Abstract
Background
Liver-transplanted, immunosuppressed pediatric patients undergoing repeated percutaneous transhepatic cholangiography (PTC) require optimized exposure to ionizing radiation.
Objective
To establish local diagnostic reference levels (DRL) for pediatric PTC and investigate the routine use of X-ray equipment.
Materials and methods
The study retrospectively analyzed data collected between October 2016 and June 2018 from a single center performing PTC. We collected exposure parameters including kerma area product (PKA), air kerma at patient entrance reference point (Ka,r) and fluoroscopy time via a dose archiving and communication system. Local diagnostic reference levels were derived as the 50th percentile of the distributions while considering published recommended weight groups. We investigated exposure variability with procedure complexity and with technical parameters recovered from the radiation dose structured report.
Results
The analysis included 162 PTC procedures performed in 64 children: 58% male, average age 6 years (range 39 days to 16 years) and weight 24 kg (range 3–60 kg). Local DRLs for weight groups 0–5 kg, 5–15 kg, 15–30 kg, 30–50 kg and 50–80 kg were, respectively, 6 cGy.cm2, 22 cGy.cm2, 68 cGy.cm2, 107 cGy.cm2 and 179 cGy.cm2 in PKA. Local DRLs per weight group were also established for intermediate and complex procedures. Radiation dose structured report analysis highlighted good local practice with efficient collimation, low fluoroscopy pulse rate, no magnification and limited use of radiographic acquisitions. Meanwhile, table and detector positioning and tube projection could still be optimized. PKA correlated significantly with the number of acquisitions and tube-to-table distance.
Conclusion
We established local DRLs for children undergoing PTC.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lorenz JM, Funaki B, Leef JA et al (2001) Percutaneous transhepatic cholangiography and biliary drainage in pediatric liver transplant patients. AJR Am J Roentgenol 176:761–765
Lorenz JM (2015) The role of interventional radiology in the multidisciplinary management of biliary complications after liver transplantation. Tech Vasc Interv Radiol 18:266–275
Czubkowski P, Markiewicz-Kijewska M, Janiszewski K et al (2018) Percutaneous treatment of biliary strictures after pediatric liver transplantation. Ann Transplant 23:845–851
Heffron TG, Emond JC, Whitington PF et al (1992) Biliary complications in pediatric liver transplantation. A comparison of decreased-size and whole grafts. Transplantation 53:391–395
Lallier M, St-Vil D, Luks FI et al (1993) Biliary tract complications in pediatric orthotopic liver transplantation. J Pediatr Surg 28:1102–1105
Horvat N, Marcelino ASZ, Horvat JV et al (2017) Pediatric liver transplant: techniques and complications. Radiographics 37:1612–1631
Kleinerman R (2006) Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 36:121–125
Linet M, Kim K, Rajaraman P (2009) Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol 39:S4–S26
International Commission on Radiological Protection (2017) ICRP publication 135: diagnostic reference levels in medical imaging. Ann ICRP 46:1–144
European Commission (2018) Radiation protection No. 185: European guidelines on diagnostic reference levels for paediatric imaging. http://www.eurosafeimaging.org/wp/wp-content/uploads/2018/09/rp_185.pdf. Accessed 26 Dec 2019
Righi D, Doriguzzi A, Rampado O et al (2008) Interventional procedures for biliary drainage with bilioplasty in pediatric patients: dosimetric aspects. Radiol Med 113:429–438
Miraglia R, Maruzzelli L, Tuzzolino F et al (2013) Radiation exposure in biliary procedures performed to manage anastomotic strictures in pediatric liver transplant recipients: comparison between radiation exposure levels using an image intensifier and a flat-panel detector-based system. Cardiovasc Intervent Radiol 36:1670–1676
Digital Imaging and Communications in Medicine (DICOM) (2005) Supplement 94: diagnostic X-ray radiation dose reporting (dose SR). DICOM Standards Committee, Rosslyn
R (2019) The R Project for statistical computing. https://www.R-project.org. Accessed 26 Dec 2019
National Council on Radiation Protection and Measurements (2011) Radiation dose management for fluoroscopically guided interventional medical procedures. NCRP Report 168. NCRP, Bethesda
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Farah, J., Pariente, D., Esaki, A. et al. Establishing local diagnostic reference levels for pediatric percutaneous transhepatic cholangiography interventions and optimizing the routine practice. Pediatr Radiol 50, 827–832 (2020). https://doi.org/10.1007/s00247-020-04627-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-020-04627-y