Author: Wilfred R Furtado, Gary Y. Ge, Jie Zhang 👨🔬
Affiliation: Department of Radiology, University of Kentucky, University of Kentucky 🌍
Purpose: The United Kingdom and several other countries already have well-established diagnostic reference levels (DRLs) for gastrointestinal fluoroscopic procedures, whereas the United States does not. This study evaluates barium contrast procedure dose data from a single U.S. institution and compares these findings with the UK’s DRL values.
Methods: Six fluoroscopy procedures were selected for review. These included Barium Enema Single Contrast (BES), Barium Swallow Double Contrast (BSD), Barium Swallow Single Contrast (BSS), Modified Barium Swallow (MBS), Upper GI and Small Bowel Follow-through (UGI+SBFT), and Upper Gastrointestinal (UGI). For each procedure, 100 patients were exported from PACS for analysis. Demographic information, dose-area-product (DAP), and fluoro time data were collected using MATLAB. Dose quartiles were calculated, and the third quartiles for DAP and fluoro time were compared to values for similar procedures in the UK dataset. The UK dataset does not include a UGI+SBFT category, so a combined reference was created from a sum of the UK UGI and SBFT values.
Results: Third quartiles for DAP(µGy.m2) and fluoro time(s) each of the six procedures are as follows: BES(3199.5,210), BSD(958.4,193.5), BSS(767.7,186), MBS(427.9,168), UGI+SBFT(2714.6,276), UGI(1488.4,198). The UK DRLs for comparable procedures are as follows: BES(2100,123), BSD(750,107), BSS(750,107), MBS(340,175), UGI+SBFT(2020,211), UGI(1180,119). BSC DAP is comparable to the UK DRL value. BES DAP is 52% higher than UK DRL. BSD, MBS, UGI+SBFT, and UGI are all ~30% higher than UK DRL values. Fluoro times were ~80% higher for BES, BSD, BSS, and UGI, 30% higher for UGI+SBFT, and 4% lower for MBS. Mean patient weight is 10kg higher than reported UK values (81kg vs 71kg).
Conclusion: Institutional doses were higher than UK DRL values, likely influenced by differences in patient size and potentially other factors. Ongoing data collection from local and additional institutions will help refine U.S. dose benchmarks and inform the development of national DRLs.