Influence of pulsed fluoroscopy and special radiation risk training on the radiation dose in pneumatic reduction of ileocoecal intussusceptions. Poster No.: C-0599 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit J. L. Cullmann, E. Stranzinger, R. W. Wolf, S. Puig; Bern/CH Radiation safety, Fluoroscopy, Pediatric, Gastrointestinal tract, Abdomen, Acute 10.1594/ecr2013/C-0599 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 7
Purpose Air enema is a well accepted procedure for the diagnosis and treatment of childhood intussusception in many institutions (1,2,3). However, radiation doses of pneumatic reduction with conventional non-pulsed fluoroscopy units were reported to be quite high. Previous studies reported screening times of up to 22.6 minutes (mean: 5.9 min) and a dose-area-product (DAP) of up to 1278 cgycm 2 and an ED of 12.73 msv, which is equivalent to approximately 400 abdominal x-rays for a 1-year-old child (1). Several technical innovations, e.g. pulsed fluoroscopy, which lead to reduced patient radiation dose were established in the last years (1). Furthermore, improved knowledge about radiation risk results in more responsible control of fluoroscopic time. The purpose of the study was to assess if the introduction of a radiation risk training and the use of pulsed fluoroscopy technique might decrease fluoroscopic time and radiation dose. Methods and Materials All radiologists performing repositions of intussusceptions received a radiation risk training at our pediatric fluoroscopy unit including patient positioning, radiation field size and the use of protective shielding as well as low frequency pulsed fluoroscopy. In addition, an algorithm was established in the diagnosis and treatment of intussuception. For subsequent management of complications occurring during the reduction maneuver, such as perforation or non-reducibility, all procedures were performed in the presence of an experienced pediatric surgeon. We retrospectively analyzed the data of 45 children (30 male and 15 female) between five months and eight years of age, who underwent a total of 48 pneumatic reductions of an ileocoecal intussusception in our department during a four year period. The insufflation pressure of the oxygen/air mixture was 90-120 mmhg. Fluoroscopic monitoring was performed with a Diagnost 97 (Philips, Eindhoven, The Netherlands) using the pulse fluoroscopy option (1.56 images/sec). The screening times and dosearea-product (DAP) of all fluoroscopic examinations were monitored with a DAP-meter (PTW, Freiburg, Germany). Clinical records were retrospectively studied for screening time and dose-area-product. Institutional review board (IRB) was informed but approval was not required. Images for this section: Page 2 of 7
Fig. 1: Sonography of an ileocoecal intussusception in a four year-old boy. Page 3 of 7
Fig. 2: Fluoroscopy (anteposterior view in supine position) of the same patient with ileocoecal intussusception (red arrow). Page 4 of 7
Fig. 3: Fluoroscopy of the same patient after reposition of the ileocoecal intussusception. Page 5 of 7
Results The mean screening time was 53.8 sec (range: 1-320 sec). The mean DAP was 11,4 cgycm2 (range: 1-145 cgycm2). Compared to previous studies the mean screening time was reduced by 84%, the maximum DAP by 89%. There was one perforation in a 1-year-old boy requiring surgical revision. The remaining 47 pneumatic reductions were successful and without complications. Conclusion There were considerable lower screening times and dose-area-products in our population than reported in previous studies (1). Low frequency pulsed fluoroscopy as well as the presented radiation risk training may account for this observation and became the standard procedure in pediatric patients presenting with ileocoecal intussusception. References 1. S. D. Heenan, J. Kyrioz, M. Fitzgerald, E. J. Adam, Effective Dose at Pneumatic Reduction of Paediatric Intussusception, Clinical Radiology (2000) 55, 811-816 2. K. E. Applegate, Intussusception in children: evidence-based diagnosis and treatment, Pediatric Radiology (2009) 39 (Suppl 2):S140-S143 3. W. Rohrschneider, Invagination, Radiologe (1997) 37:446-453 Personal Information Jennifer Cullmann, MD jennifer.cullmann@insel.ch Page 6 of 7
Enno Stranzinger, MD enno.stranzinger@insel.ch Rainer Wolf, MD rainer.wolf@insel.ch Stefan Puig, MD stefan.puig@insel.ch Page 7 of 7