Minimizing radiation exposure in children: the role of spot region of interest imaging in venous access procedures.

Abstract

Purpose: To evaluate the effectiveness of the spot region of interest (ROI) technique in reducing radiation exposure during fluoroscopically guided venous access procedures in pediatric patients.

Methods: This retrospective study included pediatric patients who underwent central venous access procedures in an interventional radiology unit of a tertiary care center. Data collected included patient demographics, procedure type, target vein, dose area product (DAP), cumulative dose, fluoroscopy time, and the DAP/fluoroscopy time ratio.

Results: A total of 131 patients (mean age: 8 ± 4.91; 48.9% women) were included, of whom 44 (33.6%) underwent procedures using the spot ROI technique. The spot ROI group demonstrated significantly lower DAP and cumulative dose than the non-ROI group (reduction ratios: 63.8% and 67.2%, respectively, P < 0.001 for all). When normalized to fluoroscopy time, the DAP/fluoroscopy time ratio was also significantly reduced in the spot ROI group [15.34 (7.18-23.57) vs. 25.17 (18.49-42.03); P < 0.001].

Conclusion: Spot ROI is an effective and safe technique for reducing radiation exposure during pediatric venous access procedures without compromising procedural success. Given the high radiation sensitivity of pediatric patients and the potential need for repeated interventions in those with chronic conditions, spot ROI represents a valuable tool for dose optimization and aligns with the As Low As Reasonably Achievable (ALARA) principle.

Clinical significance: Spot ROI-based fluoroscopy significantly reduces radiation exposure in pediatric central venous catheterization without compromising procedural success. This hardware-based dose reduction technique complements the traditional ALARA principle and is particularly valuable for children requiring repeated interventions. These findings support broader clinical adoption and warrant validation in future prospective multicenter studies.