Patient exposure in paediatric Interventional Cardiology: a multicenter inter-comparison of clinical practices in...

This multicenter study aims to assess compliance with Image Gently Alliance dose optimization principles in paediatric Interventional Cardiology (IC) and to examine inter-center variability in patient radiation exposure.

Leading centers in Italy were involved. An operational survey,developed in agreement with the Image Gently recommendations, was administered to investigate clinical practices and identify any deviations from established guidelines.Data from 2841 procedures were collected. Dosimetric data (PKA, Ka,r, fluoroscopy time) from centers were compared and analyzed alongside the questionnaire responses.Inter-center differences were assessed using the Kruskal-Wallis test (p < 0.05).

Despite adherence to recommendations,the questionnaire identified deviations correlated with exposure,including failure to remove the anti-scatter grid for patients < 20 kg, excessive magnification,and extensive cine-acquisition. Statistically significant inter-center differences in dose were observed. Centre A shows a significant reduction in patient dose for almost all procedure types. As an example, for angioplasty, centre A showed a lower median value (P_KA = 3.5 Gy·cm²), less than half that of C (P_KA = 9.2 Gy·cm²), D (P_KA = 10.3 Gy·cm²) and E (P_KA = 10.0 Gy·cm²). Centre E exhibited higher doses for most procedures: a median P_KA = 5.6 Gy·cm² in diagnostic catheterizations compared to a range of 1.6-4.6 Gy·cm² in the other centres, and a median P_KA = 3.2 Gy·cm² for Patent Ductus Arteriosus closure compared to 0.7-1.4 Gy·cm². These results can be attributed to an outdated equipment.

Investigating clinical practices in a multicenter context is crucial for harmonizing operations and ensuring dose monitoring. Identifying differences in practices, equipment, and image quality that affect patient dose is essential for enhancing patient safety.