Examination techniques and patient dose in paediatric barium meal procedures

Abstract

The paediatric barium meal procedure is an examination that employs ionizing radiation and implies radiation exposure of children with doses that can be rather high. Radiation risk for paediatric patients is higher than for adult patients. It is possible to reduce the dose values optimizing the technical parameters of the equipment that usually is not configured for paediatric imaging. In this work, we analyse the examination techniques applied by two fluoroscopic devices during the examinations performed by the same professionals in the same hospital. The procedures were conducted using the Philips Diagnost 93 manufactured in 1993 (49 exams) and Flexavision F3 from Shimadzu manufactured in 2016 (37 exams). The patients were categorized into age groups of 0–1, 1–5, 5–10 and 10–18 years. Unlike the old device, the new equipment has pulsed exposition and removable anti-scatter grid which should ensure a reduction in dose. However, our study shows that implementation of a modern equipment with new features enabling dose reduction does not guarantee a positive result. The reduction of kVp and mAs at the new equipment is completely compensated by smaller FDD. The significant dose reduction (up to 3 times) for the youngest patients was achieved by removing of the anti-scatter grid. No positive effect of pulsed exposition was observed. Producing the radiographic images, the professionals systematically use kVp lower than that chosen by the equipment, which indicates possible source of reduction of patient dose.