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Radiation burden of pediatric ultrasound-guided percutaneous central venous access devices: A prospective cohort
Mohit Bajaj1, Jon Wells1, Anuja Liyanage1
1Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand.
Insights
Radiation exposure during pediatric central venous access device insertion is minimal, comparable to a chest radiograph. Lower patient weight (<10kg) and left internal jugular vein access are linked to higher radiation doses.
Area of Science:
- Pediatric Interventional Radiology
- Medical Imaging Safety
Background:
- Permanent central venous access is crucial for managing pediatric patients.
- Understanding ionizing radiation exposure during device insertion is important for patient safety.
Purpose of the Study:
- To quantify radiation dose during percutaneous insertion of central venous access devices in children.
- To correlate radiation exposure with patient weight and insertion site.
Main Methods:
- Prospective data collection over 12 months for ultrasound-guided central venous access device insertions.
- Image intensifier used for all insertions; radiation dose and screening time recorded.
- Cohort study design (Level of Evidence: II).
Main Results:
- 145 devices inserted in 127 pediatric patients (median age 5.5 years, median weight 21kg).
- Median radiation dose was 0.00599 mGym², with a median screening time of 18 seconds.
- Higher median doses observed in children <10kg and for left internal jugular vein insertions.
Conclusions:
- Radiation burden from these procedures in children is small, similar to a chest radiograph.
- Patient weight <10kg and left internal jugular vein access are associated with increased radiation doses.
Abstract:
Permanent central venous access is essential for the management of many pediatric patients. Knowing the amount of ionizing radiation used during the insertion of these devices is important. Our aim was to identify the radiation used in percutaneous insertion of central venous access devices, and to correlate radiation exposure to patient weight.
Methods:
Data was prospectively collected during a 12-month period from August 2015 to August 2016 on all ultrasound-guided percutaneous central venous access device insertions. An image intensifier was used in all insertions with data on radiation dose and screening time extracted, when available. The total radiation dose was measured in mGym2 and the total radiation time in seconds. A p-value <0.05 was used to denote statistical significance.
Results:
A total of 145 central venous access devices were inserted (82 portacaths, 43 double lumen lines, 16 single lumen lines and 4 hemocaths) in 127 patients (Median Age: 5.5years (Range 0-17); Median Weight 21kg (Range 1.9-100)) with 15 patients requiring multiple insertions over the course of the study. Of these, 88 had data captured for total radiation dose and time used and a further 23 had screening time only recorded. Median radiation dose was 0.00599 mGym2 (range 0.000543-0.148) with a median fluoroscopic screening time of 18s (range 2-479). Median dose was higher for children <10kg compared to larger children, 0.00661 mGym2 (range 0.00202-0.0468) versus 0.005715 mGym2 (range 0.000543-0.148) respectively. Left-sided internal jugular vein (IJV) insertions also had a higher median radiation dose of 0.0091 mGym2 (range 0.00142-0.148 mGym2) versus 0.005245 mGym2 (range 0.000543-0.0285 mGym2) for right-sided IJV insertions.
Conclusion:
The radiation burden to children from percutaneous ultrasound-guided central venous access device insertions is small, in the order of that received during a chest radiograph. Weight<10kg and access of the left IJV are associated with receiving higher doses.
Study Type:
Cohort Study (Level of Evidence: II).
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