Jason G Domina1, Ramon Sanchez, Indu R Meesa, Emmanuel Christodoulou. 1. Department of Radiology, University of Michigan Health System Section of Pediatric Radiology, 1500 E. Medical Center Drive, UH B1-D502, Ann Arbor, MI, 48109-5030, USA, dominaj@med.umich.edu.
Abstract
BACKGROUND: There is heterogeneity in how pediatric voiding cystourethrography (VCUG) is performed. Some institutions, including our own, obtain a radiographic scout image prior to contrast agent instillation. OBJECTIVE: To demonstrate that the radiographic scout image does not augment VCUG interpretation or contribute management-changing information but nonetheless carries a non-negligible effective dose. MATERIALS AND METHODS: We evaluated 181 children who underwent VCUG in 2012, with an age breakdown of less than 1 year (56 children), 1-5 years (66 children), 6-10 years (43 children) and 11-18 years (16 children), with a mean age of 4.0 years. We investigated patient demographics, clinical indication for the examination, scout image findings and estimated effective radiation dose, as well as overall exam findings and impression. RESULTS: No clinically significant or management-changing findings were present on scout images, and no radiopaque urinary tract calculi or concerning incidental finding was identified. Scout image estimated effective radiation dose averaged 0.09 mSv in children younger than 1 y, 0.09 mSv in children age 1-5, 0.13 mSv in children age 6-10 and 0.18 mSv in children age 11-18. Total fluoroscopy time per examination averaged 36.7 s (range 34.8-39.6 s for all age group averages). Evaluation of known or suspected vesicoureteral reflux (VUR) and urinary tract infection (UTI) were the most common clinical indications, stated in 40.9% and 37.0% of exams, respectively. CONCLUSION: Although the estimated effective dose is low for VCUG radiographic scout images, this step did not augment VCUG interpretation or contribute management-changing information. This step should be omitted or substituted to further reduce dose in pediatric VCUG.
BACKGROUND: There is heterogeneity in how pediatric voiding cystourethrography (VCUG) is performed. Some institutions, including our own, obtain a radiographic scout image prior to contrast agent instillation. OBJECTIVE: To demonstrate that the radiographic scout image does not augment VCUG interpretation or contribute management-changing information but nonetheless carries a non-negligible effective dose. MATERIALS AND METHODS: We evaluated 181 children who underwent VCUG in 2012, with an age breakdown of less than 1 year (56 children), 1-5 years (66 children), 6-10 years (43 children) and 11-18 years (16 children), with a mean age of 4.0 years. We investigated patient demographics, clinical indication for the examination, scout image findings and estimated effective radiation dose, as well as overall exam findings and impression. RESULTS: No clinically significant or management-changing findings were present on scout images, and no radiopaque urinary tract calculi or concerning incidental finding was identified. Scout image estimated effective radiation dose averaged 0.09 mSv in children younger than 1 y, 0.09 mSv in children age 1-5, 0.13 mSv in children age 6-10 and 0.18 mSv in children age 11-18. Total fluoroscopy time per examination averaged 36.7 s (range 34.8-39.6 s for all age group averages). Evaluation of known or suspected vesicoureteral reflux (VUR) and urinary tract infection (UTI) were the most common clinical indications, stated in 40.9% and 37.0% of exams, respectively. CONCLUSION: Although the estimated effective dose is low for VCUG radiographic scout images, this step did not augment VCUG interpretation or contribute management-changing information. This step should be omitted or substituted to further reduce dose in pediatric VCUG.
Authors: Nancy R Fefferman; Amy S Sabach; Rafael Rivera; Sarah Milla; Lynne P Pinkney; Naomi A Strubel; James Babb Journal: Pediatr Radiol Date: 2009-08-29
Authors: Valerie L Ward; Keith J Strauss; Carol E Barnewolt; David Zurakowski; Vaidehi Venkatakrishnan; Frederic H Fahey; Robert L Lebowitz; George A Taylor Journal: Radiology Date: 2008-10-21 Impact factor: 11.105
Authors: K Smans; E Vaño; R Sanchez; F W Schultz; J Zoetelief; T Kiljunen; C Maccia; H Järvinen; R Bly; A Kosunen; K Faulkner; H Bosmans Journal: Radiat Prot Dosimetry Date: 2008-02-29 Impact factor: 0.972
Authors: Jason G Domina; Jonathan R Dillman; Jeremy Adler; Emmanuel Christodoulou; Shokoufeh Khalatbari; Adam L Dorfman; Peter J Strouse Journal: AJR Am J Roentgenol Date: 2013-07 Impact factor: 3.959