Radiation dose to the pediatric cardiac catheterization and intervention patient.

OBJECTIVE The radiation dose from cardiac catheterization is particularly relevant when treating children because of their greater radiosensitivity compared with adults. Moreover, cardiac catheterization is being used increasingly for interventional radiology procedures, possibly resulting in higher patient radiation doses. This article reports the radiation doses and related factors, such as fluoroscopy time, for children who underwent cardiac catheterization and children who underwent other interventional radiology procedures. MATERIALS AND METHODS We evaluated 239 consecutive patients who underwent cardiac catheterization (n = 205) or another interventional radiology procedure (n = 34) for which the dose-area product (DAP) was measured. The number of cine runs and fluoroscopic time for each procedure and the body mass index and body weight of each patient were recorded. We also used the double product combined with body weight, which is the weight- fluoroscopic time product. RESULTS The average DAP ± SD of cardiac catheterization and of an interventional radiology procedure was 1,702.6 ± 2,110.1 cGy × cm² and 2,242.2 ± 2,509.4 cGy × cm², respectively. The average fluoroscopic time ± SD of cardiac catheterization and of an interventional radiology procedure was 24.1 ± 16.8 minutes and 37.2 ± 20.0 minutes. For children who underwent cardiac catheterization and those who underwent an interventional radiology procedure, a strong correlation was seen between the DAP and weight-fluoroscopic time product (cardiac catheterization, r = 0.906; interventional radiology procedure, r = 0.885) and a good correlation was detected between the DAP and weight (r = 0.819 and 0.895, respectively). CONCLUSION There was a good correlation between the DAP and weight and between DAP and weight-fluoroscopic time product for children who underwent cardiac catheterization or an interventional radiology procedure. Therefore, body weight is important for determining radiation dose to children undergoing cardiac catheterization or an interventional radiology procedure. The normalized DAP (i.e., DAP divided by body weight), fluoroscopy time, and number of cine runs were greater in children who underwent an interventional radiology procedure than in those who underwent cardiac catheterization. Therefore, the radiation dose to children from interventional radiology procedures is a more critical issue.

[1]  H. Bosmans,et al.  Radiation dose survey in a paediatric cardiac catheterisation laboratory equipped with flat-panel detectors. , 2008, Radiation protection dosimetry.

[2]  J D Waldman,et al.  Radiation Exposure to the Child During Cardiac Catheterization , 1981, Circulation.

[3]  Masayuki Zuguchi,et al.  Comparison of dose at an interventional reference point between the displayed estimated value and measured value , 2011, Radiological physics and technology.

[4]  K. Chida,et al.  Clarifying and visualizing sources of staff-received scattered radiation in interventional procedures. , 2011, AJR. American journal of roentgenology.

[5]  M. Kohzuki,et al.  Ventriculography Using ECG-Gated Multiple Diastolic Injection of Contrast Material in Pediatric Angiocardiography , 2002, Pediatric Cardiology.

[6]  J. Valentin,et al.  Abstract: Avoidance of radiation injuries from medical interventional procedures, ICRP Publication 85 , 2000 .

[7]  D. Onnasch,et al.  Diagnostic reference levels and effective dose in paediatric cardiac catheterization. , 2007, The British journal of radiology.

[8]  Stephen Balter,et al.  Methods for measuring fluoroscopic skin dose , 2006, Pediatric Radiology.

[9]  Masayuki Zuguchi,et al.  Radiation dose of interventional radiology system using a flat-panel detector. , 2009, AJR. American journal of roentgenology.

[10]  F. Mettler,et al.  Skin injuries from fluoroscopically guided procedures: part 2, review of 73 cases and recommendations for minimizing dose delivered to patient. , 2001, AJR. American journal of roentgenology.

[11]  F. Mettler,et al.  Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. , 2001, AJR. American journal of roentgenology.

[12]  D. Onnasch,et al.  Optimization of radiographic parameters for paediatric cardiac angiography. , 2004, The British journal of radiology.

[13]  Y. Kagaya,et al.  Indicators of the maximum radiation dose to the skin during percutaneous coronary intervention in different target vessels , 2006, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[14]  Alaa M Roushdy,et al.  Radiation Exposure in Children During the Current Era of Pediatric Cardiac Intervention , 2011, Pediatric Cardiology.

[15]  Virginia Tsapaki,et al.  Radiation exposure to patients during interventional procedures in 20 countries: initial IAEA project results. , 2009, AJR. American journal of roentgenology.

[16]  Masayuki Zuguchi,et al.  Relationship between fluoroscopic time, dose-area product, body weight, and maximum radiation skin dose in cardiac interventional procedures. , 2006, AJR. American journal of roentgenology.

[17]  T. Ishibashi,et al.  Optimizing patient radiation dose in intervention procedures , 2010, Acta radiologica.

[18]  H. Thierens,et al.  Patient-Specific Dose and Radiation Risk Estimation in Pediatric Cardiac Catheterization , 2005, Circulation.

[19]  D. Dance,et al.  Conversion factors for the estimation of effective dose in paediatric cardiac angiography , 2000, Physics in medicine and biology.

[20]  Masayuki Zuguchi,et al.  Total entrance skin dose: an effective indicator of maximum radiation dose to the skin during percutaneous coronary intervention. , 2007, AJR. American journal of roentgenology.

[21]  J. Racadio,et al.  Efficacy of a radiation safety education initiative in reducing radiation exposure in the pediatric IR suite , 2008, Pediatric Radiology.

[22]  Masayuki Zuguchi,et al.  Comparison of the radiation dose in a cardiac IVR X-ray system. , 2011, Radiation protection dosimetry.

[23]  Masayuki Zuguchi,et al.  Does digital acquisition reduce patients' skin dose in cardiac interventional procedures? An experimental study. , 2004, AJR. American journal of roentgenology.