IONIZING RADIATION EXPOSURE REVIEW IN CHILDREN WITH INTESTINAL FAILURE

Abstract

Introduction: Intestinal failure (IF) is a chronic condition with increasing incidence and survival rates. Children with IF undergo many radiological studies and procedures involving ionizing radiation. There is no evidence regarding its long-term outcomes. The aim of this study is to estimate cumulative radiation dose (CRD), in order to optimize imaging studies prescription. Methods: Retrospective study. Cohort. Inclusion criteria: children with IF under 18 y.o., 2007-2019. Clinical records review: age, follow up time, type of study/procedure and CRD (mSv). The CRD was established according to existing normative data. Three average doses were calculated for fluoroscopy procedures, according to the difficulty described in surgical reports. Results: N 95. Age 6.19 y.o. (R: 0.15 - 20), follow up 4.78 years (R: 0.08 - 12.41). Mean number of imaging studies/ procedures 49.43/patient. CRD 74.64 mSv/patient: 43% due to CT scans (28.2 mSv), 17% enema contrast studies (10.97 mSv), 14% fluoroscopy during central venous access placement (8.81 mSv). The remaining 26% due to plain X ray films, voiding cystourethrography, upper GI contrast studies, scyntigraphy and bone densitometry. Discussion: According to investigations about nuclear bomb survivors, an association has been established between exposure doses in the range of 30 and 90 mSv and radiation induced cancer risk. Children are at a greater risk than adults at a given dose, both because they are more radiosensitive and also they have more remaining years of life during which radiation induced cancer can develop. Our cohort received a CRD of 74.64 mSv, which is considered as a high risk CRD. Although it is not possible to predict its consequences, this fact means a warning sign for future potential morbidity. Conclusions: Our cohort received a CD higher than current recommendations. A concerted effort should be made to reduce and optimize studies and procedures involving radiation. A future plan for improvement will include standardized indication of radiological studies and introduction of radiology- free techniques for diagnosis and placement of central lines.