Standardizing radiation dose reporting in the pediatric cardiac catheterization laboratory-A multicenter study by the CCISC (Congenital Cardiovascular Interventional Study Consortium)

• Published in: Catheterization and cardiovascular interventions Vol. 84; no. 5; pp. 785 - 793
• Main Authors: Kobayashi, Daisuke, Meadows, Jeffery, Forbes, Thomas J., Moore, Phillip, Javois, Alexander J., Pedra, Carlos A., Du, Wei, Gruenstein, Daniel H., Wax, David F., Hill, James A., Graziano, Joseph N., Fagan, Thomas E., Alvarez, Walter Mosquera, Nykanen, David G., Divekar, Abhay A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-11-2014; Wiley Subscription Services, Inc
• Subjects: Adolescent; Age Factors; air Kerma area product; body weight; Cardiac Catheterization - standards; Cardiology Service, Hospital; Child; Child, Preschool; Fluoroscopy - adverse effects; Fluoroscopy - methods; Humans; Infant; Laboratories, Hospital; multicenter study; Patient Safety; pediatric cardiac catheterization laboratory; Pediatrics - methods; Radiation Dosage; radiation dose; Radiation Protection - standards; Radiography, Interventional - standards; Registries; Risk Assessment; Statistics, Nonparametric; Time Factors; body weight; multicenter study; air Kerma area product; radiation dose; pediatric cardiac catheterization laboratory
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25467

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. © 2014 Wiley Periodicals, Inc.