Author: Janet Ching-Mei Feng, Jimmy Huynh 👨🔬
Affiliation: UTHealth McGovern Medical School 🌍
Purpose: The Image Gently Alliance had provided helpful information to optimize image protocols in pediatric patients since 2007, and our assumption was that newer units could use near-to-optimal protocol and advanced post-processing techniques to lower overall patient doses. In this study, we aim to retrospectively compare the radiation usage of five pediatric fluoroscopic procedures in three didactic pediatric units.
Methods: 4172 pediatric patients underwent fluoroscopic procedures using three didactic pediatric fluoroscopic units between the years 2018-2023. Patients’ air kerma in mGy were retrospectively collected after each procedure from a Philips Easy Diagnost Eleva RF (“Baseline,” 2018-19), Siemens Lumino RF (“Siemens,” 2020-22), and Philips ProxiDiagnost N90 (“Philips,” 2022-23). Data collected from the Siemens and Philips units were compared with the baseline unit to assess radiation usage differences in five common procedures, including barium enemas (BE), upper GI (UGI), esophagrams, voiding cystourethrograms (VCUG), and modified barium swallow studies (MBSS). Patients were then categorized into the following age groups: 0-18, 0-1, 2-5, 6-11, and 12-18. Weight information was inconsistently entered and could not be accounted for in the study and a gender-neutral analysis was used.
Results: Both Siemens and Philips showed higher usage of radiation except for the following conditions: Philips BE-ages 12-18, Philips esophagram 12-18, and Siemens MBSS 12-18. BE provides the most potential for further improvement of the protocol. In addition, priority of the effort should be given to Siemens esophagram 2-5, Philips VCUG 0-1, and Siemens VCUG 6-11, as the differences are over 200%.
Conclusion: The resulting relative air-kerma differences compared to the baseline unit suggest that both Siemens and Philips units require more effort in protocol optimization in these five pediatric procedures.