Mind the Zap: Radiation Exposure for Pediatric Gastrojejunostomy Tube Exchanges

Purpose To evaluate the radiation exposure of pediatric patients during exchange of percutaneous gastrojejunostomy tubes.

Materials and Methods Retrospective review of consecutive pediatric patients undergoing percutaneous gastrojejunostomy tube exchanges from January 1, 2010 to August 8, 2016 was performed. Procedural records were evaluated for total fluoroscopy time, cumulative air kerma, and cumulative dose area product (DAP). The total number of procedures, indications, and interval time for repeat procedures were also recorded. Patients were subcategorized into an increased cumulative procedure group if three or more procedures were performed and an increased frequency group if the interval between any two consecutive procedures occurred within a 6-month period.

Results In the 77-month study period, a total of 175 gastrojejunostomy tube exchanges were performed on 62 patients, median age 62 months (range: 1 month–206 months). The mean fluoroscopy time was 7.36 minutes (range: 0.20–40 minutes), mean cumulative air kerma was 41.13 mGy (range: 0.40–507 mGy), and mean cumulative DAP was 3,717.19 mGy-cm² (range: 102–72,479 mGy-cm²).

Twenty-six patients were subcategorized into an “increased cumulative procedure” group with an average of five procedures during the study period. The mean fluoroscopy time, cumulative air kerma, and cumulative DAP for the individual procedures of this group was 8.13 minutes, 49.07 mGy, and 4250.73 mGy-cm², respectively.

Thirty-three patients were subcategorized into an “increased frequency” group with average 2 months interval between procedures. The mean fluoroscopy time, cumulative air kerma, and cumulative DAP for the individual procedures of this group was 7.87 minutes, 46.77 mGy, and 4147.52 mGy-cm², respectively.

Twenty-three patients underwent single procedures during the study period. The mean fluoroscopy time, cumulative air kerma, and cumulative DAP for the individual procedures of this group was 3.02 minutes, 6.11 mGy, and 1232.13 mGy-cm², respectively.

A statistically significant difference in means (p < 0.05) exists in all radiation metrics for a given procedure while comparing either the “increased cumulative procedure” group or the “increased frequency group” to the single procedure group.

Conclusion Chronically ill pediatric patients may require serial percutaneous gastrojejunostomy tube exchanges, subjecting them to high doses of radiation exposure, particularly if repeat procedures are required. Such patients may benefit from alternative methods of enteral feeding, such as through surgical interventions.

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