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Erschienen in: European Radiology 6/2016

18.09.2015 | Paediatric

Ultra low-dose VCUG in children using a modern flat detectorunit

verfasst von: Sara Y. S. Linke, Ilias Tsiflikas, Klaus Herz, Phillipp Szavay, Sergios Gatidis, Jürgen F. Schäfer

Erschienen in: European Radiology | Ausgabe 6/2016

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Abstract

Objectives

To assess dose area products (DAP) and effective doses (ED) of voiding cystourethrography (VCUG) in children using optimized protocols on a modern flat detector unit.

Methods

DAP and ED were evaluated in 651 VCUG (316 girls, median age: 2.25 years) between 2009 and 2012. DAP was analyzed in relation to patient characteristics (gender, age, presence of pathological findings) and experience of performing physician using analysis of variance. ED values were estimated using adapted conversion factors from the literature. Diagnostic image quality was validated by two experienced physicians using a 3-point scale.

Results

Median DAP/ED was 0.5 cGycm2/4.56 μSv (boys: 0.6 cGycm2/6.16 μSv; girls: 0.4 cGycm2/3.54 μSv). In 300 studies without pathologic findings DAP was 0.35 cGycm2, whereas 351 studies with pathologic findings had a median DAP of 0.7 cGycm2. No significant relationship between DAP and experience of radiologist was observed. Image validation resulted in an overall good to excellent rating.

Conclusions

DAP and ED can be markedly reduced in paediatric VCUG performed with optimized protocols on modern equipment without a noticeable decrease in diagnostic image quality.

Key points

Voiding cystourethrography is a comprehensive examination in diagnosing vesicoureteral reflux (VUR).
Radiation reduction is achieved in VCUG through modern equipment and optimized protocols.
Low-dose VCUG is possible without noticeable decrease in diagnostic image quality.
Literatur
1.
Zurück zum Zitat Ammenti A, Cataldi L, Chimenz R et al (2012) Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow‐up. Acta Paediatr 101:451–457CrossRefPubMed Ammenti A, Cataldi L, Chimenz R et al (2012) Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow‐up. Acta Paediatr 101:451–457CrossRefPubMed
2.
Zurück zum Zitat Ward VL, Strauss KJ, Barnewolt CE et al (2008) Pediatric radiation exposure and effective dose reduction during voiding cystourethrography1. Radiology 249:1002–1009CrossRefPubMed Ward VL, Strauss KJ, Barnewolt CE et al (2008) Pediatric radiation exposure and effective dose reduction during voiding cystourethrography1. Radiology 249:1002–1009CrossRefPubMed
3.
Zurück zum Zitat Ward VL, Barnewolt CE, Strauss KJ et al (2006) Radiation exposure reduction during voiding cystourethrography in a pediatric porcine model of vesicoureteral reflux. Radiol Radiol Soc N Am 238:96–106 Ward VL, Barnewolt CE, Strauss KJ et al (2006) Radiation exposure reduction during voiding cystourethrography in a pediatric porcine model of vesicoureteral reflux. Radiol Radiol Soc N Am 238:96–106
5.
Zurück zum Zitat Roberts KB, Revised AAP (2012) Guideline on UTI in febrile infants and young children. Am Fam Physician 86:940–946PubMed Roberts KB, Revised AAP (2012) Guideline on UTI in febrile infants and young children. Am Fam Physician 86:940–946PubMed
6.
Zurück zum Zitat Riccabona M, Avni FE, Blickman JG et al (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145CrossRefPubMed Riccabona M, Avni FE, Blickman JG et al (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145CrossRefPubMed
7.
Zurück zum Zitat Schultz F, Geleijns J, Holscher H, Weststrate J, Zonderland H, Zoetelief J (1999) Radiation burden to paediatric patients due to micturating cystourethrography examinations in a Dutch children’s hospital. Br J Radiol 72:763–772CrossRefPubMed Schultz F, Geleijns J, Holscher H, Weststrate J, Zonderland H, Zoetelief J (1999) Radiation burden to paediatric patients due to micturating cystourethrography examinations in a Dutch children’s hospital. Br J Radiol 72:763–772CrossRefPubMed
8.
Zurück zum Zitat Stueve D (2006) Management of pediatric radiation dose using Philips fluoroscopy systems DoseWise: perfect image, perfect sense. Pediatr Radiol 36:216–220CrossRefPubMedPubMedCentral Stueve D (2006) Management of pediatric radiation dose using Philips fluoroscopy systems DoseWise: perfect image, perfect sense. Pediatr Radiol 36:216–220CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Ogden CL, Kuczmarski RJ, Flegal KM et al (2002) Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60CrossRefPubMed Ogden CL, Kuczmarski RJ, Flegal KM et al (2002) Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60CrossRefPubMed
10.
Zurück zum Zitat Gosch D, Gosch K, Kahn T (2007) Conversion coefficients for estimation of effective dose to patients from dose area product during fluoroscopy x-ray examinations. Röfo 179:1035–1042PubMed Gosch D, Gosch K, Kahn T (2007) Conversion coefficients for estimation of effective dose to patients from dose area product during fluoroscopy x-ray examinations. Röfo 179:1035–1042PubMed
11.
Zurück zum Zitat Le Heron J (1992) Estimation of effective dose to the patient during medical x-ray examinations from measurements of the dose-area product. Phys Med Biol 37:2117CrossRefPubMed Le Heron J (1992) Estimation of effective dose to the patient during medical x-ray examinations from measurements of the dose-area product. Phys Med Biol 37:2117CrossRefPubMed
12.
Zurück zum Zitat Fefferman NR, Sabach AS, Rivera R et al (2009) The efficacy of digital fluoroscopic image capture in the evaluation of vesicoureteral reflux in children. Pediatr Radiol 39:1179–1187CrossRefPubMed Fefferman NR, Sabach AS, Rivera R et al (2009) The efficacy of digital fluoroscopic image capture in the evaluation of vesicoureteral reflux in children. Pediatr Radiol 39:1179–1187CrossRefPubMed
13.
Zurück zum Zitat Fotakis M, Athanasopoulou EM, Psarrakos K, Economou I (2003) Radiation doses to paediatric patients up to 5 years of age undergoing micturating cystourethrography examinations and its dependence on patient age: a Monte Carlo study. Br J Radiol 76:812–817CrossRefPubMed Fotakis M, Athanasopoulou EM, Psarrakos K, Economou I (2003) Radiation doses to paediatric patients up to 5 years of age undergoing micturating cystourethrography examinations and its dependence on patient age: a Monte Carlo study. Br J Radiol 76:812–817CrossRefPubMed
14.
Zurück zum Zitat Papadopoulou F, Efremidis SC, Oiconomou A et al (2002) Cyclic voiding cystourethrography: is vesicoureteral reflux missed with standard voiding cystourethrography? Eur Radiol 12:666–670CrossRefPubMed Papadopoulou F, Efremidis SC, Oiconomou A et al (2002) Cyclic voiding cystourethrography: is vesicoureteral reflux missed with standard voiding cystourethrography? Eur Radiol 12:666–670CrossRefPubMed
15.
Zurück zum Zitat Paltiel HJ, Rupich RC, Kiruluta HG (1992) Enhanced detection of vesicoureteral reflux in infants and children with use of cyclic voiding cystourethrography. Radiology 184:753–755CrossRefPubMed Paltiel HJ, Rupich RC, Kiruluta HG (1992) Enhanced detection of vesicoureteral reflux in infants and children with use of cyclic voiding cystourethrography. Radiology 184:753–755CrossRefPubMed
16.
Zurück zum Zitat Born M, Spiller L, Bachour H, Heydweiller A, Franke I (2013) Dose area product of pediatric VCUG with regard to the strongly lowered German diagnostic reference levels. Röfo 185:262–267PubMed Born M, Spiller L, Bachour H, Heydweiller A, Franke I (2013) Dose area product of pediatric VCUG with regard to the strongly lowered German diagnostic reference levels. Röfo 185:262–267PubMed
17.
Zurück zum Zitat González L, Vañó E, Ruiz M (1995) Radiation doses to paediatric patients undergoing micturating cystourethrography examinations and potential reduction by radiation protection optimization. Br J Radiol 68:291–295CrossRefPubMed González L, Vañó E, Ruiz M (1995) Radiation doses to paediatric patients undergoing micturating cystourethrography examinations and potential reduction by radiation protection optimization. Br J Radiol 68:291–295CrossRefPubMed
18.
Zurück zum Zitat Merkle EM, Aschoff AJ, Vogel J, Merk J, Bachor R, Brambs HJ (1997) Radiation exposure in digital micturition cystourethrography in children. How much exposure by fluoroscopy? Der Urologe Ausg A 36:181–185CrossRefPubMed Merkle EM, Aschoff AJ, Vogel J, Merk J, Bachor R, Brambs HJ (1997) Radiation exposure in digital micturition cystourethrography in children. How much exposure by fluoroscopy? Der Urologe Ausg A 36:181–185CrossRefPubMed
19.
Zurück zum Zitat Perisinakis K, Raissaki M, Damilakis J, Stratakis J, Neratzoulakis J, Gourtsoyiannis N (2006) Fluoroscopy-controlled voiding cystourethrography in infants and children: are the radiation risks trivial? Eur Radiol 16:846–851CrossRefPubMed Perisinakis K, Raissaki M, Damilakis J, Stratakis J, Neratzoulakis J, Gourtsoyiannis N (2006) Fluoroscopy-controlled voiding cystourethrography in infants and children: are the radiation risks trivial? Eur Radiol 16:846–851CrossRefPubMed
20.
Zurück zum Zitat Pazik FD, Staton RJ, Williams JL, Arreola MM, Hintenlang DE, Bolch WE (2007) Organ and effective doses in newborns and infants undergoing voiding cystourethrograms (VCUG): a comparison of stylized and tomographic phantoms. Med Phys 34:294–306CrossRefPubMed Pazik FD, Staton RJ, Williams JL, Arreola MM, Hintenlang DE, Bolch WE (2007) Organ and effective doses in newborns and infants undergoing voiding cystourethrograms (VCUG): a comparison of stylized and tomographic phantoms. Med Phys 34:294–306CrossRefPubMed
22.
Zurück zum Zitat Kliegman R (2011) Nelson textbook of pediatrics. Elsevier/Saunders Kliegman R (2011) Nelson textbook of pediatrics. Elsevier/Saunders
23.
Zurück zum Zitat Lassmann M, Treves ST (2014) Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 1.5.2008) and the 2010 North American consensus guidelines. Eur J Nucl Med Mol Imaging 41:1036–1041CrossRefPubMed Lassmann M, Treves ST (2014) Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 1.5.2008) and the 2010 North American consensus guidelines. Eur J Nucl Med Mol Imaging 41:1036–1041CrossRefPubMed
24.
Zurück zum Zitat Kim SW, Im YJ, Hong CH, Han SW (2010) The clinical significance of intrarenal reflux in voiding cystourethrography (VCUG). Korean J Urol 51:60–63CrossRefPubMedPubMedCentral Kim SW, Im YJ, Hong CH, Han SW (2010) The clinical significance of intrarenal reflux in voiding cystourethrography (VCUG). Korean J Urol 51:60–63CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Boubnova J, Sergent-Alaoui A, Deschenes G, Audry G (2011) Evolution and prognosis value of intrarenal reflux. J Pediatr Urol 7:638–643CrossRefPubMed Boubnova J, Sergent-Alaoui A, Deschenes G, Audry G (2011) Evolution and prognosis value of intrarenal reflux. J Pediatr Urol 7:638–643CrossRefPubMed
26.
Zurück zum Zitat Fukui S, Watanabe M, Yoshino K (2013) Intrarenal reflux in primary vesicoureteral reflux. Int J Urol Off J Jpn Urol Assoc 20:631–636 Fukui S, Watanabe M, Yoshino K (2013) Intrarenal reflux in primary vesicoureteral reflux. Int J Urol Off J Jpn Urol Assoc 20:631–636
Metadaten
Titel
Ultra low-dose VCUG in children using a modern flat detectorunit
verfasst von
Sara Y. S. Linke
Ilias Tsiflikas
Klaus Herz
Phillipp Szavay
Sergios Gatidis
Jürgen F. Schäfer
Publikationsdatum
18.09.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 6/2016
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3996-5

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