Removal of scatter radiation in paediatric cardiac catheterisation: a randomised controlled clinical trial

Gould, Richard; McFadden, Sonyia; Sands, Andrew J; McCrossan, Brian; Horn, Simon; Prise, Kevin M.; Doyle, Philip C.; Hughes, Ciara

doi:10.1088/1361-6498/aa80a4

Cited by 4 publications

(3 citation statements)

References 40 publications

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“…However, their results were not stratified by patient size and their baseline comparison involved the use of an anti-scatter grid in all patients including those <20 kg. 16 Our study demonstrated similar dose reductions when comparing AGT to standard imaging with an anti-scatter grid in place…”

Section: Discussionsupporting

confidence: 62%

Estimating radiation exposure during paediatric cardiac catheterisation: a potential for radiation reduction with air gap technique

et al. 2019

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Introduction:The air gap technique (AGT) is an approach to radiation dose optimisation during fluoroscopy where an “air gap” is used in place of an anti-scatter grid to reduce scatter irradiation. The AGT is effective in adults but remains largely untested in children. Effects are expected to vary depending on patient size and the amount of scatter irradiation produced.Methods:Fluoroscopy and cineangiography were performed using a Phillips Allura Fluoroscope on tissue simulation anthropomorphic phantoms representing a neonate, 5-year-old, and teenager. Monte Carlo simulations were then used to estimate effective radiation dose first using a standard recommended imaging approach and then repeated using the AGT. Objective image quality assessments were performed using an image quality phantom.Results:Effective radiation doses for the neonate and 5-year-old phantom increased consistently (2–92%) when the AGT was used compared to the standard recommended imaging approaches in which the anti-scatter grid is removed at baseline. In the teenage phantom, the AGT reduced effective doses by 5–59%, with greater dose reductions for imaging across the greater thoracic dimension of lateral projection. The AGT increased geometric magnification but with no detectable change in image blur or contrast differentiation.Conclusions:The AGT is an effective approach for dose reduction in larger patients, particularly for lateral imaging. Compared to the current dose optimisation guidelines, the technique may be harmful in smaller children where scatter irradiation is minimal.

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Section: Discussionsupporting

confidence: 62%

Estimating radiation exposure during paediatric cardiac catheterisation: a potential for radiation reduction with air gap technique

et al. 2019

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“…Roy et al [26] reported a 47% reduction in radiation dose to the patient as well as reduced scatter to the operator with removal of the grid during coronary angiography. In pediatric cardiac catheterization, Gould et al [27] reported a 30% decrease in DNA double-strand breakages with grid removal. Fritz et al [28] also found that the benefit of the antiscatter grid in pediatric abdominal radiographs decreases in smaller patients and proposed not using it in certain situations.…”

Section: Discussionmentioning

confidence: 99%

“…In pediatric cardiac catheterization, Gould et al . [27] reported a 30% decrease in DNA double-strand breakages with grid removal. Fritz et al .…”

Section: Discussionmentioning

confidence: 99%

Reliability of radiographic measurements for hip dysplasia using a reduced radiation technique

Lawing

Gorbe

Maciel

et al. 2022

Journal of Pediatric Orthopaedics B

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The purpose of this study was to examine whether measurement accuracy is impacted with a low radiation radiograph technique. Treatment decisions for hip dysplasia require serial radiographs to monitor acetabular anatomy. However, radiation use creates concern for future malignancy. Standard radiograph technique utilizes a grid to enhance clarity, but requires a larger X-ray dose. We hypothesized grid removal would lower radiation exposure without decreasing measurement accuracy. This is a retrospective cohort study of patients with idiopathic DDH and neuromuscular hip displacement at a single institution from 2019 to 2020 receiving surveillance radiographs. A cohort receiving modified technique radiographs (grid removed) was compared to an age-matched cohort receiving standard technique radiographs. Four examiners measured radiographs on two separate occasions, a minimum of 2 weeks apart. Migration percentage (MP) was measured for neuromuscular patients and acetabular index (AI) for idiopathic DDH. Intraclass correlation coefficient (ICC) with a 95% confidence interval (CI) was used to evaluate inter-observer and intra-observer agreement for measurements. Average radiation dose for both techniques. A total of 134 age-matched patients were included for measurement of MP. Thirty age-matched patients were included for AI measurements. Inter and intra-rater reliability of MP and AI were not different with or without use of the grid. There was a 50–75% decrease in radiation dose per radiograph following grid removal, dependent on patient size. The adjusted radiograph technique showed no significant difference in MP or AI reliability. A slight decrease in picture contrast did not jeopardize measurement reliability and decreased radiation exposure for the patient significantly. This simple technique can be useful for patients requiring multiple radiographs over time.

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Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety

Modarai¹,

Haulon²,

Hertault³

et al. 2023

European Journal of Vascular and Endovascular Surgery

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Removal of scatter radiation in paediatric cardiac catheterisation: a randomised controlled clinical trial

Cited by 4 publications

References 40 publications

Estimating radiation exposure during paediatric cardiac catheterisation: a potential for radiation reduction with air gap technique

Estimating radiation exposure during paediatric cardiac catheterisation: a potential for radiation reduction with air gap technique

Reliability of radiographic measurements for hip dysplasia using a reduced radiation technique

Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety

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