Radiation exposure in infants with oesophageal atresia and tracheo-oesophageal fistula

Abstract

Purpose

Oesophageal atresia and tracheo-oesophageal atresia require surgical repair in early infancy. These children have significant disease-related morbidity requiring frequent radiological examinations resulting in an increased malignancy risk.

Methods

A single-centre, retrospective review was performed of radiation exposure in children with OA/TOF born 2011–2015. Medical records were reviewed to determine the number and type of imaging studies involving ionising radiation exposure enabling the calculation of the estimated effective dose per child over the first year of life.

Results

Forty-nine children were included. Each child underwent a median of 19 (IQR 11.5–35) imaging studies, which were primarily plain radiography (median = 14, IQR 7–26.5). The overall median estimated effective dose per patient was 4.7 (IQR 3.0–9.4) mSv, with the majority of radiation exposure resulting from fluoroscopic imaging (median 3.3 mSv, IQR 2.2–6.0). 'Routine' postoperative oesophagrams showed no leak in 35/36 (97%) with the remaining study showing an insignificant leak that did not alter management.

Conclusions

Careful consideration should be given to the use of imaging in OA/TOF to minimise morbidity in these vulnerable infants. Oesophagrams in children without the symptoms of anastomotic leak or stricture should be discontinued. Standardisation of monitoring protocols with regard to radiation exposure should be considered.

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