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Published on: September 11, 2011
Cumulative radiation exposure in pediatric patients with congenital heart disease
Mark A Walsh1, Michelle Noga, Jennifer Rutledge
1Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada, mark.walsh4@nhs.net.
Insights
Pediatric patients with severe congenital heart disease receive high radiation doses. Cardiac catheterization accounts for most cumulative radiation exposure, highlighting the need for alternative imaging like MRI.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Radiation Oncology
Background:
- Congenital heart disease (CHD) patients, especially those with single-ventricle physiology, undergo numerous medical imaging procedures.
- High cumulative doses of ionizing radiation are a concern in this vulnerable pediatric population.
- Previous evaluations of total radiation exposure from all modalities are limited.
Purpose of the Study:
- To assess the cumulative radiation exposure from all imaging modalities in pediatric patients undergoing single-ventricle palliation.
- To identify which procedures contribute most significantly to the total radiation dose.
- To inform strategies for reducing radiation exposure in these patients.
Main Methods:
- Retrospective, single-center study of pediatric patients (n=70) undergoing Fontan completion (May 2005-May 2010).
- Evaluation of radiation exposure (dose area product in μGy m²) from cardiac catheterizations, computed tomography (CT) scans, plain film radiography, and nuclear medicine scans.
- Calculation of cumulative radiation dose per patient across all procedures.
Main Results:
- Mean cumulative exposure from chest X-rays was 1,320 μGy m² (32 ± 8 exams per patient).
- Mean cumulative exposure from cardiac catheterizations was 9,054 μGy m² (2.45 ± 1.3 procedures per patient), significantly higher than CT scans (154 μGy m²) or radiography.
- Radiation exposure varied widely among patients, with cardiac catheterization being the primary source.
Conclusions:
- Radiation exposure in pediatric patients with CHD undergoing single-ventricle palliation is highly variable.
- Cardiac catheterization is the dominant source of cumulative ionizing radiation exposure in this cohort.
- Utilizing alternative imaging modalities like MRI may reduce radiation burden in these susceptible patients.
Abstract:
Certain pediatric patients undergoing surgery for the most severe forms of congenital heart disease are exposed to high doses of ionizing radiation. The amount of cumulative radiation exposure from all modalities has not yet been evaluated. The purpose of our study was to evaluate the cumulative radiation exposure in a contemporary cohort of patients with congenital heart disease undergoing single-ventricle palliation. This is a single-center, retrospective study of pediatric patients undergoing Fontan completion between May 2005 and May 2010. Radiation exposure from all procedures including cardiac catheterizations, computed tomography (CT) scans, plain film radiography, and nuclear medicine scans was evaluated. Radiation dose was calculated as the dose area product (μGy m(2)) and was measured in all cardiac catheterizations, CT scans, and other imaging modalities. Seventy patients who underwent Fontan completion at a mean age of 3.6 ± 1.5 years (range 1.4-8 years) were included in the study. Mean number of chest X-rays was 32 ± 8 (range 10-285) with a mean cumulative total exposure of 1,320 μGy m(2) (range 480-12,960) per patient. Mean number of cardiac catheterizations was 2.45 ± 1.3 (range 1-8), and mean fluoroscopy and cine angiography exposures per case were 1,103 ± 245 and 1,412 ± 273 μGy m(2) giving a mean cumulative exposure of 9,054 μGy m(2) (range 2,515-201,200) per patient for all catheterizations. Mean number of CT scans performed was 0.44 ± 0.4 (0-11), and the mean exposure was 352 μGy m(2), giving a mean cumulative total of 154 μGy m(2) (range 0-3,872) per person. A total of five lung perfusion scans were carried out. Radiation exposure in patients with congenital heart disease undergoing single-ventricle palliation is quite variable. Most of the exposure to ionizing radiation occurs during cardiac catheterization. Strategies to utilize other imaging modalities such as MRI would decrease exposure in this particular group of patients who may be particularly vulnerable to its side effects.
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