Doses Received by Pediatric Patients from Interventional Fluoroscopy Procedures

I. Thierry-Chef1; S.L. Simon1; and D.L. Miller2 (1National Cancer Institute - Radiation Epidemiology Branch; 2National Naval Medical Center - Department of Radiology)

Interventional fluoroscopy procedures are medical procedures where fluoroscopy is used to guide the navigation, placement, or manipulation of medical devices within the body. Cardiac-related interventions represent the greatest proportion of procedures conducted though other parts of the body are often involved as well. The use of fluoroscopy to provide real-time information during complex operations has increased in recent years the number of patients exposed to relatively high doses of ionizing radiation, inducing, in rare cases, radiation-related skin burns. Interventional fluoroscopy procedures are rarely carried out on pediatric patients. Children may be at particular risk of late health effects as they are more sensitive to ionizing radiation and because their remaining life span is sufficiently long for cancer to develop. We present here the results of an analysis of doses recorded during 85 interventional fluoroscopy procedures carried out on pediatric patients. These data likely represent the largest set of radiation doses recorded on children undergoing these procedures. Commonly, doses are not recorded. For each case, our database includes patient age, gender, height and weight; procedure type and characteristics, such as fluoroscopy time and number of images obtained; dose-area product (DAP), cumulative dose were also recorded for each case. Peak skin dose data were recorded for 54 cases as well. Preliminary analysis reveals that interventions for embolization of arteries in the brain, typically performed to treat tumors, aneurysms and arteriovenous malformations, are associated with higher doses than all other procedures we studied. The DAP recorded for these patients was on average 208 Gy•cm2 though it varied from 25 to 900 Gy•cm2. On average, DAP from these procedures was 3.3 times higher than DAP received by children involved in other types of interventional procedures. Absorbed doses to the brain are being derived from the DAP with the objective of assessing cancer risk for each case. These dose assessments and risk projections are the first of their type to be conducted and the findings are expected to be of considerable importance regarding the risk of radiation exposure to pediatric patients.

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