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Giannone A, De Monte F, Colangelo M, Di Salvo G, Fraccaro C, Sirico D, Paiusco M, Castaldi B. Standardized diagnostic reference levels for paediatric interventional cardiology: Data from an Italian referral centre. Phys Med 2024; 124:104487. [PMID: 39084137 DOI: 10.1016/j.ejmp.2024.104487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 07/08/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE To provide data on radiation exposure in paediatric interventional cardiology procedures, addressing the scarcity of valuable Local Diagnostic Reference Levels (LDRLs),established according to the standardized approach proposed by the Radiation Protection 185 report (RP185). METHODS Paediatric catheterization procedures conducted at the University-Hospital of Padua from September 2019 to December 2022 were stratified by body weight (BW) classes and procedure type. LDRLs were calculated for groups with at least 20 patients as the 75th percentile of Kerma-Area Product (PKA) and Air Kerma at reference point (Ka,r) values. Kruskal-Wallis test was applied to evaluate differences in the dose-related quantities among BW groups for a selected procedure and among procedures for the same BW class. Results were compared with recent literature. RESULTS A total of 838 procedures were analysed. LDRL were provided for five therapeutic procedures. The 75th percentile of PKA and Ka,r increases with weight, regardless procedure type. PKA and Ka,r are generally statistically different between BW groups, for both diagnostic and therapeutic procedures, and between different procedures at fixed weight group. Angioplasty and Right Ventricular Outflow Tract treatments (PVR) showed exposure values approximately doubled then other procedures. PKA/(BW·FT) is not statistically different among procedures except for Atrial Septal Defect (ASD) closures. LDRL values from this study are generally lower than the published ones. CONCLUSIONS The study stands out as one of the few that presents a considerable number of LDRLs for weight categories and procedure types with a sample size of at least 20 patients per group, in agreement with RP185. PKA shows strong correlation with the product BW·FT.
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Affiliation(s)
- Angelo Giannone
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | | | - Giovanni Di Salvo
- Paediatric Cardiology Unit, Department of Woman and Child's Health, University of Padua, Padua, Italy
| | - Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Domenico Sirico
- Paediatric Cardiology Unit, Department of Woman and Child's Health, University of Padua, Padua, Italy
| | - Marta Paiusco
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Woman and Child's Health, University of Padua, Padua, Italy
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Ubeda C, Vano E, Del Rosario Perez M, Ramirez R, Nader A, Miranda P, Fernandez JM, Pérez-Peña M. Regional Workshop on Optimization of Protection in Pediatric Interventional Radiology in Latin American and Caribbean Countries. HEALTH PHYSICS 2024:00004032-990000000-00168. [PMID: 38975877 DOI: 10.1097/hp.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
ABSTRACT The purpose of this article is to describe the activities developed within the framework "Regional Workshop on Optimization of Protection in Pediatric Interventional Radiology in Latin American and Caribbean countries," developed between October 16th and 19th of the year 2023 in the city of San José, Costa Rica. The workshop was carried out as part of a joint work between the Pan American Health Organization (PAHO) and the World Health Organization (WHO), in cooperation with the International Atomic Energy Agency (IAEA). The main objective of the regional workshop was to gather the experiences and future work planning among participants in the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean (OPRIPALC) program. It involved professionals from 14 centers across 11 countries in the region, along with 4 experts from PAHO/WHO/IAEA. The work modalities during the workshop consisted of keynote presentations, individual presentations, group work, and general discussions. An online survey was carried out after the workshop, with the objective of knowing the opinion of the event participants and determining the impact and projection of the OPRIPALC program. During the workshop the centers had to present their experiences: the use of the DOLQA dose management system was presented and work was done on the consensus document on good practices. The activities, topics and organization of the workshop were valued positively by the participants. There is unanimity among the centers that the OPRIPALC program has had a positive impact and they wish to continue actively participating in the next biennium.
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Affiliation(s)
- Carlos Ubeda
- Medical Technology Department, Health Sciences Faculty, Tarapaca University, Arica, Chile
| | - Eliseo Vano
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - María Del Rosario Perez
- Argentine Society for Radiological Protection, Buenos Aires, Argentina; External consultant World Health Organization (WHO)
| | - Raúl Ramirez
- International Atomic Energy Agency, Vienna, Austria
| | | | - Patricia Miranda
- Luis Calvo Mackenna's Hospital, Antonio Varas 360, Santiago, Chile
| | - José Miguel Fernandez
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - Mar Pérez-Peña
- Radiology Service, Álvarez-Buylla Hospital, Mieres, Asturias, Spain; External consultant World Health Organization (WHO)
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Vano E, Fernández-Soto JM, Sánchez-Casanueva RM, Ten Morón JI. Improving a regional project on diagnostic reference levels for interventional procedures (OPRIPALC) with the support of a dose management system for the protection of patients and staff. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021520. [PMID: 38834050 DOI: 10.1088/1361-6498/ad53d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/04/2024] [Indexed: 06/06/2024]
Abstract
Interventional radiology is a clinical practice with important benefits for patients, but which involves high radiation doses. The optimisation of radiation protection (RP) for paediatric interventional cardiology is a priority for both patients and staff. The use of diagnostic reference levels (DRLs) has been proposed by the International Commission on Radiological Protection to improve RP in imaging procedures. Dose management systems (DMSs) allow the automatic collection of dosimetric, geometric and technical data to assist the optimisation process, with a continuous audit of the procedures, generating alerts to implement corrective actions when necessary. Patient dose indicators may be analysed individually and for different radiation events (fluoroscopy and cine runs). Occupational doses per procedure may be analysed (if electronic dosimeters are available) and linked with patient doses for an integrated approach to RP. Regional optimisation programmes require data collection and processing from several countries to set and periodically update the DRLs. Patient data is anonymised, and each participating hospital has access to their data in a central computer server. Using DMSs may be one of the best ways to support these programs in the collection and analysis of data, raising alerts about high patient and occupational doses and suggesting optimisation actions.
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Affiliation(s)
- E Vano
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - J M Fernández-Soto
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - R M Sánchez-Casanueva
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - J I Ten Morón
- Unidad Técnica de Imagen Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
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Krmek N, Környei L, Kralik I, Delić-Brkljačić D, Milošević M, Rode M, Kocsis F, Radeljić V. X-ray Doses in Relation to Body Mass, Indication, and Substrate During Pediatric Electrophysiological Procedures on the Heart. Pediatr Cardiol 2024; 45:804-813. [PMID: 38411709 DOI: 10.1007/s00246-024-03428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/21/2024] [Indexed: 02/28/2024]
Abstract
The main goal of this study is to determine typical values of dose area product (DAP) and difference in the effective dose (ED) for pediatric electrophysiological procedures on the heart in relation to patient body mass. This paper also shows DAP and ED in relation to the indication, the arrhythmia substrate determined during the procedure, and in relation to the reason for using radiation. Organ doses are described as well. The subjects were children who have had an electrophysiological study done with a 3D mapping system and X-rays in two healthcare institutions. Children with congenital heart defects were excluded. There were 347 children included. Significant difference was noted between mass groups, while heavier children had higher values of DAP and ED. Median DAP in different mass groups was between 4.00 (IQR 1.00-14.00) to 26.33 (IQR 8.77-140.84) cGycm2. ED median was between 23.18 (IQR 5.21-67.70) to 60.96 (IQR 20.64-394.04) µSv. The highest DAP and ED in relation to indication were noted for premature ventricular contractions and ventricular tachycardia-27.65 (IQR 12.91-75.0) cGycm2 and 100.73 (IQR 53.31-258.10) µSv, respectively. In arrhythmia substrate groups, results were similar, and the highest doses were in ventricular substrates with DAP 29.62 (IQR 13.81-76.0) cGycm2 and ED 103.15 (IQR 60.78-266.99) µSv. Pediatric electrophysiology can be done with very low doses of X-rays when using 3D mapping systems compared to X-rays-based electrophysiology, or when compared to pediatric interventional cardiology or adult electrophysiology.
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Affiliation(s)
- Nikola Krmek
- University of Zagreb, School of Medicine, Zagreb, Croatia.
| | - László Környei
- Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary
| | | | | | | | - Mirta Rode
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Flóra Kocsis
- Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary
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Azcurra P, Leyton F, Lucini V, Rivarola M, Trentacoste L, Marques A, Chiabrando J, Seropian I, Mundo N, Ubeda C, Agatiello C. Local Diagnostic Reference Levels for Pediatric Interventional Cardiology Procedures in Argentina. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1877. [PMID: 38136079 PMCID: PMC10741962 DOI: 10.3390/children10121877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/02/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
The aim of this work was to propose a preliminary local diagnostic reference levels (DRL) for pediatric interventional cardiology (PIC) procedures in Argentina, for different ranges of age and weight. This work has been conducted in the framework of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency to ensuring that radiation exposures of pediatric patients are the minimum necessary during fluoroscopy-guided interventional procedures. The local DRL values presented in this paper by weight group and age group were 7.1 Gy·cm2 (<5 kg), 10.7 Gy·cm2 (5-15 kg), 18.0 Gy·cm2 (15-30 kg), 15.9 Gy·cm2 (30-50 kg), and 28.2 Gy·cm2 (50-80 kg) and 5.3 Gy·cm2 (<1), 11.2 Gy·cm2 (1 to 5<), 19.6 Gy·cm2 (5 to 10<), and 21.4 Gy·cm2 (10 to 16<), respectively. Our dose results are among the values found in other international studies; however, there is great potential for dose optimization.
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Affiliation(s)
- Patricia Azcurra
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Fernando Leyton
- Personal Dosimetry Laboratory (LABODOP), School of Medical Technology, Faculty of Health Sciences, University of Tarapacá, Arica 1010072, Chile
| | - Victorio Lucini
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Marcelo Rivarola
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Luis Trentacoste
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Adela Marques
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Juan Chiabrando
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Ignacio Seropian
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Nicolas Mundo
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Carlos Ubeda
- Personal Dosimetry Laboratory (LABODOP), School of Medical Technology, Faculty of Health Sciences, University of Tarapacá, Arica 1010072, Chile
| | - Carla Agatiello
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
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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. New Optimization Strategies on Radiation Protection in Fluoroscopy-Guided Interventional Procedures in Pediatrics. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050883. [PMID: 37238432 DOI: 10.3390/children10050883] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023]
Abstract
The term fluoroscopically guided interventional procedure describes a clinical practice in medicine, where fluoroscopic systems are used to conduct diagnostic procedures or provide image guidance for therapeutic interventional procedures performed via percutaneous or other access routes [...].
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Affiliation(s)
- Carlos Ubeda
- Departamento de Tecnología Médica, Laboratorio de Dosimetría Personal (LABODOP), Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica Casilla 7D, Chile
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