Patient radiation exposure during pediatric cardiac catheterization

Area of Science:

• Medical Physics
• Pediatric Cardiology
• Radiology

Background:

• Cardiac catheterization in pediatric patients involves significant radiation exposure.
• Fluoroscopy and cineangiocardiography are key imaging modalities used, contributing to dose.
• Accurate measurement of radiation dose is crucial for patient safety and protocol optimization.

Purpose of the Study:

• To quantify radiation exposure, specifically Exposure Area Product (EAP) and center field entrance exposure, in pediatric patients undergoing cardiac catheterization.
• To differentiate exposure contributions from biplane fluoroscopy and cineangiocardiography.
• To identify potential areas for dose reduction strategies.

Main Methods:

• Measurements of EAP and center field entrance exposure were performed in 17 pediatric patients.
• Radiation doses were recorded separately for fluoroscopy and cineangiocardiography using flat-plate ionization chambers.
• Exposures were analyzed for both posterior-anterior (PA) and lateral projections.

Main Results:

• Median EAP in PA projections was 425 R-cm2, with 29-35% from cine filming. Median EAP in lateral projections was 276 R-cm2, with 52-59% from cine filming.
• Median center field entrance exposure was 7.86 R in PA and 7.39 R in lateral projections.
• Manual "test" exposures for cine radiographic kVp accounted for up to 25% of the total examination exposure.

Conclusions:

• Cineangiocardiography significantly contributes to overall radiation dose in pediatric cardiac catheterization.
• Manual setting of cine radiographic factors represents a substantial source of unnecessary radiation.
• Implementing automated testing circuits for cine radiographic factors is recommended to lower patient radiation exposure levels.