Estimates of Diagnostic Reference Levels for Pediatric Peripheral and Abdominal Fluoroscopically Guided Procedures

Strauss, Keith J.; Racadio, John M.; Johnson, Neil; Patel, Manish; Nachabé, Rami

doi:10.2214/ajr.14.13630

Cited by 10 publications

(9 citation statements)

References 31 publications

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“…If the median P KA and/or K a,r in a particular institution exceeds the corresponding DRL value, evaluation of fluoroscopy time and the number of acquired images may help to determine whether these are contributing factors. The Commission recommends that data for all suitable DRL quantities that are available should be tracked for interventional procedures at facilities where these procedures are performed. (191) While the literature contains data for K a,r , P KA , or fluoroscopy time at multiple healthcare facilities and nations for adult interventional fluoroscopic procedures, these data have only been published recently for paediatric examinations, and the numbers of cases in these paediatric studies are typically more limited (Strauss et al., 2015; Ubeda et al., 2015). (192) If the median values of the DRL quantities are higher than expected, investigation of the fluoroscopic equipment is appropriate.…”

Section: Interventional Proceduresmentioning

confidence: 99%

“…(191) While the literature contains data for K a,r , P KA , or fluoroscopy time at multiple healthcare facilities and nations for adult interventional fluoroscopic procedures, these data have only been published recently for paediatric examinations, and the numbers of cases in these paediatric studies are typically more limited (Strauss et al., 2015; Ubeda et al., 2015).…”

Section: Interventional Proceduresmentioning

confidence: 99%

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ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging

Vañó¹,

Miller²,

Martin³

et al. 2017

Ann ICRP

629

383

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The International Commission on Radiological Protection (ICRP) first introduced the term ‘diagnostic reference level’ (DRL) in 1996 in Publication 73. The concept was subsequently developed further, and practical guidance was provided in 2001. The DRL has been proven to be an effective tool that aids in optimisation of protection in the medical exposure of patients for diagnostic and interventional procedures. However, with time, it has become evident that additional advice is needed. There are issues related to definitions of the terms used in previous guidance, determination of the values for DRLs, the appropriate interval for re-evaluating and updating these values, appropriate use of DRLs in clinical practice, methods for practical application of DRLs, and application of the DRL concept to newer imaging technologies. This publication is intended as a further source of information and guidance on these issues. Some terminology has been clarified. In addition, this publication recommends quantities for use as DRLs for various imaging modalities, and provides information on the use of DRLs for interventional procedures and in paediatric imaging. It suggests modifications in the conduct of DRL surveys that take advantage of automated reporting of radiation-dose-related quantities, and highlights the importance of including information on DRLs in training programmes for healthcare workers. The target audience for this publication is national, regional, and local authorities; professional societies; and facilities that use ionising radiation for medical purposes, and responsible staff within these facilities. A full set of the Commission’s recommendations is provided.

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Section: Interventional Proceduresmentioning

confidence: 99%

Section: Interventional Proceduresmentioning

confidence: 99%

ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging

Vañó¹,

Miller²,

Martin³

et al. 2017

Ann ICRP

629

383

View full text Add to dashboard Cite

show abstract

“…A few studies in the United States of pediatric patient dose levels during fluoroscopy from singe institutions have been published. [18][19][20][21][22] While dose data as a function of patient thickness are limited, two comparisons can be made. A publication in 2008 found that for 21 patients 10-14 cm in thickness received an average RAK of 0.58 mGy with a (0.28-0.80) 95% confidence interval for a VCUG examination.…”

Section: Discussionmentioning

confidence: 99%

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Somasundaram

Brady

Strauss

2022

J Applied Clin Med Phys

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The purpose of this study was to provide an empirical model to develop reference air kerma (RAK) alert levels as a function of patient thickness or age for pediatric fluoroscopy for any institution to use in a Quality Assurance program. RAK and patient thickness were collected for 10&663 general fluoroscopic examinations and 1500 fluoroscopically guided interventions (FGIs). RAK and patient age were collected for 6137 fluoroscopic examinations with mobile-C-arms (MC). Coefficients of linear regression fits of logarithmic RAK as a function of patient thickness or age were generated for each fluoroscopy group. Regression fits of RAK for 50%, 90%, and 98% upper prediction levels were used as inputs to derive an empirical formula to estimate alert levels as a function of patient thickness. A methodology is presented to scale results from this study for any patient thickness or age for any institution, for example, the patient thickness dependent RAK alert level at the top 1% of expected RAK can be set using the 98% upper prediction interval boundary given by: RAK 98% = e m.x avg +s 98 . ĉ , where x avg is the institute's average patient thickness or age, and ĉ is the intercept based on the average RAK of the patient population calculated as ĉ = ln(RAK avg ) − m.x avg .RAK avg is the institution's average RAK (mGy). m and s 98 are constants presented for each type of fluoroscope and RAK group and represent slope of the fit and scale factor, respectively. An empirical equation, which estimates alert levels expressed as air Kerma without backscatter at the interventional reference point as a function of patient thickness or age is provided for each fluoroscopic examination type. The empirical equations allow any facility with limited data to scale the results of this study's single facility data to model their practice's unique RAK alert levels and patient population demographics to establish pediatric alert levels for fluoroscopic procedures.

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“…La ICRP introdujo en 1996 los niveles de referencia para dignóstico (DRL) (10,11) que desde entonces se usan para optimizar y monitorizar los niveles de radiación a los que se exponen los pacientes. Este concepto es fundamental y ha sido revisado por múltiples instituciones internacionales (11)(12)(13)(14)(15)(16). Dichos valores ayudan a orientar si la dosis de radiación del paciente es inusualmente alta.…”

Section: Introductionunclassified

Niveles de referencia de dosis de radiación para la toma de imágenes en pediatría

Álvarez

Bolaños

Montoya

et al. 2020

Rev. colomb. radiol.

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Introducción: El uso de dosis adecuadas de radiación en pacientes pediátricos es un deber de los centros de diagnóstico médico debido a las características y retos que implica esta población. Por lo anterior, se han establecido unos niveles internacionales de referencia de dosis (DRL, del inglés dose reference level) para optimizar y comparar los protocolos de cada institución. En Colombia no se cuenta con estudios al respecto. Objetivo: Mostrar los DRL utilizados en un hospital universitario de alta complejidad en las modalidades de tomografía computarizada (TC), radiografía y fluoroscopia y compararlos con los estándares internacionales. Metodología: Estudio descriptivo retrospectivo realizado entre 2018 y 2019. Se analizaron datos de producto dosis longitud (DLP) para TC de cráneo, tórax, abdomen y TC de tórax de alta resolución (TACAR); y producto dosis área (DAP) para radiografía de tórax, abdomen, huesos y fluoroscopia por grupos etarios. Resultados: Se obtuvieron los datos de 780 pacientes: 360 radiografías, 100 de fluoroscopia y 320 tomografías. Se encontró que los niveles de referencia de dosis de radiación usados en el hospital son bajos, comparados con guías europeas de 2018 de niveles de referencia. Se describen DRL para cada estudio y grupo etario. Conclusión: Se demostró que en el hospital donde hizo el estudio los niveles de referencia de radiación en la población pediátrica son bajos. El presente trabajo puede servir como referente nacional

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Estimates of Diagnostic Reference Levels for Pediatric Peripheral and Abdominal Fluoroscopically Guided Procedures

Abstract: Estimates of dose indexes of pediatric peripheral and abdominal fluoroscopically guided, clinical procedures should assist in the development of DRLs to foster management of radiation doses of pediatric patients.

Cited by 10 publications

References 31 publications

ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging

ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Niveles de referencia de dosis de radiación para la toma de imágenes en pediatría

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