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Simple preoperative radiation safety interventions significantly lower radiation doses during central venous line

Beatrix Hyemin Choi1, Kamalou Yaya2, Vinay Prabhu2

  • 1Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY.

Journal of Pediatric Surgery
|November 13, 2018
PubMed

Insights

Implementing a radiation safety process, including briefings and time-outs, significantly reduced radiation exposure during pediatric central venous line (CVL) placement. This intervention lowered radiation dose and time, decreasing the need for follow-up imaging.

Area of Science:

  • Pediatric radiology
  • Interventional radiology
  • Radiation safety

Background:

  • Central venous line (CVL) placement in children often involves ionizing radiation.
  • Minimizing radiation exposure is crucial for pediatric patients due to their radiosensitivity.
  • Existing protocols may not sufficiently address radiation reduction during these procedures.

Purpose of the Study:

  • To decrease radiation exposure in pediatric patients undergoing central venous line (CVL) placement.
  • To evaluate the effectiveness of a novel radiation safety process.
  • To implement a job-instruction model with a pre-procedural radiation safety briefing and time-out.

Main Methods:

  • A case-control study design was employed.
  • Radiation data (dose area product, radiation time) and chest radiograph use were analyzed for patients under 21 before and after intervention.
  • The intervention included a surgeon-led radiation safety briefing and a time-out before each procedure.

Main Results:

  • A 79% reduction in median dose area product (DAP) and a 73% decrease in median radiation time were observed post-intervention.
  • The use of post-procedural confirmatory chest X-rays (CXRs) significantly decreased from 95% to 15%.
  • Statistical significance (P < 0.001 for DAP and time; P < 0.01 for CXR) was achieved.

Conclusions:

  • A preoperative radiation safety briefing and time-out, supported by a job-instruction model, effectively reduced radiation doses in pediatric CVL insertions.
  • The implemented safety process demonstrated significant improvements in radiation safety metrics.
  • This approach offers a viable strategy for minimizing radiation risks in pediatric interventional procedures.
Abstract

Keywords:
Central venous lineFluoroscopyInterventionIntraoperative imagingRadiation exposureRadiation safety

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