Trends in Radiation Exposure With the Refinement of Radiation Exposure Categories in Congenital Cardiac Catheterization: Insights From the CRISP Registry

Gurumurthy Hiremath MD , Juan Carlos Samayoa MD , Alexander Javois MD , Osamah Aldoss MBBS, MD , Ryan Leahy MD, MA , Reid Chamberlain MD, MSCI , Elena Amin MD , Marko Vezmar MD , Makram Ebeid MD , Shyam Sathanandam MD , David Nykanen MD , Thomas Forbes MD , Christopher Curzon MD , Martin Bocks MD , Daisuke Kobayashi MD, MPH, MHA
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Abstract

Background

The Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry proposed 3-tier radiation exposure categories (REC: I [low], II [medium], and III [high]) consisting of 40 procedure types. This study sought to evaluate the recent trend of radiation exposure in the Catheterization Risk Score for Pediatrics (CRISP) registry organized by the Congenital Cardiovascular Interventional Study Consortium.

Methods

The analysis was conducted on a comprehensive data set from the CRISP registry, covering 13 institutions from January 1, 2016, to December 31, 2020. Radiation dosage in μGym2/kg was evaluated by REC, time, and institutions. The study period was divided into the first half (S1: 1/2016-6/2018) and the second half (S2: 7/2018-12/2020). Radiation dosage was compared between S1 and S2. Radiation reduction practices were assessed at participating centers through a questionnaire.

Results

Among 20,524 cases, the majority (n = 18,603, 90.2%) were assigned to C3PO REC procedure types. From S1 (n = 8956) to S2 (n = 9647), median radiation dosage significantly improved in all 3 tiers (P < .001): (1) REC I, −18%; (2) REC II, −33%; and (3) REC III, −30%. REC successfully stratified cases by median radiation dosage: (1) REC I, 18.2 μGym2/kg (n = 14,234); (2) REC II, 49.8 μGym2/kg (n = 3012); and (3) REC III, 67.0 μGym2/kg (n = 1357) but showed significant intraclass variability and heterogeneity. REC I exhibited the most variability in radiation dosage. To address these limitations, the procedures were organized into 6 updated REC categories (CRISP REC).

Conclusions

A significant reduction in radiation dosage was observed in the CRISP registry, although a few centers showed a trend of increasing radiation dosage. Despite its limitations, the C3PO REC provides a practical way to stratify cases for reporting dosage. We propose the CRISP REC as a refined alternative to the C3PO REC to improve stratification and decrease variability in radiation exposure across different categories.
随着先天性心导管插管中辐射暴露类别的细化,辐射暴露的趋势:来自CRISP注册表的见解
先天性心导管置入术预后项目(C3PO)注册中心提出了3层辐射暴露分类(REC: I[低],II[中]和III[高]),包括40种手术类型。本研究旨在评估由先天性心血管介入研究联盟组织的儿科导管置入风险评分(CRISP)注册表中辐射暴露的最新趋势。方法对CRISP注册表的综合数据集进行分析,涵盖2016年1月1日至2020年12月31日的13家机构。采用REC、时间和机构评价辐照剂量(μGym2/kg)。研究期间分为上半年(S1: 1/2016-6/2018)和下半年(S2: 7/2018-12/2020)。比较S1和S2的辐射剂量。参与中心通过问卷调查评估了减少辐射的做法。结果20524例患者中,绝大多数(18603例,90.2%)属于C3PO REC手术类型。从S1 (n = 8956)到S2 (n = 9647), 3个级别的中位辐射剂量均显著提高(P < .001):(1) REC I, - 18%;(2) rec ii,−33%;(3) REC III,−30%。REC按中位辐射剂量成功分层病例:(1)REC I为18.2 μGym2/kg (n = 14,234);(2) REC II, 49.8 μGym2/kg (n = 3012);(3) REC III为67.0 μGym2/kg (n = 1357),但具有显著的类内变异和异质性。REC I在辐射剂量上表现出最大的变异性。为了解决这些限制,程序被组织成6个更新的REC类别(CRISP REC)。结论在CRISP注册表中观察到辐射剂量显著降低,尽管少数中心显示出辐射剂量增加的趋势。尽管有其局限性,C3PO REC提供了一种实用的分层病例报告剂量的方法。我们建议CRISP REC作为C3PO REC的改进替代方案,以改善分层并减少不同类别辐射暴露的变异性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
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