Diagnostic reference levels for common paediatric fluoroscopic examinations performed at a dedicated paediatric Australian hospital

Abstract

Introduction: Diagnostic reference levels (DRL) of procedures involving ionising radiation are important tools for optimising radiation doses delivered to patients and to identify cases where the levels of dose are unusually high. This is particularly important for paediatric patients undergoing fluoroscopic examinations as these examinations can be associated with a high radiation dose. In this study, a large amount of paediatric fluoroscopic data has been analysed to: 1 establish local DRL, 2 identify the most significant factors determining radiation dose to patients, and 3 modify fluoroscopic techniques to optimise the examination protocols. Methods: Paediatric fluoroscopic studies performed at our institution from April 2010 to May 2015 have been retrospectively analysed to determine range, mean, 75th and 95th percentiles of Dose-Area Product (DAP) and fluoroscopic screening time for Micturating Cystourethrography (MCU), Airway, Airway and Swallow, Barium Swallow and Meal, Barium Follow Through and Barium Enema studies. Results: Currently, no Australian paediatric fluoroscopic DRL data are available for comparison and thus our data can only be compared with international published data. No major changes to examination protocols or modification to fluoroscopic techniques were found necessary as our data compared well with the international published values. Conclusion: The dose delivered to patients depend on a number of factors particularly the experience of the operators. However, DRL are also important, as shown in this study, as they enable best practice by providing feedback to the operators on their performance and benchmarking the institution with other institutions.

Effective doses and standardised risk factors from paediatric diagnostic medical radiation exposures: Information for radiation risk communication

“…The paediatric patient dose data analysed here are from the examinations performed at the Women's and Children's Hospital (WCH) in Adelaide. In particular, computed tomography (CT), fluoroscopy and nuclear medicine examinations are from these modality's databases. Minimum, maximum and average effective doses have been calculated for CT, fluoroscopic, general radiographic and nuclear medicine examinations in the age groups 0 to <5 years, 5 to <10 years, 10 to <15 years and 15 to <18 years.…”

Radiation dose in fluoroscopy: Experience does matter

“…It has been shown that screening time is a poor indicator of dose. It does not correlate with DAP and Bibbo et al . have confirmed this.…”

“…The study by Bibbo et al . in this issue is recommended reading for radiologists performing fluoroscopy and/or angiography.…”

“…Although Bibbo et al . studied data for children, it is likely that some of the findings would easily translate to the adult environment.…”

“…The more acquisitions, the higher the dose to the patient, regardless of fluoroscopy time. The Dose Area Product (DAP) has been used as the dose metric in this study …”