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Establishing diagnostic reference levels for pediatric fluoroscopic examinations in a tertiary hospital. Pediatr Radiol 2022; 52:1296-1305. [PMID: 35284948 DOI: 10.1007/s00247-022-05290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diagnostic reference levels (DRLs) identify unusually high patient radiation exposures and are required for dose optimisation. DRLs for pediatric fluoroscopic examinations are not widely determined in Australia. OBJECTIVE Our objectives were to establish DRLs for pediatric fluoroscopic examinations in a South Australian tertiary hospital and compare these to previously published data and to explore relationships between patient dose area product (DAP), age and fluoroscopy times. MATERIALS AND METHODS Dose data from 365 pediatric patients undergoing 5 fluoroscopic examinations were retrospectively collected for a 3-year period commencing January 2018 to develop local DRLs. Relationships between DAP, age and fluoroscopy time were explored using scatterplots, Spearman's correlation, and regression analyses. RESULTS Local DRLs were significantly lower than data published previously, possibly reflecting technological and procedural advancements. Each 1-year increase in patient age was associated with a 0.77 μGy·m2 increase in DAP for barium meal and follow-through studies (95% confidence interval [CI]=0.055, 1.48) (P=0.04), and a 1.37 μGy·m2 increase in DAP for barium swallow studies (95% CI=0.61, 2.12) (P<0.001). A low correlation was demonstrated between DAP and fluoroscopy time for micturating cystourethrography studies (r=0.35, 95% CI=0.15, 0.51, P<0.001) and barium meal and follow-through studies (r=0.37, 95% CI= -0.011, 0.65, P=0.05). Age and fluoroscopy time were not significantly related. CONCLUSION This study provides updated Australian pediatric fluoroscopic DRLs, with the intention of promoting a national database for benchmarking pediatric doses. The local DRLs can be used for dose comparisons and optimisation between facilities.
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Forbes A, Geryes BH, Hornbeck A, Kien N, Quelquejay C, Adamsbaum C, Farah J, le Pointe HD. Harmonisation of imaging protocols, radiation doses and image quality in gastrointestinal fluoroscopy examinations - multicentre study. Pediatr Radiol 2022; 52:50-57. [PMID: 34657168 DOI: 10.1007/s00247-021-05194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/24/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Paediatric gastrointestinal fluoroscopy examinations can impart varying amounts of radiation for the same patient size and exam type. OBJECTIVE To investigate the variability of imaging protocol, radiation dose and image quality in paediatric fluoroscopy examinations in order to provide recommendations for the harmonisation and optimisation of local practices. MATERIALS AND METHODS Five paediatric radiology departments performing fluoroscopically-guided contrast enema, micturating cystourethrography and upper gastrointestinal tract examinations participated in this study. Information on imaging protocols and radiation doses was retrospectively collected for more than 2,400 examinations. Image quality was analysed on clinical and phantom images. RESULTS Patient doses showed great variability among centers with up to a factor of 5 for similar fluoroscopy times. The five departments had imaging protocols with major differences in fluoroscopy dose regulation curves and additional filtration. Image quality analysis on phantoms and patients images showed no major improvement in contrast, spatial resolution or noise when increasing the radiation dose. Age-based diagnostic reference levels using both dose area product and fluoroscopy time were proposed per procedure type. CONCLUSION Disparities between centers and no correlation of radiation dose with image quality criteria create margins for optimisation. These results highlight the need for guidelines on fluoroscopy image quality and dose reference levels in paediatric gastrointestinal examinations to harmonise practices and optimise patient dose.
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Affiliation(s)
- Aurélie Forbes
- Radiology Department, Public Assistance - Paris Hospitals Antoine Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France.
| | - Bouchra Habib Geryes
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Necker-Enfants Malades University Hospital, Paris, France
| | - Amaury Hornbeck
- Radiology Department, Public Assistance - Paris Hospitals Armand-Trousseau Paediatric Hospital, Paris, France
- ALARA Expertise, Entzheim, France
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
| | - Nicolas Kien
- ALARA Expertise, Entzheim, France
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
| | - Caroline Quelquejay
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Necker-Enfants Malades University Hospital, Paris, France
| | - Catherine Adamsbaum
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Jad Farah
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Hubert Ducou le Pointe
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
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Hong JY, Hwang NK, Lee G, Park JS, Jung YJ. Radiation Safety in Videofluoroscopic Swallowing Study: Systematic Review. Dysphagia 2020; 36:73-82. [PMID: 32279120 DOI: 10.1007/s00455-020-10112-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/01/2020] [Indexed: 01/01/2023]
Abstract
Videofluoroscopic swallowing study (VFSS) is generally used to diagnose dysphagia and oropharyngeal aspiration during swallowing movement. Patients and bolus-feeding operators (such as occupational therapist and speech language pathologist) may undergo multiple VFSS procedure, placing them at risk for more radiation exposure due to increased scan time. The present study investigated the dose-area product, effective dose of various protocols, and summarized dose reports from various studies of VFSS. The PubMed database searched for relevant publications reporting radiation dose in the VFSS procedure. 13 articles were selected to be reviewed. This systematic review involved 13 peer-reviewed articles that reported the specific dose of the VFSS procedure. The articles were categorized into three types: operator radiation dose, adult patient radiation dose, and pediatric radiation dose. The operator dose reports showed that the operators' scattering exposure, equivalent dose (across the whole body, eyes, and hands), and annual effective dose were significantly lower than the annual dose limit of 20 mSv. Both adult and pediatric patient dose reports showed that the effective dose, which was estimated from recorded dose-area product, was significantly lower than the annual background exposure of 2.4 mSv in various protocols. The present literature review suggested that the radiation dose of VFSS by modified barium swallowing is acceptable in both operators and patients. However, various radiation protection strategies should be conducted during the procedure to reduce the risk of stochastic effect.
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Affiliation(s)
- Jun-Yong Hong
- Department of Multidisplinary Radiological Science, Graduate School, DongSeo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea
| | - Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul, Republic of Korea
| | - Gihyoun Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji-Su Park
- Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, Dongseo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea.
| | - Young-Jin Jung
- Department of Multidisplinary Radiological Science, Graduate School, DongSeo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea. .,Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, Dongseo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea. .,Department of Radiological Science at Health Sciences Division in DongSeo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea.
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Machado S, Filipov D, Schelin H, Denyak V, Paschuk S, Setti J, Legnani A, Ledesma J. Examination techniques and patient dose in paediatric barium meal procedures. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Multicentre survey on patient dose in paediatric imaging and proposal for updated diagnostic reference levels for France. Part 2: plain radiography and diagnostic fluoroscopy. Eur Radiol 2019; 30:1182-1190. [DOI: 10.1007/s00330-019-06406-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/03/2019] [Accepted: 07/31/2019] [Indexed: 11/27/2022]
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Im HW, Kim SY, Oh BM, Han TR, Seo HG. Radiation Dose During Videofluoroscopic Swallowing Studies and Associated Factors in Pediatric Patients. Dysphagia 2019; 35:84-89. [DOI: 10.1007/s00455-019-10006-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
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Sturm A, Maaser C, Calabrese E, Annese V, Fiorino G, Kucharzik T, Vavricka SR, Verstockt B, van Rheenen P, Tolan D, Taylor SA, Rimola J, Rieder F, Limdi JK, Laghi A, Krustiņš E, Kotze PG, Kopylov U, Katsanos K, Halligan S, Gordon H, González Lama Y, Ellul P, Eliakim R, Castiglione F, Burisch J, Borralho Nunes P, Bettenworth D, Baumgart DC, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis 2019; 13:273-284. [PMID: 30137278 DOI: 10.1093/ecco-jcc/jjy114] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | - Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | | | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Belgium
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza - University of Rome, Rome, Italy
| | - Eduards Krustiņš
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná PUCPR, Curitiba, Brazil
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Hannah Gordon
- Section of Gastroenterology & Hepatology, Royal London Hospital, London, UK
| | - Yago González Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands
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Earl VJ, Badawy MK. Radiation Exposure to Staff and Patient During Videofluoroscopic Swallowing Studies and Recommended Protection Strategies. Dysphagia 2018; 34:290-297. [DOI: 10.1007/s00455-018-9945-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/17/2018] [Indexed: 12/27/2022]
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Sulieman A, Elhag B, Alkhorayef M, Babikir E, Theodorou K, Kappas C, Bradley D. Estimation of effective dose and radiation risk in pediatric barium studies procedures. Appl Radiat Isot 2017; 138:40-44. [PMID: 28757351 DOI: 10.1016/j.apradiso.2017.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
The objectives of this study are to assess pediatric radiation exposure in certain barium studies and to quantify the organ and effective doses and radiation risk resultant from patients' irradiation. A total of 69 pediatric barium studies for upper and lower gastrointestinal tract. Patients' radiation dose was quantified in terms of Entrance surface air kerma (ESAKs) using exposure parameters and DosCal software. Organ and effective doses (E) were extrapolated using national Radiological Protection Board software (NRPB-R279). The mean ± (SD) and the range of patient doses per procedure were 3.7 ± 0.4 (1.0-13.0)mGy, 7.4 ± 1.7(5.5-8.0)mGy and 1.4 ± 0.9 (0.5-3.6)mGy for barium meal, swallow and enema, respectively. The mean effective doses were 0.3 ± 0.03 (0.08-1.1)mSv, 0.2 ± 1.6 (0.44-0.7)mSv and 0.3 ± 0.9 (0.1-0.8)mSv at the same order. The radiation dose were higher compared to previous studies. Therefore, pediatrics are exposed to avoidable radiation exposure. Certain optimization measures are recommended along with establishing national diagnostic reference level (DRL) to reduce the radiation risk.
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Affiliation(s)
- A Sulieman
- Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P.O.Box 422, 11942, Saudi Arabia.
| | - B Elhag
- Alghad International Colleges for Applied Medical Sciences, Radiology and Medical Imaging Department, Almadinah Almunawra, Saudi Arabia
| | - M Alkhorayef
- King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P.O.Box 10219, Riyadh 11433, Saudi Arabia; Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
| | - E Babikir
- King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P.O.Box 10219, Riyadh 11433, Saudi Arabia
| | - K Theodorou
- Medical Physics Department, University Hospital of Larissa, PO Box 1425, Larissa 41110, Greece
| | - C Kappas
- Medical Physics Department, University Hospital of Larissa, PO Box 1425, Larissa 41110, Greece
| | - D Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom; Sunway University, Institute for Health Care Development, Jalan Universiti, 46150 PJ, Malaysia
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11
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Bibbo G. Effective doses and standardised risk factors from paediatric diagnostic medical radiation exposures: Information for radiation risk communication. J Med Imaging Radiat Oncol 2017; 62:43-50. [DOI: 10.1111/1754-9485.12628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Giovanni Bibbo
- SA Medical Imaging; Women's and Children's Hospital; North Adelaide South Australia Australia
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