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Patient dose reduction during voiding cystourethrography.

Ward VL - Pediatr Radiol (2006)

Bottom Line: Voiding cystourethrography (VCUG) is a commonly performed examination in a pediatric uroradiology practice.This article contains suggestions on how the radiation dose to a child from VCUG can be made "as low as reasonably achievable" (ALARA).The pediatric radiologist should consider the appropriateness of the clinical indication before performing VCUG and utilize radiation exposure techniques and parameters during VCUG to reduce radiation exposure to a child.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA. valerie.ward@childrens.harvard.edu

ABSTRACT
Voiding cystourethrography (VCUG) is a commonly performed examination in a pediatric uroradiology practice. This article contains suggestions on how the radiation dose to a child from VCUG can be made "as low as reasonably achievable" (ALARA). The pediatric radiologist should consider the appropriateness of the clinical indication before performing VCUG and utilize radiation exposure techniques and parameters during VCUG to reduce radiation exposure to a child. The medical physicist and fluoroscope manufacturer can also work together to optimize a pulsed-fluoroscopy unit and further reduce the radiation exposure. Laboratory and clinical research is necessary to investigate methods that reduce radiation exposures during VCUG, and current research is presented here.

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Comparisons of (a) total radiation exposure, (b) fluoroscopic radiation exposure, (c) recorded image radiation exposure, and (d) fluoroscopy time between the continuous fluoroscopy and GCPFL units for all three groups. Group 1 corresponds to girths in the range 8–0 cm (human newborn to 6-month-old infant), group 2 to girths in the range 12–3 cm (2- to 3-year-old child), and group 3 to girths in the range 15–7 cm (10-year-old child). The radiation exposures are expressed as kerma. Reproduced with the permission of the Radiological Society of North America, ©RSNA, 2006; Ward VL, Barnewolt CE, Strauss KJ, et al (2006) Radiation exposure reduction during voiding cystourethrography in a pediatric porcine model of vesicoureteral reflux. Radiology 238:96–06
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Fig1: Comparisons of (a) total radiation exposure, (b) fluoroscopic radiation exposure, (c) recorded image radiation exposure, and (d) fluoroscopy time between the continuous fluoroscopy and GCPFL units for all three groups. Group 1 corresponds to girths in the range 8–0 cm (human newborn to 6-month-old infant), group 2 to girths in the range 12–3 cm (2- to 3-year-old child), and group 3 to girths in the range 15–7 cm (10-year-old child). The radiation exposures are expressed as kerma. Reproduced with the permission of the Radiological Society of North America, ©RSNA, 2006; Ward VL, Barnewolt CE, Strauss KJ, et al (2006) Radiation exposure reduction during voiding cystourethrography in a pediatric porcine model of vesicoureteral reflux. Radiology 238:96–06

Mentions: The animal model investigation of VCUG with pulsed fluoroscopy that was performed by our group was as follows. We compared an optimized, grid-controlled variable-rate pulsed fluoroscopy (GCPFL) unit to a continuous fluoroscopy unit in a pediatric porcine model of vesicoureteral reflux [25]. The pigs underwent VCUG at three different abdominal girth ranges that corresponded to the girth of a newborn to 6-month-old human infant (group 1), a young child approximately 2 to 3 years of age (group 2), and an older child approximately 10 years of age (group 3). An electronic online patient exposure monitoring device was used to accurately calculate the exposure at the entrance skin plane of the animal [26, 27]. Table 1 and Fig. 1 summarize our results for total radiation exposure, fluoroscopic radiation exposure, recorded VCUG image exposure and fluoroscopy time for all three groups [25]. The optimized GCPFL unit delivered radiation exposures to a pig that ranged from 4.6 to 7.5 times lower than with a continuous fluoroscopy unit. The fluoroscopy times for VCUG between the fluoroscopy units were not significantly different. Figures 2 and 3 are examples of actual recorded VCUG images demonstrating that anatomic conspicuity and diagnostic image quality were maintained. Tables 2 and 3 underscore the anatomic conspicuity and diagnostic image quality scores for the 48 VCUGs assigned by two experienced pediatric radiologists [25].Table 1


Patient dose reduction during voiding cystourethrography.

Ward VL - Pediatr Radiol (2006)

Comparisons of (a) total radiation exposure, (b) fluoroscopic radiation exposure, (c) recorded image radiation exposure, and (d) fluoroscopy time between the continuous fluoroscopy and GCPFL units for all three groups. Group 1 corresponds to girths in the range 8–0 cm (human newborn to 6-month-old infant), group 2 to girths in the range 12–3 cm (2- to 3-year-old child), and group 3 to girths in the range 15–7 cm (10-year-old child). The radiation exposures are expressed as kerma. Reproduced with the permission of the Radiological Society of North America, ©RSNA, 2006; Ward VL, Barnewolt CE, Strauss KJ, et al (2006) Radiation exposure reduction during voiding cystourethrography in a pediatric porcine model of vesicoureteral reflux. Radiology 238:96–06
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2663640&req=5

Fig1: Comparisons of (a) total radiation exposure, (b) fluoroscopic radiation exposure, (c) recorded image radiation exposure, and (d) fluoroscopy time between the continuous fluoroscopy and GCPFL units for all three groups. Group 1 corresponds to girths in the range 8–0 cm (human newborn to 6-month-old infant), group 2 to girths in the range 12–3 cm (2- to 3-year-old child), and group 3 to girths in the range 15–7 cm (10-year-old child). The radiation exposures are expressed as kerma. Reproduced with the permission of the Radiological Society of North America, ©RSNA, 2006; Ward VL, Barnewolt CE, Strauss KJ, et al (2006) Radiation exposure reduction during voiding cystourethrography in a pediatric porcine model of vesicoureteral reflux. Radiology 238:96–06
Mentions: The animal model investigation of VCUG with pulsed fluoroscopy that was performed by our group was as follows. We compared an optimized, grid-controlled variable-rate pulsed fluoroscopy (GCPFL) unit to a continuous fluoroscopy unit in a pediatric porcine model of vesicoureteral reflux [25]. The pigs underwent VCUG at three different abdominal girth ranges that corresponded to the girth of a newborn to 6-month-old human infant (group 1), a young child approximately 2 to 3 years of age (group 2), and an older child approximately 10 years of age (group 3). An electronic online patient exposure monitoring device was used to accurately calculate the exposure at the entrance skin plane of the animal [26, 27]. Table 1 and Fig. 1 summarize our results for total radiation exposure, fluoroscopic radiation exposure, recorded VCUG image exposure and fluoroscopy time for all three groups [25]. The optimized GCPFL unit delivered radiation exposures to a pig that ranged from 4.6 to 7.5 times lower than with a continuous fluoroscopy unit. The fluoroscopy times for VCUG between the fluoroscopy units were not significantly different. Figures 2 and 3 are examples of actual recorded VCUG images demonstrating that anatomic conspicuity and diagnostic image quality were maintained. Tables 2 and 3 underscore the anatomic conspicuity and diagnostic image quality scores for the 48 VCUGs assigned by two experienced pediatric radiologists [25].Table 1

Bottom Line: Voiding cystourethrography (VCUG) is a commonly performed examination in a pediatric uroradiology practice.This article contains suggestions on how the radiation dose to a child from VCUG can be made "as low as reasonably achievable" (ALARA).The pediatric radiologist should consider the appropriateness of the clinical indication before performing VCUG and utilize radiation exposure techniques and parameters during VCUG to reduce radiation exposure to a child.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA. valerie.ward@childrens.harvard.edu

ABSTRACT
Voiding cystourethrography (VCUG) is a commonly performed examination in a pediatric uroradiology practice. This article contains suggestions on how the radiation dose to a child from VCUG can be made "as low as reasonably achievable" (ALARA). The pediatric radiologist should consider the appropriateness of the clinical indication before performing VCUG and utilize radiation exposure techniques and parameters during VCUG to reduce radiation exposure to a child. The medical physicist and fluoroscope manufacturer can also work together to optimize a pulsed-fluoroscopy unit and further reduce the radiation exposure. Laboratory and clinical research is necessary to investigate methods that reduce radiation exposures during VCUG, and current research is presented here.

Show MeSH
Related in: MedlinePlus