Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations.

BACKGROUND: Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. OBJECTIVE: To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. MATERIALS AND METHODS: We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. RESULTS: We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. CONCLUSION: Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold.

Radiation exposure contribution of the scout abdomen radiograph in common pediatric fluoroscopic procedures.

BACKGROUND: Contrast enema, voiding cystourethrography and upper gastrointestinal studies are the most common fluoroscopic procedures in children. Scout abdomen radiographs have been routinely obtained prior to fluoroscopy and add to the radiation exposure from these procedures. Elimination of unnecessary routine scout radiographs in select studies might significantly reduce radiation exposure to children and improve the overall benefit-to-risk ratio of these fluoroscopic procedures. OBJECTIVE: To determine the radiation exposure contribution of the preliminary/scout abdomen radiographs with respect to the radiation exposure of the total procedure. MATERIALS AND METHODS: We retrospectively collected demographic information and radiation exposure values of dose area product (in Gy-cm(2)) and entrance air kerma (in mGy) - initially for the scout abdomen radiographs done prior to fluoroscopy and subsequently the total procedural radiation values (the combined values of the scout radiograph and fluoroscopic radiation exposure) - in children who underwent contrast enemas, voiding cystourethrograms and upper gastrointestinal studies in a 4-month period. The radiation parameters, including fluoroscopy time, dose area product and entrance air kerma, were available in the log book maintained in the fluoroscopy suite. Fluoroscopy procedures were performed on a single fluoroscopy machine using four frames per second pulse rate and other radiation-minimizing techniques. Usage of the grid to obtain scout radiographs was also recorded. The proportion of radiation exposure from the scout radiograph relative to that of the total procedure was calculated by dividing the individual parameters of the scout to the total procedural values and multiplied by 100 to express these values as a percentage. We calculated mean, median and range and performed statistical analysis of the data. RESULTS: A total of 151 procedures performed on 71 males and 80 females qualified for the study. The age range of the patients was 2 days to 18 years, with a mean of nearly 3.5 years (40 months) and median of 15 months. There were 63 upper gastrointestinal studies, 65 voiding cystourethrography studies and 23 contrast enema studies. The fluoroscopy time for all procedures combined ranged from 0.1 min (6 s) to 2 min, with mean and median values of 0.4 min and 0.3 min, respectively. The fractional radiation exposure contribution for the dose area product of scout abdomen radiograph to the total procedure ranged from 4% to 98%, with mean and median values of 51% and 49%, respectively. The fractional contribution of the scout radiograph to the total procedure for the entrance air kerma values ranged from 6% to 97%, with mean and median values of 29% and 26%, respectively. There was a significant negative correlation (P<0.001) between fluoroscopy radiation time and the proportion of radiation parameters of scout radiograph to total procedural values. CONCLUSION: Scout radiographs can contribute a significant proportion (median values of approximately 50% for the dose area product and 26% for the entrance air kerma) of radiation exposure in common fluoroscopy procedures in children.