mAs), focus film distance (FFD), film size and DAP (after the exam) were recorded for all patients. To evaluate the validity of the photographs, we calculated sensitivity, specificity, predictive values and agreement between the two methods using the kappa statistic. If the kappa was greater than 0.75, between 0.4-0.75 or less than 0.4, then the agreement was excellent, good or poor, respectively. P values less than 0.05 were statistically significant.
Vesicoureteral reflux (VUR) was detected in 74 KUU (33.3%) in standard films and in 71 (32%) in photographic images. The photographs had no false positives and 3 false negatives. Therefore, the new method had a sensitivity of 96%, a specificity of 100%, a negative predictive value of 98% and a positive predictive value of 100%. The two-method agreement in the VUR diagnosis for grades 1, 4, 5 and the overall grading were excellent (kappa > 0.83); however, for grades 2 and 3, agreement was 80%, which was good (kappa = 0.64).
Our study suggests that the high validity and excellent agreement of the photofluorography method in the diagnosis and grading of VUR, which is comparable to spot films and represents a 50%-90% reduction in radiation, makes it the preferred method.

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Available from: Mitra Naseri, Dec 18, 2013
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    ABSTRACT: Background Many image-intensifier fluoroscopy systems have been replaced by flat-panel detectors in recent years. Objective To compare the level of contrast, image resolution and radiation dose between an image-intensifier and a newer-generation flat-panel detector system in a pediatric radiology unit. Materials and methods We compared two systems — a conventional image intensifier and a newer-generation flat-panel system. We measured image quality and radiation dose using a technical phantom. Additionally, we retrospectively compared age-matched fluoroscopic pediatric voiding cystourethrography (n = 15) and upper gastrointestinal investigations (n = 25). Results In phantom studies image contrast was equal while image resolution was higher and mean radiation dose lower using the flat-panel system (P < 0.0001). In pediatric investigations, mean dose area product was significantly reduced on the flat-panel system for upper gastrointestinal investigation (45 ± 38 μGy*m2 vs. 11 ± 9 μGy*m2; P < 0.0001) and for voiding cystourethrography (18 ± 20 μGy*m2 vs. 10 ± 12 μGy*m2; P = 0.04). Conclusion The newer flat-panel system performs at lower dose levels with equal to better image quality and therefore seems to be the more suitable technique for pediatric fluoroscopy in comparison to image-intensifier systems.
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