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

Cevallos, Priscila; Armstrong, Aimee K.; Glatz, Andrew C.; Goldstein, Bryan H.; Gudausky, Todd M.; Leahy, Ryan; Petit, Christopher J.; Shahanavaz, Shabana; Trucco, Sara M.; Bergersen, Lisa

doi:10.1002/ccd.26911

Cited by 44 publications

(33 citation statements)

References 25 publications

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“…Given the increased lifetime risk of cancer associated with exposure to low‐dose ionizing radiation, it is important to consider potential for additional radiation exposure combining CTA and catheterization . In recent years, improvements in technology and protocols have significantly reduced the radiation exposure during a CT, now with effective doses of around 1 mSv .…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, improvements in technology and protocols have significantly reduced the radiation exposure during a CT, now with effective doses of around 1 mSv . Currently no benchmark radiation dose is available for DS placement; however, in children <1 year of age, effective radiation doses from chest CTA are a fraction of those from diagnostic catheterizations with median doses of 0.76 mSv for CT compared to 13.4 mSv for catheterization . Taken together, the risk from the small additional radiation dose of CTA in this patient population may be acceptable given the benefit to procedural planning and outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Preprocedural three‐dimensional planning aids in transcatheter ductal stent placement: A single‐center experience

Chamberlain

Ezekian

Sturgeon

et al. 2019

Cathet Cardio Intervent

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Objectives: Describe the use of three-dimensional (3D) patent ductus arteriosus (PDA) modeling to better define ductal anatomy to improve preprocedural planning for ductal stent placement.Background: Ductal stenting is an alternative to surgical shunting in patients with ductal dependent pulmonary blood flow. Ductal anatomy is often complex with extreme tortuosity and risk of pulmonary artery isolation, thus increasing procedural risks.Methods: CT angiograms were segmented to produce 3D PDA models. Ductal morphology was characterized with attention to access approach, degree of pulmonary artery offset/risk of isolation and ductal tortuosity. 3D models were retrospectively compared with biplane angiography.Results: 3D modeling was performed in 12 patients with adequate image quality for complete analysis in 11; median (interquartile range) age/weight 17 days (8-20 days) and 3.1 kg (2.4-3.9 kg). The PDA was reverse oriented in nine with average length of 17.2 ± 2.5 mm and high tortuosity (mean tortuosity index 52, range 3-108). From 3D modeling, two patients were excluded from ductal stenting-extreme ductal tortuosity and threatened pulmonary artery discontinuity, respectively. Ductal stenting was successful in the remaining nine with no major procedural complications. 3D modeling predicted a successful access approach based on the aortic orientation of the ductus in all patients (five carotid, two axillary, two femoral). When comparing 2D angiography with 3D models, angiography consistently underestimated ductal length (−3.2 mm ± 1.6 mm) and tortuosity (−14.8 ± 7.2).Conclusions: 3D modeling prior to ductal stent placement for ductal dependent pulmonary blood flow is useful in procedural planning, specifically for eligibility, access approach, and accurate ductal measurements. Further studies are needed to determine if 3D planning improves procedural outcomes. K E Y W O R D SBare metal, Congenital heart disease, Electron beam CT/multidetector CT, Imaging, Pediatrics, Pediatric intervention, Stent

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preprocedural three‐dimensional planning aids in transcatheter ductal stent placement: A single‐center experience

Chamberlain

Ezekian

Sturgeon

et al. 2019

Cathet Cardio Intervent

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“…In pediatrics, the stochastic risk of radiation is the main concern rather than deterministic effects 4. DAP is the product of the air kerma dose and the cross-sectional area exposed to the X-ray beam (μGy-M 2 ) 5.…”

Section: Methodsmentioning

confidence: 99%

Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs

et al. 2019

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BackgroundThe importance of registries for collaborative quality improvement has been overlooked in low/middle-income countries (LMIC). Aga Khan University Hospital (AKUH) in Pakistan joined the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in March 2017 with the goal of leveraging international collaboration to improve patient care and institutional standards.MethodsThe C3PO-QI key driver-based approach was used, with certain modifications, for process re-engineering in AKUH’s congenital cardiac catheterisation laboratory (CCL) to reduce radiation exposure during cardiac catheterisation procedures (the primary outcome of C3PO- QI). Educating staff and standardising procedural documentation were the principal goals of the process re-engineering. Data survey was used to assess staff knowledge, attitude and practice before and after the initiative. Additionally, case demographics and outcomes were compared between AKUH and C3PO-QI centres.ResultsThere was an increase in appropriate recording of radiation surrogates (0%–100%, p=0.00) and in the percentage of cases that met the established benchmark of ‘Ideal documentation’ (35% vs 95%, p=0.001). There was also an increase in self-reported staff interest during the case (25% vs 75%, p=0.001). AKUH versus C3PO-QI data showed similar demographic characteristics. There was a slight over-representation of diagnostic cases (42% vs 32%) as compared with interventional (58% vs 68%) at AKUH. Furthermore, interventional procedures were predominately PDA and ASD device closures (n=19 and 15, respectively). The frequency of adverse events were the same between AKUH and collaborative sites.ConclusionCollaborative efforts between developed and LMIC CCL are significant in advancing system-level processes.

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“…From these data, DAP per body weight (μG•m 2 /kg) was calculated as a surrogate for energy delivered indexed by body weight. Although DAP/kg has been reported in previous studies and seems to be a valuable metric, it has never been validated as a method of reporting radiation exposure but was calculated for comparisons to published contemporary benchmarks [12].…”

Section: Data Collectionmentioning

confidence: 99%

“…us, the primary aim of this study was to define radiation exposure for diagnostic and interventional catheterizations from a larger representative sample of pediatric CHD patients from multiple centers and to compare these exposure data to published contemporary benchmarks [12].…”

Section: Introductionmentioning

confidence: 99%

Multicenter Assessment of Radiation Exposure during Pediatric Cardiac Catheterizations Using a Novel Imaging System

Lamers

Morray

Nugent

et al. 2019

Journal of Interventional Cardiology

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Objectives. To quantify radiation exposure during pediatric cardiac catheterizations performed by multiple operators on a new imaging platform, the Artis Q.zen (Siemens Healthcare, Forchheim, Germany), and to compare these data to contemporary benchmark values. Background. The Artis Q.zen has been shown to achieve significant radiation reduction during select types of pediatric cardiac catheterizations in small single-center studies. No large multicenter study exists quantifying patient dose exposure for a broad spectrum of procedures. Methods. Retrospective collection of Air Kerma (AK) and dose area product (DAP) for all pediatric cardiac catheterizations performed on this new imaging platform at four institutions over a two-year time period. Results. A total of 1,127 pediatric cardiac catheterizations were analyzed. Compared to dose data from earlier generation Artis Zee imaging systems, this study demonstrates 70–80% dose reduction (AK and DAP) for similar patient and procedure types. Compared to contemporary benchmark data for common interventional procedures, this study demonstrates an average percent reduction in AK and DAP from the lowest dose saving per intervention of 39% for AK and 27% for DAP for transcatheter pulmonary valve implantation up to 77% reduction in AK and 70% reduction in DAP for atrial septal defect closure. Conclusion. Use of next-generation imaging platforms for pediatric cardiac catheterizations can substantially decrease patient radiation exposure. This multicenter study defines new low-dose radiation measures achievable on a novel imaging system.

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

Abstract: This study updates previously established benchmarks to reflect QI efforts over time. These thresholds can be applied for quality measurement and comparison. © 2017 Wiley Periodicals, Inc.

Cited by 44 publications

References 25 publications

Preprocedural three‐dimensional planning aids in transcatheter ductal stent placement: A single‐center experience

Preprocedural three‐dimensional planning aids in transcatheter ductal stent placement: A single‐center experience

Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs

Multicenter Assessment of Radiation Exposure during Pediatric Cardiac Catheterizations Using a Novel Imaging System

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