Purpose or Case Report: Fluoroscopy is a valuable diagnostic tool, but it also exposes patients to radiation. Our study assesses variation in pediatric fluoroscopy radiation dose performance by hospital site and radiologist experience.
Methods & Materials: We retrospectively analyzed the top three fluoroscopy exams performed most frequently during 33 months of practice: videofluoroscopic swallow studies (VFSS), upper gastrointestinal (UGI) series, and voiding cystourethrograms (VCUG). The amount of radiation exposure (reference air kerma, or RAK) was measured for each exam and compared between two dedicated Children’s hospitals, and between radiologists with less than five and more than five years of experience after fellowship. Site-specific factors, such as patient demographics and procedural protocols, were also considered in the analysis. Wilcoxon rank-sum tests and chi-square tests were used for statistical analysis with a significance level of P<0.05. All studies were performed on Siemens AgileMax machines.
Results: The number of exams analyzed for VFSS, UGI, and VCUG was higher at Hospital 1 (3501, 2514, 766) than Hospital 2 (1224, 647, 108). The median RAK at Hospital 1 was significantly higher for VFSS (1.5 mGy; P<10^-16) and UGI (0.6 mGy; P<10^-5), compared to Hospital 2 (VFSS: 1.0 mGy, UGI: 0.5 mGy). For VCUG, the median RAK was significantly lower (P<10^-12) at Hospital 1 (0.2 mGy), compared to Hospital 2 (0.3 mGy). The median patient weight and height were significantly higher (P<10^-16) at Hospital 1 compared to Hospital 2 for VFSS, while the median patient weight and height were comparable between the two hospitals for UGI and VCUG. For VFSS and UGI studies, the median RAK of radiologists with >5 years of experience (VFSS: 1.5 mGy, UGI: 0.6 mGy) was significantly higher (P<10^-16, P<10^-5) than the median RAK of those with <5 years of experience (VFSS: 1.0 mGy, UGI: 0.5 mGy).
Conclusions: Dose performance differences in RAK were influenced by patient demographics and the number of fluoroscopic examinations performed. The study found significant radiation dose variations tied to hospital sites and radiologist experience. Experienced radiologists used more radiation, even when accounting for patient demographics and protocols. This highlights an opportunity to limit radiation exposure in pediatric fluoroscopy through standardization of practice and dose optimization training.