Radiation Reduction in Paediatric Cardiac Catheterization: We Can Go Even Lower

Background

Radiation reduction is an integral component in the management of a paediatric cardiac catheterization laboratory. Simple and easily implementable protocol changes and technical upgrades have been shown to significantly reduce radiation exposure.

Methods

Radiation exposures (2020-2022) at Safra Children’s Hospital, Sheba Medical Center, Israel (unit A: n = 672) were retrospectively reviewed, including dose area product (DAP) (μGy m²), DAP/kg, Air Kerma (mGy), and fluoroscopy time (minutes) for 16 procedural types. Median doses were compared with those measured (2011-2014) at the Hospital for Sick Children, Toronto, Canada (unit B: n = 2033). Radiation reduction techniques included fluoroscopy acquisition at 7.5 frames/s, removal of antiscatter grids for children <30 kg, limiting field of view, use of Philips ClarityIQ technology, and an institutional culture of radiation mindedness.

Results

Exposure was significantly lower in unit A in 14 of 16 procedure types. Total median doses were lower in unit A (DAP: 91.4 [44.7-205.4] vs 387 [138.2-1339] μGy m² [P < 0.001], DAP/kg: 9.33 [4.3-16.4] vs 29.22 [12.8-65.9] μGy m²/kg [P < 0.001], and Air Kerma: 14.9 [7.8-29] vs 61 [23-176.4] mGy [P < 0.001]) despite higher fluoroscopy time (14.1 [4.2-24.6] vs 12.3 [6.8-23.3] minutes [P = 0.03]). DAP was lower for specific procedures including pulmonary valvuloplasty (46.3 [14.3-219.3] vs 127 [60-323] μGy m² [P < 0.001]) and patent ductus arteriosus closure (51.9 [18.8-111.8] vs 178 [96-410] μGy m² [P < 0.001]).

Conclusions

Enhanced radiation reduction techniques can lead to lower than previously published exposure levels across a wide range of procedure types when employing dose-limiting protocols and radiation reduction technology.