Cumulative effective dose from imaging in infants with esophageal atresia: How low can we go?

With the increasing life expectancy for patients with esophageal atresia (EA), and a known predisposition to certain cancers, cumulative radiation exposure from imaging is of increasing significance. This study describes the cumulative effective radiation dose (CED), during the first 6 months of life, estimated from radiologic procedures when dose reduction methods are used. Medical records of newborns with EA followed in our pediatric hospital in 2019-2020 were reviewed for demographics, EA subtype and hospitalization length of stay. Number and type of imaging studies, and radiation exposure were recorded in order to estimate CED in mSv. Twenty-one children were included. Each child underwent a median of 16 (IQR 13-39) imaging studies, which were primarily chest radiography (median of 12 (IQR 10-35)). The overall median CED per patient was 0.4 mSv (IQR 0.08-1.28), with the majority of radiation exposure resulting from plain radiography (median of 0.3 mSv (0.08-0.52)). Careful consideration should be given to the use of imaging in EA to minimize morbidity in these vulnerable infants. A low dose of radiation can be achieved by following these recommendations: proscription of systematic superfluous examinations, standardization and optimization of the imaging protocols, dosimetry monitoring and proper training of operators.