Data were prospectively collected on consecutive procedures (750 total) performed from January 2016 to December 2016 on 2 different fluoroscopy units (Siemens Iconos R200,
Luminos dRF).
Of each procedure patients data (name,
weight and birth date),
examination-data (kind of procedure,
date,
DAP [cGy*cm2],
total fluoroscopy time,
number of images) were recorded.
Data from micturating-cystourethrography (MCU),
barium meal (BM),
barium swallow (BS) and most commonly performed procedures were divided into 4 weight-groups (<10Kg,
10kg - <15Kg,
15kg - <30Kg,
30kg - <60Kg) and of each one 75th-percentile was calculated.
Data were compared to European DRL and recent literature data.
Weight groups were compared to age groups of previous data as indicated in table 11.2 of PidRL guidelines (<10Kg to newborn,
10kg - <15Kg to 1 years,
15 - <30Kg to 5 years,
30 -<60Kg to 10 years).
Weight-groups are considered a representative sample if at least 20-patients per procedure-type and per patient-group are included.
Results of most common diagnostic fluoroscopic examinations performed in our Hospital are summarized in figure 1.
Fig. 1
Our local DRL are substantially lower than that proposed by PiDRL guidelines.
MCU/VCUG
Results are summarized in figure 2.
Fig. 2
All weight groups are representative (at least 20-patients per group included).
Our updated LDRL for MCU are 7 (<10Kg),
10 (10-15Kg),
24 (15-30Kg) and 57 (30-60Kg).
Figure 3 shows the revised LDRL OPBG 2016 in comparison to previous LDRL OPBG data of 2012 and 2014,
European DRLs and most representative literature data (Hart 2012,
Hiorns 2006,
Ruiz 2015).
Fig. 3
DAP results to be lower than PiDRLs values (30,
70,
80,
75) and LDRL OPBG 2012 but higher if compared to a previous local survey of 2014 (4,
9,
18,
29).
This is probably due to change in technology: in 2015 a new combined 2-in-1 equipment for digital fluoroscopy and radiography (Luminos dRF) was installed in our Hospital and MUC/VCUG protocols were empirically setted.
The revision of the protocol parameters (e.g.
tube voltage,
mAs,
copper filtration,
etc.,
etc.) highlighted the use of a tube voltage higher than necessary (e.g.
85 kV vs <75 kV).
A revision of protocol settings has been done.
OTHERS
LDRL for barium swallow,
barium meal,
barium follow through and barium enema are summarized in figure 4.
Fig. 4
Few weight groups per procedure-type reached an adequate number of patients so that they can be considered "representative":
- In barium swallow data all age groups,
except 10-15 kg (DRL 15) are not representative.
- Representative DRL for barium meal are 9 (<10Kg),
32 (10-15Kg) and 28 (15-30Kg) respectively.
Other weight groups >30 kg are not representative.
- DRL for barium follow through are 19 (10-15Kg),
43 (15-30Kg) respectively.
Other weight groups (<10kg,
30-60 kg,
>60kg) are not representative.
- DRL for barium enema are 8 (<10Kg) and 26 (10-15Kg).
Weight groups >15 kg are not representative.
Figures 5-6 shows these data in comparison to previous LDRL OPBG 2012 and most representative literature data.
Fig. 5
Fig. 6