Division of Image Guided Therapy in the Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada M5G 1X8.
J Vasc Interv Radiol. 2012 Apr;23(4):443-50. doi: 10.1016/j.jvir.2011.11.020. Epub 2012 Jan 25.
To determine the range of effective doses encountered during common enteric and venous access procedures by using a method to estimate effective dose based on fluoroscopy time.
A pediatric phantom and metal oxide semiconductor field-effect transistor model was used to calculate effective doses associated with nine enteric and venous access procedures involving fluoroscopy only. Enteric procedures included primary gastrostomy, gastrojejunostomy, cecostomy tube insertions, and their "maintenance procedures" (eg, tube checks and changes, reinsertions, and exchanges). Venous access procedures included insertion of peripherally inserted central catheters, central venous catheters, and port catheters. Effective dose estimates were determined from phantom simulations of each procedure accounting for patient age, collimation, magnification, and tube position. Effective dose calculations from the simulations were normalized to fluoroscopy time, resulting in age- and procedure-specific factors (in mSv·min(-1)). These factors were retrospectively applied to fluoroscopy times logged in a database for 7,074 patient encounters, yielding a range of effective dose estimates for each procedure type.
From 3,699 venous access procedures reviewed, the mean effective dose was 0.1 mSv (range, 0.01-3.28 mSv). Review of 3,405 enteric access procedures showed doses that vary considerably, with mean doses of 0.3-1.7 mSv (range, 0.01-11.35 mSv). Several complex cases were identified with doses exceeding 4 mSv. Maintenance enteric procedures usually required lower doses (approximately 50%) than primary insertions.
Effective doses for pediatric enteric and venous access procedures performed in children are generally low. In difficult cases, effective doses can reach levels comparable to those of pediatric computed tomography.
通过一种基于透视时间估算有效剂量的方法，确定常见肠内和静脉通路程序中遇到的有效剂量范围。
使用儿科体模和金属氧化物半导体场效应晶体管模型，计算仅涉及透视的 9 种肠内和静脉通路程序相关的有效剂量。肠内程序包括胃造口术、胃空肠吻合术、盲肠造口管插入术及其“维持程序”（例如，管检查和更换、重新插入和交换）。静脉通路程序包括外周插入中心导管、中心静脉导管和端口导管的插入。有效剂量估算值是从每个程序的体模模拟中得出的，考虑了患者年龄、准直、放大率和管位置。模拟得出的有效剂量计算结果归一化为透视时间，从而得出与年龄和程序相关的因素（以 mSv·min(-1) 表示）。这些因素被 retrospective 应用于 7074 例患者的透视时间数据库中，得出每种程序类型的有效剂量范围。
从 3699 例静脉通路程序中，平均有效剂量为 0.1 mSv（范围，0.01-3.28 mSv）。对 3405 例肠内通路程序的审查显示，剂量差异很大，平均剂量为 0.3-1.7 mSv（范围，0.01-11.35 mSv）。有几个复杂的病例剂量超过 4 mSv。肠内维持程序通常需要较低的剂量（约 50%）比初次插入。
在儿科患者中进行的儿科肠内和静脉通路程序的有效剂量通常较低。在困难的情况下，有效剂量可以达到与儿科计算机断层扫描相当的水平。
