[Paediatric varicocele embolization dosimetric study]. / Estudio dosimétrico de la embolización endovascular de varicocele en pacientes pediátricos.

INTRODUCTION AND OBJECTIVES: Varicocele is a benign condition, often asymptomatic, that appears among young men with a normal life expectancy. The endovascular embolization is a minimally invasive therapeutic procedure indicated for varicocele treatment, although there are safe surgical alternatives. It is essential to know the radiological risk associated with the procedure. The aim of this work is to determine local dose levels in paediatric varicocele embolization, in order to minimize and to estimate the radiological risk. MATERIAL AND METHODS: In the retrospective study, 15 cases were analyzed, all of which were paediatric patients (10-18 years). The screening time and the dose-area product were known, as provided by the X-ray equipment. In the prospective study, dose optimization techniques were implemented, and in addition, radiographic films were used in order to verify the radiated zone and termoluminiscense dosimeters in order to evaluate gonad dose and maximum skin dose for 10 paediatric patients (10-16 years). RESULTS: In the retrospective group, the average effective dose was 8.8 mSv. The total average risk of a fatal cancer induction in any location was 0.16%, and 0.0007% for hereditary effects. The maximum skin dose was 250 mGy, which is far from the threshold for deterministic effects (2 Gy). In the prospective group, dose and radiological risk decreased by more than 70%. CONCLUSIONS: Hereditary effects were very low in contrast to the fatal cancer risk estimation. According to the results we can discard deterministic effects, unless complications appear in the procedure. Radiation exposure must be optimized. It is necessary that medical staff know the radiological risks associated with the intervention, and inform the patients about them.

[Evaluation of radiological risk associated to pieloureteral surgery in paediatric patients]. / Estimación del riesgo radiológico asociado a la dilatación endourológica de la estenosis pieloureteral congénita en pacientes pediátricos.

INTRODUCTION: Because of the application of ionising radiation in surgical procedures, it is necessary to perform an evaluation of the radiological risks. Potential hazards are of greater influence in paediatric patients, due to their longer life expectancy and greater radiosensibility. The aim of this paper was, with the exception of deterministic injuries, trying to evaluate patient doses and stochastic risks induced by ionising radiations in paediatric pieloureteral surgery. MATERIAL AND METHODS: Twenty paediatric patients of both sexes, from 2 months to 9 years, were included in the study. All the procedures were performed in 2006 and 2007. The X-Ray equipment shows fluoroscopy time and dose area product in each procedure, thermoluminiscent dosimeters (TLD's) measure patient's skin dose and non screen films verify the radiated field and dose. RESULTS: The average effective dose per minute was 0.36 mSv for patients under 5-year-old and 0.43 mSv for over 5. These figures were lower than previously published results for this kind of surgery. The average total risk of fatal cancer induction in any location, for each study group, was 0.012%. Maximum skin dose was 19.81 mGy, which is well bellow the threshold for deterministic injuries (2 Gy). CONCLUSIONS: Although stochastic risks were small, it's highly recommended to employ all the available methods and techniques developed for patient radiological protection. A strong coordination between team members is advisable for improving the dose optimization.