Fluoroscopy-SocietyforPediatricRadiology.PDFVIP

Marta Hernanz-Schulman MD, FAAP, FACR Professor, Radiology and Pediatrics Vanderbilt University Medical Center Vanderbilt Children’s Hospital Steering Committee: Alliance for Radiation Safety in Pediatric Imaging Interventional Radiology Fluoroscopy CR-DR Nuclear Medicine Committee Members Eileen Ahlswede, RTR, FASRT Sue C. Kaste MD Ishtiak H. Bercha MSc Ceela McElveny, ELS, CAE Jennifer K. Boylan MA Beverly Newman MD, FACR Michael J. Callahan MD Keith J. Strauss MS Susan D. John MD Valerie L. Ward MD Marilyn J. Goske MD Daniel W. Young MD Approximately 5,000 fluoroscopies annually Maximum 17,000 (SCORCH survey, 2007) Dose regulations “Normal mode”: 10R/min exposure rate “High dose”: 20R/min (audible tone emitted) “5 minute” reminder  No regulations on mode of operation, time, dose →Privilege programs: training in radiation protection Fluoroscopic procedures help us save kids’ lives! IMAGE KIDS WITH CARE Pause and child-size technique Use the lowest pulse rate possible Consider ultrasound or MRI when possible RATIONALE: Pulsing the X-ray will decrease exposure time decrease radiation dose Voltage to the X-ray tube is switched on and off at the generator, at a given pulse rate: kVp pulsed fluoro leads to a ramp-up and trail-down of the pulses  Based on the capacitance of the cable from generator to tube Ramp-and-trail effect increases non-diagnostic radiation, without substantially reducing overall dose Negatively charged grid is interposed between cathode and anode Grid can be rapidly switched on and off, intermittently stopping the electron flow Results in true pulsed fluoroscopy Grid-controlled fluoroscopy eliminates t