Radiation exposure in infants with oesophageal atresia and tracheo-oesophageal fistula

  • Kiera RobertsEmail author
  • Jonathan Karpelowsky
  • Dominic A. Fitzgerald
  • Soundappan S. V. Soundappan
Original Article



Oesophageal atresia and tracheo-oesophageal atresia require surgical repair in early infancy. These children have significant disease-related morbidity requiring frequent radiological examinations resulting in an increased malignancy risk.


A single-centre, retrospective review was performed of radiation exposure in children with OA/TOF born 2011–2015. Medical records were reviewed to determine the number and type of imaging studies involving ionising radiation exposure enabling the calculation of the estimated effective dose per child over the first year of life.


Forty-nine children were included. Each child underwent a median of 19 (IQR 11.5–35) imaging studies, which were primarily plain radiography (median = 14, IQR 7–26.5). The overall median estimated effective dose per patient was 4.7 (IQR 3.0–9.4) mSv, with the majority of radiation exposure resulting from fluoroscopic imaging (median 3.3 mSv, IQR 2.2–6.0). ‘Routine’ postoperative oesophagrams showed no leak in 35/36 (97%) with the remaining study showing an insignificant leak that did not alter management.


Careful consideration should be given to the use of imaging in OA/TOF to minimise morbidity in these vulnerable infants. Oesophagrams in children without the symptoms of anastomotic leak or stricture should be discontinued. Standardisation of monitoring protocols with regard to radiation exposure should be considered.


Oesophageal atresia Tracheo-oesophageal fistula Radiation exposure Fluoroscopy 



Oesophageal atresia and tracheo-oesophageal fistula


Gastro-oesophageal reflux disease


Interquartile range


Estimated effective dose


Author contributions

Dr Roberts conceptualised and designed the study, collected data and carried out data analysis, drafted the initial manuscript, and revised the manuscript. Associate Professor Karpelowsky, Professor Fitzgerald, and Dr Soundappan conceptualised and designed the study, supervised data collection and analysis, and reviewed and revised the manuscript.


This study did not receive funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Sydney Children’s Hospital Network Human Research Ethics Committee. This study was performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Not applicable (requirement for informed consent waived by the institutional research committee as a retrospective, de-identified study).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryChildren’s Hospital at WestmeadSydneyAustralia
  2. 2.Sydney Medical SchoolUniversity of SydneySydneyAustralia
  3. 3.Department of Respiratory MedicineChildren’s Hospital at WestmeadSydneyAustralia

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