Reducing Radiation Exposure in Cardiac Catheterizations for Congenital Heart Disease
- 51 Downloads
Ionizing radiation exposure is a necessary risk entailed during congenital cardiac catheterizations. The congenital catheterization lab at Yale New Haven Children’s Hospital employed quality improvement strategies to minimize radiation exposure in this vulnerable population. In two phases, we implemented six interventions, which included adding and utilizing lower fluoroscopy and digital angiography (DA) doses, increasing staff and physician radiation awareness, focusing on tighter collimation, and changing the default fluoroscopy and DA doses to lower settings. Post-intervention data were collected prospectively for all procedures in the congenital catheterization lab and compared to pre-intervention radiation data collected retrospectively. Radiation exposure was measured in total air kerma (mGy), dose area product per body weight (DAP/kg) (µGy m2/kg), and fluoroscopy time (min). Data were collected for a total of 312 cases. In considering all procedures, the DAP/kg decreased by 67.6% and air kerma decreased by 63%. Fluoroscopy time did not change over the study period. Significant decreases in radiation exposure (DAP/kg) by procedure type were seen for atrial septal defect, patent ductus arteriosus, and transcatheter pulmonary valve procedures with a 45%, 42% and 83% decrease, respectively. Air kerma decreased significantly for ASD and PDA procedures with an 80% and 72% decrease, respectively. When compared to national benchmarks, the median DAP/kg and air kerma for these procedures are lower at our institution. The decreases continue to be sustained 2 years post-interventions. Systems-based interventions can be readily implemented in the congenital cardiac catheterization lab with dramatic and sustainable radiation dose reduction for patients.
KeywordsRadiation exposure Pediatric catheterization Congenital heart disease
Atrial septal defect
Congenital heart disease
Dose area product
Patent ductus arteriosus
Transcatheter pulmonary valve
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest and financial relationships relevant to this article to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
For this type of study, formal consent is not required.
- 3.Kobayashi D, Meadows J, Forbes TJ et al (2014) Standardizing radiation dose reporting in the pediatric cardiac catheterization laboratory—a multicenter study by the CCISC (congenital cardiovascular interventional study consortium). Catheter Cardiovasc Interv 84(5):786–793. https://doi.org/10.1002/ccd.25467 CrossRefGoogle Scholar
- 7.Shewhart WA, Deming W (1939) Statistical method from the viewpoint of quality control. The Graduate School of the Department of Agriculture, WashintonGoogle Scholar
- 8.Provost LP, Murray S (2011) The health care data guide: learning from data for improvement. Jossey-Bass, San FranciscoGoogle Scholar
- 9.R Core Team (2018) R: A language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
- 11.Bacher K (2005) Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation 111(1):83–89. https://doi.org/10.1161/01.CIR.0000151098.52656.3A CrossRefPubMedGoogle Scholar
- 13.Hill KD, Frush DP, Han BK et al (2017) Radiation safety in children with congenital and acquired heart disease: a scientific position statement on multimodality dose optimization from the image gently alliance. JACC Cardiovasc Imaging 10(7):797–818. https://doi.org/10.1016/j.jcmg.2017.04.003 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.FDA white paper: initiative to reduce unnecessary radiation exposure from medical imaging. FDA white paper. http://www.fda.gov/downloads/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/UCM200087.pdf. Published 2010. Accessed 11 April 2018
- 19.Have-a-heart and image gently. The image gently alliance. http://www.imagegently.org/Procedures/Cardiac-Imaging. Published 2014. Accessed 11 April 2018
- 22.Smith BG, Tibby SM, Qureshi SA, Rosenthal E, Krasemann T (2012) Quantification of temporal, procedural, and hardware-related factors influencing radiation exposure during pediatric cardiac catheterization. Catheter Cardiovasc Interv 80(6):931–936. https://doi.org/10.1002/ccd.24359 CrossRefPubMedGoogle Scholar
- 23.Hirshfeld JW, Balter S, Brinker JA et al (2004) ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on clinical competence and training. J Am Coll Cardiol 44(11):2259–2282. https://doi.org/10.1016/j.jacc.2004.10.014 CrossRefPubMedGoogle Scholar
- 27.Verghese GR, McElhinney DB, Strauss KJ, Bergersen L (2012) Characterization of radiation exposure and effect of a radiation monitoring policy in a large volume pediatric cardiac catheterization lab. Catheter Cardiovasc Interv 79(2):294–301. https://doi.org/10.1002/ccd.23118 CrossRefPubMedGoogle Scholar