Abstract
PurposeThis study aims to determine local diagnostic reference levels (LDRLs) of intra-arterial chemotherapy (IAC) procedures of pediatric patients with retinoblastoma (RB) to provide data for establishing diagnostic reference levels (DRLs) in pediatric interventional radiology (IR).MethodsIn a retrospective study design, LDRLs and achievable dose (AD) were assessed for children undergoing superselective IAC for RB treatment. All procedures were performed at the flat-panel angiography systems (I) ArtisQ biplane (Siemens Healthineers) and (II) Allura Xper (Philips Healthcare). Patients were differentiated according to age (A1: 1–3 months; A2: 4–12 months; A3: 13–72 months; A4: 73 months–10 years; A5: > 10 years), sex, conducted or not-conducted chemotherapy.Results248 neurointerventional procedures of 130 pediatric patients (median age 14.5 months, range 5–127 months) with RB (68 unilateral, 62 bilateral) could be included between January 2010 and March 2020. The following diagnostic reference values, AD, and mean values could be determined: (A2) DRL 3.9 Gy cm2, AD 2.9 Gy cm2, mean 3.5 Gy cm2; (A3) DRL 7.0 Gy cm2, AD 4.3 Gy cm2, mean 6.0 Gy cm2; (A4) DRL 14.5 Gy cm2, AD 10.7 Gy cm2, mean 10.8 Gy cm2; (A5) AD 8.8 Gy cm2, mean 8.8 Gy cm2. Kruskal-Wallis-test confirmed a significant dose difference between the examined age groups (A2–A5) (p < 0.001). There was no statistical difference considering sex (p = 0.076) and conducted or not-conducted chemotherapy (p = 0.627). A successful procedure was achieved in 207/248 cases.ConclusionWe report on radiation exposure during superselective IAC of a pediatric cohort at the German Retinoblastoma Referral Centre. Although an IAC formally represents a therapeutic procedure, our results confirm that radiation exposure lies within the exposure of a diagnostic interventional procedure. DRLs for superselective IAC are substantially lower compared with DRLs of more complex endovascular interventions.
Highlights
The role of pediatric interventional radiology (IR) procedures has increased over the last decade
The internal database of the radiology department of the University Hospital Essen was searched with an in-house-developed software for all intra-arterial chemotherapy (IAC) on retinoblastoma that were performed in the period between January 2010 and March 2020
The presented results show that the local diagnostic reference values and the achievable dose for superselective IAC therapy are substantially lower compared with diagnostic reference levels (DRLs) of more complex endovascular interventions like thrombus aspiration (DRL 179.99 Gy cm2) or aneurysm coiling (DRL 249.99 Gy cm2) in adults, published by the Federal Office for Radiation Protection (Neuherberg, Germany) [19]
Summary
The role of pediatric interventional radiology (IR) procedures has increased over the last decade. DRLs are a vital element for dose monitoring and are globally accepted in order to achieve dose optimization in the clinical routine They represent the 75th percentile of a dose distribution of a specific radiological procedure and may indicate whether the radiation dose lies within the normal range of a dose distribution at radiological departments [2, 3]. The International Commission on Radiological Protection (ICRP) and the European Guidelines on Diagnostic Reference Levels for Pediatric Imaging are proclaiming the necessity for DRLs for pediatric patients [1, 5] It is expected in the pediatric radiology community that pediatric DRLs will increase dose awareness and in the long term optimize the modification of equipment, technique, and imaging parameters
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