Direct physician reporting is associated with reductions in radiation exposure in pediatric cardiac catheterizations

Nicholson, George T.; Gao, Kevin; Kim, Sung In; Kim, Dennis W.; Vincent, Robert; Balfour, Virginia; Petit, Christopher J.

doi:10.1002/ccd.26098

Cited by 10 publications

(6 citation statements)

References 28 publications

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“…Examples of such initiatives include increased radiation safety awareness in the catheterization lab, inter‐institutional sharing of practices and operator techniques among participating sites in C3PO‐QI, online reporting tools allowing for tracking of radiation doses longitudinally, and identification of procedural specific areas requiring improvement using new reporting programs such as Tableau TM (Tableau Software, Seattle, Washington). Importantly, some participants have noted that the radiation dose data immediately available for review via the C3PO‐QI website enables and empowers physicians to further reduce radiation dose . Additionally, installation of new catheterization laboratory equipment and utilization of radiation reporting software have made it easier for operators to make modifications to radiation settings (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Radiation dose outcomes were reported as median, 75 th percentile, and 95 th percentile with corresponding 95% confidence interval, stratified by case type and age group (<1 yr of age, 1–4 yrs of age, 5–9 yrs of age, 10–15 yrs of age and >15 yrs of age). To determine the relationship between radiation exposure and body weight, as previously reported in other studies, DAP per body weight was further stratified by body weight group according to the following categories: <10 kg, 10–20 kg, 20–30 kg, 30–50 kg, and >50 kg . Case types, age groups, and body weight categories with insufficient data, arbitrarily chosen to be less than 10 representative cases, were excluded in the summary tables.…”

Section: Methodsmentioning

confidence: 99%

“…Further, as life expectancy in children with congenital heart disease increases, often from the interventional procedures themselves, these children may be subject to repeated catheterizations, resulting in higher cumulative radiation exposure over their lifetimes . As a result of increased awareness and publication on radiation exposure in children with congenital heart disease, many pediatric catheterization labs have begun to participate in radiation reduction initiatives, such as implementing local radiation safety protocols, as well as collaborating in national and international radiation reduction quality improvement (QI) efforts . However, there is a paucity of published radiation dose metrics for reference and comparison among pediatric cardiac catheterization procedures.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi‐center C3PO‐QI study

Cevallos

Armstrong

Glatz

et al. 2017

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi‐center C3PO‐QI study

Cevallos

Armstrong

Glatz

et al. 2017

Cathet Cardio Intervent

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“…Several technical developments have impacted positively on the reduction of radiation exposure, notably the transition to flat panel detector (FPD) technology, which converts X-ray photon energy to digital signals more efficiently than image intensifiers 30 , 34 – 36 . Innovation in FPD including increased pixel bit depth and usage of crystalline silicon rather than amorphous silicon combined with novel flat emitter X-ray tubes offers further reduction in radiation dose owing to better digitalization and lower detector noise 37 .…”

Section: Radiation Safetymentioning

confidence: 99%

Recent advances in cardiac catheterization for congenital heart disease

Kang

Benson

2018

F1000Res

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The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety.

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“…1,[6][7][8] Radiation dose during interventional cardiac procedure greatly depends on the operator's knowledge, training, and tactics of radiation protection. 1,6,[9][10][11][12][13] The main goal of this study was to investigate how much radiation reduction could be achieved during the most common paediatric interventional procedures by using a modified radiation safety protocol with efforts to increase the awareness and refine the tactics of the operators.…”

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confidence: 99%

Reducing radiation dose in paediatric interventional cardiac catheterisation

et al. 2019

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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.

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Direct physician reporting is associated with reductions in radiation exposure in pediatric cardiac catheterizations

Cited by 10 publications

References 28 publications

Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi‐center C3PO‐QI study

Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi‐center C3PO‐QI study

Recent advances in cardiac catheterization for congenital heart disease

Reducing radiation dose in paediatric interventional cardiac catheterisation

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