Radiation dose in patients undergoing peripherally-inserted central catheter procedure

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#IVTEAM #Intravenous literature: Lee, T., Shin, S.W., Choi, D., Cho, S.K., Hyun, D., Do, Y.S., Jeon, S., Cha, B., Bok, E.K. and Kim, S. (2013) Risk factors of radiation dose in patients undergoing peripherally-inserted central catheter procedure using conventional angiography equipment and flat panel detector-based mobile C-arm fluoroscopy. November 29th. [epub ahead of print].

Abstract:

BACKGROUND: Although peripherally-inserted central catheter (PICC) insertion is commonly performed under fluoroscopic guidance, few reports have addressed performance and dosimetry when PICC is inserted under C-arm fluoroscopy.

PURPOSE: To evaluate the risk factors of radiation dose in performing PICC insertion using flat panel detector-based mobile C-arm fluoroscopy and a conventional angiography machine.

MATERIAL AND METHODS: Ninety-eight patients underwent the PICC procedure using conventional angiography equipment (n=49) or flat panel detector-based mobile C-arm fluoroscopy (n=49). Data were prospectively analyzed from July to November 2012. Dose-area product (DAP), tube voltage, tube current, fluoroscopy time, and image quality measured on a 5-point scale were estimated and compared using appropriate statistical tests.

RESULTS: There were no significant differences in tube voltage, fluoroscopy time, and image quality between conventional angiography and mobile C-arm fluoroscopy. DAP, mean arm tube current, and tube current in chest fluoroscopy were significantly lower in mobile C-arm fluoroscopy than using the conventional angiography machine (P <0.05). Multivariate analysis identified tube current in chest fluoroscopy, arm tube current, and fluoroscopy equipment as significant risk factors for elevated radiation dose in PICC insertion.

CONCLUSION: PICC insertion can be performed using flat panel detector-based mobile C-arm fluoroscopy instead of a conventional angiography machine. Image quality and fluoroscopy time were not different between the two systems and the use of C-arm fluoroscopy significantly reduced radiation dose.

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