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Updated: Jun 17, 2025
Photoacoustic Cystography
Published on: June 11, 2013
Impact of contrast agents on organ dosimetry in pediatric diagnostic fluoroscopy: the voiding cystourethrogram
Wyatt W Smither1, Emily L Marshall2, David Borrego3
1Medical Physics Program, College of Medicine, University of Florida, Gainesville, FL 32611, United States of America.
Insights
Including contrast media in pediatric voiding cystourethrogram (VCUG) simulations is crucial for accurate organ dose calculations. This study highlights how contrast concentration impacts dose coefficients in pediatric fluoroscopy, affecting radiation safety assessments.
Area of Science:
- Medical Physics
- Radiological Dosimetry
- Pediatric Imaging
Background:
- The International Commission on Radiological Protection (ICRP) Task Group 113 is establishing reference dose coefficients (DCs) for various imaging modalities.
- Accurate dose assessment in pediatric diagnostic fluoroscopy, particularly for voiding cystourethrogram (VCUG) examinations, requires consideration of contrast agents.
- Previous dose calculations may not have fully accounted for the impact of contrast media volume concentrations.
Purpose of the Study:
- To investigate the influence of iodinated contrast volume concentration on organ dose coefficients (DCs) for pediatric diagnostic fluoroscopy.
- To demonstrate the importance of including contrast media in Monte Carlo radiation transport simulations for VCUG examinations.
- To provide data supporting the development of reference organ DCs by ICRP Task Group 113.
Main Methods:
- Utilized ICRP newborn and 15-year-old female reference phantoms within the Particle and Heavy Ion Transport code system.
- Modeled four imaging fields representative of clinical VCUG examinations, defined by an experienced pediatric radiologist.
- Simulated iodinated contrast solutions at 0%, 25%, 50%, 75%, and 100% volume concentrations, calculating organ DCs for in-field organs.
Main Results:
- Organ DCs for the urinary bladder wall, colon wall, ovaries, and uterus were computed for both female phantoms.
- Observed variations in organ DCs with increasing iodine contrast volume; some increased, while others decreased at 100% concentration.
- Percent differences in organ DCs ranged from 0%-10% for the newborn phantom and 0%-22% for the 15-year-old phantom.
Conclusions:
- The concentration of iodinated contrast media significantly affects organ dose coefficients in pediatric VCUG examinations.
- Incorporating contrast media volume into radiation transport simulations is essential for accurate dose calculations in VCUG.
- These findings are critical for refining reference dose coefficients and ensuring radiation safety in pediatric fluoroscopy.
Abstract:
Objective.International Commission on Radiological Protection (ICRP) Task Group 113 is developing reference values of organ and effective dose coefficients (DCs) for radiography, fluoroscopy, and computed tomography imaging exams. In support of these efforts, our focus is on pediatric diagnostic fluoroscopy. Contrast agents used during clinical examinations are an important consideration of the work undertaken by the Task Group. This work demonstrates the importance of including organ contrast volume concentrations for the calculation of reference organ DCs in the voiding cystourethrogram (VCUG).Approach.The ICRP newborn and 15 year female reference phantoms were utilized within the Particle and Heavy Ion Transport code system for the calculation of organ DCs. A pediatric radiologist with over 30 years of clinical experience defined the imaging fields for a VCUG examination consistent with clinical practice. Of these, four imaging fields were selected for investigation. The transport simulations modeled an iodinated contrast solution similar to Bracco Group's 18% weight per volume, cystografin diatrizoate meglumine and typical bladder content was supplemented to make up the remainder volume. Iodinated contrast volumes of 0%, 25%, 50%, 75%, and 100% concentration by volume were modeled and associated DCs for in-field organs were computed.Main results.Organ DCs were calculated for the urinary bladder wall, colon wall, ovaries, and uterus for both female phantoms under irradiation geometries representative of a VCUG examination. Some organ DCs increased with iodine volume in the bladder and other organ DCs decreased as the iodine contrast volume completely filled the bladder (100%).Significance.The study results demonstrate for the newborn phantom percent differences in organ DCs varied between 0%-10% for the organs of interest, while they varied between 0%-22% in the 15 year phantom suggesting the importance of including contrast media in Monte Carlo radiation transport simulations of the VCUG examination.
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