PMID- 25981990
OWN - NLM
STAT- MEDLINE
DCOM- 20160218
LR  - 20181202
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Linking)
VI  - 50
IP  - 7
DP  - 2015 Jul
TI  - Review of the radiation exposure during screening of surgically implanted central 
      venous access devices.
PG  - 1214-9
LID - S0022-3468(15)00324-3 [pii]
LID - 10.1016/j.jpedsurg.2015.04.017 [doi]
AB  - PURPOSE: Ionizing radiation is used for the insertion of surgically implanted 
      venous access devices (SIVADs) with children at the highest risk of cumulative 
      radiation effects from these procedures. This study examines the radiation dose 
      in a pediatric population during intraoperative radiological screening. METHODS: 
      A retrospective study looked at all pediatric patients in a tertiary hospital 
      between January 2008 and January 2014 who had a surgically implanted venous 
      access device inserted using intraoperative fluoroscopy. Patient demographics, 
      reason for SIVAD insertion, the type and method of insertion, fluoroscopy time 
      and radiation dose area product were determined. RESULTS: A total of 505 patients 
      had 682 SIVADs inserted, with 123 patients receiving multiple SIVAD over the six 
      year period. There were two types of SIVAD inserted, 492 were totally implanted 
      venous access devices (TIVAD) and 190 were tunneled central venous catheters 
      (cuffed central line). Five hundred seven of the SIVAD inserted recorded the dose 
      area product and fluoroscopy time. The median time for screening was 5seconds 
      (range 1 to 275seconds) and the median dose area product was 0.00352mGym(2) 
      (range 0.000001mGym(2) to 0.28mGym(2)). Of the 507 SIVAD that recorded the 
      radiation data, 479 were open surgical cut-down insertion and 27 were 
      percutaneous insertion. Percutaneously inserted surgically implanted venous 
      access devices (mean 0.0060mGym(2)) had a longer dose area product than open 
      insertion (mean 0.0034mGym(2); p=0.05). CONCLUSION: Screening of SIVAD involves 
      low levels of radiation exposure and is comparable to a chest x-ray or a 
      transatlantic flight. The excess lifetime cancer risk to patients is estimated to 
      be very low and is considered to be outweighed by the benefits of insertion. Open 
      surgical cut-down insertion has a significantly reduced radiation exposure 
      compared to percutaneous techniques. Although radiation dose is higher with 
      percutaneous procedures, the clinical effects are considered minimal, and the 
      resultant radiation risk is estimated to be very low. Radiation dose should not 
      determine technique of insertion of SIVAD.
CI  - Crown Copyright (c) 2015. Published by Elsevier Inc. All rights reserved.
FAU - Friend, Jikol
AU  - Friend J
AD  - Departments of Pediatric General Surgery, Princess Margaret Hospital, Subiaco, 
      Western Australia, Australia. Electronic address: jikol.friend@gmail.com.
FAU - Lindsey-Temple, Suzanna
AU  - Lindsey-Temple S
AD  - Departments of Pediatric General Surgery, Princess Margaret Hospital, Subiaco, 
      Western Australia, Australia.
FAU - Gollow, Ian
AU  - Gollow I
AD  - Departments of Pediatric General Surgery, Princess Margaret Hospital, Subiaco, 
      Western Australia, Australia.
FAU - Whan, Elizabeth
AU  - Whan E
AD  - Departments of Pediatric General Surgery, Princess Margaret Hospital, Subiaco, 
      Western Australia, Australia.
FAU - Gera, Parshotam
AU  - Gera P
AD  - Departments of Pediatric General Surgery, Princess Margaret Hospital, Subiaco, 
      Western Australia, Australia.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20150506
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
SB  - IM
MH  - Adolescent
MH  - *Central Venous Catheters
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Fluoroscopy
MH  - Humans
MH  - Infant
MH  - Male
MH  - Neoplasms, Radiation-Induced
MH  - Radiation Exposure/*statistics & numerical data
MH  - Radiography, Thoracic/adverse effects
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Dose area product
OT  - Effective dose
OT  - Pediatric
OT  - Radiation exposure
OT  - Venous access device
EDAT- 2015/05/20 06:00
MHDA- 2016/02/19 06:00
CRDT- 2015/05/19 06:00
PHST- 2014/12/18 00:00 [received]
PHST- 2015/03/20 00:00 [revised]
PHST- 2015/04/22 00:00 [accepted]
PHST- 2015/05/19 06:00 [entrez]
PHST- 2015/05/20 06:00 [pubmed]
PHST- 2016/02/19 06:00 [medline]
AID - S0022-3468(15)00324-3 [pii]
AID - 10.1016/j.jpedsurg.2015.04.017 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2015 Jul;50(7):1214-9. doi: 10.1016/j.jpedsurg.2015.04.017. Epub 
      2015 May 6.