Abstract
ObjectiveThe aim of the study was to calculate the effective dose during fluoroscopy-guided pediatric interventional procedures of the liver in a phantom model before and after adjustment of preset parameters.MethodsOrgan doses were measured in three anthropomorphic Rando-Alderson phantoms representing children at various age and body weight (newborn 3.5kg, toddler 10kg, child 19kg). Collimation was performed focusing on the upper abdomen representing mock interventional radiology procedures such as percutaneous transhepatic cholangiography and drainage placement (PTCD). Fluoroscopy and digital subtraction angiography (DSA) acquisitions were performed in a posterior-anterior geometry using a state of the art flat-panel detector. Effective dose was directly measured from multiple incorporated thermoluminescent dosimeters (TLDs) using two different parameter settings.ResultsEffective dose values for each pediatric phantom were below 0.1mSv per minute fluoroscopy, and below 1mSv for a 1 minute DSA acquisition with a frame rate of 2 f/s. Lowering the values for the detector entrance dose enabled a reduction of the applied effective dose from 12 to 27% for fluoroscopy and 22 to 63% for DSA acquisitions. Similarly, organ doses of radiosensitive organs could be reduced by over 50%, especially when close to the primary x-ray beam.ConclusionModification of preset parameter settings enabled to decrease the effective dose for pediatric interventional procedures, as determined by effective dose calculations using dedicated pediatric Rando-Alderson phantoms.
Highlights
The use of medical imaging and intervention in children has steadily increased over the last decades
Lowering the values for the detector entrance dose enabled a reduction of the applied effective dose from 12 to 27% for fluoroscopy and 22 to 63% for digital subtraction angiography (DSA) acquisitions
Most data regarding radiation dose in children is derived from Computed Tomography (CT) examinations
Summary
The use of medical imaging and intervention in children has steadily increased over the last decades. Most data regarding radiation dose in children is derived from Computed Tomography (CT) examinations. CT is considered the greatest source of medical radiation exposure, a 2009 report on radiation dose emphasized the increasing pediatric dose from fluoroscopy-guided interventional procedures together with the need to promote radiation safety precautions[1]. Ultrasound is the preferred modality for pediatric image-guided therapies as it avoids radiation exposure. Technical advances and increased knowledge on radiation exposure have led to a substantial decrease of radiation dose, especially long and complex procedures still carry the likelihood of higher and potentially harmful radiation doses. For neurovascular interventions the radiation dose associated with fluoroscopic and angiographic imaging carries an inherent risk to pediatric patients[3]. Children are even more susceptible to the adverse effects of ionizing radiation compared to adults
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