title: Comparison between radiation exposure levels using an image intensifier and a flat-panel detector-based system in image-guided central venous catheter placement in children weighing less than 10 kg.
abstract: BACKGROUND
  Ultrasound-guided central venous puncture and fluoroscopic guidance during central venous catheter (CVC) positioning optimizes technical success and lowers the complication rates in children, and is therefore considered standard practice.
  
  
  OBJECTIVE
  The purpose of this study was to compare the radiation exposure levels recorded during CVC placement in children weighing less than 10 kg in procedures performed using an image intensifier-based angiographic system (IIDS) to those performed in a flat-panel detector-based interventional suite (FPDS).
  
  
  METHODS
  A retrospective review of 96 image-guided CVC placements, between January 2008 and October 2013, in 49 children weighing less than 10 kg was performed. Mean age was 8.2 ± 4.4 months (range: 1-22 months). Mean weight was 7.1 ± 2.7 kg (range: 2.5-9.8 kg). The procedures were classified into two categories: non-tunneled and tunneled CVC placement.
  
  
  RESULTS
  Thirty-five procedures were performed with the IIDS (21 non-tunneled CVC, 14 tunneled CVC); 61 procedures were performed with the FPDS (47 non-tunneled CVC, 14 tunneled CVC). For non-tunneled CVC, mean DAP was 113.5 ± 126.7 cGy cm(2) with the IIDS and 15.9 ± 44.6 cGy · cm(2) with the FPDS (P < 0.001). For tunneled CVC, mean DAP was 84.6 ± 81.2 cGy · cm(2) with the IIDS and 37.1 ± 33.5 cGy cm(2) with the FPDS (P = 0.02).
  
  
  CONCLUSIONS
  The use of flat-panel angiographic equipment reduces radiation exposure in small children undergoing image-guided CVC placement.
authors.affiliation: Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90100, Palermo, Italy, rmiraglia@ismett.edu.
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.forename: Luigi
authors.initials: L
authors.lastname: Maruzzelli
authors.forename: Kelvin
authors.initials: K
authors.lastname: Cortis
authors.forename: Marcello
authors.initials: M
authors.lastname: Piazza
authors.forename: Roberta
authors.initials: R
authors.lastname: Gerasia
authors.forename: Simona
authors.initials: S
authors.lastname: Maggio
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuzzolino
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
mesh_terms: D000792:Angiography; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D008297:Male; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000295:instrumentation*; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D014963:X-Ray Intensifying Screens