Radiation Safety and Pediatric Videourodynamics
Jennifer Rosen, MD, Loretta Johnson, PhD, David Joseph, MD.
UAB, Birmingham, AL, USA.
Children with spina bifida (SB) undergo a videourodynamic study (VUDS) or urodynamic study and voiding cystourethrogram (VCUG). A standardized protocol for imaging during a pediatric VUDS has not been established. Our aim is to quantify radiation exposure and estimate risk for children with spina bifida (SB) undergoing VUDS in current practice to determine whether the ALARA principle, as low as reasonably achievable, has been met.
This is an IRB approved retrospective study from 2013-2020 of consecutive pediatric SB patients undergoing VUDS by a single provider. Patients were categorized into three groups based on age; group 1 (0-2YR), group 2 (2-10YR), group 3 (>10YR). Radiation data was reported as mean air kerma (AK), dose area product (DAP) and exposure time (seconds). Effective dose (ED) was calculated based on radiation quantity (Air Kerma) and organ sensitivity. The lifetime attributable risk (LAR) was calculated based on Air Kerma and a risk coefficient. This data is compared to institutional data based on age for a VCUG.
603 patients were reviewed; 398 met inclusion criteria. The mean ED for VUDS groups 1-3 was 0.010 mSv (N=151), 0.018 mSv (N=178), and 0.058 mSv (N=69), respectively. Mean fluoroscopic time for these groups was 2.37 seconds, 2.39 seconds, 3 seconds, respectively. Mean ED for VCUG in 262 patients was 0.061 mSv (N=158), 0.163 mSv (N=84), and 0.378 mSv (N =20), respectively. ED increased with age in both VUDS and VCUG. All VCUG groups were found to have a statistically significant higher ED than VUDS (p<0.0001). The LAR for VUDS groups 1-3 was 0.001, 0.002, and 0.006, respectively. Reported in percentages, there is an 0.01%, 0.02%, and 0.06% chance, respectively, of age groups 1, 2 and 3 developing cancer as a result of the radiation exposure from VUDS. Statistical significance was noted amongst each of these groups (p<0.0001).
Our current practice for pediatric VUDS is consistent with the ALARA principle. Moving forward, we have the foundation to create an imaging protocol for pediatric VUDS. A protocol adhering to the ALARA principle could provide consistency across institutions and aid in multi-institutional studies.
|Group (Age years)||Air Kerma (mGy)||DAP (cGycm2)||ED (mSv)||Fluoro Time (seconds)||LAR|
|Grp 1 (0-2)||0.080||0.51||2.782||28.95||0.010||0.061||2.365||38.74||0.001|
|Grp 2 (2-10)||0.152||1.36||6.214||76.86||0.018||0.163||2.385||40.16||0.002|
|Grp 3 (>10)||0.487||3.15||22.10||178.20||0.058||0.378||3.00||46.35||0.006|
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