Clinical study
Estimates of Effective Dose to Pediatric Patients Undergoing Enteric and Venous Access Procedures

https://doi.org/10.1016/j.jvir.2011.11.020Get rights and content

Abstract

Purpose

To determine the range of effective doses encountered during common enteric and venous access procedures by using a method to estimate effective dose based on fluoroscopy time.

Materials and Methods

A pediatric phantom and metal oxide semiconductor field-effect transistor model was used to calculate effective doses associated with nine enteric and venous access procedures involving fluoroscopy only. Enteric procedures included primary gastrostomy, gastrojejunostomy, cecostomy tube insertions, and their “maintenance procedures” (eg, tube checks and changes, reinsertions, and exchanges). Venous access procedures included insertion of peripherally inserted central catheters, central venous catheters, and port catheters. Effective dose estimates were determined from phantom simulations of each procedure accounting for patient age, collimation, magnification, and tube position. Effective dose calculations from the simulations were normalized to fluoroscopy time, resulting in age- and procedure-specific factors (in mSv·min−1). These factors were retrospectively applied to fluoroscopy times logged in a database for 7,074 patient encounters, yielding a range of effective dose estimates for each procedure type.

Results

From 3,699 venous access procedures reviewed, the mean effective dose was 0.1 mSv (range, 0.01–3.28 mSv). Review of 3,405 enteric access procedures showed doses that vary considerably, with mean doses of 0.3–1.7 mSv (range, 0.01–11.35 mSv). Several complex cases were identified with doses exceeding 4 mSv. Maintenance enteric procedures usually required lower doses (approximately 50%) than primary insertions.

Conclusions

Effective doses for pediatric enteric and venous access procedures performed in children are generally low. In difficult cases, effective doses can reach levels comparable to those of pediatric computed tomography.

Section snippets

Study Overview

This study was approved by the hospital institutional review board and complied with all institutional review board guidelines for patient data access and storage.

A retrospective review was conducted of enteric and venous access procedures performed at our institution. Cases were identified through a dedicated interventional radiology database that has records on patient demographics, procedure performed, equipment use, costs, personnel, and fluoroscopy time since 1993. For this study, 7,074

Results

The number of cases for each of the nine procedures performed in the time period from 2004 to 2008 are given in Table 1. In total, 3,405 enteric and 3,669 venous access cases had effective dose estimates retrospectively estimated.

Table 2 outlines the standardized magnification and geometry parameters applied to each of the nine simulation examinations. The measured entrance exposure recorded with the digital dose meter is also given and represents the proportioned exposure associated with 1

Discussion

Fluoroscopically guided enteric and venous access procedures represent a significant portion of IR practice in adults and children, accounting for 63% of procedures in our center and 66% of IR cases involving ionizing radiation. Rarely do enteric and venous access cases result in radiation doses that approach or exceed the 2-Gy threshold for deterministic skin effects (16, 17), even if multiple procedures are performed within a relatively short period of time (18, 19). In children, peak skin

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      Overall, this would indicate that the collective burden is lower for the appendicostomy cohort. That said, all REE in this work applied a relatively low dose of radiation compared to other radiological modalities and only that which was necessary to satisfy the intervention and diagnostic task, which is in keeping with other series interrogating the effective dose of radiation in children undergoing enteric access procedures, and raises the argument that the differences in radiation exposure between the groups is of unclear clinical significance [16]. Furthermore, as technology improves the cumulative dose may become even lower.

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    From the SIR 2010 Annual Meeting.

    None of the authors have identified a conflict of interest.

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