Diagnostic reference levels and effective dose in paediatric cardiac catheterization

Area of Science:

• Medical Physics
• Pediatric Cardiology
• Radiology

Background:

• European states require diagnostic reference levels (DRLs) for X-ray examinations.
• DRLs for pediatric cardiac catheterization and effective dose estimations are currently lacking.
• Radiation dose monitoring is crucial in pediatric interventional procedures.

Purpose of the Study:

• To evaluate dose-area products (DAPs) in pediatric cardiac catheterization.
• To establish appropriate diagnostic reference levels (DRLs) for pediatric cardiac catheterization.
• To investigate the relationship between dose-area product (DAP), body weight (BW), and procedure type.

Main Methods:

• DAPs were evaluated for three angiocardiography systems over 8 years.
• Dose-area product (DAP) was normalized to body weight (BW) to account for growth.
• Doses for cine acquisition (DAPA) and fluoroscopy (DAPF) were indexed to image acquisition (AN) and fluoroscopy time (FT).

Main Results:

• DAP increased proportionally with BW, with a decreasing proportionality constant over time.
• Normalized DAP (DAP/BW) showed high correlation with BW for both cine acquisition and fluoroscopy.
• Interventional procedures for congenital heart diseases had significantly higher DAP/BW than diagnostic examinations, with variations among specific procedures.

Conclusions:

• Normalizing DAP to BW effectively eliminates growth-dependent variations, making DAP/BW suitable for pediatric DRLs.
• DRLs based on DAP/BW are recommended over mean DAP values for age groups.
• This approach aids in managing cumulative effective doses in children undergoing repeated cardiac catheterizations.