Diagnostic Radiology Department, Bicetre University Hospital, 78 Rue Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Centrale Supélec, Université Paris-Saclay, Gif-sur-Yvette, France.
Pediatr Radiol. 2020 May;50(6):827-832. doi: 10.1007/s00247-020-04627-y. Epub 2020 Feb 18.
Liver-transplanted, immunosuppressed pediatric patients undergoing repeated percutaneous transhepatic cholangiography (PTC) require optimized exposure to ionizing radiation.
To establish local diagnostic reference levels (DRL) for pediatric PTC and investigate the routine use of X-ray equipment.
The study retrospectively analyzed data collected between October 2016 and June 2018 from a single center performing PTC. We collected exposure parameters including kerma area product (P), air kerma at patient entrance reference point (K) and fluoroscopy time via a dose archiving and communication system. Local diagnostic reference levels were derived as the 50th percentile of the distributions while considering published recommended weight groups. We investigated exposure variability with procedure complexity and with technical parameters recovered from the radiation dose structured report.
The analysis included 162 PTC procedures performed in 64 children: 58% male, average age 6 years (range 39 days to 16 years) and weight 24 kg (range 3-60 kg). Local DRLs for weight groups 0-5 kg, 5-15 kg, 15-30 kg, 30-50 kg and 50-80 kg were, respectively, 6 cGy.cm, 22 cGy.cm, 68 cGy.cm, 107 cGy.cm and 179 cGy.cm in P. Local DRLs per weight group were also established for intermediate and complex procedures. Radiation dose structured report analysis highlighted good local practice with efficient collimation, low fluoroscopy pulse rate, no magnification and limited use of radiographic acquisitions. Meanwhile, table and detector positioning and tube projection could still be optimized. P correlated significantly with the number of acquisitions and tube-to-table distance.
We established local DRLs for children undergoing PTC.
接受重复经皮肝穿刺胆道造影（PTC）的肝移植、免疫抑制的儿科患者需要优化电离辐射暴露。
为儿科经皮肝穿刺胆道造影术建立局部诊断参考水平（DRL），并研究 X 射线设备的常规使用情况。
本研究回顾性分析了 2016 年 10 月至 2018 年 6 月期间在一家进行 PTC 的单中心收集的数据。我们通过剂量档案和通信系统收集了包括比释动能面积乘积（P）、患者入射参考点处空气比释动能（K）和透视时间在内的曝光参数。局部诊断参考水平是在考虑已发表的推荐体重组的情况下，从分布的第 50 百分位数推导得出的。我们通过与程序复杂性相关的暴露变异性和从辐射剂量结构化报告中恢复的技术参数进行了研究。
分析包括对 64 名儿童进行的 162 次 PTC 手术：58%为男性，平均年龄 6 岁（范围 39 天至 16 岁），体重 24kg（范围 3-60kg）。体重组 0-5kg、5-15kg、15-30kg、30-50kg 和 50-80kg 的局部 DRL 分别为 P 中的 6cGy.cm、22cGy.cm、68cGy.cm、107cGy.cm 和 179cGy.cm。每个体重组还建立了中间和复杂手术的局部 DRL。辐射剂量结构化报告分析强调了良好的局部实践，包括有效的准直、低透视脉冲率、无放大和有限使用射线照相采集。同时，还可以优化桌子和探测器的定位以及管的投影。P 与采集次数和管-桌距离显著相关。
我们为接受 PTC 的儿童建立了局部 DRL。
