1
|
Shelly E, Waldron MG, Field E, Moore N, Young R, Scally A, England A, Maher M, McEntee MF. Cumulative Radiation Dose from Medical Imaging in Children with Congenital Heart Disease: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040645. [PMID: 37189893 DOI: 10.3390/children10040645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
Children with congenital heart disease are exposed to repeated medical imaging throughout their lifetime. Although the imaging contributes to their care and treatment, exposure to ionising radiation is known to increase one's lifetime attributable risk of malignancy. A systematic search of multiple databases was performed. Inclusion and exclusion criteria were applied to all relevant papers and seven were deemed acceptable for quality assessment and risk of bias assessment. The cumulative effective dose (CED) varied widely across the patient cohorts, ranging from 0.96 mSv to 53.5 mSv. However, it was evident across many of the included studies that a significant number of patients were exposed to a CED >20 mSv, the current annual occupational exposure limit. Many factors affected the dose which patients received, including age and clinical demographics. The imaging modality which contributed the most radiation dose to patients was cardiology interventional procedures. Paediatric patients with congenital heart disease are at an increased risk of receiving an elevated cumulative radiation dose across their lifetime. Further research should focus on identifying risk factors for receiving higher radiation doses, keeping track of doses, and dose optimisation where possible.
Collapse
Affiliation(s)
- Emer Shelly
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Michael G Waldron
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
| | - Erica Field
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Andy Scally
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Michael Maher
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
- Department of Medicine, University College Cork, T12 AK54 Cork, Ireland
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| |
Collapse
|
2
|
Sieverding L, Michel J, Urla C, Sturm E, Winkler F, Hofbeck M, Fuchs J, Hilberath J, Warmann SW. Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access. Front Nutr 2022; 9:863063. [PMID: 35419386 PMCID: PMC8995563 DOI: 10.3389/fnut.2022.863063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Loss of available central vein access sites for parenteral nutrition delivery represents one of the main indications for intestinal transplantation in children with intestinal failure. Placement of central venous catheters can be challenging in advanced loss of patent venous pathways. We recently described the hybrid technique (interventional plus surgical approach) of central line placement in children. The aim of this study was to describe and analyze the interventions used during the hybrid procedures regarding feasibility, safety and outcome. Methods We retrospectively analyzed the course of all children in our intestinal rehabilitation program undergoing hybrid central line placement. We evaluated patients' conditions, interventional techniques and surgical peculiarities as well as outcome. Results 203 children were treated in our intestinal rehabilitation program between 2010 and 2021. Due to loss of venous access, hybrid technique was performed in 53 children during 76 interventions. In 40 cases the same vessel was reused via Seldinger technique. Among the 30 ultrasound-guided new vessel punctures, 12 were performed by puncture of collateral vessels. Extended interventions due to thoracic central venous obstruction and/or thrombosis requiring additional access via a femoral vein for rehabilitation of the vascular system was performed during 29 procedures including catheter extraction (1), angioplasties (18), stent placement (1), revascularization (5) and thrombectomy (4). Placement of a central line was not possible in 6 children which eventually underwent extended thoracic/vascular surgery: in three children the previously placed catheter could not be removed, in one child, placement of a thrombectomy-catheter was not possible because of inferior vena cava occlusion, and in two children, revascularization failed. Intestinal transplantation was considered in one patient because of impending loss of vascular access. Two self-limiting minor extravasations and one intervention-associated pericardial effusion occurred. Conclusions Hybrid interventions for central venous catheter placement and vascular rehabilitation enable a high success rate in children with intestinal failure and end-stage vascular access, circumventing the need for intestinal transplantation or advanced surgery. The relevant procedures are complex and require a foresighted and individualized approach with a wide range of interventional techniques. If performed with expertise, this combined interventional/surgical approach is feasible and safe.
Collapse
Affiliation(s)
- Ludger Sieverding
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Jörg Michel
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Christian Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Ekkehard Sturm
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Franziska Winkler
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Johannes Hilberath
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Steven Walter Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| |
Collapse
|
3
|
Yuya I, Urikura A, Yoshida T, Takiguchi K, Ikegaya M. Inaccurate table height setting affects the organ-specific radiation dose in computed tomography. Eur J Radiol 2022; 151:110317. [DOI: 10.1016/j.ejrad.2022.110317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
|
4
|
Sarycheva SS. EFFECTIVE DOSE IN PEDIATRIC INTERVENTIONAL CARDIOLOGY. RADIATION PROTECTION DOSIMETRY 2021; 195:273-278. [PMID: 33836530 DOI: 10.1093/rpd/ncab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study was to estimate the effective doses (EDs) to children undergoing pediatric interventional cardiology examinations in hospitals of St.-Petersburg, to calculate associated dose conversion coefficients (DCCs) and to investigate their dependence of different parameters of the various procedures. Basic parameters of pediatric cardiology examinations and patient doses were studied in three main pediatric city hospitals. More than 300 examinations were under consideration. The technical, geometrical and dosimetric parameters, as well as patients' parameters, for each individual procedure were collected. All cardiac examinations were divided into five age groups (newborn, 1, 5, 10 and 15 y old). The EDs and the corresponding DCCs from the dose-area product to ED were calculated using PCXMC 2.0 software and based on the collected data. The study included the evaluation of the relations between the DCCs, patient age and parameters of examinations. The results of the study indicated significant dependence of the DCCs on the patients' age and the beam quality. The DCCs for the newborns and 15-year old groups differed by a factor of 10. The maximum estimated ED of 26 mSv was found in the newborn age group.
Collapse
Affiliation(s)
- S S Sarycheva
- Radiation Protection Laboratory, Saint-Petersburg Research Institute of Radiation Hygiene, Saint Petersburg, Mira st. 8, 197101 St.Petersburg, Russian Federation, Russia
| |
Collapse
|
5
|
Takiguchi K, Urikura A, Yoshida T, Nakaya Y, Endo M, Aramaki T. Radiation dose and image quality of CT fluoroscopy with partial exposure mode. ACTA ACUST UNITED AC 2021; 26:333-338. [PMID: 32490834 DOI: 10.5152/dir.2019.19091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The present study aimed to evaluate the scan technique of computed tomography (CT)-guided puncture procedures using partial exposure mode (PEM) on the radiation dose of the operator's hand and image quality. METHODS Radiation dose was evaluated using three types of scanning methods: one-shot scan (OS), OS with a bismuth shield added (OSBismuth), and a half-scan (i.e., PEM) capable of an adjustable exposure angle. Dose evaluation was performed using a torso phantom, while a circular phantom simulating the liver parenchyma and lesions was used for image quality evaluation. For each scanning method, four measurements were made to determine the radiation dose to the operator's hand and the dose distribution on the surface of the patient's torso; the output-dose profile was determined from five measurements. Image quality was evaluated in terms of contrast and contrast-to-noise ratio (CNR). Analysis of variance (ANOVA) or Friedman test were used for comparison between groups as appropriate. The post hoc tests were Tukey's honestly difference (HSD) test for parametric data or Wilcoxon signed rank test with Bonferroni correction for nonparametric data. RESULTS The PEM yielded a radiation dose to the operator's hand that was 84% (0.35 vs. 2.33 mGy) lower than that of the OS. The dose to the patient's torso was reduced by 35% and 68% for the OSBismuth and PEM, respectively, relative to that of the OS. Compared with the CNR of the other two scanning methods (OS, 2.9±0.1; OSBismuth, 2.9±0.1), the PEM increased the standard deviation and decreased the CNR (2.1±0.04, Tukey's HSD, P < 0.001 for all). Images acquired with PEM showed visibility equivalent to that of other scanning methods when window conditions were adjusted. CONCLUSION This study demonstrated that CT-guided puncture procedure using PEM effectively reduces the operator's exposure to radiation while minimizing image quality deterioration.
Collapse
Affiliation(s)
- Keisuke Takiguchi
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Atsushi Urikura
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tsukasa Yoshida
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshihiro Nakaya
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| |
Collapse
|
6
|
Fum WKS, Wong JHD, Tan LK. Monte Carlo-based patient internal dosimetry in fluoroscopy-guided interventional procedures: A review. Phys Med 2021; 84:228-240. [PMID: 33849785 DOI: 10.1016/j.ejmp.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This systematic review aims to understand the dose estimation approaches and their major challenges. Specifically, we focused on state-of-the-art Monte Carlo (MC) methods in fluoroscopy-guided interventional procedures. METHODS All relevant studies were identified through keyword searches in electronic databases from inception until September 2020. The searched publications were reviewed, categorised and analysed based on their respective methodology. RESULTS Hundred and one publications were identified which utilised existing MC-based applications/programs or customised MC simulations. Two outstanding challenges were identified that contribute to uncertainties in the virtual simulation reconstruction. The first challenge involves the use of anatomical models to represent individuals. Currently, phantom libraries best balance the needs of clinical practicality with those of specificity. However, mismatches of anatomical variations including body size and organ shape can create significant discrepancies in dose estimations. The second challenge is that the exact positioning of the patient relative to the beam is generally unknown. Most dose prediction models assume the patient is located centrally on the examination couch, which can lead to significant errors. CONCLUSION The continuing rise of computing power suggests a near future where MC methods become practical for routine clinical dosimetry. Dynamic, deformable phantoms help to improve patient specificity, but at present are only limited to adjustment of gross body volume. Dynamic internal organ displacement or reshaping is likely the next logical frontier. Image-based alignment is probably the most promising solution to enable this, but it must be automated to be clinically practical.
Collapse
Affiliation(s)
- Wilbur K S Fum
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| |
Collapse
|
7
|
Rizk C, Fares G, Vanhavere F, Saliba Z, Farah J. Diagnostic Reference Levels, Deterministic and Stochastic Risks in Pediatric Interventional Cardiology Procedures. HEALTH PHYSICS 2020; 118:85-95. [PMID: 31764423 DOI: 10.1097/hp.0000000000001114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To establish diagnostic reference levels (DRLs) and investigate deterministic and stochastic risks in pediatric interventional cardiology (IC) procedures. Exposure parameters were retrospectively reviewed for 373 patients treated between May 2016 and November 2018 at a single specialized hospital. Weight specific DRLs were derived for pediatric IC procedures. Additionally, peak skin dose (Dskin,max) was measured using thermoluminescent dosimeters for a sample of 7 diagnostic and 43 therapeutic procedures. Finally, using PCXMC software, organ doses were computed and the risk of exposure-induced cancer death (REID) was estimated using the risk models of the Biological Effects of Ionizing Radiation VII committee. DRLs for ventricular septal defect (VSD) occlusions, lacking in the literature, in terms of air kerma at patient entrance reference point (388 and 629 mGy) and total air kerma-area product (28 and 61 Gycm) were proposed for patients weight-groups 5 - < 15 kg and 15 - < 30 kg, respectively. The mean (range) Dskin,max was 15 (1-30) mGy and 94 (1-491) mGy for diagnostic and therapeutic procedures, respectively. Meanwhile, VSD occlusion involved the highest organ doses where the lungs, liver, stomach, and breasts mean doses were 57, 37, 6, and 10 mGy, respectively, and the associated REID were 0.5% and 0.3% in female and male patients, respectively. DRLs were proposed for pediatric IC procedures; these will help optimize patient exposure. Dskin,max values were lower than the 2 Gy threshold for skin injuries. Pediatric organ doses and the REID were the highest during VSD occlusion and may be critical for repetitive procedures.
Collapse
Affiliation(s)
| | - Georges Fares
- Faculty of Sciences, Saint Joseph University, 11-514 Beirut, Lebanon
| | - Filip Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), BE-2400 Mol, Belgium
| | - Zakhia Saliba
- Department of pediatrics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Jad Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, 94270 Le Kremlin-Bicêtre, France
| |
Collapse
|
8
|
Kawasaki T, Sakakubo M, Ito K, Kitagawa A. ESTIMATION OF ORGAN DOSES AND EFFECTIVE DOSES BASED ON IN-PHANTOM DOSIMETRY FOR PAEDIATRIC DIAGNOSTIC CARDIAC CATHETERISATION. RADIATION PROTECTION DOSIMETRY 2019; 185:215-221. [PMID: 30624664 DOI: 10.1093/rpd/ncy298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/29/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
The present study evaluated the organ doses, effective doses and conversion factors from the dose-area product to effective dose in pediatric diagnostic cardiac catheterization performed by in-phantom dosimetry and Monte Carlo simulation. The organ and effective doses in 5-y-olds during diagnostic cardiac catheterizations were evaluated using radiophotoluminescence glass dosemeters implanted into a pediatric anthropomorphic phantom and PCXMC software. The mean effective dose was 3.8 mSv (range: 1.8-7.5 mSv). The conversion factors from the dose-area product to effective dose were 0.9 and 1.6 mSv (Gy cm2)-1 for posteroanterior and lateral fluoroscopy, respectively, and 0.9 and 1.5 mSv (Gy cm2)-1 for posteroanterior and lateral cineangiography, respectively. Effective doses evaluated using the pediatric dosimetry system agreed with those obtained using PCXMC software within 12%. The dose data and conversion factors evaluated may guide the estimation of exposure doses in children undergoing diagnostic cardiac catheterization.
Collapse
Affiliation(s)
- Toshio Kawasaki
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| | - Masami Sakakubo
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| | - Kanako Ito
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| | - Ai Kitagawa
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| |
Collapse
|
9
|
Ubeda C, Salazar L, Retana V, Gutierrez R, Nocetti D, Reyes C. Organ doses in paediatric interventional cardiology. First values for patients in Costa Rica. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2019.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Kawasaki T, Sakakubo M, Ito K. ESTIMATION OF ORGAN DOSES AND EFFECTIVE DOSES BASED ON IN-PHANTOM DOSIMETRY FOR INFANT DIAGNOSTIC CARDIAC CATHETERISATIONS WITH NOVEL X-RAY IMAGING TECHNOLOGY. RADIATION PROTECTION DOSIMETRY 2019; 183:528-533. [PMID: 30289542 DOI: 10.1093/rpd/ncy174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/29/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
The present study evaluated the organ and effective doses in infant diagnostic cardiac catheterisation performed using a modern x-ray imaging unit by in-phantom dosimetry. In addition, conversion factors from dose-area product (DAP) to effective dose were determined. The organ and effective doses in 1-year old during diagnostic cardiac catheterisations were measured using radiophotoluminescence glass dosemeters implanted into an infant anthropomorphic phantom. The mean effective doses, evaluated according to the International Commission on Radiologic Protection Publication 103, were 4.0 mSv (range: 1.5-8.7 mSv). The conversion factors from DAP to effective dose were 2 and 3.5 mSv (Gy cm2)-1 for posteroanterior and lateral fluoroscopy, respectively, and 1.8 and 3.3 mSv (Gy cm2)-1 for posteroanterior and lateral cineangiography, respectively. The dose data and conversion factors evaluated in the present study may be useful for estimating radiation exposure in infants during diagnostic cardiac catheterisation.
Collapse
Affiliation(s)
- Toshio Kawasaki
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| | - Masami Sakakubo
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| | - Kanako Ito
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| |
Collapse
|
11
|
Ubeda C, Vano E, Miranda P, Figueroa X. Organ and effective doses detriment to paediatric patients undergoing multiple interventional cardiology procedures. Phys Med 2019; 60:182-187. [PMID: 31000081 DOI: 10.1016/j.ejmp.2019.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/10/2019] [Accepted: 03/19/2019] [Indexed: 11/29/2022] Open
Abstract
The aims of the present study were to present the frequency of multiple interventional cardiac procedures for a certain group of patients obtained at one of the largest paediatric hospitals in Chile. In addition it has been analysed cumulative kerma area product (KAP) and cumulative air kerma (CAK), and calculated organ doses for the patient groups undergoing 2, 3 and ≥ 4 procedures, using Monte Carlo software. Effective doses were also estimated for epidemiological purposes and to permit comparison with other imaging procedures. The sample used corresponds to the last 9 years and refers to a total of 1521 paediatric patients and 1824 interventional cardiac procedures. The results for frequency were: 13.7% of patients underwent 2 procedures, 4.1% underwent 3 procedures and 1.4% underwent 4 or more procedures. The median KAP and CAK values measured for the cumulative procedures in these three groups of patients were 3.7, 5.4 and 10.8 Gy·cm2 and 59.9, 83.2 and 147.6 mGy, respectively. In terms of the most irradiated organs during interventional cardiac procedures, the highest median values (for the group of ≥4 procedures) were: active bone marrow 5.0 mGy, lungs 23.5 mGy, oesophagus 15.2 mGy, thyroid 7.8 mGy and breast 11.0 mGy. Median dose value to the heart (for the group of ≥4 procedures) was 12.7 mGy. Median values in terms of calculated effective dose for the three patient groups (with 2, 3 and ≥4 procedures) were 3.4, 5.9 and 8.7 mSv, respectively.
Collapse
Affiliation(s)
- Carlos Ubeda
- Medical Technology Department, Health Sciences Faculty, Universidad de Tarapacá, Arica, Chile.
| | - Eliseo Vano
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - Patricia Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Ximena Figueroa
- Medical Technology Department, Health Sciences Faculty, Universidad de Tarapacá, Arica, Chile
| |
Collapse
|
12
|
Towards the definition of Institutional diagnostic reference levels in paediatric interventional cardiology procedures in Greece. Phys Med 2018. [PMID: 29519409 DOI: 10.1016/j.ejmp.2018.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study aimed to evaluate paediatric radiation doses in a dedicated cardiology hospital, with the objective of characterising patterns in dose variation. The ultimate purpose was to define Local (Institutional) Diagnostic Reference Levels (LDRLs) for different types of paediatric cardiac interventional procedures (IC), according to patient age. From a total of 710 cases performed during three consecutive years, by operators with more than 15 years of experience, the age was noted in only 477 IC procedures. The median values obtained for Fluoroscopy Time (FT), Number of Frames (N) and Kerma Area Product (PKA) by age range were 5.8 min, 1322 and 2.0 Gy.cm2 for <1 y; 6.5 min, 1403 and 3.0 Gy.cm2 for 1 to <5 y; 5.9 min, 950 and 7.0 Gy.cm2 for 5 to <10 y; 5.7 min, 940 and 14.0 Gy.cm2 for 10 to <16 y, respectively. A large range of patient dose data is observed, depending greatly on procedure type and patient age. In all age groups the range of median FT, N and PKA values was 3.1-15.8 min, 579-1779 and 1.0-20.8 Gy.cm2 respectively. Consequently, the definition of LDRLs presents challenges mainly due to the multiple clinical and technical factors affecting the outcome. On the other hand the lack of paediatric IC DRLs makes the identification of good practices more difficult. A consensus is needed on IC procedures nomenclature and grouping in order to allow a common assessment and comparison of doses.
Collapse
|
13
|
Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous access. J Pediatr Surg 2018; 53:553-557. [PMID: 28365108 DOI: 10.1016/j.jpedsurg.2017.03.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/23/2017] [Accepted: 03/19/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study is to analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access. METHODS Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention; catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions. RESULTS Median age at intervention was 47months (interquartile range (IQR),29-74), median time for interventions was 66min (IQR,42-111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2Gy*cm2 (IQR, 0.2-0.6), no complications occurred during or after interventions. CONCLUSIONS Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE Level IV.
Collapse
|
14
|
Ubeda C, Miranda P, Vano E, Nocetti D, Manterola C. Organ and effective doses from paediatric interventional cardiology procedures in Chile. Phys Med 2017; 40:95-103. [PMID: 28743619 DOI: 10.1016/j.ejmp.2017.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/26/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022] Open
Abstract
The aim of this study was to present the results of organ and effective doses for paediatric patients for different types of interventional cardiology procedures for age and weight groups, derived from a patient dosimetry pilot programme carried out in Chile, under the auspices of the International Atomic Energy Agency. Over seven years, a retrospective collection of demographic and patient dose data was obtained: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time, dose-area product (DAP) and cumulative dose at patient entrance reference point. Monte Carlo software was used to calculate organ and effective doses. 1506 procedures were divided into four age and seven weight groups. Organ doses (median values) for diagnostic and therapeutic procedures were: active bone marrow 0.90 and 0.64mGy; heart 1.99 and 1.46mGy; lungs 3.56 and 2.59mGy; thyroid 1.27 and 0.83; and breast (in the case of females) 1.78 and 1.36mGy. The ranges for effective doses (median values) and weight bands were 1.2-3.9mSv for diagnostic procedures and 1.0-2.5mSv for therapeutic procedures. The resulting conversion factors (median values) to estimate effective dose from DAP (in mSv/Gy.cm2) were: 1.70; 0.89; 0.58; and 0.40, for age groups of <1year, 1-<5years, 5-<10years and 10-<16years, respectively. The obtained set of dose values will enable comparisons with other imaging procedures (comparing the same age bands) for justification and optimization purposes.
Collapse
Affiliation(s)
- Carlos Ubeda
- Medical Technology Department, Radiological Sciences Center, Health Sciences Faculty, Tarapaca University, Arica, Chile.
| | - Patricia Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Eliseo Vano
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - Diego Nocetti
- Medical Technology Department, Radiological Sciences Center, Health Sciences Faculty, Tarapaca University, Arica, Chile
| | - Carlos Manterola
- Hepatobiliary Surgery Unit, Department of Surgery, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
| |
Collapse
|
15
|
Harbron RW, Dreuil S, Bernier MO, Pearce MS, Thierry-Chef I, Chapple CL, Baysson H. Patient radiation doses in paediatric interventional cardiology procedures: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:R131-R144. [PMID: 27893455 DOI: 10.1088/0952-4746/36/4/r131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A large number of investigations into the radiation doses from x-ray guided interventional cardiology procedures in children have been carried out in recent years. A review was conducted of these studies, gathering data on kerma area product (P KA), fluoroscopic screening time (FT), air kerma, and estimates of effective dose and organ doses. The majority of studies focus on P KA and FT with no estimation of dose to the patient. A greater than ten-fold variation in average P KA was found between different studies, even where data were stratified by patient age or weight. Typical values of P KA were 0.6-10 Gy · cm2 (<1 year/10 kg), 1.5-30 Gy · cm2 (1-5 years), 2-40 Gy · cm2 (5-10 years), 5-100 Gy · cm2 (10-16 years) and 10-200 Gy · cm2 (>16 years). P KA was lowest for heart biopsy (0.3-10 Gy · cm2 for all ages combined) and atrial septostomy (0.4-4.0 Gy · cm2), and highest for pulmonary artery angioplasty (1.5-35 Gy · cm2) and right ventricular outflow tract dilatation (139 Gy · cm2). Most estimates of patient dose were in the form of effective dose (typically 3-15 mSv) which is of limited usefulness in individualised risk assessment. Few studies estimated organ doses. Despite advances in radiation protection, recent publications have reported surprisingly large doses, as represented by P KA and air kerma. There is little indication of a fall in these dose indicators over the last 15 years. Nor is there much suggestion of a fall in doses associated with the use of flat panel detectors, as opposed to image intensifiers. An assessment of the impact of radiation dose in the context of overall patient outcome is required.
Collapse
Affiliation(s)
- R W Harbron
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP, UK. NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, Newcastle-upon-Tyne, UK
| | | | | | | | | | | | | |
Collapse
|