title: Radiation exposure and safety practices during pediatric central line placement.
abstract: OBJECTIVE
  Pediatric surgeons routinely use fluoroscopy for central venous line (CVL) placement. We examined radiation safety practices and patient/surgeon exposure during fluoroscopic CVL.
  
  
  METHODS
  Fluoroscopic CVL procedures performed by 11 pediatric surgeons in 2012 were reviewed. Fluoroscopic time (FT), patient exposure (mGy), and procedural data were collected. Anthropomorphic phantom simulations were used to calculate scatter and dose (mSv). Surgeons were surveyed regarding safety practices.
  
  
  RESULTS
  386 procedures were reviewed. Median FT was 12.8 seconds. Median patient estimated effective dose was 0.13 mSv. Median annual FT per surgeon was 15.4 minutes. Simulations showed no significant difference (p=0.14) between reported exposures (median 3.5 mGy/minute) and the modeled regression exposures from the C-arm default mode (median 3.4 mGy/minute). Median calculated surgeon exposure was 1.5 mGy/year. Eight of 11 surgeons responded to the survey. Only three reported 100% lead protection and frequent dosimeter use.
  
  
  CONCLUSIONS
  We found nonstandard radiation training, safety practices, and dose monitoring for the 11 surgeons. Based on simulations, the C-arm default setting was typically used instead of low dose. While most CVL procedures have low patient/surgeon doses, every effort should be used to minimize patient and occupational exposure, suggesting the need for formal hands-on training for nonradiologist providers using fluoroscopy.
authors.affiliation: University of Texas Southwestern Medical Center Department of Surgery, Dallas, TX, USA. Electronic address: Melody.Saeman@UTSouthwestern.edu.
authors.forename: Melody R
authors.initials: MR
authors.lastname: Saeman
authors.affiliation: Children's Medical Center Department of Surgery, Dallas, TX, USA.
authors.forename: Lorrie S
authors.initials: LS
authors.lastname: Burkhalter
authors.affiliation: University of Texas Southwestern Medical Center Department of Radiology, Dallas, TX, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Blackburn
authors.affiliation: University of Texas Southwestern Medical Center Department of Surgery, Dallas, TX, USA; Children's Medical Center Department of Surgery, Dallas, TX, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016273:Occupational Exposure / Q000517:prevention & control / Q000706:statistics & numerical data; D061214:Patient Safety / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000069079:Radiation Exposure / Q000517:prevention & control / Q000706:statistics & numerical data; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D066231:Surgeons; D055815:Young Adult
keywords: Fluoroscopy; Occupational exposure; Pediatric; Radiation dose
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