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Radiat Res. 2019 Oct 14. doi: 10.1667/RR15445.1. [Epub ahead of print]

A Scalable Database of Organ Doses for Common Diagnostic Fluoroscopy Procedures of Children: Procedures of Historical Practice for Use in Radiation Epidemiology Studies.

Author information

1
J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida.
2
Department of Radiology, University of Florida, Gainesville, Florida.
3
Medical Physics Program, College of Medicine, University of Florida, Gainesville, Florida.
4
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
5
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
6
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
7
Division of Research, Kaiser Permanente Northern California, Oakland, California.
8
Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, California.
9
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
10
Department of Radiology and Biomedical Imaging, Epidemiology, and Biostatistics, and the Phillip R. Lee Institute for Health Policy Studies, The University of California - San Francisco School of Medicine, San Francisco, California.

Abstract

Assessment of health effects from low-dose radiation exposures in patients undergoing diagnostic imaging is an active area of research. High-quality dosimetry information pertaining to these medical exposures is generally not readily available to clinicians or epidemiologists studying radiation-related health risks. The purpose of this study was to provide methods for organ dose estimation in pediatric patients undergoing four common diagnostic fluoroscopy procedures: the upper gastrointestinal (UGI) series, the lower gastrointestinal (LGI) series, the voiding cystourethrogram (VCUG) and the modified barium swallow (MBS). Abstracted X-ray film data and physician interviews were combined to generate procedure outlines detailing X-ray beam projections, imaged anatomy, length of X-ray exposure, and presence and amount of contrast within imaged anatomy. Monte Carlo radiation transport simulations were completed for each of the four diagnostic fluoroscopy procedures across the 162-member (87 males and 75 females) University of Florida/National Cancer Institute pediatric phantom library, which covers variations in both subject height and weight. Absorbed doses to 28 organs, including the active marrow and bone endosteum, were assigned for all 162 phantoms by procedure. Additionally, we provide dose coefficients (DCs) in a series of supplementary tables. The DCs give organ doses normalized to procedure-specific dose metrics, including: air kerma-area product (μGy/mGy · cm2), air kerma at the reference point (μGy/μGy), number of spot films (SF) (μGy/number of SFs) and total fluoroscopy time (μGy/s). Organs accumulating the highest absorbed doses per procedure were as follows: kidneys between 0.9-25.4 mGy, 1.1-16.6 mGy and 1.1-9.7 mGy for the UGI, LGI and VCUG procedures, respectively, and salivary glands between 0.2-3.7 mGy for the MBS procedure. Average values of detriment-weighted dose, a phantom-specific surrogate for the effective dose based on ICRP Publication 103 tissue-weighting factors, were 0.98 mSv, 1.16 mSv, 0.83 mSv and 0.15 mSv for the UGI, LGI, VCUG and MBS procedures, respectively. Scalable database of organ dose coefficients by patient sex, height and weight, and by procedure exposure time, reference point air kerma, kerma-area product or number of spot films, allows clinicians and researchers to compute organ absorbed doses based on their institution-specific and patient-specific dose metrics. In addition to informing on patient dosimetry, this work has the potential to facilitate exposure assessments in epidemiological studies designed to investigate radiation-related risks.

PMID:
31609677
DOI:
10.1667/RR15445.1

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