Interventional procedures for biliary drainage with bilioplasty in paediatric patients: dosimetric aspects

Righi, Dorico; Doriguzzi, Andrea; Rampado, Osvaldo; Sávio, Luís Felipe; Faletti, Riccardo; Caggiula, P.; Ropolo, R.; Gandini, Giovanni

doi:10.1007/s11547-008-0252-y

Cited by 10 publications

(7 citation statements)

References 7 publications

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“…However, the introduction of new imaging technologies has, in some instances, resulted in increased use of paediatric imaging, influencing the age profile for the examinations performed (UNSCEAR, 2010). (Martinez et al, 2007;Righi et al, 2008;Molina Ló pez et al, 2008;Calama Santiago et al, 2008;.…”

Section: Levels Of Radiation Dosementioning

confidence: 99%

Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Rehani¹,

Ciraj-Bjelac²,

Vañó³

et al. 2010

Ann ICRP

217

137

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An increasing number of medical specialists are using fluoroscopy outside imaging departments, but there has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography,and bile duct stenting and drainage have the potential to impart skin doses exceeding Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology,the level of fluoroscopy use outside imaging departments creates potential for such injuries.A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology,gastroenterology and hepatobiliary system, and anaesthetics and pain management.Although sentinel lymph node biopsy involves the use of radio-isotopic methods rather than fluoroscopy, performance of this procedure in operating theatres is covered in this report as it is unlikely that this topic will be addressed in another ICRP publication in coming years. Information on radiation dose levels to patients and workers, and dose management is presented for each speciality.

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Section: Levels Of Radiation Dosementioning

confidence: 99%

Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Rehani¹,

Ciraj-Bjelac²,

Vañó³

et al. 2010

Ann ICRP

217

137

View full text Add to dashboard Cite

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“…There were no skin complications due to radiation exposure, and none of the patients developed any radiation‐born neoplasms during the follow‐up (as of this writing). According to Righi et al, more than 40 procedures would be needed to produce a 1% likelihood of a radiation‐induced malignancy. PTC is an invasive procedure, and complications such as bleeding, fever, bacteremia, and perforation can occur in up to 11% of the procedures .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients

et al. 2014

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The incidence of biliary complications (BCs) after living donor liver transplantation (LDLT) can reach 40%. Published data on the pediatric population are limited, and treatment protocols vary. Our aim was to describe the clinical scenario for BCs and treatment approaches after LDLT. Between October 1995 and December 2012, 489 pediatric LDLT procedures were performed. BCs developed in 71 patients (14.5%). Biliary strictures (BSs) developed in 45 (9.2%) patients, and bile leaks (BLs) developed in 33 patients (6.7%). The BL diagnosis was clinical in all cases, and 69.7% of the patients underwent surgery. Nearly half of the BS cases had clinical features or suggestive ultrasound findings. Liver biopsy findings suggested BSs in 51.7%. Percutaneous transhepatic cholangiography was performed in 95.6% of the BS patients. The success rate was 77% [mean number of percutaneous biliary interventions (PBIs) 5 3.9 6 1.98, median drainage time 5 8 months]. In conclusion, BL patients can be managed with conservative therapy, even though most of these patients will ultimately be treated with surgery. Diagnosing a BS requires a high degree of clinical suspicion because the available resources for its identification can fail in up to 50% of cases. A higher number of PBIs and the use of a drainage catheter for a longer time may be required to achieve better results with this technique. Liver Transpl 20:882-892,

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“…To our knowledge, our group has published the single article reported in the literature on the radiation protection of paediatric patients during percutaneous biliary procedures [12]. In this study, the average dose recorded during the procedures (which are part of this series) ranged from 0.9 to 1.5 mSv for each procedure [12], about one-tenth of the mean dose in abdominal CT, according to De Ville [11]. Furthermore, our radiation protection measures were extremely restrictive in accordance with the ALARA (as low as reasonably achievable) principle of optimisation.…”

Section: Discussionmentioning

confidence: 99%

The role of interventional radiology in the treatment of biliary strictures after paediatric liver transplantation

Fonio¹,

Calandri²,

Faletti³

et al. 2014

Radiol med

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Purpose The aim of this study is to evaluate the safety and efficacy of percutaneous treatment of biliary strictures after paediatric liver transplantation. Materials and methods In the period between October 1999 and October 2010, a total of 92 transplants in 86 children were performed at our Liver Transplant Centre. Eighteen patients had anastomotic biliary strictures (in four cases associated with intrahepatic bile duct stenosis). Percutaneous treatment (transhepatic biliary drainage and conventional/cutting balloon dilatation) was proposed as a first approach in 13/18 patients. Strict radiation protection precautions were taken in accordance with the ALARA (as low as reasonably achievable) principle. Mean follow-up time was 2,364 days. Results Surgical correction was required in 3/13 patients; in 8/13 cases, there was complete disappearance of clinical symptoms without bile duct dilatation; in one case, an asymptomatic persistent bile duct dilatation was detected while in the other case, the liver is currently in cirrhotic degeneration (69 % clinical success including the asymptomatic patient with biliary dilatation). Two of the five patients who were initially treated with surgery required percutaneous revision (clinical success of 100 %). There were two cases of long-term restenosis and two cases of transient haemobilia.Conclusions Percutaneous procedures are safe and effective therapeutic options for the treatment of biliary strictures after paediatric liver transplantation.

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Interventional procedures for biliary drainage with bilioplasty in paediatric patients: dosimetric aspects

Cited by 10 publications

References 7 publications

Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients

The role of interventional radiology in the treatment of biliary strictures after paediatric liver transplantation

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