Practice of ALARA in the pediatric interventional suite

Abstract

As interventional procedures have become progressively more sophisticated and lengthy, the potential for high patient radiation dose has increased. Staff exposure arises from patient scatter, so steps to minimize patient dose will in turn reduce operator and staff dose. The practice of ALARA in an interventional radiology (IR) suite, therefore, requires careful attention to technical detail in order to reduce patient dose. The choice of imaging modality should minimize radiation when and where possible. In this paper practical steps are outlined to reduce patient dose. Further details are included that specifically reduce operator exposure. Challenges unique to pediatric intervention are reviewed. Reference is made to experience from modern pediatric interventional suites. Given the potential for high exposures, the practice of ALARA is a team responsibility. Various measures are outlined for consideration when implementing a quality assurance (QA) program for an IR service.

Ionising radiation exposure in paediatric trauma

“…The mean DAP during all cases performed by consultants was 58.49Gycm 2 and that for a junior registrar was 90.46Gycm 2 (Table 3). This equates to a 55% increase in radiation exposure between these groups (p=0.0030).…”

“…1 Medical personnel should observe the 'as low as reasonably achievable' (ALARA) principle: a procedure should only be performed when indicated and when a procedure is performed, one should minimise or avoid radiation whenever possible (ie use ultrasonography where possible). 2 Radiation exposure during orthopaedic procedures using fluoroscopy is influenced by many factors including the type and difficulty of the procedure, patient position, radiation protection used and the experience of the surgeon. 3 Paediatric patients provide a unique challenge during surgery owing to their size.…”

Intraoperative Intermittent Blocking of the Common Iliac Arteries in Cases of Placenta Percreta without the Use of Fluoroscopy

“…The fetal and maternal fluoroscopy time is between 4:30 and 8:12 minutes depending on the study and case [8,9]. Reduction attempts have included changing tube and patient positioning, selecting fluoroscopy parameters (no magnification, collimation, road mapping) and using a particularly experienced interventionalist [28]. In our study radiation during balloon occlusion could be completely eliminated due to preinterventional measurement and planning.…”

Single session of percutaneous alcohol sclerotherapy for the treatment of isolated draining intrahepatic biliary duct: case report in a 5 months-old pediatric liver transplant recipient.

“…The total radiation dose in each procedure was less than 2 Gy, which is the dose considered to be the threshold for adverse effects such as transient erythema and depilation (8). A dose higher than 12 Gy puts the patient at risk for dermal necrosis (8).…”