Is it possible to reduce radiation exposure during transcatheter atrial septal defect closure in children?
İbrahim Cansaran Tanıdır1, Selman Gökalp1, Erkut Özturk1
1Department of Pediatric Cardiology, İstanbul University of Health Sciences İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
Insights
Lowering fluoroscopy rates to 3.75 frames per second significantly reduces radiation exposure during transcatheter atrial septal defect closure. This radiation dose reduction is crucial for protecting pediatric patients and healthcare professionals.
Area of Science:
- Cardiology
- Medical Imaging
- Radiation Safety
Background:
- Cardiac catheterization is a significant source of radiation exposure, particularly for pediatric patients with congenital heart disease.
- Children are more susceptible to the harmful effects of radiation, necessitating dose reduction strategies.
Purpose of the Study:
- To evaluate the radiation dose reduction achieved by implementing a 3.75 frames per second (fps) pulse fluoroscopy rate.
- To compare radiation exposure with a previous 15 fps protocol during transcatheter atrial septal defect (ASD) closure.
Main Methods:
- Retrospective comparison of radiation doses (air kerma and dose area product) in two groups of patients undergoing ASD device closure.
- Group 1 (2014-2016) used a 3.75 fps fluoroscopy rate; Group 2 (2011-2014) used a 15 fps rate.
- Radiation doses were indexed to fluoroscopy time due to significant differences between groups.
Main Results:
- Both groups had 80 patients with similar baseline characteristics.
- Mean fluoroscopy time was longer in the 15 fps group (Group 2).
- Radiation doses (DAP and air kerma indexed to body weight) were significantly lower in the 3.75 fps group (Group 1) (p<0.001).
Conclusions:
- Implementing a 3.75 fps pulse fluoroscopy rate significantly reduces radiation dose during transcatheter ASD closure.
- This low-dose protocol can be safely and effectively applied.
- Radiation dose reduction protocols are essential for patient and staff safety.
Objective:
Cardiac catheterization continues to be a major source of radiation exposure for patients with congenital heart disease. As children are more prone to both deterministic and stochastic effects of radiation, every effort should be made to reduce radiation exposure. One way to reduce the radiation dose is to lower the pulse fluoroscopy rate. This study is an examination of the magnitude of radiation exposure with a 3.75 frames per second (fps) pulse fluoroscopy rate and a comparison with the previous 15 fps protocol used for transcatheter atrial septal defect (ASD) closure.
Methods:
The radiation dose delivered during ASD device closure procedures performed between 2014 and 2016 (Group 1: 3.75 fps fluoroscopy rate) was compared with that recorded in procedures performed between 2011 and 2014 (Group 2: 15 fps fluoroscopy rate). The radiation dose was quantified as air kerma dose (milligray, mGy) and dose area product (DAP; mGy/m2).
Results:
There were 80 patients in each group. Baseline demographic characteristics and the body weight and height measurements were similar between groups. The mean fluoroscopy time was significantly longer in Group 2. Since the fluoroscopy time was significantly different between groups, the DAP and air kerma dose were indexed according to fluoroscopy time. In Group 1, the DAP and air kerma indexed to body weight values were statistically lower than those of Group 2 (p<0.001).
Conclusion:
A significant reduction in the radiation dose was observed with the implementation of 3.75 fps pulse fluoroscopy, which is the lowest in use. Novel radiation dose reduction protocols can be easily applied without compromising safety or the effectiveness of transcatheter ASD closure and should be utilized for the safety of patients and healthcare staff.
