Use of Stored Fluoroscopic Images as an Alternative to ... · PDF fileReduce Radiation Dose to...
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Use of Stored Fluoroscopic Images as an Alternative to Spot Images to Reduce Radiation Dose to Children Undergoing Fluoroscopic Studies
Saxena AK, Sodhi KS, Khandelwal N.Department of Radio Diagnosis and Imaging,
Post Graduate Institute of Medical Education and Research, Chandigarh-160012, IndiaPOSTGR
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Fig. 1 : 7 ½ year old female child with history of recurrent episodes of urinary tract infections. SFI shows normal cystogram.
Fig. 2 : 2½ year old male child with history of urinary tract infections. SFI shows normal urethra and absence of VUR.
Fig. 3 : 5 month old child with history of poor urinary stream. SFI features suggestive of posterior urethral valves (PUV).
Fig. 4 : 5 year old male child with history of fulguration of posterior urethral valves. SI (a) and SFI (b) provide similar information about mildly dilated posterior urethra and good anterior urethral stream.
Fig. 5 : 1¼ year old male child with history of urinary tract infection. SI (a) failed while SFI (b) succeeded in documenting urethra. Left vesico-ureteric reflux is seen in both SI & SFI.
Fig. 6 : 5 month old male child who was earlier operated for esophageal atresia and tracheo-esophageal fistula. Lateral (a) and Antero-Posterior (b) views of SFI show short segment esophageal stricture. No SI was taken during this study.
Fig. 7 : 8 month old child with history of failure to thrive. SFI shows f is tu lous c o m m u n i c a t i o n between esophagus and trachea (arrow).
Fig. 8 : 5 year old male child with history of abdomino-perineal pull through with anal stenosis. Patency of distal colon, partial sacral agenesis and absence of recto-urethral fistula is evident on antero-posterior (a) and lateral (b) views of SFI of distal cologram study.
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Year MCU Enema Swallow UGI FT NGM RGU DCBE Distal Cologram
Others Total
2003 105 56 52 13 42 40 4 0 19 13 344
2004 311 115 133 23 66 76 10 1 56 33 824
2005 453 144 109 27 61 74 16 0 39 66 989
Total 869 315 294 63 169 190 30 1 114 112 2157
MCU= Micturating Cystourethrogram, UGI= Upper Gastro Intestinal
Study, FT= Follow Through, NGM= Nephrostogram, RGU= Retrograde
Urethrography, DCBE= Double Contrast Barium Enema
Illustrations
Take Home Message :
Radiation Risk
Management Benefits
Use of SFI = ALARA
Background
Objective
What is stored fluoroscopic image (SFI)?
Strategy
Materials & Methods
• Radiation dose during fluoroscopic procedure = Fluoroscopy
time + radiation dose due to spot images (SI)
• To reduce the radiation dose to paediatric patients undergoing
fluoroscopic procedures
• SFI = Permanent recording of last frame of fluoroscopy
• Also called image grab and last image recall
• Does not add to fluoroscopy time or radiation dose
• SFI can be electronically enhanced by post processing
• Replace SI with SFI to achieve decrease in radiation without
compromising diagnostic information
• Period July 2003- Dec. 2005
• Machine: Shimadzu UD150B30 Digitex Pro series
fluoroscopy machine
• Details of procedures:
Observations and Results
• It was possible to replace a large number of SI with SFI without
losing diagnostic information
• Many a times no spot image was required for whole study
• ALARA principle implemented
SFI better than SI
Using SFI: Additional advantages
Lacunae
Conclusions
SFI: Possible future uses
By virtue of being instantaneous, SFI is better
than SI for:
• Documentation of DJ flexure
• Documenting urethra if voiding is intermittent
• Documentation of tracheo esophageal fistula
• Retrograde urethrography
• Reduced scatter radiation dose to medical personnels
• Prolongation of X Ray tube life
• Conservation of electrical energy
• Advantages not quantified
• Reasons:
• This was not a case control study
• Historical data on radiation doses not available
• Radiation dose varies with experience of radiologist, number of
spot images and body weight
• SFI is a good alternative to SI
• Radiation dose can be reduced without compromising diagnostic
information
• In many studies, SI can be completely eliminated
• Use of SFI conforms to ALARA principle
• Low suspicion of abnormal chest X-Ray e.g. bronchiolitis
• Mobile fluoroscopy units for follow up chest X-Rays in intensive
care units
• Localizing radio opaque foreign bodies in abdomen
• Repeat evaluation to exclude artifacts