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PEDIATRIC UROLOGY RADIATION SAFETY EVALUATION (PURSE): A
PROSPECTIVE ASSESSMENT OF OF PEDIATRIC RADIATION EXPOSURE DURING
FLUOROSCOPY-GUIDED ENDOUROLOGIC PROCEDURES
Moira DWYER
1
, Janelle FOX
2
, Joseph DWYER
3
, Anne DUDLEY
4
, Benjamin RISTAU
4
, Pankaj DANGLE
1
, Omaya BANIHANI
1
,
Heidi STEPHANY
1
, Glenn CANNON, JR.
1
, Francis SCHNECK
1
, Michael SHEETZ
5
and Michael OST
1
1) Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Urology, Pittsburgh, USA - 2) Naval
Medical Center, Urology, Portsmouth, USA - 3) De la Torre Research, New York, USA - 4) University of Pittsburgh
Medical Center, Urology, Pittsburgh, USA - 5) University of Pittsburgh, Radiology, Pittsburgh, USA
PURPOSE
The recommended limit of ionizing radiation exposure for children under age 18 is 5 mGy per year. We prospectively
evaluated radiation exposure during fluoroscopy-guided pediatric urologic procedures at our institution with single point
dosimeters.
MATERIAL AND METHODS
From 2013-2015, children undergoing fluoroscopy-guided urologic procedures were prospectively enrolled in an
Institutional Review Board-approved study. Dosimeters were affixed to the skin at standardized locations during
procedures. Dosimeter analysis was performed in a blinded manner.
RESULTS
There were 98 events in 80 patients. The average age was 10.7 years (median 12, range 0.3-17). Male-to-female ratio
was 0.85. The dosimeter readings (i.e., absorbed dose, mGy) were correlated with the air kerma values (mGy; r=0.75,
95% CI 0.53-0.87) (see Figure 1). Absorbed dose was linearly dependent on body surface area (p=0.05); age
(p=0.04); laterality (p=0.04); BMI percentile (p<0.01); whether the procedure was a definitive intervention or
temporizing measure (p<0.001); and the duration of radiation administration (p<0.001). Linear dependence existed
between the duration of radiation and when in the study the procedure was performed (p=0.02) whereas age, body
surface area, BMI percentile, skin-to-source distance, and frames per second were not significant. Radiation exposure
was <1 mGy per case in 67% (59/88) of cases, exceeded 5 mGy in 5.7% (5/88) of cases, and averaged 1.32 mGy per
case (median 0.74, range 0.01-10.68). Study patients had undergone an average of 1.9 (median 1, range 1-11)
fluoroscopy-guided urologic procedures at our institution in their lifetimes and had averaged 2.7 (median 1, range 0-35)
episodes of diagnostic ionizing radiation over a period of 3.25 years.
CONCLUSIONS
Radiation exposure during a single pediatric urologic procedure accounts for 26% of the recommended annual limit on
average. Pediatric urologists can enhance radiation safety for their patients by minimizing the duration of fluoroscopy
utilization.