Radiation Safety in Children With Congenital and Acquired Heart Disease

Abstract

There is a need for consensus recommendations for ionizing radiation dose optimization during multimodality medical imaging in children with congenital and acquired heart disease (CAHD). These children often have complex diseases and may be exposed to a relatively high cumulative burden of ionizing radiation from medical imaging procedures, including cardiac computed tomography, nuclear cardiology studies, and fluoroscopically guided diagnostic and interventional catheterization and electrophysiology procedures. Although these imaging procedures are all essential to the care of children with CAHD and have contributed to meaningfully improved outcomes in these patients, exposure to ionizing radiation is associated with potential risks, including an increased lifetime attributable risk of cancer. The goal of these recommendations is to encourage informed imaging to achieve appropriate study quality at the lowest achievable dose. Other strategies to improve care include a patient-centered approach to imaging, emphasizing education and informed decision making and programmatic approaches to ensure appropriate dose monitoring. Looking ahead, there is a need for standardization of dose metrics across imaging modalities, so as to encourage comparative effectiveness studies across the spectrum of CAHD in children.

Increased Cancer Incidence Following up to 15 Years after Cardiac Catheterization in Infants under One Year between 1980 and 1998—A Single Center Observational Study

“…Therefore, the risk of inducing cancer by cardiac catherization in the young age group is still an issue. Diagnostic alternatives as catherization by use of magnetic resonance imaging (MRI) are important inputs for the reduction of ionizing radiation burden, as suggested by a recent scientific position statement [44]. In the light of a 4.4-fold increase in cancer incidence in our study, MRI as the most promising guidance of cardiac catheterization should heavily promote development of technical equipment such as wires and catheters and improve image quality of real time imaging.…”

Cardiac CT in the Preoperative Diagnostics of Neonates with Congenital Heart Disease: Radiation Dose Optimization by Omitting Test Bolus or Bolus Tracking

“…Despite these advances, there is a continuous challenge for the radiologist regarding the optimization of radiation dose, especially in the most critical and radiosensitive group of neonates (15). Therefore, we explored the feasibility of further reducing the CT radiation dose in cardiac CTA of neonates by not using the test bolus or bolus tracking scan.…”

Cardiovascular CT in Cyanotic Congenital Heart Disease

“…Radiation exposure is of concern in all children but is particularly a matter of concern for those with cyanotic CHD [29]. They may undergo numerous chest x-rays, catheterizations, nuclear stress tests, and lung perfusion scans.…”

“…Performing cardiovascular CT in patients with cyanotic cardiac defects, who span the spectrum of neonates to adults and may be unrepaired, palliated, or fully repaired, requires careful individualization of the exam to the patient, the physiology of the defect, and the clinical question being addressed. Detailed guidelines addressing scan protocols and radiation dose reduction in pediatric and congenital heart disease have been published elsewhere, but we will briefly review a few considerations pertinent to cyanotic CHD patients [28,29,32,[94][95][96]. Fig.…”