Direct Effective Dose Calculations in Pediatric Fluoroscopy-Guided Abdominal Interventions with Rando-Alderson Phantoms – Optimization of Preset Parameter Settings

Abstract

ObjectiveThe aim of the study was to calculate the effective dose during fluoroscopy-guided pediatric interventional procedures of the liver in a phantom model before and after adjustment of preset parameters.MethodsOrgan doses were measured in three anthropomorphic Rando-Alderson phantoms representing children at various age and body weight (newborn 3.5kg, toddler 10kg, child 19kg). Collimation was performed focusing on the upper abdomen representing mock interventional radiology procedures such as percutaneous transhepatic cholangiography and drainage placement (PTCD). Fluoroscopy and digital subtraction angiography (DSA) acquisitions were performed in a posterior-anterior geometry using a state of the art flat-panel detector. Effective dose was directly measured from multiple incorporated thermoluminescent dosimeters (TLDs) using two different parameter settings.ResultsEffective dose values for each pediatric phantom were below 0.1mSv per minute fluoroscopy, and below 1mSv for a 1 minute DSA acquisition with a frame rate of 2 f/s. Lowering the values for the detector entrance dose enabled a reduction of the applied effective dose from 12 to 27% for fluoroscopy and 22 to 63% for DSA acquisitions. Similarly, organ doses of radiosensitive organs could be reduced by over 50%, especially when close to the primary x-ray beam.ConclusionModification of preset parameter settings enabled to decrease the effective dose for pediatric interventional procedures, as determined by effective dose calculations using dedicated pediatric Rando-Alderson phantoms.

Percutaneous Biliary Interventions in Pediatric Patients

“…32,33 In the last several decades, several campaigns have brought awareness to this issue with the best known as the ALARA (As Low As Reasonably Achievable) principle. In 2009, a "step lightly, image gently" campaign was launched by the Alliance for Radiation Safety in Pediatric Imaging 11,12,[33][34][35] to further educate and raise awareness about the use of radiographic examinations in the pediatric population.…”

Additively Manufactured Patient-Specific Anthropomorphic Thorax Phantom With Realistic Radiation Attenuation Properties

“…Various anthropomorphic models were implemented for the assessment of CT image quality in terms of contrast, spatial resolution, density and image-to-background noise (Wildgruber et al, 2016;Nardi et al, 2017;Witowski et al, 2019). By applying dedicated algorithms and protocols, the stability of the imaging system can be measured in dependence of the size of the object, position of different anatomic areas, dose levels and source-detector trajectories (Hatamikia et al, 2019a,b,c;Hernandez-Giron et al, 2019;Russ et al, 2020).…”

“…By applying dedicated algorithms and protocols, the stability of the imaging system can be measured in dependence of the size of the object, position of different anatomic areas, dose levels and source-detector trajectories (Hatamikia et al, 2019a,b,c;Hernandez-Giron et al, 2019;Russ et al, 2020). Commercially available Alderson Rando anthropomorphic thorax phantoms (Phantom Laboratory, Salem, NY, United States) for X-ray and other diagnostic modalities consist of sections of human skeletons surrounded by tissue equivalent material (Wildgruber et al, 2016;Nardi et al, 2017). However, these phantoms are relatively expensive and not patient specific (Homolka et al, 2017;Filippou and Tsoumpas, 2018).…”

Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri‐Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility

“…In cases of PAD lesions affecting the superficial femoral artery (SFA) and popliteal artery (PA), investigations have been limited to comparing quantitative, color-coded DSA against CCDS and nonimaging modalities, specifically ankle-brachial index (ABI) [6,12]. Importantly, these studies limited their investigation to the evaluation color-coded DSA, which uses frame rates and order of magnitude slower (3-4 frames/s vs. ≥30 frames/s) and radiation exposure and order of magnitude higher (∼1 mSv/min vs. ∼0.1 mSv/min) than quantitative fluoroscopy, resulting in coarse time resolution and increased exposure to ionizing radiation [13]. In contrast, TDC-derived flow parameters measured via quantitative fluoroscopy have received no direct clinical investigation in the context of peripheral arterial lesions; thus, there exists a substantial possibility that the full clinical utility of quantitative fluoroscopy has yet to be utilized.…”