Radiation exposure in pediatric port implantations - How low is reasonable achievable? A retrospective single-center study.

Aim Of The Study
The objective of the present study was to establish local reference data for radiation exposure in children undergoing port implantation.Methods
A retrospective analysis of radiation exposure was conducted, with the primary endpoint being the third quartile of the dose area product (DAP) measured in cGy · cm2. The study included all pediatric port implantations performed at our institution between 2018 and 2023. Secondary endpoints comprised patient age, underlying diagnoses, radiation duration, and duration of surgery. All procedures were performed under fluoroscopy using a mobile C-arm with a flat panel detector (Ziehm Vision, Leu AG). This device automatically adjusts power output based on tissue density. The standard pre-installed program, "Children and Heart", delivers 12 pulses per second. At our institution, pediatric surgeons are responsible for intraoperative fluoroscopy. Mandatory annual radiation protection training is provided for all surgeons utilizing fluoroscopic equipment.Main Results
A total of 157 port implantations in 143 patients were analyzed. Of these, 57 % (n = 82) were male and 59 % (n = 93) of the procedures were conducted on patients younger than seven years. The most common indications for port implantation were leukemia (41 %, n = 59) and brain tumors (16 %, n = 23). The value for the third quartile of the DAP was 24.6 cGy · cm2, with calculated effective doses ranging from 0.009 mSv to 0.023, depending on patient weight. The mean radiation duration was 31 s. The radiation exposure was found to be positively correlated with patient's weight.Conclusion
The literature on radiation exposure in pediatric port implantation is limited. The present analysis provides a benchmark for children and adolescents, useful for quality control and the development of protocols that aim to reduce radiation exposure in children.