Volume : 09, Issue : 12, December – 2022
Title:
19.RADIATION DOSE ASSOCIATED WITH FLUOROSCOPY X-RAY EXAMINATIONS FOR PEDIATRICS
Authors :
Sultan Hilal Althubaiti, Prof. Dr. Saud Hamid Ahmad Allehyani, MOHAMMED ALI ALHUZALI, SULTAN FAWZAN ALOMAYRI, Ali Mohammad algubbi, Abdulaziz Abdullah althebyani, Ali Saleh Alessi, Safeir mukhled safeir alroqi, Wael ali Alzahraani, Mohammad ibrahim Alzahraani , Salah Abdraboh Slmee aljahdali, Khalid Mohammad al mehmadi, Abdulaziz jameel Alharbi, Mohammed Eidhah Althobaiti , Faiz Abdurhman ALshikh, Abdullah Saleh Alattani
Abstract :
Introduction: Diagnostic reference levels (DRL) of procedures involving ionizing radiation are important tools for optimizing radiation doses delivered to patients and to identify cases where the levels of dose are unusually high. This is very important for pediatric patients undergoing fluoroscopic examinations, as these examinations can be associated with a high radiation dose.
Material and Methods: Pediatrics fluoroscopic studies performed at Maternity and Children Hospitals in Makah city was conducted on 140 patient Children ranging in age from (1 to 14 years) analyzed to determine range, mean, 75th percentiles of Dose–Area Product (DAP) undergoing X-ray Fluoroscopy examination to evaluate the diagnostic and measure Total Effective dose (msv), and Total Entrance Dose (mGy.cm2). This data is automatically collected from DF by the structured sent by the imaging network’s to the software (DICOM, RIS, HIS, and Dose watch.
Results: were obtained Result Comparing the dose (DAP, and ESR) with the (NPDD-IAEA-ICRP) depend on range or median, all radiation doses for pediatric are within the limit.
Conclusion: Diagnostic reference levels are recommended as an optimization tool for radiation dose assessment in medical imaging procedures involving the utilization of radiation. So can be divided the optimization for reducing doses to exposure setting and exposure protocol.
Cite This Article:
Please cite this article in press Sultan Hilal Althubaiti et al, Radiation Dose Associated With Fluoroscopy X-Ray Examinations For Pediatrics., Indo Am. J. P. Sci, 2022; 09(12).
Number of Downloads : 10
References:
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K. (2009). The past, present, and future of x-ray technology for invivo imaging of function and form. Journal of Applied Physics, 105(10). https://doi.org/10.1063/1.3115643
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8- Naas GT, Cornelius L. Fluoroscopy-induced radio dermatitis after Tran’s jugular intrahepatic Porto systemic shunt. Am J Gastroenterology 1998; 93(9):1546-9.
9- Vane E, Gonzalez L, Beneytez F et al. Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories. Br J Radial 1998; 71(847):728-33.
10- Esposito F, Ambrosia C, De Frunze S, Panic MR, D’Aprano M, Giuliana AM, Novella D, Rosetta P. Fluoroscopy-guided hydrostatic reduction of intussusception in infancy: role of pharmacological premedication. Radial Med. 2015; 120:549–556. [PubMed] [Google Scholar]
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12- Demimonde AK, Post a, Dusk R Jar, Duong PT. Radiology Trainee vs. Faculty Radiologist Fluoroscopy Time for Imaging-Guided Procedures: A Retrospective Study of 17,966 Reports over a 5.5-Year Period. Cur Prowl Deign Radial. 2018; 47:233–237. [PMC free article] [PubMed] [Google Scholar]
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14- Mahesh M. Minimizing Risks from Fluoroscopy [Slide Presentation]. 2019.
Available from: https://Lms14.learnshare.com/
15- Mahesh M. Minimizing Risks from Fluoroscopy [Slide Presentation]. 2019.
Available from: https://Lms14.learnshare.com/
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19- Osier EK, Faulkner K. Fetal doses from radiological examinations. BJR 1999; 72:773e80.
20- . President J, Helm rot E, Hot P, Reshod M. Dose and image quality in the comparison of analogue and digital techniques in pediatric urology examinations. Ear Radial 2004; 4:638e44.
21- Crawley MT, Booth A. Reducing dose at barium enema: radiographers do it digitally. BJR 2002;75:652e6
22- Huda W. Radiation dosimeter in diagnostic radiology. AJR 1997; 169:1487e8.
23- K S Coaly, J Radcliffe and J Mosel (2014), Measurement of radiation dose received by the hands and thyroid of staff performing griddles fluoroscopic procedures in children. Vol. 70, No. 837
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28- Narayan AK, Lopez DB, Kambadakone AR, Gravis DA. Nationwide, Longitudinal Trends in CT Colonography Utilization: Cross-Sectional Survey Results From the 2010 and 2015 National Health Interview Survey. J Am Cull Radial. 2019; 16:1052–1057. [PubMed] [Google Scholar]
29- American College of Radiology. Medicare Physician Fee Schedule. [Cited 2020 May 24]. Available from: https://www.acr.org/Advocacy-and- Economics/Radiology-Economics/Medicare-Medicaid/MPFS.
30- Relative value units (RVUs) Nat’l Health Policy Forum. [Published 2015 January 12]. Available from: https://www.nhpf.org/Library/the- basics/Basics_RVUs_01-12-15.pdf.
31- Demimonde AK, Post a, Dusk R Jar, Duong PT. Radiology Trainee vs. Faculty Radiologist Fluoroscopy Time for Imaging-Guided Procedures: A Retrospective Study of 17,966 Reports Over a 5.5-Year Period. Cur Prowl Deign Radial. 2018; 47:233–237. [PMC free article] [PubMed] [Google Scholar]
32- Levine MS, Rubes in SE, Her linger H, Lauer I. Double-contrast upper gastrointestinal examination: technique and interpretation. Radiology. 1988; 168:593–602. [PubMed] [Google Scholar]
33- Mahesh M. Minimizing Risks from Fluoroscopy [Slide Presentation]. 2019.
Available from: https://Lms14.learnshare.com/
34- Hung RK. Real-Time Radiographic Identification of Contrast Consistency in Modified Barium Swallow Studies: An Alternative Technique. Practical Gastroenterology 2017; 9 Available from: https://practicalgastro.com/2017/09/02/real-time-radiographic- identification-of-contrast-consistency-in-modified-barium-swallow-studies- an-alternative-technique/ [Google Scholar]
35- Chand DH, Rhoades T, Poe SA, Kraus S, Strife CF. Incidence and severity of vesicoureteral reflux in children related to age, gender, race and diagnosis. J Urol. 2003; 170:1548–1550. [PubMed] [Google Scholar] In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020. [Google Scholar]
36- Kumara SS, Qi J. Fluoroscopic Diagnosis of Malrotation: Technique, Challenges, and Trouble Shooting. Cur Prowl Deign Radial. 2020; 49:476–
488. [PubMed] [Google Scholar]
37- Esposito F, Ambrosia C, De Frunze S, Panic MR, D’Aprano M, Giuliana AM, Novella D, Rosetta P. Fluoroscopy-guided hydrostatic reduction of intussusception in infancy: role of pharmacological premedication. Radial Med. 2015; 120:549–556. [PubMed] [Google Scholar]
38- Bazile J, Kenny JF, Khodorkovsky B, Youssef E, Argolis B, Chacko J, Hahn
B. Effects of eliminating routine use of oral contrast for computed tomography of the abdomen and pelvis: A pilot study. Clan Imaging. 2018; 49:159–162. [PubMed] [Google Scholar]
39- Donner MW, Siegel CI. The evaluation of pharyngeal neuromuscular disorders by cineradiography. Am J Roentgen 1965; 94:299-307? [Google Scholar]
40- Loge Mann JA. Diagnosis and treatment of swallowing disorders. San Diego, California: College-Hill Press; 1983. [Google Scholar]
41- Loge Mann JA. Manual for the video fluoroscopic study of swallowing.
Second Edition. Austin, Texas: PRO-ED; 1993. [Google Scholar]
42- Huda W, Peters KR. Radiation-induced temporary epilation after a neuroradiologically guided embolization procedure. Radiology 1994; 193(3):642-4.
43- Naas GT, Cornelius L. Fluoroscopy-induced radio dermatitis after Tran’s jugular intrahepatic Porto systemic shunt. Am J Gastroenterology 1998; 93(9):1546-9.
44- Vane E, Gonzalez L, Beneytez F et al. Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories. Br J Radial 1998; 71(847):728-33.
45- Middy PF, Quinn AD, Frayne PJ et al. Dose reduction in double contrast barium enema by use of low fluoroscopic current. Br J Radial 1996; 69(825):852-4.
46- Brown PH, Thomas RD, Silberberg PJ et al. Optimization of a fluoroscope to reduce radiation exposure in pediatric imaging. Pediatric Radial 2000; 30(4):229-35.
47- Tapiovaara MJ, Sandburg M, Dance DR. A search for improved technique factors in pediatric fluoroscopy. Phis Med Boil 1999; 44(2):537-59.
48- Hernandez RJ, Godwit MM. Reduction of radiation dose in pediatric patients using pulsed fluoroscopy. AJR Am J Roentgen 1996; 167(5):1247- 53.
49- Vane E, Geiger B, Schreiner a et al. Dynamic flat panel detector versus image intensifier in cardiac imaging: dose and image quality. Phis Med Boil2005; 50(23):5731-42.
50- Triennia A, Bernard G, Radovan R. Are new technologies always reducing patient doses in cardiac procedures? Radiate Port Dosimeter 2005; 117(1- 3):97-101
51- Wagner LK, Eifel PJ, Geese RA. Potential biological effects following high x-ray dose interventional procedures. J Vass Intern Radial 1994; 5:71– 84.
52- Boone JM, Pfeiffer DE, Strauss KJ, et al. A survey of fluoroscopic exposure rates: AAPM Task Group No. 11 Report. Med Phis 1993; 20:789 – 794.
53- Chakra borty DP. Routine fluoroscopic quality control. In: Seibert JA, Barnes GT, Gould RG, eds. Specification, acceptance testing and quality control of diagnostic x-ray imaging equipment. Medical Physics Monograph no. 20. College Park, Mad: American Association of Physicists in Medicine,1994; 569 –596.
54- Maynard H. Digital flour acceptance testing: the AAPM approach. In: Seibert JA, Barnes GT, Gould RG, eds. Specification, acceptance testing and quality control of diagnostic x-ray imaging equipment. Medical Physics Monograph no. 20. College Park, Mad: American Association of Physicists in Medicine, 1994; 709 –730
55- Pattie PL, Johns PC, Chambers RJ. Radiation risk to patients from percutaneous Tran’s luminal coronary angioplasty. J Am Cull Cardio 1993; 22: 1044 –1051.
56- Colden RA, Reedman LP. Coronary angiography: an analysis of radiographic practice in the UK. Br J Radial 1993; 66:327–331.
57- Rosenthal LS, Mahesh M, Beck TJ, et al. Predictors of fluoroscopy time and estimated radiation exposure during radiofrequency catheter ablation procedures: a multicenter experience. Am J Cardio 1998; 82:451– 458?
58- Geiger H, Beckman KW, Anderson T et al. Radiation dose optimization in coronary angiography and percutaneous coronary intervention (PCI). I. Experimental studies. Ear Radial 2002; 12(10):2571-81.
59- Axel’s son B, Bowden K, Branson SG et al. A comparison of analogue and digital techniques in upper gastrointestinal examinations: absorbed dose and diagnostic quality of the images. Ear Radial 2000; 10(8):1351-4.
60- Hansson B, Finnbogason T, Schubert P et al. Added copper filtration in digital pediatric double-contrast colon examinations: effects on radiation dose and image quality. Ear Radial 1997; 7(7):1117-22.
61- Fanner JW, Morrison GD, Kerry J et al. A practical demonstration of improved technique factors in pediatric fluoroscopy. Br J Radial 2002; 75(895):596-602.
62- Sideman M, Hansson B, Axel’s son B. Radiation dose and image quality in neuroangiography: effects of increased tube voltage, added x-ray filtration and ant scatter grid removal. Intern Neuroma 1998; 4:199-207
63- ( NPDD) Hart, D., Hillier, M. C., & Wall, B. F. (2009). National reference doses for common radiographic, fluoroscopic and dental X-ray examinations in the UK. The British journal of radiology, 82(973), 1-12.
64- Book IAEA SAFETY STANDARDS AND RELATED PUBLICATIONS N. 71
65- Book ‘ICRP, 2013. Radiological protection in pediatric diagnostic and interventional radiology. ICRP Publication 121. Ann. ICRP 42(2)
Coolidge X-ray tube Retrieved from
2- https://physicsmuseum.uq.edu.au/coolidge-x-ray-tube on 01/06/2020
3- X-ray Radiation Beam Retrieved from
https://www.britannica.com/science/X-ray on 29/05/2020
4- Hand, E. (2009). X-ray free-electron lasers fire up. Nature, 461(7265), 708–
709. https://doi.org/10.1038/461708a
5- Fours, A., Kitchen, M. J., Dusky, S., Lewis, R. A., Hooper, S. B., & Hooligan,
K. (2009). The past, present, and future of x-ray technology for invivo imaging of function and form. Journal of Applied Physics, 105(10). https://doi.org/10.1063/1.3115643
6- Molten, R. (2020). X-Ray Imaging: Fundamentals of X-Ray. In Micro- computed Tomography (micro-CT) in Medicine and Engineering (pp. 7-25). Springer, Cham.
7- Michael Sandburg, Radiography and Fluoroscopy: physical principles and biohazards (pp.6) department of medicine and care radio physics, faculty of health sciences, 1995.
8- Naas GT, Cornelius L. Fluoroscopy-induced radio dermatitis after Tran’s jugular intrahepatic Porto systemic shunt. Am J Gastroenterology 1998; 93(9):1546-9.
9- Vane E, Gonzalez L, Beneytez F et al. Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories. Br J Radial 1998; 71(847):728-33.
10- Esposito F, Ambrosia C, De Frunze S, Panic MR, D’Aprano M, Giuliana AM, Novella D, Rosetta P. Fluoroscopy-guided hydrostatic reduction of intussusception in infancy: role of pharmacological premedication. Radial Med. 2015; 120:549–556. [PubMed] [Google Scholar]
11- Nickoloff EL. Physics of Flat Panel Fluoroscopy Systems. Radiographic, 2011. 31(2):p591-602. Available At: http://pubs.rsna.org/doi/pdf/10.1148/rg.312105185. Accessed October 23, 2014.
12- Demimonde AK, Post a, Dusk R Jar, Duong PT. Radiology Trainee vs. Faculty Radiologist Fluoroscopy Time for Imaging-Guided Procedures: A Retrospective Study of 17,966 Reports over a 5.5-Year Period. Cur Prowl Deign Radial. 2018; 47:233–237. [PMC free article] [PubMed] [Google Scholar]
13- Levine MS, Rubes in SE, Her linger H, Lauer I. Double-contrast upper gastrointestinal examination: technique and interpretation. Radiology. 1988; 168:593–602. [PubMed] [Google Scholar]
14- Mahesh M. Minimizing Risks from Fluoroscopy [Slide Presentation]. 2019.
Available from: https://Lms14.learnshare.com/
15- Mahesh M. Minimizing Risks from Fluoroscopy [Slide Presentation]. 2019.
Available from: https://Lms14.learnshare.com/
16- Rosenthal LS, Mahesh M, Beck TJ, et al. Predictors of fluoroscopy time and estimated radiation exposure during radiofrequency catheter ablation procedures: a multicenter experience. Am J Cardio 1998; 82:451– 458?
17- Brenner D. J. What we know and what we do not know about cancer risks associated with radiation doses from radiological imaging. Br. J. Radial. 87(1035), 20130629 (2014). [PMC free article] [PubMed] [Google Scholar]
18- Livingstone RS, Augustine P, Parana I, Raj DV. Dose audit and evaluation of work practices during barium examinations using digital radiography techniques. Health Phis 2004; 87: 358e65.
19- Osier EK, Faulkner K. Fetal doses from radiological examinations. BJR 1999; 72:773e80.
20- . President J, Helm rot E, Hot P, Reshod M. Dose and image quality in the comparison of analogue and digital techniques in pediatric urology examinations. Ear Radial 2004; 4:638e44.
21- Crawley MT, Booth A. Reducing dose at barium enema: radiographers do it digitally. BJR 2002;75:652e6
22- Huda W. Radiation dosimeter in diagnostic radiology. AJR 1997; 169:1487e8.
23- K S Coaly, J Radcliffe and J Mosel (2014), Measurement of radiation dose received by the hands and thyroid of staff performing griddles fluoroscopic procedures in children. Vol. 70, No. 837
24- Suleiman OH (2004) Radiation doses in pediatric radiology: influence of regulations and standards. Pediatric Radial 34 [Supple 3]:242–246
25- Maynard H. Digital flour acceptance testing: the AAPM approach. In: Seibert JA, Barnes GT, Gould RG, eds. Specification, acceptance testing and quality control of diagnostic x-ray imaging equipment. Medical Physics Monograph no. 20. College Park, Mad: American Association of Physicists in Medicine, 2001 ; 709 –730
26- Brady Z., Ramanauskas F., Cain T. M., Johnston P. N. Assessment of pediatric CT dose indicators for purpose of optimization. Br. J. Radial. 85, 1488–1498 (2012).
27- Levine MS, Rubes in SE, Lauer I. Barium studies in modern radiology: do they have a role? Radiology. 2009; 250:18–22. [PubMed] [Google Scholar]
28- Narayan AK, Lopez DB, Kambadakone AR, Gravis DA. Nationwide, Longitudinal Trends in CT Colonography Utilization: Cross-Sectional Survey Results From the 2010 and 2015 National Health Interview Survey. J Am Cull Radial. 2019; 16:1052–1057. [PubMed] [Google Scholar]
29- American College of Radiology. Medicare Physician Fee Schedule. [Cited 2020 May 24]. Available from: https://www.acr.org/Advocacy-and- Economics/Radiology-Economics/Medicare-Medicaid/MPFS.
30- Relative value units (RVUs) Nat’l Health Policy Forum. [Published 2015 January 12]. Available from: https://www.nhpf.org/Library/the- basics/Basics_RVUs_01-12-15.pdf.
31- Demimonde AK, Post a, Dusk R Jar, Duong PT. Radiology Trainee vs. Faculty Radiologist Fluoroscopy Time for Imaging-Guided Procedures: A Retrospective Study of 17,966 Reports Over a 5.5-Year Period. Cur Prowl Deign Radial. 2018; 47:233–237. [PMC free article] [PubMed] [Google Scholar]
32- Levine MS, Rubes in SE, Her linger H, Lauer I. Double-contrast upper gastrointestinal examination: technique and interpretation. Radiology. 1988; 168:593–602. [PubMed] [Google Scholar]
33- Mahesh M. Minimizing Risks from Fluoroscopy [Slide Presentation]. 2019.
Available from: https://Lms14.learnshare.com/
34- Hung RK. Real-Time Radiographic Identification of Contrast Consistency in Modified Barium Swallow Studies: An Alternative Technique. Practical Gastroenterology 2017; 9 Available from: https://practicalgastro.com/2017/09/02/real-time-radiographic- identification-of-contrast-consistency-in-modified-barium-swallow-studies- an-alternative-technique/ [Google Scholar]
35- Chand DH, Rhoades T, Poe SA, Kraus S, Strife CF. Incidence and severity of vesicoureteral reflux in children related to age, gender, race and diagnosis. J Urol. 2003; 170:1548–1550. [PubMed] [Google Scholar] In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020. [Google Scholar]
36- Kumara SS, Qi J. Fluoroscopic Diagnosis of Malrotation: Technique, Challenges, and Trouble Shooting. Cur Prowl Deign Radial. 2020; 49:476–
488. [PubMed] [Google Scholar]
37- Esposito F, Ambrosia C, De Frunze S, Panic MR, D’Aprano M, Giuliana AM, Novella D, Rosetta P. Fluoroscopy-guided hydrostatic reduction of intussusception in infancy: role of pharmacological premedication. Radial Med. 2015; 120:549–556. [PubMed] [Google Scholar]
38- Bazile J, Kenny JF, Khodorkovsky B, Youssef E, Argolis B, Chacko J, Hahn
B. Effects of eliminating routine use of oral contrast for computed tomography of the abdomen and pelvis: A pilot study. Clan Imaging. 2018; 49:159–162. [PubMed] [Google Scholar]
39- Donner MW, Siegel CI. The evaluation of pharyngeal neuromuscular disorders by cineradiography. Am J Roentgen 1965; 94:299-307? [Google Scholar]
40- Loge Mann JA. Diagnosis and treatment of swallowing disorders. San Diego, California: College-Hill Press; 1983. [Google Scholar]
41- Loge Mann JA. Manual for the video fluoroscopic study of swallowing.
Second Edition. Austin, Texas: PRO-ED; 1993. [Google Scholar]
42- Huda W, Peters KR. Radiation-induced temporary epilation after a neuroradiologically guided embolization procedure. Radiology 1994; 193(3):642-4.
43- Naas GT, Cornelius L. Fluoroscopy-induced radio dermatitis after Tran’s jugular intrahepatic Porto systemic shunt. Am J Gastroenterology 1998; 93(9):1546-9.
44- Vane E, Gonzalez L, Beneytez F et al. Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories. Br J Radial 1998; 71(847):728-33.
45- Middy PF, Quinn AD, Frayne PJ et al. Dose reduction in double contrast barium enema by use of low fluoroscopic current. Br J Radial 1996; 69(825):852-4.
46- Brown PH, Thomas RD, Silberberg PJ et al. Optimization of a fluoroscope to reduce radiation exposure in pediatric imaging. Pediatric Radial 2000; 30(4):229-35.
47- Tapiovaara MJ, Sandburg M, Dance DR. A search for improved technique factors in pediatric fluoroscopy. Phis Med Boil 1999; 44(2):537-59.
48- Hernandez RJ, Godwit MM. Reduction of radiation dose in pediatric patients using pulsed fluoroscopy. AJR Am J Roentgen 1996; 167(5):1247- 53.
49- Vane E, Geiger B, Schreiner a et al. Dynamic flat panel detector versus image intensifier in cardiac imaging: dose and image quality. Phis Med Boil2005; 50(23):5731-42.
50- Triennia A, Bernard G, Radovan R. Are new technologies always reducing patient doses in cardiac procedures? Radiate Port Dosimeter 2005; 117(1- 3):97-101
51- Wagner LK, Eifel PJ, Geese RA. Potential biological effects following high x-ray dose interventional procedures. J Vass Intern Radial 1994; 5:71– 84.
52- Boone JM, Pfeiffer DE, Strauss KJ, et al. A survey of fluoroscopic exposure rates: AAPM Task Group No. 11 Report. Med Phis 1993; 20:789 – 794.
53- Chakra borty DP. Routine fluoroscopic quality control. In: Seibert JA, Barnes GT, Gould RG, eds. Specification, acceptance testing and quality control of diagnostic x-ray imaging equipment. Medical Physics Monograph no. 20. College Park, Mad: American Association of Physicists in Medicine,1994; 569 –596.
54- Maynard H. Digital flour acceptance testing: the AAPM approach. In: Seibert JA, Barnes GT, Gould RG, eds. Specification, acceptance testing and quality control of diagnostic x-ray imaging equipment. Medical Physics Monograph no. 20. College Park, Mad: American Association of Physicists in Medicine, 1994; 709 –730
55- Pattie PL, Johns PC, Chambers RJ. Radiation risk to patients from percutaneous Tran’s luminal coronary angioplasty. J Am Cull Cardio 1993; 22: 1044 –1051.
56- Colden RA, Reedman LP. Coronary angiography: an analysis of radiographic practice in the UK. Br J Radial 1993; 66:327–331.
57- Rosenthal LS, Mahesh M, Beck TJ, et al. Predictors of fluoroscopy time and estimated radiation exposure during radiofrequency catheter ablation procedures: a multicenter experience. Am J Cardio 1998; 82:451– 458?
58- Geiger H, Beckman KW, Anderson T et al. Radiation dose optimization in coronary angiography and percutaneous coronary intervention (PCI). I. Experimental studies. Ear Radial 2002; 12(10):2571-81.
59- Axel’s son B, Bowden K, Branson SG et al. A comparison of analogue and digital techniques in upper gastrointestinal examinations: absorbed dose and diagnostic quality of the images. Ear Radial 2000; 10(8):1351-4.
60- Hansson B, Finnbogason T, Schubert P et al. Added copper filtration in digital pediatric double-contrast colon examinations: effects on radiation dose and image quality. Ear Radial 1997; 7(7):1117-22.
61- Fanner JW, Morrison GD, Kerry J et al. A practical demonstration of improved technique factors in pediatric fluoroscopy. Br J Radial 2002; 75(895):596-602.
62- Sideman M, Hansson B, Axel’s son B. Radiation dose and image quality in neuroangiography: effects of increased tube voltage, added x-ray filtration and ant scatter grid removal. Intern Neuroma 1998; 4:199-207
63- ( NPDD) Hart, D., Hillier, M. C., & Wall, B. F. (2009). National reference doses for common radiographic, fluoroscopic and dental X-ray examinations in the UK. The British journal of radiology, 82(973), 1-12.
64- Book IAEA SAFETY STANDARDS AND RELATED PUBLICATIONS N. 71
65- Book ‘ICRP, 2013. Radiological protection in pediatric diagnostic and interventional radiology. ICRP Publication 121. Ann. ICRP 42(2)