Radiation dose and image quality for paediatric interventional cardiology systems. A national survey in Chile

Abstract

Radiation dose and image quality for paediatric protocols in all five X-ray fluoroscopy systems used for interventional cardiology procedures existing in Chile have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object (TO) and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-16 cm of PMMA). Images from fluoroscopy (low (FL), medium and high) and cine (CI) modes have been archived in DICOM format. Signal-to-noise ratio (SNR), figure of merit (FOM) and high-contrast spatial resolution (HCSR) have been computed from the images. The ratio between the maximum and the minimum value of ESAK per frame for a given fluoroscopy mode between the five systems ranges from 2 to 5 and from 14 to 38 for CI mode. SNR, FOM and HCSR showed a great variability for the different acquisition modes (AMs) and PMMA thickness. In the near future, it is urgent to upgrade Chilean legislation on radiation protection to incorporate quality assurance programmes that will allow us to evaluate and optimise the X-ray systems used in medical applications. Increments in doses per frame when increasing phantom thickness and when used CI runs instead of FL runs can be considered by the cardiologist in the good management of patient dose and allow them to select the best imaging AM during clinical procedures.

Pilot program on patient dosimetry in pediatric interventional cardiology in Chile

“…The Chilean population is currently 17 Â 10 6 , 22% of them are children aged between 0 and 14. 20 A biplane x-ray angiography Siemens Axiom Artis BC system, 21 equipped with a generator of 100 kW at 100 kV, installed in 2006 and adapted for pediatric interventional procedures, was used in the survey. The system was equipped with two image intensifiers (II) of 33 cm in diameter and offering three fields of view (33, 22, and 17 cm).…”

Protección Radiológica en Cardiología Intervencionista Pediátrica: Avances Y Desafíos Para Chile

“…En este sentido, pensamos que el primer y fundamental paso que se podría dar en Chile, sería revisar y actualizar la legislación que regula el uso de radiaciones ionizantes en el ámbito médico, situación planteada por parte del equipo de investigación ya desde al año 2007 27 . Los resultados de los trabajos realizados como parte de los proyectos RLA/9/057 13 y RLA/9/067 14 en el ámbito de la cardiología pediátrica pueden apoyar esta iniciativa de modernización de la normativa vigente 12,[16][17][18][19][20]26,27 . Dentro de las actualizaciones más urgentes, la implementación de los programas de Garantía de Calidad resulta fundamental l6 .…”

“…Los principales resultados alcanzados en términos de tasas de dosis a la entrada de los pacientes (simulados con polimetil metacrilato) han sido desde 0,15 µGy imagen -1 hasta 323,2 µGy imagen -1 . En cuanto a la calidad de imagen, se evaluó la resolución a bajo y alto contraste y se establecieron parámetros numéricos denominados figuras de mérito que relacionan la dosis de radiación necesaria para lograr cierta calidad de imagen [16][17][18] .…”

Avaliação de exposições médicas em procedimentos pediátricos de radiologia intervencionista

“…Because of the above mentioned risks, studies have pointed towards the need for adopting specific approaches to optimize pediatric procedures by means of imaging quality assessment simultaneously with the investigation of radiation doses, with the purpose of maintaining them as low as possible (9)(10)(11)(12)(13) .…”