Publisher: En , la Academia Americana de Pediatría recomendó realizar una ecografía renal y una cistouretrografía miccional a todos los. O paciente foi então submetido a uma cistouretrografia miccional, que revelou bexiga com capacidade normal, de contornos trabeculados e formações. Cistouretrografía miccional seriada. (CUMS): Esta técnica informa sobre la presencia de reflujo vésico-ureteral, sobre las características de la uretra proximal y.
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Evaluation of radiation dose in voiding cystourethrography in children. To evaluate dose-area product, skin entrance dose and doses from fluoroscopy and radiography in voiding cystourethrography studies of pediatric patients. Procedures performed in 37 patients by four physicians of the institution were evaluated. Measurements were performed with an equipment including an ionization chamber directly coupled to the x-ray tube window and an electrometer Diamentor connected to a computer for data collection.
Some procedures heterogeneity was observed and guidelines for good radiographic techniques were not followed. On average, 11 radiographies are performed for each study, cistouretrogfafia extended fluoroscopy time delivering a higher average final dose than those reported in the literature. The cjstouretrografia of radiography with high kilovoltage technique and restricted utilization of fluoroscopy can result in a significant reduction of doses during this procedure, considering that the major contribution to the final dose comes from fluoroscopy.
The use of ionizing radiation for diagnosis and therapy of pediatric patients has become a common practice with unquestionable benefits. However, even being such use justifiable by the benefits to patients, standards and radioprotection techniques cannot be forgotten. This means that all patients must receive the maximum attention in order to minimize the possibility of acute and late biological effects resulting from radiation exposure.
Thus, if radioprotection of patients exposed to ionizing radiations is important, it is moreover so, with pediatric patients 1,2. The main indications for this imaging method are: The dose delivered by a determined radiological examination reaches its maximum on the surface of the irradiated area. One can determine the radiation dose incident on the exposed areas micccional using the Diamentor, a device that is coupled to the x-ray tube that allows the monitoring of accumulative radiation emitted by the x-ray tube during the examination, and which will not interfere on the procedure performance.
Considering these factors and cistouretrogratia following variables, a anatomic differentiation, b discrepancy among techniques utilized to obtain pediatric radiographic images and c different doses to which patients are exposed, the European Community has issued the European Guidelines on Quality Criteria for Diagnostic Radiographic Images in Paediatrics 5defining the quality midcional of images for most of these procedures. This hospital is a reference cistourtrografia neonatology, pediatric surgery and medical genetics; consequently, the number of patients with congenital abnormalities is miccionl high, with frequent cases of urinary abnormalities.
Considering the predominantly pediatric profile of the institution, the present study is aimed at analyzing the radiation doses to which children are exposed during voiding cystourethrography. This chamber, positioned immediately below the collimator, registers the radiation emitted by the miccioal during the examination time, monitoring the DAP and ESD cistkuretrografia the patient being submitted to radiography and fluoroscopy.
The patients were divided into four age groups: The routine for examination starts with an abdominal radiograph in anteroposterior micciobal, with the patient in dorsal decubitus. The next step is a careful genital antisepsis and introduction of a catheter through the urethra to the interior of the bladder.
Through this catheter, iodinated contrast medium diluted in saline solution is administered, and anteroposterior radiographs are made during the vesical filling, at csitouretrografia low, medium and full filling stages. These images will allow cistouetrografia evaluation of a possible vesicoureteral reflux, of the contents and of the bladder wall. The radiographs in the full filling stage should cistourerografia the entire presumable urinary tract. After the bladder filling phase, the voiding study is performed with anteroposterior radiographs in the case of girls, and with lateral or oblique, in the case of cistouretrografix.
After the voiding is completed, anteroposterior abdominal radiography is performed to evaluate the degree of vesical emptying and the presence or not of vesicoureteral reflux. One half the children were one year old or less at the time the examinations were performed.
Their weight ranged from 2. The body mass index Cisrouretrografia was calculated and ranged from Mean values for voltage kV and load mAs obtained in the examinations were 72 kV and 6. Total DAP ranged from to 1, cGy. Mean total DAP for radiography and fluoroscopy was separately evaluated for each age group, noticing that in the highest age group, the utilization of larger films and fluoroscopy fields contributes for a larger irradiated area, and consequently, to an increase in the dose Table 3.
The comparison of doses in relation to sex demonstrated that, in spite the higher mean body mass index for girls, the dose on the boys was higher Table 4probably because of the inherent difficulties presented by the male anatomy, and the higher number of abnormal studies in boys, which caused greater time in fluoroscopy, and increase in dose.
The comparison by examiner radiologist showed small differences in the way the examinations were conducted, and highlights the extension of the fluoroscopy time by cistouertrografia the examiners as per Table 5. It is important to observe that the radiologist A performed the highest number and percentage of abnormal studies. One of micconal units produced a DAP five times higher than the other and 4, cGy.
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This demonstrates the need for a rigorous quality control in radiological equipment for medical applications, especially in a pediatric hospital. Voiding cystourethrography is considered the standard method in the evaluation of vesicoureteral reflux and malformations of the urethra and bladder 4.
For being anatomically related with the genital area where the ovaries that cannot be protected and testicles that can be partially protected from the inherent high examination dose by means of gonad protectorsthis imaging method causes a great exposure of these structures that are so sensitive to radiation.
Quantifying the radiation exposure determined by an imaging method is a relevant task, especially when this method has such a clarifying meaning as observed in voiding cystourethrography, considering that there is the opportunity to define the actual level of exposure caused by the method mifcional, within the acceptable cistouretrogdafia to produce a good micciohal image, to correct the application of eventually high doses which many times are caused by the radiologist habit of trying to produce a diagnosis by means of fluoroscopy, forgetting the radiation dose delivered to the patient.
One should remember that some radiologists perform the examination without using fluoroscopy, because they have learned to do so, in a time when image intensifiers were not available. In the present study, one of the factors that contributed for the magnitude of entrance skin doses was the lack of uniformity of the radiographic imaging techniques employed.
However, all of them used fluoroscopy for an extended time, increasing the radiation dose delivered to the patient. This fact can be explained by the abnormal studies, which require additional incidences to adequately document alterations in the urinary tract such as, for example, the presence of bladder diverticula, male urethral abnormalities and other more complex abnormalities.
Considering that the fluoroscopy time ranged from 82 to 1, seconds mean, secondsthe authors can suggest a radical reduction of this time. The utilization of high-kilovoltage and low-milliampere techniques, cistoyretrografia well as fluoroscopy only for positioning the patient and observing the most remarkable alterations, will certainly result in an important dose reduction.
The observation of total ESD ranging from 17 to In a review of similar studies in developed in other countries, one can better evaluate such difference.
In this latter hospital, the fluoroscopy time ranged from 0. In the present study, in one study, the fluoroscopy time reached more than 20 minutes, perhaps justified by the problems of the patient affected by spine deformity, with severe scoliosis causing extreme difficulty in the manipulation of the region for images cistourdtrografia.
On the other hand, Ruiz et al. One even questioned if there might be an expressive difference in the biometric profile among the children, however, the BMI evaluation showed that the majority of them were low-weight children.
Only one child might be considered obese, which does not influence the average technical factors. However, considering what occurred in the fluoroscopy study, where similar equipment presented very different doses, leading to the finding of a serious problem in one of them which led to its deactivation, one may question if some technical non-conformity might be happening, and thus justify the high doses observed in the present study.
The authors’ findings allow them to suggest that both DAP and ESD are good parameters to evaluate appropriate dose levels for voiding cystourethrography. Higher patients or those in the higher age ranges require larger films to document the images, which in certain instances should include the whole collecting system from the bladder to the kidneys.
The limitation of the fluoroscopy area only to the area of interest, even in equipment with automatic collimation as a function of the programmed film division, could be an additional dose reducing factor in these higher patients. It was found that the equipment makes divisions only “in the vertical sense”, meaning that one 30 x 40 film will always have images with 30 or kiccional cm cistouretrigrafia height, if the manual collimation is not made, which increases the exposed cisoturetrografia.
At the first years of life, the patients tend to be more cistouretrografla during the examination and, consequently, end up staying longer under fluoroscopy, which cistouretrogrqfia contributes to the higher final dose. In one of the patients included in this age group, fluoroscopy accounted for However the values found were discrepant, ranging from 0.
Setting the fluoroscopy values for current and voltage in a sufficiently low level to allow the identification of the desired structures may result in a considerable reduction of the total dose of the procedure. Most recent studies 19,20 approach the utilization of technically more updated equipment, mmiccional the so called pulsed fluoroscopy, which considerably reduces the total dose, by directly influencing the fluoroscopy dose reduction. Ward 20 also suggests that, previously to the examination, the radiologist should obtain the clinical history of the patient and confirm if the indication is correct, or if some other method, such as radionuclide cystogram for example, might be a better indication to clarify the doubts of the assisting physician.
The dose delivered to the patient in voiding cystourethrography is high, with fluoroscopy being its primary contributor. In an important Brazilian Institution of pediatric radiology, the doses are above those found in similar studies. The authors propose a greater awareness of cistouretrografiq, towards utilizing high kilovoltage techniques and reduced fluoroscopy time in the examination.
Which is the best way of performing a micturating cystourethrogram in children? Saudi J Kidney Dis Transpl. Radiation dose cistouretrotrafia and risk estimation for paediatric patients undergoing micturating cysto-urethrography. European cistouretrogradia on quality criteria for diagnostic radiographic images in paediatrics.
Assessment of dosimetric quantities for patients undergoing X-ray examinations in a large public hospital in Brazil – a preliminary study. Survey of doses miccionap frequency of X-ray examinations on children at cistouretrografiz intensive care unit of a large reference pediatric hospital. Radiation dose reduction in paediatric fluoroscopy using added filtration. Evaluation of work practices and radiation dose during adult micturating cystourethrography examinations performed using a digital imaging system.
Dose and image quality in the comparison of analogue and digital techniques in ciatouretrografia urology examinations. Dose-area product values in frequently performed complex paediatric radiology examinations. Radiation doses to paediatric patients undergoing micturating cystourethrography examinations and potential reduction by radiation protection optimization.
Estimation of adult patient doses for common diagnostic X-ray examinations in Rio de Janeiro, Brazil.
cistouretrografía miccional con TV | Spanish to English | Medical: Health Care
cistkuretrografia Paediatric x-ray examinations in Rio de Janeiro. A comparison of doses and techniques between specialist and non-specialist centres in the diagnostic X-ray imaging of children.
Pediatric radiation exposure and effective dose reduction during voiding cystourethrography. Cistouretrogeafia dose reduction during voiding cystourethrography. Received October 31, Accepted after revision November 14,