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Cajigas-Loyola SC, Chow JS, Hayatghaibi S, Iyer RS, Kwon J, Rubesova E, Sánchez-Jacob R, Wyers M, Otero HJ. Imaging of Vesicoureteral Reflux: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329741. [PMID: 37672329 DOI: 10.2214/ajr.23.29741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that can present with collecting system dilation or as a febrile infection. VUR can lead to permanent renal sequelae requiring surgery but can also spontaneously resolve without complication. Therefore, recognizing patient populations who warrant imaging for screening, confirmation, or ongoing surveillance for VUR is important, as is avoiding overdiagnosis. In the appropriate patient populations, an accurate diagnosis of VUR allows early treatment and prevention of pyelonephritis and scarring. Various imaging modalities are available to diagnose and grade VUR, including voiding cystourethrography, radionucleotide cystography, and contrast-enhanced voiding urosonography (ceVUS). The objective of this article is to summarize the current understanding of VUR diagnosis and management and to discuss these imaging modalities' strengths and pitfalls. Considerations include indications for VUR imaging, patient preparation, conduct of the examination, issues related to radiologic reporting, and cost-effectiveness. An emphasis is placed on ceVUS, which is the most recently introduced of the three imaging modalities and is receiving growing support among pediatric radiologists.
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Affiliation(s)
- Stephanie C Cajigas-Loyola
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, Boston, MA
| | | | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, Seattle, WA
| | - Jeannie Kwon
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Erika Rubesova
- Department of Radiology, Stanford Medicine Children's Health, Palo Alto, CA
| | | | - Mary Wyers
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
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Delis H, Homolka P, Chapple C, Costa P, Attalla E, Lubis L, Sackey T, Fahey F, Lassmann M, Poli G. Developing and implementing a multi-modality imaging optimization study in paediatric radiology: Experience and recommendations from an IAEA coordinated research project. Phys Med 2021; 82:255-265. [DOI: 10.1016/j.ejmp.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
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ALARA: Impact of Practice Quality Improvement Initiative on Dose Reduction in Pediatric Voiding Cystourethrogram. AJR Am J Roentgenol 2015; 205:886-93. [DOI: 10.2214/ajr.14.13492] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ultra low-dose VCUG in children using a modern flat detectorunit. Eur Radiol 2015; 26:1678-85. [DOI: 10.1007/s00330-015-3996-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/16/2015] [Accepted: 09/01/2015] [Indexed: 02/06/2023]
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Page M, Florescu C, Johnstone L, Habteslassie D, Ditchfield M. Paediatric urological investigations--dose comparison between urology-related and CT irradiation. Pediatr Radiol 2013; 43:846-50. [PMID: 23381302 DOI: 10.1007/s00247-013-2635-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/04/2012] [Accepted: 12/19/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Urological investigation in children frequently involves high radiation doses; however, the issue of radiation for these investigations receives little attention compared with CT. OBJECTIVE To compare the radiation dose from paediatric urological investigations with CT, which is commonly regarded as the more major source of radiation exposure. MATERIALS AND METHODS We conducted a retrospective audit in a tertiary paediatric centre of the number and radiation dose of CT scans, micturating cystourethrography exams and urological nuclear medicine scans from 2006 to 2011. This was compared with radiation doses in the literature and an audit of the frequency of these studies in Australia. RESULTS The tertiary centre audit demonstrated that the ratio of the frequency of urological to CT examinations was 0.8:1 in children younger than 17 years. The ratio of the radiation dose of urological to CT examinations was 0.7:1. The ratio in children younger than 5 years was 1.9:1. In Australia the frequency of urological procedures compared with CT was 0.4:1 in children younger than 17 years and 3.1:1 in those younger than 5 years. The ratio of radiation-related publications was 1:9 favouring CT. CONCLUSION The incidence and radiation dose of paediatric urological studies is comparable to those of CT. Nevertheless the radiation dose of urological procedures receives considerably less attention in the literature.
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Affiliation(s)
- Mark Page
- Diagnostic Imaging, Southern Health, 246 Clayton Road, Melbourne, Australia, 3168
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Travassos LV, Boechat MCB, Santos EN, Oliveira SRD, Silva MOD, Carvalho ACP. Avaliação das doses de radiação em uretrocistografia miccional de crianças. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000100006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar o produto dose-área, a dose de entrada na pele do paciente e as doses relativas à fluoroscopia e às radiografias em exames de cistouretrografia miccional em crianças. MATERIAIS E MÉTODOS: Foram avaliados os procedimentos em 37 pacientes, realizados por quatro médicos do serviço. As medições foram realizadas com um equipamento composto de uma câmara de ionização acoplada diretamente à saída do tubo de raios X e um eletrômetro (Diamentor) ligado diretamente ao computador, para a coleta dos dados. RESULTADOS: Foi observada alguma heterogeneidade na realização do procedimento, que não segue padrão de técnica radiográfica. São realizadas em média 11 radiografias por exame, usando tempo longo de fluoroscopia, com dose média final mais alta que a encontrada em referências da literatura. CONCLUSÃO: A adoção da técnica de alta quilovoltagem nas radiografias e o uso restrito da fluoroscopia podem proporcionar importante redução das doses durante a realização deste procedimento, porque o maior contribuinte para as altas doses verificadas foi a utilização da fluoroscopia.
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Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008; 248:254-63. [PMID: 18566177 DOI: 10.1148/radiol.2481071451] [Citation(s) in RCA: 1339] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medical uses of radiation have grown very rapidly over the past decade, and, as of 2007, medical uses represent the largest source of exposure to the U.S. population. Most physicians have difficulty assessing the magnitude of exposure or potential risk. Effective dose provides an approximate indicator of potential detriment from ionizing radiation and should be used as one parameter in evaluating the appropriateness of examinations involving ionizing radiation. The purpose of this review is to provide a compilation of effective doses for radiologic and nuclear medicine procedures. Standard radiographic examinations have average effective doses that vary by over a factor of 1000 (0.01-10 mSv). Computed tomographic examinations tend to be in a more narrow range but have relatively high average effective doses (approximately 2-20 mSv), and average effective doses for interventional procedures usually range from 5-70 mSv. Average effective dose for most nuclear medicine procedures varies between 0.3 and 20 mSv. These doses can be compared with the average annual effective dose from background radiation of about 3 mSv.
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Affiliation(s)
- Fred A Mettler
- Department of Radiology and Nuclear Medicine, New Mexico Veterans Administration Healthcare System, 1501 San Pedro Blvd, Albuquerque, NM 87108, USA.
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Radiation dose to paediatric patients undergoing fluoroscopic examinations performed using digital imaging system. Radiography (Lond) 2008. [DOI: 10.1016/j.radi.2006.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Staton RJ, Williams JL, Arreola MM, Hintenlang DE, Bolch WE. Organ and effective doses in infants undergoing upper gastrointestinal (UGI) fluoroscopic examination. Med Phys 2007; 34:703-10. [PMID: 17388188 DOI: 10.1118/1.2426405] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To provide more detailed data on organ and effective doses in digital upper gastrointestinal (UGI) fluoroscopy studies of newborns and infants, the present study was conducted employing the time-sequence videotape-analysis technique used in a companion study of newborn and infant voiding cystourethrograms (VCUG). This technique was originally pioneered [O. H. Suleiman, J. Anderson, B. Jones, G. U. Rao, and M. Rosenstein, Radiology 178, 653-658 (1991)] for adult UGI examinations. Individual video frames were analyzed to include combinations of field size, field center, x-ray projection, image intensifier, and magnification mode. Additionally, the peak tube potential and the mA or mAs values for each segment/subsegment or digital photospot were recorded for both the fluoroscopic and radiographic modes of operation. The data from videotape analysis were then used in conjunction with a patient-scalable newborn tomographic computational phantom to report both organ and effective dose values via Monte Carlo radiation transport. The study includes dose estimates for five simulated UGI examinations representative of patients ranging from three to six months of age. Effective dose values for UGI examinations ranged from 1.17 to 6.47 mSv, with a mean of 3.14 mSv and a large standard deviation of 2.15 mSv. The colon, lungs, stomach, liver, and esophagus absorbed doses in sum were found to constitute between 63 and 75% of the effective dose in these UGI studies. Representing 23-30% of the effective dose, the lungs were found to be the most significant organ in the effective dose calculation. Approximately 80-95% of the effective dose is contributed by the dynamic fluoroscopy segments with larger percentages found in longer studies. The mean effective dose for newborn UGI examinations was not found to be statistically different from that seen in newborn VCUG examinations.
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Affiliation(s)
- Robert J Staton
- Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, Florida 32611-8300, USA
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Pazik FD, Staton RJ, Williams JL, Arreola MM, Hintenlang DE, Bolch WE. Organ and effective doses in newborns and infants undergoing voiding cystourethrograms (VCUG): A comparison of stylized and tomographic phantoms. Med Phys 2006; 34:294-306. [PMID: 17278515 DOI: 10.1118/1.2402329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The time-sequence videotape-analysis methodology, developed [Sulieman et al., Radiology 178, 653-658 (1991)] for use in tissue dose estimations in adult fluoroscopy examinations and utilized [Bolch et al., Med. Phys. 30, 667-680 (2003)] for analog fluoroscopy in newborn patients, has been extended to the study of digital fluoroscopic examinations of the urinary bladder in newborn and infant female patients. Individual frames of the fluoroscopic and radiographic video were analyzed with respect to unique combinations of field size, field center, projection, tube potential, and tube current (mA), and integral tube current (mAs), respectively. The dosimetry study was conducted on five female patients of ages ranging from four-days to 66 days. For each patient, three different phantoms were utilized: a stylized computational phantom of the reference newborn (3.5 kg), a tomographic computational phantom of the reference newborn (3.5 kg), and (3) a tomographic computational phantom uniformly rescaled to match patient total-body mass. The latter phantom set circumvented the need for mass-dependent rescaling of recorded technique factors (kVp, mA, mAs, etc.), and thus represented the highest degree of patient specificity in the individual organ dose assessment. Effective dose values for the voiding cystourethrogram examination ranged from 0.6 to 3.2 mSv, with a mean and standard deviation of 1.8+/-0.9 mSv. The ovary and colon equivalent doses contributed in total approximately 65%-80% of the effective dose in these fluoroscopy studies. Percent differences in the effective dose assessed using the two tomographic phantoms (one fixed at 3.5 kg with rescaled technique factors rescaled and one physically rescaled to individual patient masses with no adjustment of recorded technique factors) ranged for -49% to +15%. Percent differences in effective dose found using the 3.5 kg stylized phantom and the 3.5 kg tomographic phantom, both with patient-specific rescaling of technique factors, ranged from -10% to +17%. These differences are due in part to a reduced ovary dose in the tomographic phantom for right posterior oblique (RPO) views when compared to those seen in the stylized phantom.
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Affiliation(s)
- Frank D Pazik
- Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, Florida 32611-8300, USA
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Berrocal T, Alonso A, Bravo A, Gutiérrez J, de Pablo L. Estudio radiológico de las duplicaciones del tracto urinario. RADIOLOGIA 2005. [DOI: 10.1016/s0033-8338(05)72803-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Berrocal T, Gayá F, Arjonilla A. Vesicoureteral Reflux: Can the Urethra Be Adequately Assessed by Using Contrast-enhanced Voiding US of the Bladder? Radiology 2005; 234:235-41. [PMID: 15618383 DOI: 10.1148/radiol.2341031503] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate contrast material-enhanced voiding ultrasonography (US) for assessment of the urethra by using voiding cystourethrography (VCUG) as the reference standard. MATERIALS AND METHODS This study was approved by the ethics committee on human research. Written informed consent was obtained for all patients. A total of 146 pediatric patients suspected of having vesicoureteral reflux underwent US with a galactose-based contrast agent. The bladder was instilled with contrast agent and then filled with saline. US images of the urethra were videotaped before catheterization and during voiding. VCUG was subsequently performed in all patients. In female patients, the probe (a 3.5- or 5-MHz sector array or a 7.5-MHz linear transducer) was positioned longitudinally between the labia. In male patients, the transducer was placed longitudinally on the scrotum and then displaced distally toward the penile urethra. During voiding, attention was focused on the distention of the urethral walls and on the caliber of both the posterior and anterior urethra, which were measured with calipers. Sensitivity and specificity were estimated by using a confidence interval (CI) of 95%. RESULTS All female patients and 75 male patients showed a normal urethra at both US and VCUG. Posterior urethral valves (PUV) were diagnosed in three patients at voiding US and were confirmed with findings from VCUG. Urethral stenosis was diagnosed in two male patients at voiding US and was confirmed with findings from VCUG. Seven male patients who had undergone surgery for PUV were adequately evaluated with both modalities. Sensitivity of voiding US was 100% (CI 95%: 96.5%, 100%); specificity was 100% (CI 95%: 69.9%, 100%). CONCLUSION Voiding US is a reliable imaging modality for studying the urethra.
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Affiliation(s)
- Teresa Berrocal
- Department of Pediatric Radiology, University Hospital La Paz, Paseo de la Castellana 246, 28046 Madrid, Spain.
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Fotakis M, Molyvda Athanasopoulou E, Psarrakos K, Economou I. Radiation doses to paediatric patients up to 5 years of age undergoing micturating cystourethrography examinations and its dependence on patient age: a Monte Carlo study. Br J Radiol 2003; 76:812-7. [PMID: 14623783 DOI: 10.1259/bjr/31857098] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The effective dose received by children up to 5 years of age from micturating cystourethrography (MCU) examinations was estimated in this study. The MCU examination consisted of 5 radiological views, 2 anteroposterior (AP) and three oblique (OBL) views. Entrance surface doses (ESD) were measured with thermoluminescent dosimeters for 30 children. The average ESD values per view varied from 0.34 mGy up to 0.57 mGy. In order to calculate the organ and effective doses, Monte Carlo MCNP-4A radiation transport simulation code was used. It was applied to three mathematical phantoms representing newborn, 1 and 5 year old children and all the patients were classified in those three groups. The effective dose conversion factors (C(f)) were calculated as the ratio of effective dose over the entrance dose. The C(f) factors decrease as the children's age increases. Children simulated by a newborn mathematical phantom, had C(f) factors almost double those represented by a 1-year-old mathematical phantom. For children simulated by a 5 year old phantom, the C(f) factors for AP and OBL views were almost the same. This was true for both male and female patients. The mean effective dose per view for male and female patients was found to be E=0.16 mSv. The effective dose per examination for male patients was E=0.86+/-0.31 mSv and E=0.76+/-0.28 mSv for female patients.
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Affiliation(s)
- M Fotakis
- Department of Medical Physics, Medical School, Aristotelian University of Thessaloniki, Thessaloniki 54124, Greece
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Bolch WE, Pomije BD, Sessions JB, Arreola MM, Williams JL, Pazik FD. A video analysis technique for organ dose assessment in pediatric fluoroscopy: applications to voiding cystourethrograms (VCUG). Med Phys 2003; 30:667-80. [PMID: 12722819 DOI: 10.1118/1.1561624] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The time-sequence videotape-analysis methodology, originally developed by Sulieman et al. [Radiol. 178, 653-658 (1991)] for use in tissue dose estimation in adult fluoroscopy exams, has been adapted to the study of the newborn voiding cystourethrogram (VCUG). Individual frames of fluoroscopic and radiographic video were analyzed with respect to unique combinations of field size, field center, projection, tube potential, and mA or mAs, respectively. A modified version of the stylized ORNL newborn model was coupled to the MCNP4C radiation transport code to report organ doses per unit entrance air kerma (free-in-air) for each identified x-ray field. A series of urinary bladder models was additionally developed representing the organ at differing stages of contrast filling. The technique was subsequently applied to two patients, a 3-month male and a 1-month female, examined via a conventional fluoroscopy system used just prior to departmental conversion to digital systems. The effective dose to these patients was estimated as 0.47 mSv and 1.36 mSv, respectively (ratio of 2.9). Corresponding ratios of cumulative fluoroscopy time and entrance air kerma were 2.2 and 1.6, respectively. For the male patient, the mean percent dose contribution from fluoroscopy for all irradiated organs was 71 +/- 12%, while that value for the female patient was 88 +/- 4%.
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Affiliation(s)
- Wesley E Bolch
- Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, Florida 32611-8300, USA.
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King S, Pitcher EM, Smail MA. Optimizing medical radiation exposures for uroradiological procedures, with special emphasis on paediatric imaging. BJU Int 2002; 89:510-6. [PMID: 11942954 DOI: 10.1046/j.1464-410x.2002.02660.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S King
- Department of Paediatric Radiology, United Bristol Healthcare NHS Trust, Bristol, UK.
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Berrocal T, Gayá F, Arjonilla A, Lonergan GJ. Vesicoureteral reflux: diagnosis and grading with echo-enhanced cystosonography versus voiding cystourethrography. Radiology 2001; 221:359-65. [PMID: 11687676 DOI: 10.1148/radiol.2212001807] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the usefulness of echo-enhanced cystosonography compared with voiding cystourethrography (VCUG) for detecting and grading vesicoureteral reflux (VUR). MATERIALS AND METHODS Two hundred sixteen pediatric patients underwent cystosonography enhanced with SH U 508A, a galactose-based echo-enhancing agent. Sonograms of the kidneys and bladder were obtained before filling, during bladder filling, and during voiding. This examination was followed immediately with VCUG. Each kidney or portion of a kidney with its own complete collecting system was considered separately, for a total of 440 kidney units. RESULTS VUR was detected in 123 kidney units at cystosonography and in 104 at VCUG. In 401 kidney units, there was concordance between results at cystosonography and at VCUG regarding the presence or absence of VUR. Ninety-four kidney units showed VUR with both methods. Seventy-seven of the 94 refluxing units were depicted with the same grade of VUR with both modalities, and in 17 the VUR grade was greater at cystosonography than at VCUG. Twenty-nine of the 94 units showed VUR at only cystosonography, and 10 units at only VCUG. The McNemar test showed that cystosonography depicted a significantly (P = .003) higher number of units with VUR. By patient, VUR was depicted with both studies in 67 and with only one study in 25. VUR was seen at only cystosonography in 16 patients and at only VCUG in nine. The McNemar test for patients showed no significant difference between the two tests in detection of VUR. CONCLUSION Cystosonography with SH U 508A appears comparable to VCUG in the depiction of VUR.
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Affiliation(s)
- T Berrocal
- Department of Pediatric Radiology, University Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Giacco G, Cannata V, Furetta C, Santopietro F, Fariello G. On the use of pediatric phantoms in the dose evaluation during computed tomography (CT) thorax examinations. Med Phys 2001; 28:199-204. [PMID: 11243344 DOI: 10.1118/1.1344205] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This paper presents the dosimetric results obtained during computed tomography (CT) thorax examinations, carried out using two different techniques, i.e., sequential CT (SQCT) and helical CT (HECT). The radiological examinations have been carried out on pediatric phantoms expressly designed and realized. Four different phantoms have been realized, according to the children shapes of 0, 2, 6, and 12 years old. The dosimetric measurements have been carried out using thermoluminescent dosimeters. The comparison of the dosimetric data obtained using the two different techniques shows that there is not any relevant difference between them as far as the entrance dose and the doses received by the critical organs are concerned.
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Affiliation(s)
- G Giacco
- Servizio di Fisica Sanitaria, Policlinico Umberto I, Roma, Italy
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Berrocal Frutos T, Gayá Moreno F, Gómez León N, Jaureguízar Monereo E. Ecocistografía con contraste: una nueva modalidad de imagen para diagnosticar el reflujo vesicoureteral. An Pediatr (Barc) 2000. [DOI: 10.1016/s1695-4033(00)78624-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Schultz FW, Geleijns J, Holscher HC, Weststrate J, Zonderland HM, Zoetelief J. Radiation burden to paediatric patients due to micturating cystourethrography examinations in a Dutch children's hospital. Br J Radiol 1999; 72:763-72. [PMID: 10624342 DOI: 10.1259/bjr.72.860.10624342] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Micturating cystourethrography (MCU) examinations of paediatric patients in a major Dutch children's hospital (JKZ) were evaluated to generate quantitative information on effective dose (E). A standard examination involves three radiographs plus fluoroscopy. Observed total dose-area product (DAP) for 84 children increased, on average, with increasing age class from 0.2 to 2.2 Gy cm2. In 11 cases, separate DAP per view was measured; enabling determination, per view, of organ (CF) and effective (CE) dose conversion factors, i.e. dose per unit of DAP. Monte Carlo simulation of photon transport in male and female mathematical phantoms was applied for newborn, 1 year, 5 year, 10 year and 15-year-old patients, and interpolated for other ages. CE per view decreases with increasing age class, yielding about a factor of 10 difference between the extremes of the range. Female values are usually some 20-30% above male ones. CE for one of the views appeared to be representative for the complete examination and was used to estimate total E for each patient. Averaged per age class, E remains approximately constant at 0.3-0.4 mSv, although a tendency to increase with increasing age exists, for females in particular. Within an age class, individual patients may differ in E by a factor of two up to six. Stomach, lower large intestine, bladder wall, liver and ovaries receive relatively high doses. Compared with published data and DAP measured in a few other Dutch hospitals, the radiation burden of MCU is low at the JKZ. This indicates a good degree of optimization with respect to radiation protection (e.g. modern equipment, increased tube voltage, fast film-screen combination).
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Affiliation(s)
- F W Schultz
- IRI/TNO Centre for Radiological Protection and Dosimetry, Delft, The Netherlands
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Ruiz MJ, Vañó E, González L, Fernández JM. Dose-area product values in frequently performed complex paediatric radiology examinations. Br J Radiol 1996; 69:160-4. [PMID: 8785645 DOI: 10.1259/0007-1285-69-818-160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Mean values of the dose-area product for barium meal, micturating cystourethrography and intravenous urography examinations from three health centres and for four age groups are presented in this study. Values measured are between 13% and 86% higher than results previously reported, which justifies the importance of applying procedures which reduce risks to patients.
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Affiliation(s)
- M J Ruiz
- Radiology Department, School of Medicine, Complutense University Madrid, Spain
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