Pediatric patient radiation dosage during endomyocardial biopsies and right heart catheterization using a standard “ALARA” radiation reduction protocol in the modern fluoroscopic Era

Sutton, Nicole; Lamour, Jacqueline M.; Gellis, Laura A.; Pass, Robert H.

doi:10.1002/ccd.25058

Cited by 25 publications

(18 citation statements)

References 17 publications

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“…Cardiologists are discovering that selecting the "low dose" setting does not compromise the ability to carry out certain catheterization procedures. 37 In particular, a combination of very low frame rates (2-3 frames per second), antiscatter grid removal and avoidance of magnification was found to produce an excellent dose reduction for EPS procedures. 38 It should be noted, however, that higher doses can be justified if it can be demonstrated that patient outcome is improved accordingly.…”

Section: 4mentioning

confidence: 98%

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

Harbron¹,

Pearce²,

Ja³

et al. 2015

BJR

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Section: 4mentioning

confidence: 98%

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

Harbron¹,

Pearce²,

Ja³

et al. 2015

BJR

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“…It remains unknown how low the pulse rates can be to keep acceptable visibility to perform safe and effective catheterization procedures in the PCL. Previous studies have shown the usefulness of very low pulse rate fluoroscopy in certain procedures in the PCL . Sutton et al reported the use of 2‐3 p/s fluoroscopy for right heart catheterization with endomyocardial biopsy .…”

Section: Discussionmentioning

confidence: 99%

“…Lowering the frame/pulse rates of cineangiography and fluoroscopy is one of the approaches for dose optimization in the cardiac catheterization laboratory . Furthermore, lowering the pulse rate of fluoroscopy alone can significantly reduce radiation dosage in the pediatric cardiac catheterization laboratories (PCL) . However, the impact of lowering the frame rate of cineangiography on radiation dosage and procedural safety of catheterization has not been well studied in the PCL.…”

Section: Introductionmentioning

confidence: 99%

Reducing radiation exposure by lowering frame rate in children undergoing cardiac catheterization: A quality improvement study

Ross

Webster

Turner

et al. 2018

Congenital Heart Disease

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Introduction Reduction of radiation dosage in the pediatric cardiac catheterization laboratory (PCL) is important to reduce the risk of its stochastic effect in children with congenital heart disease. Lowering the frame rate would reduce radiation dosage possibly at the expense of image quality, potentially resulting in higher fluoroscopic time and procedural complication rate. Methods The data were retrospectively analyzed in three eras: era 1 (n = 234), cineangiography 30 frames/sec (f/s) and fluoroscopy 15 pulse/sec (p/s); era 2 (n = 381), cineangiography 30 f/s and fluoroscopy 6 p/s; and era 3 (n = 328), cineangiography 15 f/s and fluoroscopy 6 p/s. Also, three operators blinded to the frame rate setting evaluated cineangiography image quality. In this study, the impact of lowering the default frame rates on radiation dosage, fluoroscopic time, contrast volume, diagnostic image quality, and complication rates in the PCL was assessed. Results Overall radiation dosage progressively declined during these eras (70.0 vs 64.1 vs 36.6 µGym2/kg, P < .001) without a difference in significant adverse event rates. There was no significant increase in either fluoroscopy time or contrast volume. There was no difference in the diagnostic image quality between cineangiography 30 and 15 f/s. Lowering the default frame/pulse rates of both fluoroscopy and cineangiography significantly decreased the overall radiation dosage in the PCL. Importantly, fluoroscopy time, contrast volume, and complication rates did not increase while maintaining diagnostic image quality. Conclusion This quality improvement project proved successful in lowering radiation dosage without compromising the efficacy and safety of catheterizations.

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“…Small changes in the dose per frame and/or pulse rate can lead to major dose reduction [13, 14], but need to be tested against diagnostic yield and clinical impact.…”

Section: Substantially Reduce or Eliminate Radiation Exposure Of Pmentioning

confidence: 99%

White Paper on P4 Concepts for Pediatric Imaging

Daldrup-Link

Sammet

Hernanz‐Schulman

et al. 2016

Journal of the American College of Radiology

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Over the past decade, innovations in the field of pediatric imaging have been largely based on single center and retrospective studies, which provided limited advances for the benefit of pediatric patients. In order to identify opportunities for potential quantum leap progress to the field of Pediatric Imaging, the American College of Radiology - Pediatric Imaging Research (ACR - PIR) Committee has identified high impact research directions related to the P4 Concept of Predictive, Preventive, Personalized, and Participatory Diagnosis and Intervention. Input from 237 members of the Society for Pediatric Radiology was clustered towards ten priority areas, which will be discussed in this article. Needs of each priority area have been analyzed in detail by dedicated ACR-PIR experts in these topics. By facilitating work on these priority areas, we hope to revolutionize the care of children by shifting our efforts from unilateral reaction to clinical symptoms to interactive maintenance of child health.

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Pediatric patient radiation dosage during endomyocardial biopsies and right heart catheterization using a standard “ALARA” radiation reduction protocol in the modern fluoroscopic Era

Abstract: The use of a novel ALARA protocol for RHC and EMB in pediatric cardiac transplantation patients markedly reduced radiation exposure to levels far below any previously reported values without negatively affecting the safety or efficacy of these procedures.

Cited by 25 publications

References 17 publications

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

Reducing radiation exposure by lowering frame rate in children undergoing cardiac catheterization: A quality improvement study

White Paper on P4 Concepts for Pediatric Imaging

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