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Intervention-Training for Pediatric General Fluoroscopy: Can It Make a Difference?

E Somasundaram , S Brady , S Kraus , K Strauss*, Cincinnati Childrens Hospital Med Ctr, Cincinnati, OH


(Sunday, 7/14/2019)  

Room: ePoster Forums

Purpose: Quantitative analysis of pediatric dose reduction in three common fluoroscopic procedures due to a quality improvement training for clinicians in rotation.

Methods: An IRB approved quality improvement project included an intervention consisting of a presentation detailing best-practice imaging techniques of general pediatric fluoroscopy followed by an explanation of design features and specific controls of the available fluoroscopes (EasyDiagnost Eleva DRF, Philips Healthcare). The exam doses from the three most common pediatric fluoroscopy procedures: upper GI (UGI), lower GI (LGI), and voiding cystourethrogram (VCUG) were used to quantify the effect of the training program. For each exam, fluoroscopy time (FT), air KERMA (AK), KERMA area product (KAP), and patient size [anteroposterior (AP) dimension] were collected. Baseline data were collected for five months (Jan-May 2014) prior to the intervention; after which, a single intervention training was conducted for all fellows, five attending radiologists, one radiologist assistant, all fluoroscopy technologists, and child life specialists. Five months of data were collected following the intervention (June-Oct 2014).The two sample t-test was applied after performing log-transformation to compare the dose levels and fluoroscopy time between the treatment and control groups. A comparison of patient thickness was performed to ensure the population distribution is similar in both groups.

Results: The results demonstrated that the quality improvement training resulted in a significant reduction (P-value < 0.05) in mean AK for VCUG (1.45 Vs. 1.93 mGy), UGI (3.73 Vs. 5.72 mGy) and LGI (3.33 Vs. 4.71 mGy); reductions in mean KAP were significant only for VCUG (22.42 Vs. 30.81 µGy.m^2) and LGI (122.31 Vs. 170.02 µGy.m^2). A significant reduction in the mean FT (1.12 Vs. 1.46 min) and collimated area (140.1 Vs. 149.3 cm^2) was observed for VCUG only.

Conclusion: Staff training on best-imaging-practices enabled more conscientious imaging that lead to dose reduction for three common pediatric general fluoroscopy procedures.


Fluoroscopy, Dose, Optimization


IM- X-ray: Fluoroscopy, digital angiography, and DSA

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