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Choice of tube extremity for emission of the lowest radiation dose in pediatric patients.

ABSTRACT: Aims:To compare the dosage of radiation the thyroid and gonad glands receive in pediatric patients undergoing chest X-rays, in distinct positions, towards the goal of developing of an X-ray tube positioning protocol. Methods:A randomized controlled clinical trial was carried out in the Pediatric Intensive Care Unit (PICU) at the Institute of Cardiology/University Foundation of Cardiology of Rio Grande do Sul, Brazil from June 2014 to September 2016. Patients were divided into two groups. One group was positioned with the thyroid gland facing the anode end of an X-ray tube, and in the other group the thyroid gland faced the cathode end. Radiographs were evaluated by five observers, following criteria recommended by the Commission of the European Communities (CEC). Results:Forty-eight pediatric patients, with a mean age of 2.0?±?1.3?years, participated in this study. Based on the evaluation of 48 images, it was determined that the thyroid and gonad glands facing the cathode were exposed to 13.3?±?3.1??Gy and 13.5?±?4.1??Gy of radiation, respectively (p?=?0.008). Additionally, the thyroid and gonad glands facing the anode were exposed to 11.7?±?3.1??Gy and 12.7?±?3.1??Gy of radiation, respectively (p?=?0.007). The mean input dose in the center of the chest was 20.8?±?9.6??Gy in both positions. Discussion:The proximity of the thyroid gland to the cathode end of the X-ray tube appears to be related to the dosage of ionizing radiation. Adverse effects associated with exposure to ionizing radiation could be minimized by positioning the thyroid gland to the anodic end of the X-ray tube. Conclusion:Patients should be placed facing the anode end of the X-ray tube when taking thoracic X-rays, in order to reduce radiation exposure to the thyroid and gonad glands.ClinicalTrials.gov Identifier: NCT02925936.

SUBMITTER: Rodrigues GO

PROVIDER: S-EPMC6180336 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Choice of tube extremity for emission of the lowest radiation dose in pediatric patients.

Rodrigues Guilherme Oberto GO Medeiros Rogério Fachel RF Rodrigues Sergio Chaves SC Boll Liliana Fortini Cavalheiro LFC Irigoyen Maria Claudia MC Goldmeier Silvia S

International journal of cardiology. Heart & vasculature 20181010

<h4>Aims</h4>To compare the dosage of radiation the thyroid and gonad glands receive in pediatric patients undergoing chest X-rays, in distinct positions, towards the goal of developing of an X-ray tube positioning protocol.<h4>Methods</h4>A randomized controlled clinical trial was carried out in the Pediatric Intensive Care Unit (PICU) at the Institute of Cardiology/University Foundation of Cardiology of Rio Grande do Sul, Brazil from June 2014 to September 2016. Patients were divided into two ...[more]

PMID: 30320204

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Project description:In this article, we present GE Healthcare's design philosophy and implementation of X-ray imaging systems with dose management for pediatric patients, as embodied in its current radiography and fluoroscopy and interventional cardiovascular X-ray product offerings. First, we present a basic framework of image quality and dose in the context of a cost-benefit trade-off, with the development of the concept of imaging dose efficiency. A set of key metrics of image quality and dose efficiency is presented, including X-ray source efficiency, detector quantum efficiency (DQE), detector dynamic range, and temporal response, with an explanation of the clinical relevance of each. Second, we present design methods for automatically selecting optimal X-ray technique parameters (kVp, mA, pulse width, and spectral filtration) in real time for various clinical applications. These methods are based on an optimization scheme where patient skin dose is minimized for a target desired image contrast-to-noise ratio. Operator display of skin dose and Dose-Area Product (DAP) is covered, as well. Third, system controls and predefined protocols available to the operator are explained in the context of dose management and the need to meet varying clinical procedure imaging demands. For example, fluoroscopic dose rate is adjustable over a range of 20:1 to adapt to different procedure requirements. Fourth, we discuss the impact of image processing techniques upon dose minimization. In particular, two such techniques, dynamic range compression through adaptive multiband spectral filtering and fluoroscopic noise reduction, are explored in some detail. Fifth, we review a list of system dose-reduction features, including automatic spectral filtration, virtual collimation, variable-rate pulsed fluoroscopic, grid and no-grid techniques, and fluoroscopic loop replay with store. In addition, we describe a new feature that automatically minimizes the patient-to-detector distance, along with an estimate of its dose reduction potential. Finally, two recently developed imaging techniques and their potential effect on dose utilization are discussed. Specifically, we discuss the dose benefits of rotational angiography and low frame rate imaging with advanced image processing in lieu of higher-dose digital subtraction.

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Choice of tube extremity for emission of the lowest radiation dose in pediatric patients.

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Choice of tube extremity for emission of the lowest radiation dose in pediatric patients.

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