Radiation exposure to the paediatric patient from cardiac catheterization and angiocardiography

Martin, Eric C.; Olson, April

doi:10.1259/0007-1285-53-626-100

BJR

1980

DOI: 10.1259/0007-1285-53-626-100

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Radiation exposure to the paediatric patient from cardiac catheterization and angiocardiography

Eric C. Martin¹,

April Olson²

Abstract: Thermoluminescent dosimetry was used to study the dose received by 50 consecutive paediatric patients. The average thyroid exposure was 7.7 R and the average gonad exposure 0.35 R. The relative contribution of both fluoroscopy and serial film radiography was calculated and over 70% of the thyroid dose comes from the use of the roll film changer. The significance of high thyroid dose is discussed and it is concluded that serial film changers no longer have a primary role in the study of congenital heart disease. Show more

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Cited by 22 publications

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

et al. 2005

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“…9 Martin and Olson suggested that the method of recording the angiocardiogram contributes particularly to the thyroid dose. 5 We measured the radiation exposure to the skin, thyroid and gonads in 50 consecutive pediatric patients undergoing cardiac catheterization and angiocardiography using cine photofluorography.…”

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Radiation exposure to the pediatric patient during cardiac catheterization and angiocardiography. Emphasis on the thyroid gland.

Martin¹,

Olson²,

Steeg³

et al. 1981

Circulation

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SUMMARY Thermoluminescent dosimetry was used to measure the radiation exposure to the skin, thyroid and gonads in 50 consecutive pediatric patients undergoing cardiac catheterization and angiocardiography using cine photofluorography. Average exposures were 17.1 R to the skin, 2.3 R to the thyroid and 0.1 R to the gonads. Fluoroscopy accounted for approximately 80% of the skin and thyroid exposure and cine photofluorography for 20-25%. Occasional primary-beam irradiation was the major contributor to gonad exposure. Internal scatter of the incident x-ray beam was primarily responsible for thyroid exposure, so that infants received relatively high exposures; one receiving 7.3 R. The thyroid was not frequently in the primary beam. The significance of high radiation exposure to the thyroid, and in particular its relationship to thyroid carcinoma, are discussed. The results are compared with other series in the literature and relative exposures of cine photofluorography and serial filming are contrasted.

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Patient Radiation Exposure in a Modern, Large-Volume, Pediatric Cardiac Catheterization Laboratory

et al. 2014

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Radiation exposure from pediatric cardiac catheterization may be substantial, although published estimates vary. We sought to report patient radiation dose across a range of diagnostic and interventional cases in a modern, high-volume pediatric catheterization laboratory. We retrospectively reviewed diagnostic and interventional cases performed in our pediatric catheterization laboratory from 1 April 2009 to 30 September 2011 for which radiation usage data were available as reported by the Artis Zee(®) (Siemens Medical Solutions) system. Electrophysiology cases were excluded. Radiation dose was quantified as air kerma dose (mGy) and dose-area product (DAP; μGy m(2)). The DAP was converted to an effective dose millisievert (mSv) using the Monte Carlo method. Radiation usage data were available from 2,265 diagnostic and interventional cases with an overall median air kerma dose of 135 mGy [interquartile range (IQR) 59-433], median DAP of 760 μGy m(2) (IQR 281-2,810), of which 75 % (IQR 59-90 %) was derived from fluoroscopy, and median effective dose of 6.2 mSv (IQR 2.7-14.1). Air kerma dose from a single camera >2,000 mGy occurred in 1.8 % of cases. Significant differences in all measures of radiation exposure existed based on procedural and interventional types (p = 0.0001), with interventional cases associated with the highest effective dose after adjusting for patient weight category (p < 0.001). Patient weight, age, fluoroscopy time, and proportional use of digital acquisition were independent predictors of exposure (p ≤ 0.001; R (2) = 0.59-0.64). In a modern, large-volume pediatric catheterization laboratory, the median effective dose is 6.2 mSv with a wide range of exposure based on patient- and procedure-specific factors. Radiation monitoring is an important component of a pediatric laboratory and further dose reduction strategies are warranted.

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Radiation exposure to the paediatric patient from cardiac catheterization and angiocardiography

Cited by 22 publications

References 11 publications

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

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

Radiation exposure to the pediatric patient during cardiac catheterization and angiocardiography. Emphasis on the thyroid gland.

Patient Radiation Exposure in a Modern, Large-Volume, Pediatric Cardiac Catheterization Laboratory

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