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Estimating radiation exposure during paediatric cardiac catheterisation: a potential for radiation reduction with air gap technique

Published online by Cambridge University Press:  04 November 2019

Reid C. Chamberlain Open the ORCID record for Reid C. Chamberlain [Opens in a new window] ,
Alexis C. Shindhelm ,
Chu Wang ,
Gregory A. Fleming  and
Kevin D. Hill
Reid C. Chamberlain*
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
Alexis C. Shindhelm
Affiliation:
Department of Bioengineering, Duke University Pratt School of Engineering, Durham, NC, USA
Chu Wang
Affiliation:
University of Pittsburgh, Radiation Safety Office, Pittsburgh, PA, USA
Gregory A. Fleming
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
Kevin D. Hill
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
*
Author for correspondence: R. C. Chamberlain, MD, Department of Pediatrics, Division of Pediatric Cardiology, Duke University Hospital, DUMC Box 3090, Durham, NC 27710, USA. Tel: +1 919 681 6340; E-mail: reid.chamberlain@duke.edu
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Abstract

Introduction:

The air gap technique (AGT) is an approach to radiation dose optimisation during fluoroscopy where an “air gap” is used in place of an anti-scatter grid to reduce scatter irradiation. The AGT is effective in adults but remains largely untested in children. Effects are expected to vary depending on patient size and the amount of scatter irradiation produced.

Methods:

Fluoroscopy and cineangiography were performed using a Phillips Allura Fluoroscope on tissue simulation anthropomorphic phantoms representing a neonate, 5-year-old, and teenager. Monte Carlo simulations were then used to estimate effective radiation dose first using a standard recommended imaging approach and then repeated using the AGT. Objective image quality assessments were performed using an image quality phantom.

Results:

Effective radiation doses for the neonate and 5-year-old phantom increased consistently (2–92%) when the AGT was used compared to the standard recommended imaging approaches in which the anti-scatter grid is removed at baseline. In the teenage phantom, the AGT reduced effective doses by 5–59%, with greater dose reductions for imaging across the greater thoracic dimension of lateral projection. The AGT increased geometric magnification but with no detectable change in image blur or contrast differentiation.

Conclusions:

The AGT is an effective approach for dose reduction in larger patients, particularly for lateral imaging. Compared to the current dose optimisation guidelines, the technique may be harmful in smaller children where scatter irradiation is minimal.

Keywords

Scatteringradiationheart defectscongenitalangiography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1474 - 1480
Copyright
© Cambridge University Press 2019 

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References

Fazel, R, Krumholz, HM, Wang, Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009; 361: 849–857.CrossRefGoogle ScholarPubMed
Hall, J, Jeggo, PA, West, C, et al. Ionizing radiation biomarkers in epidemiological studies – an update. Mutat Res 2017; 771: 59–84.CrossRefGoogle ScholarPubMed
Hill, KD, Frush, DP, Han, BK, et al. Radiation Safety in children with congenital and acquired heart disease: a scientific position statement on multimodality dose optimization from the image gently alliance. JACC Cardiovasc Imaging 2017; 10: 797–818.CrossRefGoogle ScholarPubMed
Partridge, J, McGahan, G, Causton, S, et al. Radiation dose reduction without compromise of image quality in cardiac angiography and intervention with the use of a flat panel detector without an antiscatter grid. Heart 2006; 92: 507–510.CrossRefGoogle ScholarPubMed
Karoll, MP, Mintzer, RA, Lin, PJ, et al. Air gap technique for digital subtraction angiography of the extracranial carotid arteries. Invest Radiol 1985; 20: 742–745.CrossRefGoogle ScholarPubMed
Roy, JR, Sun, P, Ison, G, et al. Selective anti-scatter grid removal during coronary angiography and PCI: a simple and safe technique for radiation reduction. Int J Cardiovasc Imaging 2017; 33: 771–778.CrossRefGoogle ScholarPubMed
Osei, FA, Hayman, J, Sutton, NJ, Pass, RH. Radiation dosage during pediatric diagnostic or interventional cardiac catheterizations using the “air gap technique” and an aggressive “as low as reasonably achievable” radiation reduction protocol in patients weighing <20 kg. Ann Pediatr Cardiol 2016; 9:16–21.CrossRefGoogle ScholarPubMed
Ubeda, C, Vano, E, Gonzalez, L, Miranda, P. Influence of the antiscatter grid on dose and image quality in pediatric interventional cardiology X-ray systems. Catheter Cardiovasc Interv 2013; 82: 51–57.CrossRefGoogle ScholarPubMed
The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007; 37: 1–332.Google Scholar
Rassow, J, Schmaltz, AA, Hentrich, F, Streffer, C. Effective doses to patients from paediatric cardiac catheterization. Br J Radiol 2000; 73: 172–183.CrossRefGoogle ScholarPubMed
Johnson, JN, Hornik, CP, Li, JS, et al. Cumulative radiation exposure and cancer risk estimation in children with heart disease. Circulation 2014; 130: 161–167.CrossRefGoogle ScholarPubMed
Hill, KD, Wang, C, Einstein, AJ, et al. Impact of imaging approach on radiation dose and associated cancer risk in children undergoing cardiac catheterization. Catheter Cardiovasc Interv 2017; 89: 888–897.CrossRefGoogle ScholarPubMed
Haas, NA, Happel, CM, Mauti, M, et al. Substantial radiation reduction in pediatric and adult congenital heart disease interventions with a novel X-ray imaging technology. Int J Cardiol Heart Vasc 2015; 6: 101–109.Google ScholarPubMed
Cevallos, PC, Armstrong, AK, Glatz, AC, et al. Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi-center C3PO-QI study. Catheter Cardiovasc Interv 2017; 90: 269–280.CrossRefGoogle ScholarPubMed
Ghelani, SJ, Glatz, AC, David, S, et al. Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States. JACC Cardiovasc Interv 2014; 7: 1060–1069.CrossRefGoogle ScholarPubMed
Gould, R, McFadden, SL, Sands, AJ, et al. Removal of scatter radiation in paediatric cardiac catheterisation: a randomised controlled clinical trial. J Radiol Prot 2017; 37: 742–760.CrossRefGoogle ScholarPubMed
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