title: Estimates of effective dose to pediatric patients undergoing enteric and venous access procedures.
abstract: OBJECTIVE
  To determine the range of effective doses encountered during common enteric and venous access procedures by using a method to estimate effective dose based on fluoroscopy time.
  
  
  METHODS
  A pediatric phantom and metal oxide semiconductor field-effect transistor model was used to calculate effective doses associated with nine enteric and venous access procedures involving fluoroscopy only. Enteric procedures included primary gastrostomy, gastrojejunostomy, cecostomy tube insertions, and their "maintenance procedures" (eg, tube checks and changes, reinsertions, and exchanges). Venous access procedures included insertion of peripherally inserted central catheters, central venous catheters, and port catheters. Effective dose estimates were determined from phantom simulations of each procedure accounting for patient age, collimation, magnification, and tube position. Effective dose calculations from the simulations were normalized to fluoroscopy time, resulting in age- and procedure-specific factors (in mSv·min(-1)). These factors were retrospectively applied to fluoroscopy times logged in a database for 7,074 patient encounters, yielding a range of effective dose estimates for each procedure type.
  
  
  RESULTS
  From 3,699 venous access procedures reviewed, the mean effective dose was 0.1 mSv (range, 0.01-3.28 mSv). Review of 3,405 enteric access procedures showed doses that vary considerably, with mean doses of 0.3-1.7 mSv (range, 0.01-11.35 mSv). Several complex cases were identified with doses exceeding 4 mSv. Maintenance enteric procedures usually required lower doses (approximately 50%) than primary insertions.
  
  
  CONCLUSIONS
  Effective doses for pediatric enteric and venous access procedures performed in children are generally low. In difficult cases, effective doses can reach levels comparable to those of pediatric computed tomography.
authors.affiliation: Division of Image Guided Therapy in the Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada M5G 1X8.
authors.forename: Kiara
authors.initials: K
authors.lastname: Govia
authors.forename: Bairbre L
authors.initials: BL
authors.lastname: Connolly
authors.forename: Karen E
authors.initials: KE
authors.lastname: Thomas
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Gordon
mesh_terms: D001822:Body Burden; D002648:Child; D013505:Digestive System Surgical Procedures; D006801:Humans; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011859:Radiography; D015641:Radiography, Interventional; D011874:Radiometry; D012062:Relative Biological Effectiveness; D014656:Vascular Surgical Procedures