Experience with special pediatric contrast radiological studies and comparison of operational indicators

Abstract

Objective:  With the increased use of imaging techniques in pediatric care, a population considered more radiosensitive than adults, the optimization of contrast-enhanced radiological studies is essential. The objective was to describe the experience with specialized pediatric contrast-enhanced radiological studies performed at the Radiology Department of the Dr. Carlos Sáenz Herrera National Children's Hospital and to compare clinical practice with international benchmarks.

Methods:  This was an observational, cross-sectional study, recording all procedures performed, including their technical and procedural parameters, from March 15 to June 15, 2023. Information was collected on the types of procedures, the number of images generated per study, patient age, and fluoroscopy time. Fluoroscopy time and number of images generated per study were defined based on the distribution of the median values ​​for fluoroscopy time and number of images. The tabulated data, classified by study type and age range, were compared with values ​​reported by international references, obtained through a targeted literature review. A separate literature review of international and national theoretical frameworks on radiation protection was also conducted to develop a proposal for technical optimization.

Results: A total of 511 pediatric special contrast radiological studies were included: 167 voiding cystourethrograms, 126 gastrointestinal tract studies, 124 esophagograms and 94 contrast enemas.  With serial voiding cystourethrography, an average of 35.8 images were recorded, with an average fluoroscopy time of 17 seconds and an exposure time ranging from 2 to 195 seconds, with a median of 12 seconds. For the other barium contrast studies, the average number of images acquired was 93.6, with an average fluoroscopy time of 31.2 seconds, ranging from 1 to 229 seconds; specifically, the median was 22 seconds for the barium enema and 20.5 seconds for the esophagogram. Comparisons with all reference studies consistently showed shorter fluoroscopy times and a higher number of images generated per study in Costa Rica. A series of 14 actions was compiled to guide protection strategies.

 Conclusions: Fluoroscopy times used in the country are shorter than those typically employed in other contexts for the selected studies; however, the number of intraprocedural radiographs taken locally was higher. As part of the strategy to improve radiation protection, it is suggested that fluoroscopy times be slightly increased to reduce the number of radiographs, thereby optimizing the balance between diagnostic quality and radiation exposure.