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Review of the radiation exposure during screening of surgically implanted central venous access devices
Jikol Friend1, Suzanna Lindsey-Temple1, Ian Gollow1
1Departments of Pediatric General Surgery, Princess Margaret Hospital, Subiaco, Western Australia, Australia.
Insights
Radiation screening for pediatric surgically implanted venous access devices (SIVADs) involves minimal radiation exposure, comparable to a chest X-ray. Open surgical insertion results in lower radiation doses than percutaneous methods, with overall risks outweighed by benefits.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Radiation Oncology
Background:
- Ionizing radiation is utilized during the insertion of surgically implanted venous access devices (SIVADs) in pediatric patients.
- Children are at a higher risk for cumulative radiation effects from repeated procedures.
Purpose of the Study:
- To evaluate the radiation dose administered to pediatric patients during intraoperative radiological screening for SIVAD insertion.
- To compare radiation doses between different SIVAD insertion techniques.
Main Methods:
- Retrospective analysis of pediatric patients undergoing SIVAD insertion with intraoperative fluoroscopy (2008-2014).
- Data collected included patient demographics, SIVAD type, insertion method, fluoroscopy time, and dose area product.
- Comparison of radiation doses between open surgical cut-down and percutaneous insertion methods.
Main Results:
- A total of 505 pediatric patients received 682 SIVADs.
- Median fluoroscopy time was 5 seconds, and median dose area product was 0.00352 mGym².
- Percutaneous insertions had a higher mean dose area product (0.0060 mGym²) compared to open insertions (0.0034 mGym²; p=0.05).
Conclusions:
- Intraoperative screening for SIVADs involves low radiation doses, comparable to a chest X-ray.
- The estimated excess lifetime cancer risk is very low and outweighed by the benefits of SIVAD insertion.
- Open surgical cut-down insertion significantly reduces radiation exposure compared to percutaneous techniques; radiation dose should not dictate the insertion method.
Purpose:
Ionizing radiation is used for the insertion of surgically implanted venous access devices (SIVADs) with children at the highest risk of cumulative radiation effects from these procedures. This study examines the radiation dose in a pediatric population during intraoperative radiological screening.
Methods:
A retrospective study looked at all pediatric patients in a tertiary hospital between January 2008 and January 2014 who had a surgically implanted venous access device inserted using intraoperative fluoroscopy. Patient demographics, reason for SIVAD insertion, the type and method of insertion, fluoroscopy time and radiation dose area product were determined.
Results:
A total of 505 patients had 682 SIVADs inserted, with 123 patients receiving multiple SIVAD over the six year period. There were two types of SIVAD inserted, 492 were totally implanted venous access devices (TIVAD) and 190 were tunneled central venous catheters (cuffed central line). Five hundred seven of the SIVAD inserted recorded the dose area product and fluoroscopy time. The median time for screening was 5seconds (range 1 to 275seconds) and the median dose area product was 0.00352mGym(2) (range 0.000001mGym(2) to 0.28mGym(2)). Of the 507 SIVAD that recorded the radiation data, 479 were open surgical cut-down insertion and 27 were percutaneous insertion. Percutaneously inserted surgically implanted venous access devices (mean 0.0060mGym(2)) had a longer dose area product than open insertion (mean 0.0034mGym(2); p=0.05).
Conclusion:
Screening of SIVAD involves low levels of radiation exposure and is comparable to a chest x-ray or a transatlantic flight. The excess lifetime cancer risk to patients is estimated to be very low and is considered to be outweighed by the benefits of insertion. Open surgical cut-down insertion has a significantly reduced radiation exposure compared to percutaneous techniques. Although radiation dose is higher with percutaneous procedures, the clinical effects are considered minimal, and the resultant radiation risk is estimated to be very low. Radiation dose should not determine technique of insertion of SIVAD.
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