491 EFFECTIVE AND ORGAN SPECIFIC DOSES FROM VIDEOURODYNAMICS IN CHILDREN

Abstract

You have accessJournal of UrologyPediatrics: Neuropathic Bladder/Reconstruction1 Apr 2013491 EFFECTIVE AND ORGAN SPECIFIC DOSES FROM VIDEOURODYNAMICS IN CHILDREN Ryan Hsi, Jean Dearn, Melanie Dean, David Zamora, Kalpana Kanal, Jonathan Harper, and Paul Merguerian Ryan HsiRyan Hsi Seattle, WA More articles by this author , Jean DearnJean Dearn Seattle, WA More articles by this author , Melanie DeanMelanie Dean Seattle, WA More articles by this author , David ZamoraDavid Zamora Seattle, WA More articles by this author , Kalpana KanalKalpana Kanal Seattle, WA More articles by this author , Jonathan HarperJonathan Harper Seattle, WA More articles by this author , and Paul MerguerianPaul Merguerian Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1883AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prior studies on radiation dose from videourodynamics (VUDS) have reported displayed air kerma (AK), which is limited in its use to assess magnitude of exposure and potential risk to internal organs. No studies have reported the effective dose (ED), which takes into account the dose averaged over the entire body and is the accepted measurement to compare dose among sources of radiation and risk of future malignancy. The purpose of this study was to determine levels of radiation exposure from VUDS by calculating estimated entrance skin dose (ESD), ED, and testicular and ovarian organ dose; and determine clinical factors associated with the amount of radiation. METHODS Fluoroscopy time and displayed dose (AK and/or dose area product) from the fluoroscopic C-arm (Philips BV Pulsera) were collected from consecutive patients undergoing VUDS at our children's hospital. Documented dose metrics were used to calculate ESD after applying a series of correction factors (inverse square, table attenuation, backscatter, mean energy absorption coefficient, dose display accuracy). ED and organ dose (ovaries/testes) were estimated from ESD using Monte Carlo methods on a mathematical anthropomorphic phantom (ages 0/1/5/10/15 yrs). For each patient, the nearest-aged phantom was selected with a bladder posterior-anterior projection. Regression analysis was performed to determine patient and procedural factors associated with higher radiation dose. RESULTS Overall, 87 children (47 female, 40 male, mean age 9.4 ± 5.9 yrs, range 0.2-20.8 yrs) with the diagnosis of neurogenic bladder (70%), anatomic abnormality (15%), and functional/non-neurogenic disorder (15%) were included in this study. Mean fluoroscopy time was 0.10 ± 0.13 min with mean displayed air kerma 1.46 ± 1.32 mGy. Mean ED, ESD, testes, and ovary doses were 0.07 ± 0.05 mSv, 2.31 ± 2.08 mGy, 0.21 ± 0.14 mGy, and 0.10 ± 0.10 mGy, respectively. On univariate analysis, age, height, weight, and bladder capacity, and fluoroscopy time were associated with overall ED, but not diagnosis category, sex, or number of fill cycles. On multivariate logistic regression (R2=0.68), only higher weight (p<0.001) and fluoroscopy time (p<0.001) were associated with ED, while younger age did not reach significance (p=0.08). CONCLUSIONS This is the first study to report ED from VUDS in children. In this patient cohort, ED from VUDS was on average less than that from a VCUG study. On multivariate analysis, fluoroscopy time and weight were associated with ED, while bladder capacity was not. AK should be minimized to reduce radiation exposure to children during VUDS. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e201-e202 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Hsi Seattle, WA More articles by this author Jean Dearn Seattle, WA More articles by this author Melanie Dean Seattle, WA More articles by this author David Zamora Seattle, WA More articles by this author Kalpana Kanal Seattle, WA More articles by this author Jonathan Harper Seattle, WA More articles by this author Paul Merguerian Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...