Pediatric Cardiology

, Volume 40, Issue 3, pp 638–649 | Cite as

Reducing Radiation Exposure in Cardiac Catheterizations for Congenital Heart Disease

  • Chandni PatelEmail author
  • Matthew Grossman
  • Veronika Shabanova
  • Jeremy Asnes
Original Article


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.


Radiation exposure Pediatric catheterization Congenital heart disease 



Air kerma


Atrial septal defect


Congenital heart disease




Digital angiography


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.

Ethical Approval

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.

Informed Consent

For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pediatric CardiologyYale School of MedicineNew HavenUSA
  2. 2.PediatricsYale School of MedicineNew HavenUSA
  3. 3.Department of PediatricsYale UniversityNew HavenUSA

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