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Prospective evaluation of radiation dose with conventional fluoroscopic voiding cystourethrogram in pediatric patients

  • Rajeev Chaudhry
    Correspondence
    Correspondence to: Rajeev Chaudhry, University of Pittsburgh SOM, Division of Pediatric Urology, UPMC Children's Hospital of Pittsburgh, Department of Urology, UPMC, 4401 Penn Avenue, 4th Floor Faculty Bldg, Pittsburgh, PA, 15224, USA, Tel.: +412-692-3044
    Affiliations
    Department of Urology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
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  • Pankaj P. Dangle
    Affiliations
    Department of Urology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA

    Department of Urology, University of Alabama School of Medicine, 1600 7th Ave South, Suite 318 Lowder Bldg., Birmingham, AL, 35233, USA
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  • Glenn M. Cannon
    Affiliations
    Department of Urology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
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  • Francis X. Schneck
    Affiliations
    Department of Urology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
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  • Heidi A. Stephany
    Affiliations
    Department of Urology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA

    Department of Urology, University of California-Irvine, Children's Hospital of Orange County, 505 S Main Street, Suite 100, Orange, CA, 92868, USA
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Published:September 14, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.09.010

      Summary

      Introduction

      Skin entrance doses for voiding cystourethrogram (VCUG) have not been well characterized in the literature. Radiation exposure is measured as either dose area product (DAP) or air kerma, which estimates the effective dose, but does not accurately reflect absorbed dose at skin level.

      Objective

      The objective of this study was to measure the skin entrance dose during fluoroscopic VCUG study in pediatric patients using single point dosimeters.

      Study design

      Pediatric patients undergoing fluoroscopic VCUG were prospectively enrolled in our study. Landauer NanoDot™OSLD dosimeters were affixed to the skin overlying the sacrum to measure skin entrance dose. The fluoroscopic unit was set to the following parameters: low dose setting, skin-to-source distance of 54 cm, pulsed fluoroscopy at 3 frames/sec.

      Results

      Forty-four patients with a median age of 13.6 months (IQR 3.7–42.3) were enrolled. Median fluoroscopic time was 54 s (IQR 36–72). The median values absorbed dose by dosimeter and air kerma were 0.32 mGy (IQR 0.13–0.56, range 0.01–2.9) and 0.24 mGy (IQR 0.14–0.37), respectively. There was a positive correlation between the air kerma and absorbed dose (r = 0.69, p < 0.001) and fluoroscopy time and absorbed dose mGy (r = 0.60, p < 0.001). Absorbed dose was independent of age, body mass index and body surface area (p = 0.19, p = 0.57 and p = 0.16, respectively). Median whole body effective dose was 0.04 mSv (IQR 0.02–0.7).

      Discussion

      Overall, the absorbed dose received by the dosimeter remained low at a median of 0.32 mGy (range 0.01–2.91). These values are remarkably low and well within the accepted radiation exposure norms. Our radiologists follow a strict protocol to reduce the overall radiation emitted during a VCUG. These measures include setting the x-ray source at a low dose mode, collimating to the smallest area possible, and using pulsed fluoroscopy at 3 frames/sec. Limitations to this study include a slight variability in technique of VCUG between different technicians and providers, for which we cannot control.

      Conclusion

      Summary TableRadiographic parameters with VCUG measuring dose area product, air Kerma, dose absorbed at skin level and effective dose.
      Mean Median
      Fluoro time (sec) 55.6 ± 29.6 54 (IQR 36–79.8)
      Dose area product (mGy∗m2) 12.8 ± 22.7 5.3 (IQR 3.1–8.3)
      Air Kerma (mGy) 0.57 ± 1.0 0.24 (IQR 0.14–0.37)
      Dose absorbed (mGy) 0.55 ± 0.66 0.32 (IQR 0.13–0.56)
      Effective dose (mSv) – whole body 0.09 ± 0.20 0.04 (IQR 0.02–0.07)

      Keywords

      Abbreviations:

      mGy (milliGray), mSv (milliSievert), VCUG (voiding cystourethrogram), VUR (vesicoureteral reflux), BMI (body mass index), BSA (body surface area), DAP (dose area product)
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