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Effective dose at pneumatic reduction of paediatric intussusception
S D Heenan1, J Kyriou, M Fitzgerald
1Department of Diagnostic Radiology, St George's Hospital, London, UK.
Insights
Pneumatic reduction for paediatric intussusception has a 76.5% success rate. Longer screening times increase radiation dose, but persistence may improve outcomes, balancing risks against surgery.
Area of Science:
- Radiology
- Paediatric Imaging
- Interventional Radiology
Background:
- Intussusception is a common surgical emergency in children.
- Pneumatic reduction is a primary treatment modality.
- Assessing fluoroscopy time and radiation dose is crucial for patient safety.
Purpose of the Study:
- To evaluate screening times during pneumatic reduction for paediatric intussusception.
- To determine the radiation dose implications (Dose-Area Product and Effective Dose).
- To correlate screening time and radiation dose with procedural success and outcomes.
Main Methods:
- Retrospective review of 153 pneumatic reductions in 143 children over 4 years.
- Recorded success rates, screening times, and Dose-Area Products (DAP).
- Converted DAP to Effective Dose (ED) for 77 procedures.
Main Results:
- Achieved a 76.5% success rate with a low recurrence (6.5%) and complication rate (1 perforation).
- Screening times varied widely (15 s to 22.6 min).
- A screening time of 21 min resulted in a DAP of 1278 cGy cm(2) and ED of 12.73 mSv, equivalent to ~400 abdominal films for a 1-year-old.
Conclusions:
- The success rate is comparable to other centers.
- Longer screening times may be associated with complex cases referred to a tertiary center.
- Balancing the benefits of prolonged pneumatic reduction attempts against radiation risks and surgical alternatives is essential.
Aim:
The purpose of this study was to assess screening times and resulting dose implication at pneumatic reduction of intussusception in the paediatric age group and to examine the relationship with the outcome of the procedure.
Materials And Methods:
We retrospectively reviewed the case notes and departmental records of 143 children who had undergone a total of 153 pneumatic reductions in our department over a 4-year period. Success rates, screening times and available dose-area products (DAP) were recorded. The DAPs were converted to effective dose (ED) for 77 procedures.
Results:
A 76.5% (117/153) success rate was achieved with a recurrence rate of 6.5% and only one complication: a perforation. Screening times were recorded in 137 reductions and ranged from 15 s to 22.6 min. Although the longest screening time was associated with an unsuccessful outcome, the second longest time of 21 min was successful. This gave a DAP of 1278 cGy cm(2)and an ED of 12.73 mSv, which is equivalent to approximately 400 abdominal films for a 1-year-old. A lifetime risk of fatal cancer of one in 1000 was achieved, assuming the worst case, after a screening time of 30 min on our conventional fluoroscopy unit.
Conclusion:
Our success rate compares well with other centres. Our institution is a tertiary referral centre and the occasional long screening time may reflect the delay and complex nature of the patients referred. Persistence at air reduction may be successful and the success rate increases with delayed attempts but the risks of the increasing radiation burden must be weighed against the risks of emergency surgery and anaesthesia.Heenan, S. D. (2000). Clinical Radiology 55, 811-816.
