Fluoroscopy-controlled voiding cystourethrography in infants and children: Are the radiation risks trivial?

Abstract

The purpose of this study was to determine the gonadal dose, effective dose and relevant radiogenic risks associated with pediatric patients undergoing voiding cystourethrography (VCUG). Exposure parameters were monitored in 118 consecutive children undergoing VCUG. The entrance surface dose (ESD) was determined by thermoluminescent dosimeters (TLDs). For male patients, the gonadal dose was determined by TLDs attached on the anterior scrotum. For female patients, the gonadal dose was estimated by converting ESD to the ovarian dose. ESD-to-ovarian dose conversion factors were determined by thermoluminescence dosimetry and physical anthropomorphic phantoms representing newborn and 1-, 5- and 10-year-old individuals. The effective dose was estimated by using ESD and data obtained from the literature. The mean fluoroscopy time and number of radiographs during VCUG were 0.73 min and 2.3 for female and 0.91 min and 3.0 for male pediatric patients, respectively. The gonadal dose range was 0.34-5.17 mGy in boys and 0.36-2.57 mGy in girls. The corresponding ranges of effective dosage were 0.12-1.67 mSv and 0.15-1.45 mSv. Mean radiation risks for genetic anomalies and carcinogenesis following VCUG during childhood were estimated to be up to 15 per million and 125 per million, respectively. Radiation risks associated with pediatric patients undergoing VCUG should not be disregarded if such a procedure is to be justified adequately.

How to set up and apply reference levels in fluoroscopy at a national level

“…More and more effort is focused on dose-intensive fluoroscopy examinations. At the international level, the results of several investigations of patients' doses have been published in the recent literature [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Since the dose-intensive examinations involving fluoroscopy may result in a significant risk of deterministic effects, notably to the skin, it is recommended that the entrance surface doses be monitored for preventing skin injuries.…”

Interactive magnetic resonance voiding cystourethrography (iMRVC) for vesicoureteric reflux (VUR) in unsedated infants: a feasibility study

“…Although controversial, there is no known dose threshold at which cancer risk increases, and although the dose for a single procedure might be low, serial followup examinations result in higher cumulative doses. The radiation risk for cancer induction associated with a typical MCUG is around 1 in 10,000 [10]. Where MR is not available due to resource limitation, then the risk of MCUG may be considered justifiable.…”

“…The reliability of MCUG is dependent on the severity of reflux: only high-grade reflux is shown at MCUG with 100% reliability, and VUR itself may be intermittent [7][8][9]. MCUG carries a significant radiation burden [10] particularly to the paediatric gonads, and many of the children imaged are normal. Other imaging techniques have been used for demonstrating VUR in children (radionuclide cystography and contrast-enhanced ultrasound methods), but MCUG is considered the reference standard as it also permits imaging of the urethra.…”

The role of voiding cystourethrography in the investigation of children with urinary tract infections

“…However, it may also cause anxiety for patients and families due to its invasive nature, 16 and carries a risk of radiation exposure 17 and iatrogenic UTI. 18 When weighing the …”

“…18 Radiation exposure (~0.5-3.2 mSv) 28 is also important to consider, as it potentially has long-term implications for infertility, cancer risk, etc. 17 While VUR is a risk factor, it should be emphasized again that pyelonephritis can occur in the absence of VUR. 8 …”