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01-02-2015 | Original Article

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

Authors: Roberto Miraglia, Luigi Maruzzelli, Kelvin Cortis, Marcello Piazza, Roberta Gerasia, Simona Maggio, Fabio Tuzzolino, Angelo Luca

Published in: Pediatric Radiology | Issue 2/2015

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).

Materials and 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 cm² with the IIDS and 15.9 ± 44.6 cGy · cm² with the FPDS (P < 0.001). For tunneled CVC, mean DAP was 84.6 ± 81.2 cGy · cm² with the IIDS and 37.1 ± 33.5 cGy cm² with the FPDS (P = 0.02).

Conclusion

The use of flat-panel angiographic equipment reduces radiation exposure in small children undergoing image-guided CVC placement.

Lameris JS, Post PJ, Zonderland HM et al (1990) Percutaneous placement of Hickman catheters: comparison of sonographically guided and blind techniques. AJR Am J Roentgenol 155:1097–1099PubMedCrossRef

Jaques PF, Mauro MA, Keefe B (1992) US guidance for vascular access. Technical note. J Vasc Interv Radiol 3:427–430PubMedCrossRef

Donaldson JS (2006) Pediatric vascular access. Pediatr Radiol 36:386–397PubMedCrossRef

Krishnamurthy G, Keller MS (2011) Vascular access in children. Cardiovasc Intervent Radiol 34:14–24PubMedCrossRef

Ganeshan A, Warakaulle DR, Uberoi R (2007) Central venous access. Cardiovasc Intervent Radiol 30:26–33PubMedCrossRef

Tercan F, Oguzkurt L, Ozkan U et al (2008) Comparison of ultrasonography-guided central venous catheterization between adult and pediatric populations. Cardiovasc Intervent Radiol 31:575–580PubMedCrossRef

Adeb M, Baskin KM, Keller MS et al (2012) Radiologically placed tunneled hemodialysis catheters: a single pediatric institutional experience of 120 patients. J Vasc Interv Radiol 23:604–612PubMedCrossRef

Storm ES, Miller DL, Hoover LJ et al (2006) Radiation doses from venous access procedures. Radiology 238:1044–1050PubMedCrossRef

Govia K, Connolly BL, Thomas KE et al (2012) Estimates of effective dose to pediatric patients undergoing enteric and venous access procedures. J Vasc Interv Radiol 23:443–450PubMedCrossRef

10.

Nickoloff EL (2011) AAPM/RSNA physics tutorial for residents: physics of flat-panel fluoroscopy systems: survey of modern fluoroscopy imaging: flat-panel detectors versus image intensifiers and more. Radiographics 31:591–602PubMedCrossRef

11.

American Society of Anesthesiologists Committee (2011) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the american society of anesthesiologists committee on standards and practice parameters. Anesthesiology 114:495–511CrossRef

12.

Baskin KM, Jimenez RM, Cahill AM et al (2008) Cavoatrial junction and central venous anatomy: implications for central venous access tip position. J Vasc Interv Radiol 19:359–365PubMedCrossRef

13.

Adwan H, Gordon H, Nicholls E (2008) Are routine chest radiographs needed after fluoroscopically guided percutaneous insertion of central venous catheters in children? J Pediatr Surg 43:341–343PubMedCrossRef

14.

Suzuki S, Furui S, Kobayashi I et al (2005) Radiation dose to patients and radiologists during transcatheter arterial embolization: comparison of a digital flat-panel system and conventional unit. AJR Am J Roentgenol 185:855–859PubMedCrossRef

15.

Miraglia R, Maruzzelli L, Tuzzolino F et al (2013) 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. Cardiovasc Intervent Radiol 36:1670–1676PubMedCrossRef

16.

Wiesinger B, Kirchner S, Blumenstock G et al (2013) Difference in dose area product between analog image intensifier and digital flat panel detector in peripheral angiography and the effect of BMI. RöFo 185:153–159PubMed

17.

Wiesinger B, Stutz A, Schmehl J et al (2012) Comparison of digital flat-panel detector and conventional angiography machines: evaluation of stent detection rates, visibility scores, and dose-area products. AJR Am J Roentgenol 198:946–954PubMedCrossRef

18.

Bogaert E, Bacher K, Lapere R et al (2009) Does digital flat detector technology tip the scale towards better image quality or reduced patient dose in interventional cardiology? Eur J Radiol 72:348–353PubMedCrossRef

19.

Sidhu M, Coley BD, Goske MJ et al (2009) Image gently, step lightly: increasing radiation dose awareness in pediatric interventional radiology. Pediatr Radiol 39:1135–1138PubMedCrossRef

20.

Sidhu M (2010) Radiation safety in pediatric interventional radiology: step lightly. Pediatr Radiol 40:511–513PubMedCrossRef

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
Authors: Roberto Miraglia
Luigi Maruzzelli
Kelvin Cortis
Marcello Piazza
Roberta Gerasia
Simona Maggio
Fabio Tuzzolino
Angelo Luca
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 2/2015
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-014-3119-5

At a glance: The STEP trials

Springer Medicine

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

Objective

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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