Cumulative radiation dose from medical imaging in pediatric congenital heart disease patients with epicardial cardiac implantable electronic devices

Abstract

To determine whether pediatric congenital heart disease (CHD) patients with epicardial cardiac implantable electronic devices (CIEDs) receive high cumulative effective doses (CED) of ionizing radiation from medical imaging tests. We compared 28 pediatric CHD patients with epicardial CIEDs (cases) against 40 patients with no CIED matched by age at operation, sex, surgical era, and CHD diagnosis (controls). We performed a retrospective review of radiation exposure from medical imaging exams between 2006 and 2022. Radiation dose from computed tomography (CT) and X-ray radiography was calculated using the National Cancer Institute radiation dosimetry tool. We performed univariate analysis to compare the CED between the two groups. In the case subgroup, we convened experts review to adjudicate the prevalence of CT exams that should have been performed with MRI in the absence of a CIED. Children (median age 2.5 years at implant) with CIEDs received significantly higher median CED compared to matched controls (6.90 vs. 1.72 mSv, p = 0.0018). In cases, expert adjudication showed that 80% of the CT exams would have been performed with MRI in the absence of a CIED. This resulted, on average, a 5-fold increase in the ED from post-lead implant CTs. Pediatric CHD patients with CIED received four times higher CED than matched controls. Improved access to medical imaging tests without ionizing radiation, such as MRI, could potentially reduce the ED in CIED patients by up to five times.