title: Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures.
abstract: OBJECTIVE
  The objective of our study was to survey radiation dose indexes of pediatric peripheral and abdominal fluoroscopically guided procedures from which estimates of diagnostic reference levels (DRLs) can be proposed for both a standard fluoroscope and a novel fluoroscope with advanced image processing and lower radiation dose rates.
  
  
  METHODS
  Radiation dose structured reports were retrospectively collected for 408 clinical pediatric cases: Half of the procedures were performed with a standard imaging technology and half with a novel x-ray technology. Dose-area product (DAP), air Kerma (AK), fluoroscopy time, number of digital subtraction angiography images, and patient mass were collected to calculate and normalize radiation dose indexes for procedures completed with the standard and novel fluoroscopes.
  
  
  RESULTS
  The study population was composed of 180 and 175 patients who underwent procedures with the standard and novel technology, respectively. The 21 different types of pediatric peripheral and abdominal interventional procedures produced 408 total studies. Median ages, mass and body mass index, fluoroscopy time per procedure, and total number of recorded images for the standard and novel technologies were not statistically different. The area of the x-ray beams was square at the level of the patient with a dimension of 10-13 cm. The dose reduction achieved with the novel fluoroscope ranged from 18% to 51% of the dose required with the standard fluoroscope. The median DAP and AK patient dose indexes were 0.38 Gy · cm(2) and 4.00 mGy, respectively, for the novel fluoroscope.
  
  
  CONCLUSIONS
  Estimates of dose indexes of pediatric peripheral and abdominal fluoroscopically guided, clinical procedures should assist in the development of DRLs to foster management of radiation doses of pediatric patients.
authors.affiliation: 1 Department of Radiology, University of Cincinnati School of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Strauss
authors.forename: John M
authors.initials: JM
authors.lastname: Racadio
authors.forename: Neil
authors.initials: N
authors.lastname: Johnson
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.forename: Rami A
authors.initials: RA
authors.lastname: Nachabe
mesh_terms: D065638:Absorption, Radiation; D000293:Adolescent; D001822:Body Burden; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D005260:Female; D005471:Fluoroscopy / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008954:Models, Biological; D009820:Ohio / Q000453:epidemiology; D010372:Pediatrics / Q000592:standards; D011829:Radiation Dosage; D011860:Radiography, Abdominal / Q000592:standards / Q000706:statistics & numerical data; D015641:Radiography, Interventional / Q000592:standards* / Q000706:statistics & numerical data*; D011874:Radiometry / Q000592:standards*; D012016:Reference Values; D055815:Young Adult
keywords: diagnostic reference level; pediatric; peripheral and abdominal angiography; radiation dose