Effect of using immobilization device in fluoroscopic study in pediatric patient: Focused on radiation dose reduction in voiding cystourethrogram

Autoři: Hyun-Hae Cho aff001;  So Mi Lee aff002;  Sun Kyoung You aff003
Působiště autorů: Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea aff001;  Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea aff002;  Department of Radiology, Chungnam National University Hospital, Daejeon, Republic of Korea aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224063



To prove objective effect of using mechanical device for immobilization of pediatric patient during voiding cystourethrogram (VCUG) compare immobilization by hand-holding.


This study included 77 patients, who underwent VCUG in our center from April to October 2017, who had a clinically suspicious urinary tract infection. Patients were classified into one of two groups based on whether examination was done before (Group A) or after (Group B) adaptation of immobilization device. Patient-related data, image quality related score and dose-related data were collected and compared between two groups.


Group A included 36 patients and group B included 41. Patient related data including mean age, sex, body weight and height didn’t show significant difference between two groups (p > 0.05 for all). Among the image quality scoring, overall image quality, motion artifact, showed significant difference between two groups with improved inadequate timing and centering after adaptation of immobilization device. Dose related data showed significantly decreased shot number, mean fluoroscopic time with decreased mean dose area product (DAP) value and effective dose after adaptation of immobilization device (p < 0.05 for all).


Adaptation of immobilization device can improve overall image quality with decreased motion artifact and improved centering and timing with even shot number, mean fluoroscopic time with decreased mean DAP value and effective dose.

Klíčová slova:

Body weight – Bone imaging – Catheters – Image processing – Pediatrics – Urinary tract infections – Urine – Radiation exposure


1. Lim R, Khawaja RD, Nimkin K, Sagar P, Shailam R, Gee MS, et al. Relationship between radiologist training level and fluoroscopy time for voiding cystourethrography. AJR Am J Roentgenol. 2013;200(3):645–51. doi: 10.2214/AJR.12.8902 23436857.

2. Ahlswede EM, Hernanz-Schulman M. Fluoroscopic procedures in children. Radiol Technol. 2011;82(3):271–3. 21209427.

3. Newman B, John S, Goske M, Hernanz-Schulman M. Pause and pulse: radiation dose in pediatric fluoroscopy. Pediatr Rev. 2011;32(9):e83–90. doi: 10.1542/pir.32-9-e83 21885657.

4. Hernanz-Schulman M, Goske MJ, Bercha IH, Strauss KJ. Pause and pulse: ten steps that help manage radiation dose during pediatric fluoroscopy. AJR Am J Roentgenol. 2011;197(2):475–81. doi: 10.2214/AJR.10.6122 21785097.

5. Ward VL. Patient dose reduction during voiding cystourethrography. Pediatr Radiol. 2006;36 Suppl 2:168–72. doi: 10.1007/s00247-006-0213-3 16862408

6. Ghodadra A, Bartoletti S. Reducing Radiation Dose in Pediatric Diagnostic Fluoroscopy. J Am Coll Radiol. 2016;13(1):55–8. doi: 10.1016/j.jacr.2015.07.030 26482817.

7. Ailsa Allison KM. Immobilisation and restraining of paediatric patients in the Radiology Department: A perspective and review of legislation relevant to UK radiographic professions. Radiography. 2008;14:57–62.

8. Lee R, Thomas KE, Connolly BL, Falkiner M, Gordon CL. Effective dose estimation for pediatric voiding cystourethrography using an anthropomorphic phantom set and metal oxide semiconductor field-effect transistor (MOSFET) technology. Pediatr Radiol. 2009;39(6):608–15. doi: 10.1007/s00247-009-1161-5 19241074.

9. The American College of Radiology tSfPR. Practice guideline for the performance of voiding cystourethrography in children. 2009.

10. CRCPD’s Committee on Quality Assurance in Diagnostic X-ray(H-7). Q.A. Collectible Dose-Area Product (DAP). 2001.

11. Le Heron JC. Estimation of effective dose to the patient during medical x-ray examinations from measurements of the dose-area product. Phys Med Biol. 1992;37(11):2117–26. doi: 10.1088/0031-9155/37/11/008 1438564.

12. Perisinakis K, Raissaki M, Damilakis J, Stratakis J, Neratzoulakis J, Gourtsoyiannis N. Fluoroscopy-controlled voiding cystourethrography in infants and children: are the radiation risks trivial? Eur Radiol. 2006;16(4):846–51. doi: 10.1007/s00330-005-0072-6 16328446.

13. Riccabona M. Cystography in infants and children: a critical appraisal of the many forms with special regard to voiding cystourethrography. Eur Radiol. 2002;12(12):2910–8. doi: 10.1007/s00330-002-1430-2 12439570.

14. Agrawalla S, Pearce R, Goodman TR. How to perform the perfect voiding cystourethrogram. Pediatr Radiol. 2004;34(2):114–9. doi: 10.1007/s00247-003-1073-8 14564427.

15. Bale RJ, Vogele M, Rieger M, Buchberger W, Lukas P, Jaschke W. A new vacuum device for extremity immobilization. AJR Am J Roentgenol. 1999;172(4):1093–4. doi: 10.2214/ajr.172.4.10587154 10587154.

16. Domina JG, Sanchez R, Meesa IR, Christodoulou E. Evaluation of pediatric VCUG at an academic children’s hospital: is the radiographic scout image necessary? Pediatr Radiol. 2015;45(6):855–61. doi: 10.1007/s00247-014-3241-4 25501465.

17. Morrison G, John SD, Goske MJ, Charkot E, Herrmann T, Smith SN, et al. Pediatric digital radiography education for radiologic technologists: current state. Pediatr Radiol. 2011;41(5):602–10. doi: 10.1007/s00247-010-1904-3 21491200.

18. Dashti MA-A M., Faleh A., Al-Ostath S. Current immobilization implementation of pediatric patients in five major public hospitals in Kuwait: a prospective study into policies and guidelines for radiology departments. Indian J Innovations Dev. 2012;1(8):8.

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2019 Číslo 10
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