Radiation exposure to the child during cardiac catheterization.

Waldman, J. Deane; Rummerfield, Philip S.; Gilpin, Elizabeth A.; Kirkpatrick, Stanley E.

doi:10.1161/01.cir.64.1.158

Cited by 41 publications

(13 citation statements)

References 19 publications

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“…3,7 One should also take into account that in children with congenital heart disease, there is often a need to perform multiple examinations, resulting in an increase in the radiation risk. 2,8 These considerations point to the importance of dosereducing measures, the follow-up of the x-ray doses given to pediatric patients, and the associated radiation risks in this patient population.…”

Section: Discussionmentioning

confidence: 99%

γ-H2AX Foci as a Biomarker for Patient X-Ray Exposure in Pediatric Cardiac Catheterization

et al. 2009

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Background-A better knowledge of patient x-ray dose and the associated radiation risk in pediatric interventional cardiology is warranted in view of the extensive use of x-rays and the higher radiosensitivity of children. In the present study, ␥-H2AX foci were used as a biomarker for radiation-induced effects. Patient-specific dose was assessed and radiation risks were estimated according to the linear-no-threshold model, commonly used in radiation protection, and the ␥-H2AX foci data. Methods and Results-In 49 pediatric patients (median age, 0.75 years) with congenital heart disease who underwent cardiac catheterization procedures, blood samples were taken before and shortly after the procedure. ␥-H2AX foci were determined in peripheral blood T lymphocytes. In each patient, a net increase in ␥-H2AX foci, representing DNA double-strand breaks induced by interventional x-rays, was observed. In addition, a patient-specific Monte Carlo simulation of the procedure was performed, resulting in individual blood, organ, and tissue doses. Plotting of ␥-H2AX foci versus blood dose indicated a low-dose hypersensitivity. Median effective doses calculated according to the International Commission on Radiological Protection 60 and 103 publications are 5.6 and 6.4 mSv, respectively. The lifetime-attributable risk of cancer mortality was calculated from the linear-no-threshold model and the ␥-H2AX foci data. This resulted in lifetime-attributable risk values of 1 per thousand and 4 per thousand, respectively, for the patient population under study. Conclusions-␥-H2AX foci as a biomarker for DNA damage indicate that radiation risk estimates according to the linear-no-threshold hypothesis are possibly underestimates. Great care should be taken to minimize and optimize patient radiation exposure.

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Section: Discussionmentioning

confidence: 99%

γ-H2AX Foci as a Biomarker for Patient X-Ray Exposure in Pediatric Cardiac Catheterization

et al. 2009

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“…The median peak skin dose of 34.2 and 23.9 mGy for the anterior-posterior and the lateral exposures, respectively, may be compared with previous (mean) values of 126.2 mGy, 12 149 mGy, 13 and 74 mGy. 14 Only one study reported a mean entrance skin dose of 481 mGy for children Ͻ10 years of age. 15 Because of the moderate values of skin doses in pediatric catheterizations, radiation-induced skin injuries are unlikely.…”

Section: Discussionmentioning

confidence: 99%

“…12 Most of the radiation dosimetry studies performed in pediatric patients are based on measurements with thermoluminescence dosimeters (TLDs) for estimating the dose to the skin, thyroid, and gonads. [12][13][14][15][16] Other studies have indicated the dose-area product (DAP). 10,12,17,18,21 However, to assess the potential risk for stochastic effects such as cancer and leukemia resulting from cardiac catheterization procedures, the effective dose should be calculated.…”

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confidence: 99%

Patient-Specific Dose and Radiation Risk Estimation in Pediatric Cardiac Catheterization

et al. 2005

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Background-Because of the higher radiosensitivity of infants and children compared with adults, there is a need to evaluate the doses delivered to pediatric patients who undergo interventional cardiac procedures. However, knowledge of the effective dose in pediatric interventional cardiology is very limited. Methods and Results-For an accurate risk estimation, a patient-specific Monte Carlo simulation of the effective dose was set up in 60 patients with congenital heart disease who underwent diagnostic (nϭ28) or therapeutic (nϭ32) cardiac catheterization procedures. The dose-saving effect of using extra copper filtration in the x-ray beam was also investigated. For diagnostic cardiac catheterizations, a median effective dose of 4.6 mSv was found. Therapeutic procedures resulted in a higher median effective dose of 6.0 mSv because of the prolonged use of fluoroscopy. The overall effect of inserting extra copper filtration into the x-ray beam was a total effective dose reduction of 18% with no detrimental effect on image quality. An excellent correlation between the dose-area product and effective patient dose was found (rϭ0.95). Hence, dose-area product is suitable for online estimation of the effective dose with good accuracy. With all procedures included, the resulting median lifetime risk for stochastic effects was 0.08%. Conclusions-Because

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“…[37][38][39][43][44][45][46] Therapeutic endovascular procedures are now common and require longer fluoroscopy time than diagnostic catheterization. 45,[47][48][49] Children with congenital cardiovascular disease, including aortic coarctation, often undergo multiple XRF procedures and therefore have greater cumulative radiation exposure. Radiation-sparing procedural guidance with MRI would be attractive.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Magnetic Resonance Imaging–Guided Stenting of Aortic Coarctation With Commercially Available Catheter Devices in Swine

et al. 2005

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Background-Real-time MR imaging (rtMRI) is now technically capable of guiding catheter-based cardiovascular interventions. Compared with x-ray, rtMRI offers superior tissue imaging in any orientation without ionizing radiation. Translation to clinical trials has awaited the availability of clinical-grade catheter devices that are both MRI visible and safe. We report a preclinical safety and feasibility study of rtMRI-guided stenting in a porcine model of aortic coarctation using only commercially available catheter devices. Method and Results-Coarctation stenting was performed wholly under rtMRI guidance in 13 swine. rtMRI permitted procedure planning, device tracking, and accurate stent deployment. "Active" guidewires, incorporating MRI antennas, improved device visualization compared with unmodified "passive" nitinol guidewires and shortened procedure time (26Ϯ11 versus 106Ϯ42 minutes; Pϭ0.008). Follow-up catheterization and necropsy showed accurate stent deployment, durable gradient reduction, and appropriate neointimal formation. MRI immediately identified aortic rupture when oversized devices were tested. Conclusions-This experience demonstrates preclinical safety and feasibility of rtMRI-guided aortic coarctation stenting using commercially available catheter devices. Patients may benefit from rtMRI in the future because of combined device and tissue imaging, freedom from ionizing radiation, and the ability to identify serious complications promptly. Key Words: angioplasty Ⅲ catheterization Ⅲ coarctation Ⅲ heart defects, congenital Ⅲ stents E ndovascular stenting effectively relieves focal native and recurrent aortic coarctation in children and adults. 1-3 X-ray fluoroscopy (XRF) is used in these procedures with intermittent boluses of iodinated radiocontrast to define anatomic targets and to guide devices. This approach is limited because XRF does not visualize soft tissue, lacks depth perspective, and exposes patients to ionizing radiation.MRI displays soft tissue detail in any spatial orientation, requires no ionizing radiation, and can provide hemodynamic information. Real-time MRI (rtMRI) is now technically feasible and has enabled transcatheter treatment of congenital 4 -7 and acquired 8 -20 cardiovascular disease in animal models and humans.Razavi and colleagues 21 demonstrated safety and feasibility of cardiovascular catheterization in children and adults using a combined XRF and MRI suite. MRI-guided therapeutic human procedures will require conspicuous clinical-grade catheter devices. Our aim was to test the safety and feasibility of wholly MRI-guided stenting of aortic coarctation in swine using commercially available clinical devices. Specifically, we hypothesize that rtMRI can (1) provide safe and accurate device navigation, positioning, and deployment; (2) provide immediate preprocedural and postprocedural anatomic and hemodynamic assessment; (3) provide early recognition of significant complications; and (4) be conducted with catheter devices commercially available in the United States. Me...

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Radiation exposure to the child during cardiac catheterization.

Cited by 41 publications

References 19 publications

γ-H2AX Foci as a Biomarker for Patient X-Ray Exposure in Pediatric Cardiac Catheterization

γ-H2AX Foci as a Biomarker for Patient X-Ray Exposure in Pediatric Cardiac Catheterization

Patient-Specific Dose and Radiation Risk Estimation in Pediatric Cardiac Catheterization

Real-Time Magnetic Resonance Imaging–Guided Stenting of Aortic Coarctation With Commercially Available Catheter Devices in Swine

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