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The tailored low dose fluoroscopic voiding cystogram for familial reflux screening
D A Diamond1, P K Kleinman, M Spevak
1Division of Pediatric Urology, University of Massachusetts Medical Center, Worcester, USA.
Insights
Tailored low dose fluoroscopic voiding cystography effectively screens for familial reflux in children. This method offers comparable radiation doses to radionuclide voiding cystography while providing detailed anatomical information.
Area of Science:
- Pediatric Radiology
- Urology
Background:
- Familial reflux is often screened using radionuclide voiding cystography.
- Assessing the efficacy of alternative screening methods is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the effectiveness of a tailored, low-dose fluoroscopic voiding cystography (VCG) for detecting familial reflux.
- To compare the efficacy and radiation exposure of this technique against traditional methods.
Main Methods:
- A cohort of 20 children (siblings of patients with known reflux) aged 9 months to 10 years underwent a tailored low-dose fluoroscopic VCG.
- The protocol was specifically designed to minimize gonadal radiation dose.
Main Results:
- The technique successfully confirmed the absence of reflux in 10 patients.
- Mean fluoroscopy time was 19 seconds, with mean gonadal radiation exposure below 1.5 mrad, comparable to radionuclide VCG.
- In cases where reflux was detected, the study seamlessly transitioned to standard fluoroscopy for detailed anatomical assessment and reflux quantification, avoiding a second procedure.
Conclusions:
- Tailored low-dose fluoroscopic VCG is a practical and effective method for assessing familial reflux in pediatric patients.
- This approach offers a balance between diagnostic accuracy, radiation safety, and procedural efficiency.
Purpose:
Radionuclide voiding cystography is generally advocated as a screening study to detect familial reflux. We assessed the efficacy of tailored low dose fluoroscopic voiding cystography for this purpose.
Materials And Methods:
We evaluated 10 boys and 10 girls 9 months to 10 years old (mean age 5 years) who were siblings of patients known to have reflux. The technique used a low dose fluoroscopic system. A tailored voiding cystographic protocol was designed to minimize gonadal radiation dose.
Results:
Absence of reflux was confirmed in 10 patients. Mean fluoroscopy time was 19 seconds (range 14 to 22), resulting in mean gonadal radiation exposure of less than 1.5 mrad., which is comparable to the lowest reported doses with the radionuclide technique. After reflux was demonstrated in 10 patients the study was immediately converted to a standard fluoroscopic imaging technique to define lower tract anatomy and quantitate reflux, avoiding a second study.
Conclusions:
Tailored low dose fluoroscopic voiding cystography appears to be a practical approach for the assessment of familial reflux.