Commentary to "Lower radiation burden in state of the art fluoroscopic cystography compared to direct isotope cystography in children".
Most pediatric radiology centers worldwide prefer radiographic cystographies because of the inaccuracies inherent to sonographic cystography. Contemporary teachings state that nuclear cystography exposes patients to less radiation than fluoroscopic cystography. Thus, the ideal candidates for nuclear cystographies for the evaluation of vesicoureteral reflux (VUR) were thought to be girls, postoperative patients, and patients on active surveillance. This study provides evidence that newer technologies and techniques employed in fluoroscopic cystography can reduce its radiation burden to approximately one-third of that of nuclear studies. If one were to argue that nuclear cystography is more sensitive in detecting VUR, this study concludes that a cyclic (three cycles) fluoroscopic cystography would accrue approximately the same effective radiation dose. Assuming that indications, invasiveness, radiation exposure, and possibly cost are similar for both, then should one choose nuclear or fluoroscopic cystography? There is mounting evidence that fluoroscopic cystography provides additional clues in regard to the competency of the ureterovesical junction and therefore the clinical course of VUR. These findings include bladder volume and timing of reflux, ureteral diameter, upper