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Intussusception reduction: Effect of air vs. liquid enema on radiation dose

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Abstract

Background

Both air and radiopaque liquid contrast are used to reduce ileocolic intussusception under fluoroscopy. Some suggest air lowers radiation dose due to shorter procedure times. However, air enema likely lowers radiation dose regardless of fluoroscopy time due to less density over the automatic exposure control cells.

Objectives

We test the hypothesis that air enema reduction of ileocolic intussusception results in lower radiation dose than liquid contrast enema independent of fluoroscopy time. We describe a role for automatic exposure control in this dose difference.

Materials and methods

We retrospectively evaluated air and liquid intussusception reductions performed on a single digital fluoroscopic unit during a 26-month period. We compared patient age, weight, gender, exam time of day and year, performing radiologist(s), radiographic image acquisitions, grid and magnification use, fluoroscopy time and dose area product. We compared categorical and continuous variables statistically using chi-square and Mann-Whitney U tests, respectively.

Results

The mean dose area product was 2.7-fold lower for air enema, 1.3 ± 0.9 dGy·cm2, than for liquid, 3.5 ± 2.5 dGy·cm2 (P<0.005). The mean fluoroscopy time was similar between techniques. The mean dose area product/min was 2.3-fold lower for air, 0.6 ± 0.2 dGy·cm2/min, than for liquid, 1.4 ± 0.5 dGy·cm2/min (P<0.001). No group differences were identified in other measured dose parameters.

Conclusion

Fluoroscopic intussusception reduction using air enema uses less than half the radiation dose of liquid contrast enema. Dose savings are independent of fluoroscopy time and are likely due to automatic exposure control interaction.

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Authors and Affiliations

  1. Department of Radiology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Summer L. Kaplan, J. Christopher Edgar, Sudha A. Anupindi & Xiaowei Zhu

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Summer L. Kaplan, J. Christopher Edgar, Sudha A. Anupindi & Xiaowei Zhu

  3. Environmental Health and Radiation Safety, University of Pennsylvania, Philadelphia, PA, USA

    Dennise Magill & Marc A. Felice

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  1. Summer L. Kaplan
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  2. Dennise Magill
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  3. Marc A. Felice
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  5. Sudha A. Anupindi
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Correspondence to Summer L. Kaplan.

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Kaplan, S.L., Magill, D., Felice, M.A. et al. Intussusception reduction: Effect of air vs. liquid enema on radiation dose. Pediatr Radiol 47, 1471–1476 (2017). https://doi.org/10.1007/s00247-017-3902-1

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  • DOI: https://doi.org/10.1007/s00247-017-3902-1

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