Standardizing radiation dose reporting in the pediatric cardiac catheterization laboratory - A multicenter study by the CCISC (congenital cardiovascular interventional study consortium)

Daisuke Kobayashi, Jeffery Meadows, Thomas J. Forbes, Phillip Moore, Alexander J. Javois, Carlos A. Pedra, Wei Du, Daniel H. Gruenstein, David F. Wax, James A. Hill, Joseph N. Graziano, Thomas E. Fagan, Walter Mosquera Alvarez, David G. Nykanen, Abhay A. Divekar

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Objectives: We examine normalized air Kerma area product (PKA) by body weight (PKA/BW) as a reference value of radiation dose and benchmark PKA/BW in pediatric laboratories using a multicenter registry database.

Background: Reduction of radiation dose is an important quality improvement task in pediatric cardiac catheterization laboratories. Physicians need to agree on a standard method of reporting radiation dose that would allow comparisons to be made between operators and institutions.

Methods: This was a multicenter observational study of radiation dose in pediatric laboratories. Patient demographic, procedural and radiation data including fluoroscopic time and PKA (μGy m2) were analyzed. PKA/BW was obtained by indexing PKA to body weight.

Results: A total of 8,267 pediatric catheterization procedures (age <18 years) were included from 16 institutions. The procedures consisted of diagnostic (n = 2,827), transplant right ventricular (RV) biopsy (n =1,172), and interventional catheterizations (n=4268). PKA correlated with body weight better than with age and best correlated with weight-fluoroscopic time product. PKA/BW showed consistent values across pediatric ages. Interventional catheterizations had the highest PKA/BW (50th, 75th, and 90th percentiles:72, 151, and 281 μGy m2/kg), followed by diagnostic (59, 105, and 175 μGy m2/kg) and transplant RV biopsy (27, 79, and 114 μGy m2/kg).

Conclusion: PKA/BW appeared to be the most reliable standard to report radiation dose across all procedure types and patient age. We recommend PKA/BW to be used as the standard unit in documenting radiation usage in pediatric laboratories and can be used to evaluate strategies to lower radiation dosage in pediatric patients undergoing cardiac catheterizations.

Original languageEnglish (US)
Pages (from-to)785-793
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume84
Issue number5
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Keywords

  • Air Kerma area product
  • Body weight
  • Multicenter study
  • Pediatric cardiac catheterization laboratory
  • Radiation dose

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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