Achievable radiation reduction during pediatric cardiac catheterization: How low can we go?

Published on Nov 1, 2015in Catheterization and Cardiovascular Interventions2.044
· DOI :10.1002/CCD.26024
Sharon Borik3
Estimated H-index: 3
(U of T: University of Toronto),
Sunder Devadas1
Estimated H-index: 1
(U of T: University of Toronto)
+ 3 AuthorsLee N. Benson74
Estimated H-index: 74
(U of T: University of Toronto)
Objectives To assess the effectiveness of radiation-reduction measures implemented during pediatric catheterization, and provide data on the radiation doses for common interventional and diagnostic procedures, indexed to body weight. Background Ionizing radiation exposure must be minimized to “as low as reasonably achievable,” by instituting radiation-limiting techniques and knowledge of expected radiation exposure. Methods Radiation-reduction measures included pulsed-fluoroscopy at 7.5 pulses/second (0.032–0.045 µGy/pulse), an air-gap magnification technique for children <20 kg, operator awareness, and additional exposure reduction techniques through projection optimization. Radiation doses for procedures performed between 2007 through 2014 were retrospectively reviewed, including dose area product (DAP) and DAP/kg of body weight for 25 procedural types. Median doses were compared with those previously published from other large centers and multi-institutional databases and assessed for changes over time. Results Reviewed were 5,196 cases, which included 2,819 interventional, 710 endomyocardial biopsies and 1,667 diagnostic studies, documenting a significant difference in exposure between various procedures and body weights. The absolute exposure was significantly greater in larger children (e.g., for ductal closure median DAP/kg: 17 µGy*m2/kg 10–20 kg children vs. 37 µGy*m2/kg for those >30 kg, P < 0.001). Dose exposure using radiation-reduction techniques were the lowest reported in the literature for all procedure types compared (e.g. median DAP for pulmonary valvuloplasty 163 µGy*m2 vs. 405 to 1,230 µGy*m2 reported by 3 large centers). Reduction of fluoroscopy acquisition to 7.5 pulses/second nearly halved radiation exposure (P < 0.001). Conclusions Implementing a radiation dose reduction and awareness program can lead to documented reduction in exposure, across a variety of procedures performed by multiple operators. © 2015 Wiley Periodicals, Inc.
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