Utilization of a handheld metal detector protocol to reduce radiation exposure in pediatric patients with esophageal coins

Abstract

Objective: The primary objective of this study is to assess the utility of a handheld metal detector for identification and surveillance of patients with known esophageal coin ingestion to reduce repeat x-rays and associated radiation exposure. Methods: Prospective study of children presented to the emergency department with esophageal coins confirmed by an initial x-ray were enrolled. The otolaryngology team used the handheld metal detector to detect and localize the coin on patient. If admitted for observation, the metal detector was used to ensure coin persistence prior to going to operating room for removal. No further x-rays were done if same location is confirmed. Results: A total of 19 patients (10 months-14 years) with 20 esophageal coins were enrolled. 14 patients (73.7%) were initially detected in the emergency department by the metal detector. 11 (58%) asymptomatic patients admitted for period of observation, repeat x-rays were avoided in 10 (90.9%) patients prior to removal in the OR. All proximal esophageal coins were detected with the metal detector. There were 5 (26.3%) patients who failed initial detection of coin, and all of these were in the mid-distal esophageal location with depth from skin >7 cm. Conclusion: A handheld metal detector is rapid, cost-effective surveillance tool to reduce exposure to radiation from repeated x-rays in patients with esophageal coins. In contrast to all prior published studies, which did not objectively examine depth, the distance of the coin from skin surface appears to be a major limitation. Parents have provided positive feedback on the protocol.