Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-16T23:11:42.221Z Has data issue: false hasContentIssue false
  • English
  • Français

Reducing radiation dose in paediatric interventional cardiac catheterisation

Published online by Cambridge University Press:  09 July 2019

Jiarong Bai ,
Feng Wang ,
Haosheng Yang ,
Ying Lu  and
Lin Wu Open the ORCID record for Lin Wu [Opens in a new window]
Jiarong Bai
Affiliation:
Department of Cardiology, Cardiovascular Center, Children’s Hospital of Fudan University, Shanghai 201102, P.R. China
Feng Wang
Affiliation:
Department of Cardiology, Cardiovascular Center, Children’s Hospital of Fudan University, Shanghai 201102, P.R. China
Haosheng Yang
Affiliation:
College of Natural Sciences, The University of Texas at Austin, Austin 78705, TX, USA
Ying Lu
Affiliation:
Department of Cardiology, Cardiovascular Center, Children’s Hospital of Fudan University, Shanghai 201102, P.R. China
Lin Wu*
Affiliation:
Department of Cardiology, Cardiovascular Center, Children’s Hospital of Fudan University, Shanghai 201102, P.R. China
*
Author for correspondence: Lin Wu, Department of Cardiology, Cardiovascular Center, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai 201102, P.R China. Tel: +86-21-6493-2800; Fax: +86-21-6493-1901; E-mail: wulin0609@foxmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Radiation exposure during paediatric cardiac catheterisation procedures should be minimised to “as low as reasonably achievable”. The aim of this study was to evaluate the effectiveness of a modified radiation safety protocol in reducing patient dose during paediatric interventional cardiac catheterisation.

Methods:

Radiation dose data were retrospectively extracted from January 2014 to December 2015 (Standard group) and prospectively collected from January 2016 to December 2017 (Low-dose group) after implementation of a modified radiation safety protocol. Both groups included five most common procedures: atrial septal defect closure, patent ductus arteriosus closure, perimembranous ventricular septal defect closure, pulmonary valvuloplasty, and supraventricular tachycardia ablation.

Results:

Median air Kerma was 48.4, 50.5, 29.75, 149, 218, and 12.9 mGy for atrial septal defect closure, pulmonary valvuloplasty, patent ductus arteriosus closure <20 kg, ventricular septal defect closure <20 kg, ventricular septal defect closure ≧20 kg, and supraventricular tachycardia ablation in Standard group, respectively, which significantly decreased to 18.75, 20.7, 11.5, 41.9, 117, and 3.3 mGy in Low-dose group (p < 0.05). This represents a reduction in dose to each patient between 46 and 74%. Among five procedural types in Low-dose group, dose of ventricular septal defect closure was the highest with median air Kerma of 62.5 mGy, dose area product of 364.7 μGy.m2, and dose area product per body weight of 21.5 μGy.m2/kg, respectively, along with the longest fluoroscopy time of 9.9 minutes.

Conclusion:

We provided a feasible radiation safety protocol with specific settings on a case-by-case basis. Increasing awareness and adequate training of a practical radiation dose reduction program are essential to improve radiation protection for children.

Keywords

Fluoroscopyradiation dosepaediatriccardiac catheterisationpaediatric intervention
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 967 - 971
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Jiarong Bai and Feng Wang contributed equally to this work.

References

Justino, H. The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose. Pediatr Radiol 2006; 36: 146–153.CrossRefGoogle ScholarPubMed
Ait-Ali, L, Andreassi, MG, Foffa, I, Spadoni, I, Vano, E, Picano, E. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart 2010; 96: 269–274.CrossRefGoogle ScholarPubMed
Walsh, MA, Noga, M, Rutledge, J. Cumulative radiation exposure in pediatric patients with congenital heart disease. Pediatr Cardiol 2015; 36: 289–294.CrossRefGoogle ScholarPubMed
Kamiya, K, Ozasa, K, Akiba, S, et al. Long-term effects of radiation exposure on health. Lancet 2015; 386: 469–478.CrossRefGoogle ScholarPubMed
Song, S, Liu, C, Zhang, M. Radiation dose and mortality risk to children undergoing therapeutic interventional cardiology. Acta Radiol 2015; 56: 867–872.CrossRefGoogle ScholarPubMed
Strauss, KJ, Kaste, SC. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients – a white paper executive summary. Pediatr Radiol 2006; 36: 110–112.CrossRefGoogle Scholar
Connolly, B, Racadio, J, Towbin, R. Practice of ALARA in the pediatric interventional suite. Pediatr Radiol 2006; 36: 163–167.CrossRefGoogle ScholarPubMed
Khong, PL, Ringertz, H, Donoghue, V, et al. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP 2013; 42: 1–63.CrossRefGoogle ScholarPubMed
Hernanz-Schulman, M, Goske, MJ, Bercha, IH, Strauss, KJ. Pause and pulse: ten steps that help manage radiation dose during pediatric fluoroscopy. AJR Am J Roentgenol 2011; 197: 475–481.CrossRefGoogle ScholarPubMed
Hill, KD, Einstein, AJ. New approaches to reduce radiation exposure. Trends Cardiovasc Med 2016; 26: 55–65.CrossRefGoogle ScholarPubMed
Nicholson, GT, Gao, K, Kim, SI, et al. Direct physician reporting is associated with reductions in radiation exposure in pediatric cardiac catheterizations. Catheter Cardiovasc Interv 2015; 86: 834–840.CrossRefGoogle ScholarPubMed
Shabani, F, Hasanzadeh, H, Emadi, A, et al. Radiation Protection Knowledge, Attitude, and Practice (KAP) in interventional radiology. Oman Med J 2018; 33: 141–147.CrossRefGoogle Scholar
Aldoss, O, Patel, S, Harris, K, Divekar, A. The lateral plane delivers higher dose than the frontal plane in biplane cardiac catheterization systems. Pediatr Cardiol 2015; 36: 912–917.CrossRefGoogle Scholar
Onnasch, DG, Schemm, A, Kramer, HH. Optimization of radiographic parameters for paediatric cardiac angiography. Brit J Radiol 2004; 77: 479–487.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
McFadden, SL, Hughes, CM, Mooney, RB, Winder, RJ. An analysis of radiation dose reduction in paediatric interventional cardiology by altering frame rate and use of the anti-scatter grid. J Radiol Prot 2013; 33: 433–443.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
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 Scholar
Lamers, LJ, Moran, M, Torgeson, JN, Hokanson, JS. Radiation reduction capabilities of a next-generation pediatric imaging platform. Pediatr Cardiol 2016; 37: 24–29.CrossRefGoogle ScholarPubMed
Borik, S, Devadas, S, Mroczek, D, Lee, KJ, Chaturvedi, R, Benson, LN. Achievable radiation reduction during pediatric cardiac catheterization: how low can we go? Catheter Cardiovasc Interv 2015; 86: 841–848.CrossRefGoogle Scholar
Covi, SH, Whiteside, W, Yu, S, Zampi, JD. Pulse fluoroscopy radiation reduction in a pediatric cardiac catheterization laboratory. Congenit Heart Dis 2015; 10: E43–E47.CrossRefGoogle Scholar
Patel, AR, Ganley, J, Zhu, X, Rome, JJ, Shah, M, Glatz, AC. Radiation safety protocol using real-time dose reporting reduces patient exposure in pediatric electrophysiology procedures. Pediatr Cardiol 2014; 35: 1116–1123.CrossRefGoogle ScholarPubMed
Hiremath, G, Meadows, J, Moore, P. How slow can we go? 4 Frames Per Second (fps) Versus 7.5 fps Fluoroscopy for Atrial Septal Defects (ASDs) device closure. Pediatr Cardiol 2015; 36: 1057–1061.CrossRefGoogle ScholarPubMed
Gossett, JG, Sammet, CL, Agrawal, A, Rychlik, K, Wax, DF. Reducing fluoroscopic radiation exposure during endomyocardial biopsy in pediatric transplant recipients. Pediatr Cardiol 2017; 38: 308–313.10.1007/s00246-016-1514-4CrossRefGoogle 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
Kwon, D, Little, MP, Miller, DL. Reference air kerma and kerma-area product as estimators of peak skin dose for fluoroscopically guided interventions. Med Phys 2011; 38: 4196–4204.CrossRefGoogle ScholarPubMed
Stecker, MS, Balter, S, Towbin, RB, et al. Guidelines for patient radiation dose management. J Vasc Interv Radiol 2009; 20: S263–S273.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
Onnasch, DG, Schroder, FK, Fischer, G, Kramer, HH. Diagnostic reference levels and effective dose in paediatric cardiac catheterization. Br J Radiol 2007; 80: 177–185.CrossRefGoogle ScholarPubMed
Bourier, F, Reents, T, Ammar-Busch, S, et al. Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures. Europace 2016; 18: 1406–1410.CrossRefGoogle ScholarPubMed
Beach, C, Beerman, L, Mazzocco, S, Brooks, MM, Arora, G. Use of three-dimensional mapping in young patients decreases radiation exposure even without a goal of zero fluoroscopy. Cardiol Young 2016; 26: 1297–1302.CrossRefGoogle ScholarPubMed
Pass, RH, Gates, GG, Gellis, LA, Nappo, L, Ceresnak, SR. Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO(R) 3 in concert with “ALARA” principles profoundly lowers total dose. Cardiol Young 2015; 25: 963–968.CrossRefGoogle ScholarPubMed