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Related Experiment Videos

The "free" routine postcatheterization urogram: a cost/benefit analysis

J D Waldman, G W Kaplan, P S Rummerfield

    Pediatric Cardiology
    |January 1, 1982
    PubMed
    Summary

    Routine postangiography urography in children provides low clinical yield and significant radiation exposure. Modifying the procedure reduces average abdominal radiation dose by over 87%.

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    Area of Science:

    • Pediatric Cardiology
    • Diagnostic Imaging
    • Radiation Oncology

    Background:

    • Postangiography urography is a common procedure following cardiac catheterization in pediatric patients.
    • Concerns exist regarding the diagnostic yield and radiation exposure associated with this routine practice.

    Purpose of the Study:

    • To analyze the x-radiation dosage and clinical significance of routine postangiography urography in children.
    • To evaluate the necessity of routine postangiography cine-urography in pediatric cardiac patients.

    Main Methods:

    • Radiation exposure to the abdomen and gonads was measured using lithium fluoride thermoluminescent dosimeters in 35 children.
    • Clinical significance of 334 consecutive routine postangiography cine-urograms was retrospectively evaluated.

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  • Radiation doses from cine-urography, fluoroscopy, and abdominal roentgenograms were quantified.

    • Main Results:

    • Average abdominal radiation dose was 241 mR from cine-urography, 16 mR from fluoroscopy, and 107 mR from a single roentgenogram.
    • Gonadal dosage averaged 8 mR, consistently below 27 mR.
    • Only 3% of routine cine-urograms revealed clinically significant urologic conditions; 9% were technically inadequate.

    Conclusions:

    • Routine postangiography cine-urography in children offers a low yield of clinically significant findings and contributes substantial radiation exposure.
    • A revised protocol involving fluoroscopic examination of renal collecting systems, with selective abdominal roentgenograms, significantly reduces radiation dose.
    • This modified approach lowers the mean average absorbed abdominal radiation dose from 241 mR to 30.5 mR.