Radiation reduction in pediatric and adult congenital patients during cardiac catheterization

Methods: Data were retrospectively collected for all procedures involving children and adults with congenital heart disease (CHD) undergoing catheterization over 45 months. Cases were divided into three categories including: noninterventional (NI), simple intervention (SI), and complex intervention (CI). The change in dose was modeled as log of cumulative air kerma (K_{a, r}). The change in K_{a, r} was evaluated for each procedural category as well as changes occurring as a function of age and weight.

Objectives: Our objective was to determine if technical changes combined with radiation safety initiatives reduced the radiation dose delivered to patients during congenital catheterization.

Background: Use of ionizing radiation is necessary during cardiac catheterization. Minimizing radiation dose, while maintaining clinically useful image quality, is an important safety issue. In our congenital heart center intentional practice changes, including technical changes and provider awareness initiatives, were implemented to decrease radiation dose.

Results: Considering all procedures (n = 1,082), K_{a, r} decreased by 61%. In the NI group (n = 481), K_{a, r} decreased by 71%. In the SI group (n = 424), K_{a, r} decreased by 74%. The K_{a, r} for the 10-17 year old group (n = 125) and those >18 years (n = 709) decreased 74 and 67%, respectively. The K_{a, r} decreased 72 and 66% for those 20-60 kg and ≥60 kg, respectively. Groups not showing significant change in K_{a, r} included CI, age ≤9 years, and weight ≤20 kg.

Conclusions: Through technical changes and provider awareness initiatives, our institution dramatically reduced the radiation dose in the majority of pediatric and adult CHD patients undergoing cardiac catheterization.