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Updated: Mar 11, 2026
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Published on: September 11, 2011
Patient radiation doses in paediatric interventional cardiology procedures: a review
R W Harbron1,2, S Dreuil3, M-O Bernier3
1Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP, UK.
Insights
Pediatric interventional cardiology X-ray procedures show wide radiation dose variations, with no clear reduction over 15 years. Further research is needed to link radiation exposure to patient outcomes.
Area of Science:
- Medical Imaging
- Pediatric Cardiology
- Radiation Dosimetry
Background:
- Numerous studies have investigated radiation doses in pediatric interventional cardiology.
- Data collection focused on kerma area product (PKA) and fluoroscopic screening time (FT), often omitting patient dose estimation.
- Significant variability exists in reported PKA values across studies, even when stratified by patient demographics.
Purpose of the Study:
- To review and synthesize recent investigations on radiation doses in pediatric X-ray guided interventional cardiology.
- To analyze trends and variations in dose metrics like PKA, fluoroscopic time, and effective/organ doses.
- To assess the impact of radiation dose in relation to patient outcomes.
Main Methods:
- Systematic review of recent studies on pediatric interventional cardiology radiation doses.
- Data extraction for kerma area product (PKA), fluoroscopic screening time (FT), air kerma, effective dose, and organ doses.
- Analysis of dose variations based on patient age, weight, and specific procedures.
Main Results:
- A wide range of PKA values were observed, with significant variations (greater than ten-fold) between studies.
- Typical PKA values varied considerably by age group and procedure type, with pulmonary artery angioplasty and right ventricular outflow tract dilatation showing higher doses.
- Effective dose estimates (3-15 mSv) were common but limited for individual risk assessment; organ dose estimations were rare.
- No clear reduction in dose indicators (PKA, air kerma) was observed over the last 15 years, irrespective of detector technology (flat panel vs. image intensifiers).
Conclusions:
- Radiation doses in pediatric interventional cardiology remain highly variable and have not shown a significant decrease over time.
- Current dose metrics like effective dose have limitations for personalized risk assessment.
- There is a need to assess the clinical impact of these radiation doses in the context of patient outcomes.
Abstract:
A large number of investigations into the radiation doses from x-ray guided interventional cardiology procedures in children have been carried out in recent years. A review was conducted of these studies, gathering data on kerma area product (P KA), fluoroscopic screening time (FT), air kerma, and estimates of effective dose and organ doses. The majority of studies focus on P KA and FT with no estimation of dose to the patient. A greater than ten-fold variation in average P KA was found between different studies, even where data were stratified by patient age or weight. Typical values of P KA were 0.6-10 Gy · cm2 (<1 year/10 kg), 1.5-30 Gy · cm2 (1-5 years), 2-40 Gy · cm2 (5-10 years), 5-100 Gy · cm2 (10-16 years) and 10-200 Gy · cm2 (>16 years). P KA was lowest for heart biopsy (0.3-10 Gy · cm2 for all ages combined) and atrial septostomy (0.4-4.0 Gy · cm2), and highest for pulmonary artery angioplasty (1.5-35 Gy · cm2) and right ventricular outflow tract dilatation (139 Gy · cm2). Most estimates of patient dose were in the form of effective dose (typically 3-15 mSv) which is of limited usefulness in individualised risk assessment. Few studies estimated organ doses. Despite advances in radiation protection, recent publications have reported surprisingly large doses, as represented by P KA and air kerma. There is little indication of a fall in these dose indicators over the last 15 years. Nor is there much suggestion of a fall in doses associated with the use of flat panel detectors, as opposed to image intensifiers. An assessment of the impact of radiation dose in the context of overall patient outcome is required.
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