Purpose or Case Report: Despite the development of new methods for the detection of Vesico Urethral Reflux (VUR), Voiding Cystourethrography (VCUG) still plays an important role in pediatric uroradiology. However, the use seems to have changed over time. International guidelines exist and the main indication is the Ultrasonography (US) finding of hydronephrosis, indicating a high grade VUR or, in boys, to exclude Posterior Urethral Valve (PUV). VUR is a common condition found in 30-40 % of children with UTI. Our department performs VCUG according to the guidelines given by the ESUR subgroup for Pediatric Uroradiology. Haukeland University Hospital (HUS) serve a population of 300000 people. At the Section of Pediatric Radiology, we observed a decrease in the use of VCUG. We therefore did a systematic review of all VCUGs performed at our department during 2013 and 2014, focusing in detail on the age group 1 year or less. We aim to be true to the image gently policy, maintaining the ALARA principle, keeping the radiation doses as low as reasonably possible.
Methods & Materials: We performed a total of 94 VCUGs over a two-year period, where 47 children were 0-1 year old. The collected data include clinical indication, age and gender, referring institution and results of the examination. In addition, the radiation dose was registered from the x-ray equipment as DAP values in mGycm². The Monte-Carlo Simulating Program (PCXMC) was used to present the collected DAP values as estimated effective doses (mSv).
Results: 47 VCUGs (22 girls and 25 boys) were performed on children 0-1 year old during 2013 and 2014. 72% were below 7 months of age at time of examination. Age distribution and reason for referral are presented in figures 1 and 2. 98% were referred from a pediatrician at HUS. 57% of the VCUGSs were reported as normal and VUR was the most common pathological finding, found in 40% (fig. 3). The mean DAP dose was 98 mGycm². Figure 4 presents the simulated estimated effective doses in mSv.
Conclusions: VCUG is still an important examination and we performed 94 VCUGs during 2013-2014. Nearly all 47 patients in the group 0-1 year of age, were referred from a pediatrician at our hospital. UTI was the most common reason for referral. Pathology was found in 43% of the cases and VUR grades 3, 4 and 5 were the most common pathological findings. The mean DAP dose when findings were normal, was 99,4 mGycm², and 100.4 mGycm² in cases with pathological findings.