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Ubeda C, Vano E, Perez M, Jimenez P, van Deventer E, Ramirez R, Nader A, Miranda P. Optimization of Radiation Protection in Pediatric Interventional Radiology in Latin America and the Caribbean: Development, Advancements, Challenges and Achievements of the OPRIPALC Program. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1858. [PMID: 38136060 PMCID: PMC10742238 DOI: 10.3390/children10121858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
This article presents the development, advancements, challenges and achievements of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program. This international initiative is led by the World Health Organization, the Pan American Health Organization and the International Atomic Energy Agency. The main objectives of OPRIPALC are to foster a culture of radiological protection in pediatric interventions, enhance these procedures' quality, and define optimization strategies such as the use of diagnostic reference levels (DRLs). Currently, 33 centers from 12 countries participate actively in the program. Significant progress has been made towards the proposed objectives, overcoming the challenges posed by the COVID-19 pandemic. Through many virtual meetings for coordination, planning, training and follow-up, a comprehensive set of DRLs for both diagnostic and therapeutic procedures, categorized by weight and age, have been established and are in use. A consensus document on good practices is in the final stage of development. The program's continuation into at least a second phase is essential to address pending issues, including the integration of automatic dose management systems, the levels of occupational radiation doses, their correlation with pediatric patient doses, and strategies to reduce them.
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Affiliation(s)
- Carlos Ubeda
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica 1000000, Chile
| | - Elise Vano
- Radiology Department, Faculty of Medicine, Complutense University, IdIS, San Carlos Hospital, 28040 Madrid, Spain;
| | - María Perez
- World Health Organization (WHO), 1202 Geneva, Switzerland (E.v.D.)
| | - Pablo Jimenez
- Pan American Health Organization (PAHO), Washington, DC 20037, USA;
| | | | - Raúl Ramirez
- International Atomic Energy Agency (IAEA), 1220 Vienna, Austria; (R.R.); (A.N.)
| | - Alejandro Nader
- International Atomic Energy Agency (IAEA), 1220 Vienna, Austria; (R.R.); (A.N.)
| | - Patricia Miranda
- Luis Calvo Mackenna’s Hospital, AntonioVaras 360, Santiago 7500000, Chile;
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Aristizabal AM, Gutiérrez JA, Ramirez E, Mejía-Quiñones V, Ubeda C, Mosquera WF, Mosquera W. Diagnostic Reference Levels in Interventional Pediatric Cardiology: Two-Year Experience in a Tertiary Referral Hospital in Latin America. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1588. [PMID: 37892251 PMCID: PMC10605529 DOI: 10.3390/children10101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 10/29/2023]
Abstract
The goal of the present study was to propose the first local diagnostic reference levels (DRLs) for interventional pediatric cardiology procedures in a large hospital in Colombia. The data collection period was from April 2020 to July 2022. The local DRLs were calculated as the 3rd quartile of patient-dose distributions for the kerma-area product (Pka) values. The sample of collected clinical procedures (255) was divided into diagnostic and therapeutic procedures and grouped into five weight and five age bands. The Pka differences found between diagnostic and therapeutic procedures were statistically significant in all weight and age bands, except for the 1-5-year age group. The local DRLs for weight bands were 3.82 Gy·cm2 (<5 kg), 7.39 Gy·cm2 (5-<15 kg), 19.72 Gy·cm2 (15-<30 kg), 28.99 Gy·cm2 (30-<50 kg), and 81.71 Gy·cm2 (50-<80 kg), respectively. For age bands, the DRLs were 3.97 Gy·cm2 (<1 y), 9.94 Gy·cm2 (1-<5 y), 20.82 Gy·cm2 (5-<10 y), 58.00 Gy·cm2 (10-<16 y), and 31.56 Gy·cm2 (<16 y), respectively. In conclusion, when comparing our results with other existing DRL values, we found that they are similar to other centers and thus there is scope to continue optimizing the radiation dose values. This will contribute to establishing national DRLs for Colombia in the near future.
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Affiliation(s)
- Ana M. Aristizabal
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
| | - Jaiber A. Gutiérrez
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
| | - Emmanuel Ramirez
- Oficina de Física Médica & Protección Radiológica, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia;
| | - Valentina Mejía-Quiñones
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia
| | - Carlos Ubeda
- Diagnóstico por Imagen, Laboratorio de Dosimetría Personal (LABODOP), Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica 1020000, Chile;
| | - Walter Fernando Mosquera
- Servicio de Hospitalización, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia;
| | - Walter Mosquera
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
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Ubeda C, Vano E, Perez MD, Jímenez P, Ramirez R, Nader A, Miranda P, Azcurra P, Damsky J, Capdevila S, Oliveira M, Albuquerque J, Bocamino R, Schelin H, Yagui A, Aguirre D, Riquelme N, Cardenas L, Álvarez A, Mosquera W, Arias F, Gutierrez R, De la Mora R, Rivera T, Zapata J, Araujo P, Chiesa P. Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:031513. [PMID: 35940166 DOI: 10.1088/1361-6498/ac87b7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm2for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm2for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm2for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm2for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.
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Affiliation(s)
- C Ubeda
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - E Vano
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - M D Perez
- World Health Organization (WHO), Geneva, Switzerland
| | - P Jímenez
- Pan American Health Organization (PAHO), Washington, DC, United States of America
| | - R Ramirez
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - A Nader
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - P Miranda
- Luis Calvo Mackenna's Hospital, AntonioVaras 360, Santiago, Chile
| | - P Azcurra
- Hemodynamic Service, Italian Hospital, Buenos Aires, Argentina
| | - J Damsky
- Hemodynamic Service, Pedro de Elizalde Children's Hospital, Buenos Aires, Argentina
| | - S Capdevila
- Hemodynamic Service, Santísima Trinidad Children's Hospital, Córdova, Argentina
| | - M Oliveira
- Department of Health Technology and Biology, Federal Institute of Bahia, Salvador, Brazil
| | - J Albuquerque
- University Hospital of the Federal University of Maranhão, San Luis, Brasil
| | - R Bocamino
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brasil
| | - H Schelin
- Pequeno Príncipe Hospital, Curitiba, Brasil
| | - A Yagui
- Pequeno Príncipe Hospital, Curitiba, Brasil
| | - D Aguirre
- Hemodynamic Service, Roberto del Rio Children's, Santiago, Chile
| | - N Riquelme
- Hemodynamic Service, Roberto del Rio Children's, Santiago, Chile
| | - L Cardenas
- Hemodynamic Service, Santa Maria Clinic, Santiago, Chile
| | - A Álvarez
- Hemodynamic Service, Santa Maria Clinic, Santiago, Chile
| | - W Mosquera
- Valle del Lili Foundation University Hospital ICESI, Cali, Colombia
| | - F Arias
- National Children's Hospital, San José, Costa Rica
| | - R Gutierrez
- National Children's Hospital, San José, Costa Rica
| | - R De la Mora
- National Directorate of Environmental Health, Ministry of Public Health, Havana, Cuba
| | - T Rivera
- Center for Research in Applied Sciences and Advanced Technology Legaria, IPN, Ciudad de México, Mexico
| | - J Zapata
- National Institute of Child Health St. Borja, Lima, Peru
| | - P Araujo
- National Cardiovascular Institute, Lima, Peru
| | - P Chiesa
- Children's Cardiology Institute, Montevideo, Uruguay
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Opitz M, Bos D, Deuschl C, Radbruch A, Zensen S, Sirin S, Forsting M, Bechrakis N, Biewald E, Bornfeld N, Ketteler P, Timmermann B, Stuschke M, Guberina M, Wetter A, Göricke S, Guberina N. Estimation of radiation exposure of children undergoing superselective intra-arterial chemotherapy for retinoblastoma treatment: assessment of local diagnostic reference levels as a function of age, sex, and interventional success. Neuroradiology 2020; 63:391-398. [PMID: 32862237 PMCID: PMC7880957 DOI: 10.1007/s00234-020-02540-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE This study aims to determine local diagnostic reference levels (LDRLs) of intra-arterial chemotherapy (IAC) procedures of pediatric patients with retinoblastoma (RB) to provide data for establishing diagnostic reference levels (DRLs) in pediatric interventional radiology (IR). METHODS In a retrospective study design, LDRLs and achievable dose (AD) were assessed for children undergoing superselective IAC for RB treatment. All procedures were performed at the flat-panel angiography systems (I) ArtisQ biplane (Siemens Healthineers) and (II) Allura Xper (Philips Healthcare). Patients were differentiated according to age (A1: 1-3 months; A2: 4-12 months; A3: 13-72 months; A4: 73 months-10 years; A5: > 10 years), sex, conducted or not-conducted chemotherapy. RESULTS 248 neurointerventional procedures of 130 pediatric patients (median age 14.5 months, range 5-127 months) with RB (68 unilateral, 62 bilateral) could be included between January 2010 and March 2020. The following diagnostic reference values, AD, and mean values could be determined: (A2) DRL 3.9 Gy cm2, AD 2.9 Gy cm2, mean 3.5 Gy cm2; (A3) DRL 7.0 Gy cm2, AD 4.3 Gy cm2, mean 6.0 Gy cm2; (A4) DRL 14.5 Gy cm2, AD 10.7 Gy cm2, mean 10.8 Gy cm2; (A5) AD 8.8 Gy cm2, mean 8.8 Gy cm2. Kruskal-Wallis-test confirmed a significant dose difference between the examined age groups (A2-A5) (p < 0.001). There was no statistical difference considering sex (p = 0.076) and conducted or not-conducted chemotherapy (p = 0.627). A successful procedure was achieved in 207/248 cases. CONCLUSION We report on radiation exposure during superselective IAC of a pediatric cohort at the German Retinoblastoma Referral Centre. Although an IAC formally represents a therapeutic procedure, our results confirm that radiation exposure lies within the exposure of a diagnostic interventional procedure. DRLs for superselective IAC are substantially lower compared with DRLs of more complex endovascular interventions.
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Affiliation(s)
- Marcel Opitz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Denise Bos
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Alexander Radbruch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Sebastian Zensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Selma Sirin
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Nikolaos Bechrakis
- Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Eva Biewald
- Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Norbert Bornfeld
- Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Petra Ketteler
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Cancer Center, German Cancer Consortium (DKTK), Hufelandstrasse 55, 45147, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, University Hospital Essen, West German Cancer Center, Hufelandstrasse 55, 45147, Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, West German Cancer Center, Hufelandstrasse 55, 45147, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Sophia Göricke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Nika Guberina
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Department of Radiotherapy, University Hospital Essen, West German Cancer Center, Hufelandstrasse 55, 45147, Essen, Germany
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De Monte F, Castaldi B, Branchini M, Bettinelli A, Milanesi O, Paiusco M, Roggio A. Typical values for pediatric interventional cardiology catheterizations: A standardized approach towards Diagnostic Reference Level establishment. Phys Med 2020; 76:134-141. [DOI: 10.1016/j.ejmp.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/21/2020] [Accepted: 07/01/2020] [Indexed: 12/31/2022] Open
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Radiographer knowledge and practice of paediatric radiation dose protocols in digital radiography in Gauteng. Radiography (Lond) 2020; 26:117-121. [DOI: 10.1016/j.radi.2019.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 01/06/2023]
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Ubeda C, Vano E, Riquelme N, Aguirre D, Vasquez H, Chavez C, Dalmazzo D. Patient radiation doses in paediatric interventional cardiology and optimization actions. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rizk C, Fares G, Vanhavere F, Saliba Z, Farah J. Diagnostic Reference Levels, Deterministic and Stochastic Risks in Pediatric Interventional Cardiology Procedures. HEALTH PHYSICS 2020; 118:85-95. [PMID: 31764423 DOI: 10.1097/hp.0000000000001114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To establish diagnostic reference levels (DRLs) and investigate deterministic and stochastic risks in pediatric interventional cardiology (IC) procedures. Exposure parameters were retrospectively reviewed for 373 patients treated between May 2016 and November 2018 at a single specialized hospital. Weight specific DRLs were derived for pediatric IC procedures. Additionally, peak skin dose (Dskin,max) was measured using thermoluminescent dosimeters for a sample of 7 diagnostic and 43 therapeutic procedures. Finally, using PCXMC software, organ doses were computed and the risk of exposure-induced cancer death (REID) was estimated using the risk models of the Biological Effects of Ionizing Radiation VII committee. DRLs for ventricular septal defect (VSD) occlusions, lacking in the literature, in terms of air kerma at patient entrance reference point (388 and 629 mGy) and total air kerma-area product (28 and 61 Gycm) were proposed for patients weight-groups 5 - < 15 kg and 15 - < 30 kg, respectively. The mean (range) Dskin,max was 15 (1-30) mGy and 94 (1-491) mGy for diagnostic and therapeutic procedures, respectively. Meanwhile, VSD occlusion involved the highest organ doses where the lungs, liver, stomach, and breasts mean doses were 57, 37, 6, and 10 mGy, respectively, and the associated REID were 0.5% and 0.3% in female and male patients, respectively. DRLs were proposed for pediatric IC procedures; these will help optimize patient exposure. Dskin,max values were lower than the 2 Gy threshold for skin injuries. Pediatric organ doses and the REID were the highest during VSD occlusion and may be critical for repetitive procedures.
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Affiliation(s)
| | - Georges Fares
- Faculty of Sciences, Saint Joseph University, 11-514 Beirut, Lebanon
| | - Filip Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), BE-2400 Mol, Belgium
| | - Zakhia Saliba
- Department of pediatrics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Jad Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, 94270 Le Kremlin-Bicêtre, France
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Wu KY, Chen WT, Kuo HN, Pan LF, Pan LK. Estimation and clinical verification of the effective and skin doses for pediatric and adult patients undergoing the cardiac interventional examination using five PMMA phantoms and TLD/ionization chamber technique. Technol Health Care 2019; 27:95-108. [PMID: 31045530 PMCID: PMC6597971 DOI: 10.3233/thc-199010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Effective and skin doses gain much attention since the cardiac catheterization laboratory (CCL) is a place where both patients and medical staff are exposed to X-ray or fluoroscopy environment and gain a cumulative dose during the cardiac interventional procedure. OBJECTIVE These doses for pediatric and adult patients undergone cardiac interventional examination using five PMMA phantoms and thermoluminescence dosimeter (TLD)/ionization chamber technique were estimated in this work with the further clinical verification. METHODS Five PMMA phantoms (10, 30, 50, 70, and 90 kg) were customized to represent baby, child, adult female, adult male, and overweight adult (by Asian complexion standards), respectively, in accordance with the ICRU-48 report. Each phantom could be disassembled into 31 plates to insert TLD chips for measuring X-ray exposed dose or assisted with an auxiliary plate to insert high-sensitivity ionization chamber for surveying low-energy fluoroscopy dose. RESULTS The data acquired from five phantoms were integrated into four semi-empirical formulas, in order to fit the binary quadratic form "Dose = A⋅BMI2+B⋅DAP2+C⋅BMI+ D⋅DAP+E". The latter linked the X-ray and fluoroscopy effective/skin doses, respectively, with a high coefficient of determination R2(from 0.888 to 0.986). CONCLUSIONS The model refinement with DAP share adjustment is envisaged.
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Affiliation(s)
- Keng-Yi Wu
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung, Taiwan
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ting Chen
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung, Taiwan
- Department of Psychiatry, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hsun-Nan Kuo
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung, Taiwan
- Division of Cardiology, Yuan Rung Hospital, Yuanlin, Changhua, Taiwan
| | - Lung-Fa Pan
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung, Taiwan
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Lung-Kwang Pan
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung, Taiwan
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Rana BS, Kumar S, Ahuja CK, Singh NP, Yadav MK, Sandhu IS. ESTIMATION OF RADIATION EXPOSURE TO THE PATIENTS IN DIAGNOSTIC AND THERAPEUTIC INTERVENTIONAL PROCEDURES. RADIATION PROTECTION DOSIMETRY 2018; 181:290-300. [PMID: 29462376 DOI: 10.1093/rpd/ncy025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
The present work reports data of the radiation exposure to the patient in various diagnostic and therapeutic interventional radiological (IR) procedures. The study includes 260 diagnostic and 195 therapeutic exposure data in 455 IR procedures. All the IR procedures were performed on a biplane angiographic machine in a tertiary care hospital. The radiation exposure was estimated from dose-area product (DAP), fluoroscopy time (FT), number of fluoroscopic runs, number of images and cumulative dose (CD) value recorded during the procedure. The data reported in the present study show significant variability in DAP values in diagnostic and therapeutic IR procedures. In diagnostic procedures, the minimum median DAP value is 8.93 Gy cm2 for upper limb angiography with mean FT of 2.7 min and maximum DAP value is 108.8 Gy cm2 for inferior vena cava angiography with mean FT of 12.55 min. For therapeutic procedures, the median value of DAP ranges from 2.43 Gy cm2 for sclerotherapy with mean FT 0.65 min to 267.23 Gy cm2 for coiling of cerebral aneurysm with mean FT of 60.52 min. The DAP value for each procedure was also correlated with FT, number of fluoroscopic runs, number of images and CD. The reported DAP values in this study are within the range of earlier published results which suggest that our finding provides at least approximate applicability to other hospitals. The third quartile DAP values of the procedures having significant number of patient data (n ≥ 10) serves as provisional reference values for the optimization of procedure protocols.
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Affiliation(s)
| | - Sanjeev Kumar
- Department of Physics, G.G.D.S.D. College, Chandigarh, India
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Towards the definition of Institutional diagnostic reference levels in paediatric interventional cardiology procedures in Greece. Phys Med 2018. [PMID: 29519409 DOI: 10.1016/j.ejmp.2018.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study aimed to evaluate paediatric radiation doses in a dedicated cardiology hospital, with the objective of characterising patterns in dose variation. The ultimate purpose was to define Local (Institutional) Diagnostic Reference Levels (LDRLs) for different types of paediatric cardiac interventional procedures (IC), according to patient age. From a total of 710 cases performed during three consecutive years, by operators with more than 15 years of experience, the age was noted in only 477 IC procedures. The median values obtained for Fluoroscopy Time (FT), Number of Frames (N) and Kerma Area Product (PKA) by age range were 5.8 min, 1322 and 2.0 Gy.cm2 for <1 y; 6.5 min, 1403 and 3.0 Gy.cm2 for 1 to <5 y; 5.9 min, 950 and 7.0 Gy.cm2 for 5 to <10 y; 5.7 min, 940 and 14.0 Gy.cm2 for 10 to <16 y, respectively. A large range of patient dose data is observed, depending greatly on procedure type and patient age. In all age groups the range of median FT, N and PKA values was 3.1-15.8 min, 579-1779 and 1.0-20.8 Gy.cm2 respectively. Consequently, the definition of LDRLs presents challenges mainly due to the multiple clinical and technical factors affecting the outcome. On the other hand the lack of paediatric IC DRLs makes the identification of good practices more difficult. A consensus is needed on IC procedures nomenclature and grouping in order to allow a common assessment and comparison of doses.
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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Gould R, McFadden SL, Hughes CM. Radiation dose in paediatric cardiac catheterisation: A systematic literature review. Radiography (Lond) 2017; 23:358-364. [PMID: 28965901 DOI: 10.1016/j.radi.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES It is believed that children are more sensitive to ionising radiation than adults. This work reviewed the reported radiation dose estimates for paediatric cardiac catheterisation. A systematic literature review was performed by searching healthcare databases for studies reporting radiation dose using predetermined key words relating to children having cardiac catheterisation. The quality of publications was assessed using relevant Critical Appraisal Skills Programme questions and their reported radiation exposures were evaluated. KEY FINDINGS It is only in recent years that larger cohort observations have been undertaken. Although radiation dose from paediatric cardiac catheterisation has decreased in recent years, the literature indicated that it remains varied and potentially substantial. CONCLUSION Standardisation of weight categories and procedure types such as those recommended by the PiDRL project could help compare current and future radiation dose estimates.
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Affiliation(s)
- R Gould
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, BT37 OQB, United Kingdom.
| | - S L McFadden
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, BT37 OQB, United Kingdom
| | - C M Hughes
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, BT37 OQB, United Kingdom
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Wegner W, Silva MUMD, Peres MDA, Bandeira LE, Frantz E, Botene DZDA, Predebon CM. Patient safety in the care of hospitalised children: evidence for paediatric nursing. ACTA ACUST UNITED AC 2017; 38:e68020. [PMID: 28492813 DOI: 10.1590/1983-1447.2017.01.68020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/11/2017] [Indexed: 12/28/2022]
Abstract
Objectives To describe evidence of international literature on the safe care of the hospitalised child after the World Alliance for Patient Safety and list contributions of the general theoretical framework of patient safety for paediatric nursing. Method An integrative literature review between 2004 and 2015 using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Wiley Online Library, and the descriptors Safety or Patient safety, Hospitalised child, Paediatric nursing, and Nursing care. Results Thirty-two articles were analysed, most of which were from North American, with a descriptive approach. The quality of the recorded information in the medical records, the use of checklists, and the training of health workers contribute to safe care in paediatric nursing and improve the medication process and partnerships with parents. Conclusion General information available on patient safety should be incorporated in paediatric nursing care.
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Affiliation(s)
- Wiliam Wegner
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Merianny de Avila Peres
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Larissa Edom Bandeira
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Elemara Frantz
- Centro Universitário Metodista IPA, Curso de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Caroline Maier Predebon
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
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Ahmed NA, Nayel AI. PEDIATRIC RADIATION DOSE DURING CARDIAC CATHETERIZATION PROCEDURES IN SUDAN. RADIATION PROTECTION DOSIMETRY 2017; 174:495-500. [PMID: 27522052 DOI: 10.1093/rpd/ncw222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
Children are more radio sensitive than adult. This study aims to assess radiation doses and the associated hazards to pediatric during cardiac catheterization procedures. Radiation dose for 112 patients was estimated in the biggest cardiac center in Sudan. The median KAP in Gy cm2, CK in mGy, number of frames and fluoroscopy time in minutes were (4.6, 29.0, 340.4, 13.5) and (6.0, 35.0, 318, 9.8) for the diagnostic and therapeutic cardiac procedures, respectively. The median (KAP in Gy cm2, effective dose in mSv) for different age groups in the intervals of less than 1 year, 1-<5 years, 5-<10 years and 10-15 years old were (2.2, 4.4), (2.5, 5.0), (4.2, 5.1) and (8.5, 4.1) respectively. Including all the procedures using the multiplicative model of ICRP 60, the mean attributable lifetime risk for stochastic effect was 0.08 and 0.05% for girls and boys, respectively. Training is needed to raise staff awareness about radiation protection.
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Affiliation(s)
- Nada A Ahmed
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, P.O. Box 3001, Sudan
| | - A I Nayel
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, P.O. Box 3001, Sudan
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16
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Harbron RW, Dreuil S, Bernier MO, Pearce MS, Thierry-Chef I, Chapple CL, Baysson H. Patient radiation doses in paediatric interventional cardiology procedures: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:R131-R144. [PMID: 27893455 DOI: 10.1088/0952-4746/36/4/r131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A large number of investigations into the radiation doses from x-ray guided interventional cardiology procedures in children have been carried out in recent years. A review was conducted of these studies, gathering data on kerma area product (P KA), fluoroscopic screening time (FT), air kerma, and estimates of effective dose and organ doses. The majority of studies focus on P KA and FT with no estimation of dose to the patient. A greater than ten-fold variation in average P KA was found between different studies, even where data were stratified by patient age or weight. Typical values of P KA were 0.6-10 Gy · cm2 (<1 year/10 kg), 1.5-30 Gy · cm2 (1-5 years), 2-40 Gy · cm2 (5-10 years), 5-100 Gy · cm2 (10-16 years) and 10-200 Gy · cm2 (>16 years). P KA was lowest for heart biopsy (0.3-10 Gy · cm2 for all ages combined) and atrial septostomy (0.4-4.0 Gy · cm2), and highest for pulmonary artery angioplasty (1.5-35 Gy · cm2) and right ventricular outflow tract dilatation (139 Gy · cm2). Most estimates of patient dose were in the form of effective dose (typically 3-15 mSv) which is of limited usefulness in individualised risk assessment. Few studies estimated organ doses. Despite advances in radiation protection, recent publications have reported surprisingly large doses, as represented by P KA and air kerma. There is little indication of a fall in these dose indicators over the last 15 years. Nor is there much suggestion of a fall in doses associated with the use of flat panel detectors, as opposed to image intensifiers. An assessment of the impact of radiation dose in the context of overall patient outcome is required.
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Affiliation(s)
- R W Harbron
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP, UK. NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, Newcastle-upon-Tyne, UK
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Strauss KJ, Racadio JM, Abruzzo TA, Johnson ND, Patel MN, Kukreja KU, den Hartog MJH, Hoonaert BPA, Nachabe RA. Comparison of pediatric radiation dose and vessel visibility on angiographic systems using piglets as a surrogate: antiscatter grid removal vs. lower detector air kerma settings with a grid - a preclinical investigation. J Appl Clin Med Phys 2015; 16:408-417. [PMID: 26699297 PMCID: PMC5690159 DOI: 10.1120/jacmp.v16i5.5379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 06/03/2015] [Accepted: 06/07/2015] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to reduce pediatric doses while maintaining or improving image quality scores without removing the grid from X‐ray beam. This study was approved by the Institutional Animal Care and Use Committee. Three piglets (5, 14, and 20 kg) were imaged using six different selectable detector air kerma (Kair) per frame values (100%, 70%, 50%, 35%, 25%, 17.5%) with and without the grid. Number of distal branches visualized with diagnostic confidence relative to the injected vessel defined image quality score. Five pediatric interventional radiologists evaluated all images. Image quality score and piglet Kair were statistically compared using analysis of variance and receiver operating curve analysis to define the preferred dose setting and use of grid for a visibility of 2nd and 3rd order vessel branches. Grid removal reduced both dose to subject and imaging quality by 26%. Third order branches could only be visualized with the grid present; 100% detector Kair was required for smallest pig, while 70% detector Kair was adequate for the two larger pigs. Second order branches could be visualized with grid at 17.5% detector Kair for all three pig sizes. Without the grid, 50%, 35%, and 35% detector Kair were required for smallest to largest pig, respectively. Grid removal reduces both dose and image quality score. Image quality scores can be maintained with less dose to subject with the grid in the beam as opposed to removed. Smaller anatomy requires more dose to the detector to achieve the same image quality score. PACS numbers: 87.53.Bn, 87.57.N‐, 87.57.cj, 87.59.cf, 87.59.Dj
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Affiliation(s)
- Keith J Strauss
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine.
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Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures. AJR Am J Roentgenol 2015; 204:W713-9. [PMID: 26001261 DOI: 10.2214/ajr.14.13630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of our study was to survey radiation dose indexes of pediatric peripheral and abdominal fluoroscopically guided procedures from which estimates of diagnostic reference levels (DRLs) can be proposed for both a standard fluoroscope and a novel fluoroscope with advanced image processing and lower radiation dose rates. MATERIALS AND METHODS Radiation dose structured reports were retrospectively collected for 408 clinical pediatric cases: Half of the procedures were performed with a standard imaging technology and half with a novel x-ray technology. Dose-area product (DAP), air Kerma (AK), fluoroscopy time, number of digital subtraction angiography images, and patient mass were collected to calculate and normalize radiation dose indexes for procedures completed with the standard and novel fluoroscopes. RESULTS The study population was composed of 180 and 175 patients who underwent procedures with the standard and novel technology, respectively. The 21 different types of pediatric peripheral and abdominal interventional procedures produced 408 total studies. Median ages, mass and body mass index, fluoroscopy time per procedure, and total number of recorded images for the standard and novel technologies were not statistically different. The area of the x-ray beams was square at the level of the patient with a dimension of 10-13 cm. The dose reduction achieved with the novel fluoroscope ranged from 18% to 51% of the dose required with the standard fluoroscope. The median DAP and AK patient dose indexes were 0.38 Gy · cm(2) and 4.00 mGy, respectively, for the novel fluoroscope. CONCLUSION Estimates of dose indexes of pediatric peripheral and abdominal fluoroscopically guided, clinical procedures should assist in the development of DRLs to foster management of radiation doses of pediatric patients.
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Harbron RW, Pearce MS, Salotti JA, McHugh K, McLaren C, Abernethy L, Reed S, O'Sullivan J, Chapple CL. Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study. Br J Radiol 2015; 88:20140852. [PMID: 25654205 DOI: 10.1259/bjr.20140852] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To gather data on radiation doses from fluoroscopically guided cardiac catheterization procedures in patients aged under 22 years at multiple centres and over a prolonged period in the UK. To evaluate and explain variation in doses. To estimate patient-specific organ doses and allow for possible future epidemiological analysis of associated cancer risks. METHODS Patient-specific data including kerma area product and screening times from 10,257 procedures carried out on 7726 patients at 3 UK hospitals from 1994 until 2013 were collected. Organ doses were estimated from these data using a dedicated dosimetry system based on Monte Carlo computer simulations. RESULTS Radiation doses from these procedures have fallen significantly over the past two decades. The organs receiving the highest doses per procedure were the lungs (median across whole cohort, 20.5 mSv), heart (19.7 mSv) and breasts (13.1 mSv). Median cumulative doses, taking into account multiple procedures, were 23.2, 22.2 and 16.7 mSv for these organs, respectively. Bone marrow doses were relatively low (median per procedure, 3.2 mSv; cumulative, 3.6 mSv). CONCLUSION Most modern cardiac catheterizations in children are moderately low-dose procedures. Technological advances appear to be the single most important factor in the fall in doses. Patients undergoing heart transplants undergo the most procedures. An epidemiological assessment of cancer risks following these procedures may be possible, especially using older data when doses were higher. ADVANCES IN KNOWLEDGE This is the first large-scale, patient-specific assessment of organ doses from these procedures in a young population.
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Affiliation(s)
- R W Harbron
- 1 The Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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