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Removal of scatter radiation in paediatric cardiac catheterisation: a randomised controlled clinical trial
Richard Gould1, Sonyia L McFadden1, Andrew J Sands2
1Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, United Kingdom.
Insights
Ionising radiation during paediatric cardiac catheterisation damages DNA. Removing the anti-scatter grid reduces radiation dose and DNA damage, maintaining image quality and diagnostic efficacy.
Area of Science:
- Medical Imaging
- Radiation Oncology
- Paediatric Cardiology
Background:
- Paediatric cardiac catheterisation uses ionising radiation, raising concerns about DNA damage.
- Dose optimisation is crucial to minimise risks in children undergoing these procedures.
Purpose of the Study:
- To assess if ionising radiation from paediatric cardiac catheterisation compromises DNA integrity.
- To determine if dose optimisation techniques can maintain DNA integrity.
Main Methods:
- Children underwent imaging with or without an anti-scatter grid and with or without an air-gap.
- Dose area product, image quality, cancer risk, and DNA double-strand breaks (using γH2AX assay) were evaluated.
Main Results:
- Removing the anti-scatter grid reduced radiation dose by 20-30% and DNA double-strand breaks by 20-30%.
- Cancer mortality risk decreased by up to 45% without compromising image quality.
- The γH2AX assay effectively assessed dose optimisation strategies.
Conclusions:
- Radiation exposure during paediatric cardiac catheterisation significantly increases DNA damage.
- Removing the anti-scatter grid is a feasible dose optimisation strategy.
- The γH2AX assay is a valuable tool for evaluating dose optimisation in paediatric procedures.
Objective:
This study sought to determine if DNA integrity was compromised by ionising radiation from paediatric cardiac catheterisations and if dose optimisation techniques allowed DNA integrity to be maintained.
Materials And Methods:
Children were imaged using either: (i) an anti-scatter grid (current departmental protocol), (ii) no anti-scatter grid or, (iii) no anti-scatter grid and a 15 cm air-gap between the child and the x-ray detector. Dose area product and image quality were assessed, lifetime attributable cancer risk estimates were calculated and DNA double-strand breakages quantified using the γH2AX assay.
Results:
Consent was obtained from 70 parents/guardians/children. Image quality was sufficient for each procedure performed. Removal of the anti-scatter grid resulted in dose reductions of 20% (no anti-scatter grid) and 30% (15 cm air-gap), DNA double-strand break reductions of 30% (no anti-scatter grid) and 20% (15 cm air-gap) and a reduction of radiation-induced cancer mortality risk of up to 45%.
Conclusion:
Radiation doses received during paediatric cardiac catheterisation procedures resulted in a significant increase in DNA damage while maintaining acceptable image quality and diagnostic efficacy. It is feasible to remove the anti-scatter grid resulting in a reduction in DNA damage to the patient. The γH2AX assay may be used for assessment of dose optimisation strategies in children.
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