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Radiation burden to paediatric patients due to micturating cystourethrography examinations in a Dutch children's hospital

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Author: Schultz, F.W. · Geleijns, J. · Holscher, H.C. · Weststrate, J. · Zonderland, H.M. · Zoetelief, J.
Institution: Instituut voor Toegepaste Radiobiologie en Immunologie TNO
Source:British Journal of Radiology, AUG., 72, 763-772
Identifier: 235129
Keywords: Health · X ray film · Adolescent · Body Burden · Child · Child, Preschool · Evaluation Studies · Female · Humans · Infant · Male · Monte Carlo Method · Phantoms, Imaging · Radiation Dosage · Radiation Protection · Urethra · Urinary Bladder · Urination · Urination Disorders


Micturating cystourethrography (MCU) examinations of paediatric patients in a major Dutch children's hospital (JKZ) were evaluated to generate quantitative information on effective dose (E). A standard examination involves three radiographs plus fluoroscopy. Observed total dose-area product (DAP) for 84 children increased, on average, with increasing age class from 0.2 to 2.2 Gy cm2. In 11 cases, separate DAP per view was measured, enabling determination, per view, of organ (C(F)) and effective (C(E)) dose conversion factors, i.e. dose per unit of DAP. Monte Carlo simulation of photon transport in male and female mathematical phantoms was applied for newborn, 1 year, 5 year, 10 year and 15-year-old patients, and interpolated for other ages. C(E) per view decreases with increasing age class, yielding about a factor of 10 difference between the extremes of the range. Female values are usually some 20-30% above male ones. C(E) for one of the views appeared to be representative for the complete examination and was used to estimate total E for each patient. Averaged per age class, E remains approximately constant at 0.3-0.4 mSv, although a tendency to increase with increasing age exists, for females in particular. Within an age class, individual patients may differ in E by a factor of two up to six. Stomach, lower large intestine, bladder wall, liver and ovaries receive relatively high doses. Compared with published data and DAP measured in a few other Dutch hospitals, the radiation burden of MCU is low at the JKZ. This indicates a good degree of optimization with respect to radiation protection (e.g. modern equipment, increased tube voltage, fast film-screen combination).