Patient radiation doses in paediatric interventional cardiology procedures: a review

Abstract

A large number of investigations into the radiation doses from x-ray guided interventional cardiology procedures in children have been carried out in recent years. A review was conducted of these studies, gathering data on kerma area product (P ), fluoroscopic screening time (FT), air kerma, and estimates of effective dose and organ doses. The majority of studies focus on P and FT with no estimation of dose to the patient. A greater than ten-fold variation in average P was found between different studies, even where data were stratified by patient age or weight. Typical values of P were 0.6-10 Gy · cm (<1 year/10 kg), 1.5-30 Gy · cm (1-5 years), 2-40 Gy · cm (5-10 years), 5-100 Gy · cm (10-16 years) and 10-200 Gy · cm (>16 years). P was lowest for heart biopsy (0.3-10 Gy · cm for all ages combined) and atrial septostomy (0.4-4.0 Gy · cm), and highest for pulmonary artery angioplasty (1.5-35 Gy · cm) and right ventricular outflow tract dilatation (139 Gy · cm). Most estimates of patient dose were in the form of effective dose (typically 3-15 mSv) which is of limited usefulness in individualised risk assessment. Few studies estimated organ doses. Despite advances in radiation protection, recent publications have reported surprisingly large doses, as represented by P and air kerma. There is little indication of a fall in these dose indicators over the last 15 years. Nor is there much suggestion of a fall in doses associated with the use of flat panel detectors, as opposed to image intensifiers. An assessment of the impact of radiation dose in the context of overall patient outcome is required.

Projected Future Cancer Risks in Children Treated With Fluoroscopy-Guided Cardiac Catheterization Procedures

“…A large variability in radiation exposures among children undergoing CCPs has already been reported in previous studies 7, [25][26][27] . The survey conducted by Cevallos et al, which collected dosimetry information at nine US congenital cardiac catheterization center in 2014-2015, showed ratios of the 95 th percentile to the 50 th percentile values of individual P KA distributions ranging from 4 to 12 depending on the age group for ASD closure (n=289), PDA occlusion (n=445) and pulmonary valvuloplasty (n=250) 26 .…”

“…Other studies have also reported a large individual variability in dosimetry indexes (i.e. fluoroscopy times, P KA ) 25 , but relatively few studies have assessed its impact on organ equivalent doses 7,14,27 . The largest one was conducted at three hospitals in the UK and achieved dose reconstruction for 10,257 diagnostic and therapeutic CCPs performed between 1994 and 2013 7 .…”

Radiation exposure in transcatheter patent ductus arteriosus closure: time to tune?

“…These differences are therefore really important and deserve to be explained. Four potential explanations are provided in a recent review by Harbron et al on the patient radiation doses in paediatric interventional cardiology procedures 22 . First, the authors advocated that variations of dose area product may result from a mix of procedure types, each having different complexities and degrees of irradiation.…”

Local DRLs and automated risk estimation in paediatric interventional cardiology

“…A summary of conversion factors from DAP to effective dose (CF ED ) are shown in Table 8, which is an adjustment of Table 4 of Harbron et al [13]. Effective dose conversion factors using tissue weighting factors of ICRP publication 60 are also provided in the latter table for comparison with literature.…”