title: Radiation exposure in biliary procedures performed to manage anastomotic strictures in pediatric liver transplant recipients: comparison between radiation exposure levels using an image intensifier and a flat-panel detector-based system.
abstract: OBJECTIVE
  The aim of this study was to estimate radiation exposure in pediatric liver transplants recipients who underwent biliary interventional procedures and to compare radiation exposure levels between biliary interventional procedures performed using an image intensifier-based angiographic system (IIDS) and a flat panel detector-based interventional system (FPDS).
  
  
  METHODS
  We enrolled 34 consecutive pediatric liver transplant recipients with biliary strictures between January 2008 and March 2013 with a total of 170 image-guided procedures. The dose-area product (DAP) and fluoroscopy time was recorded for each procedure. The mean age was 61 months (range 4-192), and mean weight was 17 kg (range 4-41). The procedures were classified into three categories: percutaneous transhepatic cholangiography and biliary catheter placement (n = 40); cholangiography and balloon dilatation (n = 55); and cholangiography and biliary catheter change or removal (n = 75). Ninety-two procedures were performed using an IIDS. Seventy-eight procedures performed after July 2010 were performed using an FPDS. The difference in DAP between the two angiographic systems was compared using Wilcoxon rank-sum test and a multiple linear regression model.
  
  
  RESULTS
  Mean DAP in the three categories was significantly greater in the group of procedures performed using the IIDS compared with those performed using the FPDS. Statistical analysis showed a p value = 0.001 for the PTBD group, p = 0.0002 for the cholangiogram and balloon dilatation group, and p = 0.00001 for the group with cholangiogram and biliary catheter change or removal.
  
  
  CONCLUSIONS
  In our selected cohort of patients, the use of an FPDS decreases radiation exposure.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 1, 90100, Palermo, Italy. rmiraglia@ismett.edu.
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.affiliation: Department of Diagnostic and Interventional Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 1, 90100, Palermo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Maruzzelli
authors.affiliation: Department of Information Technology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 1, Palermo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuzzolino
authors.affiliation: Medical Physic ISMETT Consultant, Fismeco, Via Giuseppe Donati, 32, 00159, Rome, Italy.
authors.forename: Pietro Luigi
authors.initials: PL
authors.lastname: Indovina
authors.affiliation: Department of Diagnostic and Interventional Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 1, 90100, Palermo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
mesh_terms: D000293:Adolescent; D000800:Angioplasty, Balloon / Q000379:methods; D001166:Arteriovenous Shunt, Surgical; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography / Q000379:methods*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D010372:Pediatrics / Q000379:methods; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000295:instrumentation / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*