BACKGROUND Liver-transplanted, immunosuppressed pediatric patients undergoing repeated percutaneous transhepatic cholangiography (PTC) require optimized exposure to ionizing radiation. OBJECTIVE To establish local diagnostic reference levels (DRL) for pediatric PTC and investigate the routine use of X-ray equipment. MATERIALS AND METHODS The study retrospectively analyzed data collected between October 2016 and June 2018 from a single center performing PTC. We collected exposure parameters including kerma area product (PKA), air kerma at patient entrance reference point (Ka,r) and fluoroscopy time via a dose archiving and communication system. Local diagnostic reference levels were derived as the 50th percentile of the distributions while considering published recommended weight groups. We investigated exposure variability with procedure complexity and with technical parameters recovered from the radiation dose structured report. RESULTS The analysis included 162 PTC procedures performed in 64 children: 58% male, average age 6 years (range 39 days to 16 years) and weight 24 kg (range 3-60 kg). Local DRLs for weight groups 0-5 kg, 5-15 kg, 15-30 kg, 30-50 kg and 50-80 kg were, respectively, 6 cGy.cm2, 22 cGy.cm2, 68 cGy.cm2, 107 cGy.cm2 and 179 cGy.cm2 in PKA. Local DRLs per weight group were also established for intermediate and complex procedures. Radiation dose structured report analysis highlighted good local practice with efficient collimation, low fluoroscopy pulse rate, no magnification and limited use of radiographic acquisitions. Meanwhile, table and detector positioning and tube projection could still be optimized. PKA correlated significantly with the number of acquisitions and tube-to-table distance. CONCLUSION We established local DRLs for children undergoing PTC.

中文翻译：

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建立小儿经皮经肝胆管造影术干预措施的局部诊断参考水平，并优化常规操作。

背景技术经历反复的经皮经肝肝胆管造影术（PTC）的肝移植，免疫抑制的儿科患者需要优化地暴露于电离辐射。目的建立小儿PTC的局部诊断参考水平（DRL）并研究X线设备的常规使用。材料与方法这项研究回顾性分析了2016年10月至2018年6月期间从一个执行PTC的单一中心收集的数据。我们通过剂量归档和通讯系统收集了包括参数，比释动能面积乘积（PKA），患者入口参考点的空气比释动能（Ka，r）和荧光检查时间等暴露参数。在考虑发布的推荐体重组的情况下，当地诊断参考水平是分布的第50个百分位数。我们调查了程序操作复杂性和从辐射剂量结构化报告中回收的技术参数的暴露变异性。结果分析包括对64例儿童进行的162例PTC手术：58％的男性，平均年龄6岁（39天至16岁），体重24公斤（3-60公斤）。0-5 kg，5-15 kg，15-30 kg，30-50 kg和50-80 kg体重组的本地DRL分别为6 cGy.cm2、22 cGy.cm2、68 cGy.cm2、107 cGy PKA中的.cm2和179 cGy.cm2。还为中等和复杂程序建立了每个体重组的本地DRL。辐射剂量结构报告分析突出了良好的本地规范，具有有效的准直性，较低的荧光检查脉搏频率，无放大倍数和X射线照片的有限使用。同时，工作台和探测器的位置以及管子的投影仍然可以优化。PKA与采集次数和管到台的距离显着相关。结论我们为患有PTC的儿童建立了本地DRL。