Skip to main content

Advertisement

SpringerLink
Log in

Radiation Exposure in Biliary Procedures Performed to Manage Anastomotic Strictures in Pediatric Liver Transplant Recipients: Comparison Between Radiation Exposure Levels Using an Image Intensifier and a Flat-Panel Detector-Based System

  • Technical Note
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to estimate radiation exposure in pediatric liver transplants recipients who underwent biliary interventional procedures and to compare radiation exposure levels between biliary interventional procedures performed using an image intensifier-based angiographic system (IIDS) and a flat panel detector-based interventional system (FPDS).

Materials and Methods

We enrolled 34 consecutive pediatric liver transplant recipients with biliary strictures between January 2008 and March 2013 with a total of 170 image-guided procedures. The dose-area product (DAP) and fluoroscopy time was recorded for each procedure. The mean age was 61 months (range 4–192), and mean weight was 17 kg (range 4–41). The procedures were classified into three categories: percutaneous transhepatic cholangiography and biliary catheter placement (n = 40); cholangiography and balloon dilatation (n = 55); and cholangiography and biliary catheter change or removal (n = 75). Ninety-two procedures were performed using an IIDS. Seventy-eight procedures performed after July 2010 were performed using an FPDS. The difference in DAP between the two angiographic systems was compared using Wilcoxon rank-sum test and a multiple linear regression model.

Results

Mean DAP in the three categories was significantly greater in the group of procedures performed using the IIDS compared with those performed using the FPDS. Statistical analysis showed a p value = 0.001 for the PTBD group, p = 0.0002 for the cholangiogram and balloon dilatation group, and p = 0.00001 for the group with cholangiogram and biliary catheter change or removal.

Conclusion

In our selected cohort of patients, the use of an FPDS decreases radiation exposure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Heffron TG, Emond JC, Whitington PF et al (1992) Biliary complications in pediatric liver transplantation. A comparison of decreased-size and whole grafts. Transplantation 53:391–395

    Article  PubMed  CAS  Google Scholar 

  2. Lallier M, St-Vil D, Luks FI, Bensoussan AL, Guttman FM, Blanchard H et al (1993) Biliary tract complications in pediatric orthotopic liver transplantation. J Pediatr Surg 28:1102–1105

    Article  PubMed  CAS  Google Scholar 

  3. Lorenz JM, Funaki B, Leef JA et al (2001) Percutaneous transhepatic cholangiography and biliary drainage in pediatric liver transplant patients. Am J Roentgenol 176(3):761–765

    Article  CAS  Google Scholar 

  4. Lorenz JM, Denison G, Funaki B et al (2005) Balloon dilatation of biliary-enteric strictures in children. Am J Roentgenol 184(1):151–155

    Article  Google Scholar 

  5. Sunku B, Salvalaggio PR, Donaldson JS et al (2006) Outcomes and risk factors for failure of radiologic treatment of biliary strictures in pediatric liver transplantation recipients. Liver Transpl 12(5):821–826

    Article  PubMed  Google Scholar 

  6. Miraglia R, Maruzzelli L, Caruso S et al (2008) Percutaneous management of biliary strictures after pediatric liver transplantation. Cardiovasc Intervent Radiol 31(5):993–998

    Article  PubMed  Google Scholar 

  7. Brun N, Bueno J, Pérez M et al (2010) Long term follow-up of bile duct stenosis treated with interventional radiology in pediatric liver transplantation. Cir Pediatr 23(1):3–6

    PubMed  CAS  Google Scholar 

  8. Moreira AM, Carnevale FC, Tannuri U et al (2010) Long-term results of percutaneous bilioenteric anastomotic stricture treatment in liver-transplanted children. Cardiovasc Intervent Radiol 33(1):90–96

    Article  PubMed  Google Scholar 

  9. Kleinerman R (2006) Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 36(Suppl 2):121–125

    Article  PubMed  Google Scholar 

  10. Linet M, Kim K, Rajaraman P (2009) Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol 39(Suppl 1):S4–S26

    Article  PubMed  Google Scholar 

  11. Sidhu M, Coley BD, Goske MJ et al (2009) Image gently, step lightly: increasing radiation dose awareness in pediatric interventional radiology. Pediatr Radiol 39(10):1135–1138

    Article  PubMed  Google Scholar 

  12. Sidhu M (2010) Radiation safety in pediatric interventional radiology: step lightly. Pediatr Radiol 40(4):511–513

    Article  PubMed  Google Scholar 

  13. Broelsh CE, Whitington PF, Emond JC et al (1991) Liver transplantation in children from living related living donors. Ann Surg 214:428–437

    Article  Google Scholar 

  14. Stecker MS, Balter S, Towbin RB et al (2009) Guidelines for patient radiation dose management. J Vasc Interv Radiol 20(Suppl 7):S263–S273

    Article  PubMed  Google Scholar 

  15. Miller DL, Balter S, Wagner LK et al (2004) Quality improvement guidelines for recording patient radiation dose in the medical record. J Vasc Interv Radiol 15:423–429

    Article  PubMed  Google Scholar 

  16. Righi D, Doriguzzi A, Rampado O et al (2008) Interventional procedures for biliary drainage with bilioplasty in pediatric patients: dosimetric aspects. Radiol Med 113(3):429–438

    Article  PubMed  CAS  Google Scholar 

  17. Miller DL, Kwon D, Bonavia GH (2009) Reference levels for patient radiation doses in interventional radiology: proposed initial values for US practice. Radiology 253(3):753–764

    Article  PubMed  Google Scholar 

  18. Hart D, Hillier MC, Wall BF (2009) National reference doses for common radiographic, fluoroscopic and dental X-ray examinations in the UK. Br J Radiol 82(973):1–12

    Article  PubMed  CAS  Google Scholar 

  19. Kloeckner R, Bersch A, Dos Santos DP et al (2012) Radiation exposure in nonvascular fluoroscopy-guided interventional procedures. Cardiovasc Intervent Radiol 35(3):613–2018

    Article  PubMed  Google Scholar 

  20. Bacher K, Bogaert E, Lapere R et al (2005) Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation 111(1):83–89

    Article  PubMed  Google Scholar 

  21. Holmes DR Jr, Laskey WK, Wondrow MA et al (2004) Flat-panel detectors in the cardiac catheterization laboratory: revolution or evolution—what are the issues? Catheter Cardiovasc Interv 63:324–330

    Article  PubMed  Google Scholar 

  22. Tsapaki V, Kottou S, Kollaros N et al (2004) Dose performance evaluation of a charge coupled device and a flat-panel digital fluoroscopy system recently installed in an interventional cardiology laboratory. Radiat Prot Dosimetry 111:297–304

    Article  PubMed  Google Scholar 

  23. Tsapaki V, Kottou S, Kollaros N et al (2004) Comparison of a conventional and a flat-panel digital system in interventional cardiology procedures. Br J Radiol 77:562–567

    Article  PubMed  CAS  Google Scholar 

  24. Suzuki S, Furui S, Kobayashi I et al (2005) Radiation dose to patients and radiologists during transcatheter arterial embolization: comparison of a digital flat-panel system and conventional unit. Am J Roentgenol 185:855–859

    Article  Google Scholar 

  25. Davies AG, Cowen AR, Kengyelics SM et al (2007) Do flat detector cardiac X-ray systems convey advantages over image-intensifier-based systems? study comparing X-ray dose and image quality. Eur Radiol 17:1787–1794

    Article  PubMed  Google Scholar 

  26. Seibert JA (2006) Flat-panel detectors: how much better are they? Pediatr Radiol 36(Suppl 2):173–181

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 1, 90100, Palermo, Italy

    Roberto Miraglia, Luigi Maruzzelli & Angelo Luca

  2. Department of Information Technology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 1, Palermo, Italy

    Fabio Tuzzolino

  3. Medical Physic ISMETT Consultant, Fismeco, Via Giuseppe Donati, 32, 00159, Rome, Italy

    Pietro Luigi Indovina

Authors
  1. Roberto Miraglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luigi Maruzzelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabio Tuzzolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pietro Luigi Indovina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelo Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Miraglia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miraglia, R., Maruzzelli, L., Tuzzolino, F. et al. Radiation Exposure in Biliary Procedures Performed to Manage Anastomotic Strictures in Pediatric Liver Transplant Recipients: Comparison Between Radiation Exposure Levels Using an Image Intensifier and a Flat-Panel Detector-Based System. Cardiovasc Intervent Radiol 36, 1670–1676 (2013). https://doi.org/10.1007/s00270-013-0660-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-013-0660-9

Keywords

Search

Navigation