Radiation dose survey in a paediatric cardiac catheterisation laboratory equipped with flat-panel detectors

Abstract

Flat-panel X-ray detectors for fluoroscopy represent a modern imaging equipment that is being implemented in paediatric cardiac catheterisation laboratories. Infants and children represent a group of patients with a high radiosensitivity. A survey of 273 (126 diagnostic and 147 therapeutic) paediatric catheterisations was performed to investigate the radiation doses delivered by the new X-ray system. Statistical parameters (75th, 50th and 25th percentiles) of dose-area product (DAP) and fluoroscopy time are reported for patients divided into six age groups: 0 -30 d, >1-12 m, >1-3, >3-5, >5 -10 and >10-15 y. For accurate risk estimation, effective dose (E) has been determined for all patients using the PCXMC software. For diagnostic procedures, the third quartile of E ranges from 11.3 mSv for newborns to 7 mSv for children of 10-15 y. Therapeutic procedures are more complex than diagnostic. Consequently, the third quartile of E is 22.6 mSv (0-30 d), 18.6 (>1 -12 m), 13.3 (>1-3 y), 21.5 (>3 -5 y), 17.8 (>5-10 y) and 34.1 mSv (>10-15 y). Dose conversion factors, which relate the DAP and E, have been estimated for each age group. The results of this study may serve as a first step in the optimisation process, in order to make full use of the dose reduction potential of flat-panel systems.

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

“…The doses from the 1994 to 2000 era at Hospital 1 were compatible with those quoted by Boothroyd et al 7 (presented for frontal tube output only) but much higher than those reported by Rassow et al 32 for data acquired from 1994 to 1996. For both diagnostic and interventional categories, recent era P KA figures were compatible with the results of studies led by Martinez et al, 33 Dragusin et al 21 Two well-reported investigations by Verghese et al 16 (3365 procedures) and Glatz et al 31 (2265 procedures) have been published in which stratification of P KA by age or mass for individual procedure types was sufficient to allow meaningful comparisons. Given the modern equipment and the introduction of entirely sensible radiation protection measures such as reduced frame rates and antiscatter grid removal where appropriate, one would expect doses to be comparable to those of the present study over the same period; instead, they are higher by a factor of typically between two and ten, where matched for patient size and procedure type, both for P KA A recent study by Kobayashi and colleagues 18 was particularly ambitious, acquiring data from 16 centres giving a sample of 8267 procedures.…”

“…The potential for relatively high radiation doses raises concerns of the long-term risk of developing cancer. [1][2][3] The radiation doses and associated risks from cardiac catheterizations in children and young people have recently received considerable attention, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] although relatively fewer data on doses in the UK have been published. 7,17,22,23 Most previous assessments have been based on kerma area product (P KA , also known as dose-area product), defined as collision air kerma integrated over beam area.…”

Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values

“…For therapeutic procedures, these third quartile values were 1.0 Gy cm 2 (aortic angioplasty), 2.6 Gy cm 2 (pulmonary angioplasty), 5.6 Gy cm 2 (pulmonary angioplasty with stent), 1.7 Gy cm 2 (atrial septal defect closure), 2.3 Gy cm 2 (aortic valvuloplasty), 0.9 Gy cm 2 (pulmonary valvuloplasty), 1.2 Gy cm 2 (patent ductus arteriosus closure with coil), 1.9 Gy cm 2 (patent ductus arteriosus closure with device), and 4.4 Gy cm 2 (others). In their study, Dragusin et al 26 reported FT and DAP third quartile values from 11.0 to 18.0 min and from 4.1 to 16.5 Gy cm 2 , respectively, for diagnostic procedures and from 24. On the other hand, there are a higher number of studies detailing dose values grouped by age during pediatric cardiology procedures.…”

Optimization of Radiation Dose and Image Quality in Cardiac Catheterization Laboratories

“…The 25 th , 50 th and 75 th percentile per each age group for diagnostic procedure is presented in Figure 4 and for therapeutic procedures is presented in Figure 5. (Dragusin et al, 2008a) Other study reported DAP values as 75th percentile of 6.2, 6.1, 9, 10, 15, 20, 27 and 36 Gycm² for 2114 patients divided in eight age groups from newborns to 21 y (Rassow et al,2000). This study included diagnostic, therapeutic and myocardial biopsy procedures.…”

“…The main therapeutic procedures are balloon dilatation of the pulmonary valve, balloon dilatation of peripheral pulmonary stenosis, balloon dilatation for coarctation of the aorta, stent implantation, occlusion of patent ductus anteriosus, closure of atrial septal defect and closure of ventricular septal defect. We will discuss the results of a study regarding pediatric radiation doses performed in a catheterization laboratory equipped with a biplane FD system (Dragusin et al, 2008a). In this study, the population was divided in six age groups (0-30 days, 1-12 months, 1-3 years, 3-5 years, 5-10 years and 10-15 years).…”