RADIOLOGY—TECHNICAL ARTICLE Last fluoroscopy hold in paediatric fluoroscopy: Dynamic capture of physiological events and a potential for radiation exposure time reduction Michalle Soudack, 1 Aviv Hirschenbein, 2 Jacob Sosna, 3 Ehud Dafne 2 and Ahuva Engel 4 1 Pediatric Imaging, Edmond and Lily Safra Children’s Hospital, Tel Hashomer, 2 CMT Medical Technologies, Yokneam, 3 Department of Radiology, Hadassah Hebrew University Medical Center Organization, Jerusalem, and 4 Department of Diagnostic Imaging, Rambam Medical Center, Haifa, Israel M Soudack MD; A Hirschenbein MD; J Sosna MD; E Dafne PhD; A Engel MD. Correspondence Dr Michalle Soudack, Pediatric Imaging, Edmond and Lily Safra Children’s Hospital, Tel Hashomer 52621, Israel. Email: michalle.soudack@sheba.health.gov.il Conflict of interest: None. Submitted 17 May 2011; accepted 24 May 2011. doi:10.1111/j.1754-9485.2011.02322.x Summary The purpose of this study was to retrospectively evaluate last fluoroscopy hold (LFH) in paediatric fluoroscopy. LFH is a software program that enables dynamic storage of last fluoroscopy sequences. A hundred and ninety-four paediatric patients underwent 215 fluoroscopy examinations during a 14-month period. LFH was employed to review an equivocal finding, when last image hold did not provide an adequate diagnostic image or when a physi- ologic dynamic event was too fast or did not last long enough to capture. LFH was used in 29% of the examinations. The Institutional Review Board approved this study and waived informed consent. Key words: fluoroscopy; paediatric imaging; radiation protection. Introduction There is substantial evidence that paediatric patients are more sensitive to ionizing radiation than adults. 1–3 There- fore, all radiologists must adhere to the ‘as low as reasonably achievable’ (ALARA) principle. Fluoroscopic studies are performed for the diagnosis and follow-up of numerous paediatric disorders and, in many cases, have no adequate and acceptable nonionizing alternative. Fluoroscopy units are equipped with various devices to assist in radiation reduction. One of these devices, fluoro loop or last fluoroscopy hold (LFH), stores the last fluo- roscopy sequence for instant review and storage to the picture archiving and communication system (PACS) and, in many situations, obviates the need for repeat fluoroscopy, thereby potentially reducing the overall radiation exposure time. The goal of this investigation was to evaluate this feature in paediatric fluoroscopy examinations. Methods LFH LFH consists of a cyclic-buffered memory embedded in the radiography and fluoroscopy system, which stores the last 250–500 images of any fluoroscopy run. It does not require presetting. It is activated at any time by pressing a key on the system panel keyboard. Images are displayed one at a time with each subsequent key- press beginning from the last of the sequence. Any frame can be stored, edited and sent to the PACS. LFH is automatically disengaged when fluoroscopy is resumed. Patients The Institutional Review Board approved this retrospec- tive study and waived informed consent. This study included 215 consecutive paediatric fluoroscopy exami- nations during a 14-month period performed by the same paediatric radiologist (MS) or performed by a resi- dent supervised by the paediatric radiologist (MS), all equally aware of the LFH functionality. All studies were performed with a SmartSpot PrimaX Digital photospot system (Yokneam, Israel). There were 194 patients, 83 male and 111 female aged 3 days–16.4 years, mean 2.7 years at time of examination. Examinations included 158 (73.5%) voiding cysto-urethrographies (VCUGs), 47 (21.9%) upper gastrointestinal (UGI) contrast studies, four (1.8%) single-contrast enemas, three (1.4%) small bowel studies, two (0.9%) linograms and one (0.5%) air enema for intussusception reduction. Journal of Medical Imaging and Radiation Oncology 56 (2012) 93–95 © 2012 The Authors Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists 93