Projected Future Cancer Risks in Children Treated With Fluoroscopy-Guided Cardiac Catheterization Procedures

Area of Science:

• Pediatric Cardiology
• Radiation Oncology
• Medical Physics

Background:

• Children undergoing cardiac catheterization have increased life expectancy, raising concerns about long-term radiation-induced cancer risks.
• Frequent pediatric procedures include atrial septal defect closure, patent ductus arteriosus occlusion, and pulmonary valvuloplasty.

Purpose of the Study:

• To project Lifetime Attributable Risks (LARs) of cancer incidence following common pediatric cardiac catheterization procedures.
• To analyze sex-specific risks and the impact of age at treatment on radiation-related cancer risks.

Main Methods:

• Organ equivalent doses were estimated for 1251 procedures in children (≤15 years) at French centers (2009-2013).
• Sex-specific LARs were projected using Committee on Biological Effects of Ionizing Radiation VII models and the Radiation Risk Assessment Tool software.
• Uncertainty analysis considered dose variability and risk projection factors.

Main Results:

• Median LARs per 1000 procedures ranged from 0.3-1.4 (ASD closure), 0.6-5.0 (PDA occlusion), and 1.0-12.0 (pulmonary valvuloplasty), varying by sex and age.
• Radiation-related risks constituted 0.4%–6.0% of total lifetime cancer risk.
• Highest exposures showed LARs of 4.2/1000 in boys and 22.2/1000 in girls; lung cancer predominated in boys, while lung and breast cancers were significant in girls.

Conclusions:

• Radiation exposure during pediatric cardiac catheterization can result in substantial doses and elevated cancer risks.
• The findings underscore the necessity for dose reporting to guide long-term surveillance and prevention strategies for at-risk children.