J Radiol Prot. 2024 Nov 21. doi: 10.1088/1361-6498/ad958e. Online ahead of print.
ABSTRACT
Pediatric patients with congenital heart disease often undergo cardiac catheterization procedures and are exposed to considerable ionizing radiation early in life. This study aimed to develop a method for estimating the dose area product (PKA) from pediatric cardiac catheterization procedures (1975-1989) at a national centre for pediatric cardiology and to evaluate trends in PKAand exposure parameters until 2021. Data from 2200 catheterization procedures on 1685 patients (1975-1989) and 4184 procedures on 2139 patients (2000-2021) under 18 years of age were retrospectively collected. PKAvalues were missing for 1975-1989 but available from 2000 onward. The missing PKAwas estimated from air kerma and beam area, based on exposure records and input from clinicians working at that time. PKAtrends were analysed over time and age. There was a 71% reduction in median PKAfrom the period 1975-1989 (median 6.63 Gy cm2) to 2011-2021 (1.91 Gy cm2). The PKAincreases significantly (p=0.0001) with patient age, which was associated with body weight. Approximately 80% of the total PKAwas from cine acquisition in 1975-1989, while 20% was from fluoroscopy. The PKAestimate during 1975-1989 was considerably impacted by the assumptions of missing parameters such as tube filtration, focus-to-heart distance, beam area, and number of cine series. The decreasing trend in PKAvalues was attributed to advancements in both technologies and clinical practices. The high contribution of cine acquisition to the total dose during 1975-1989 was due to factors such as a high frame rate, multiple acquisitions, and high tube current. The estimated PKAvalues for the period 1975-1989 are of importance for the dose reconstruction and risk assessments in the EU epidemiology project Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC).
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PMID:39571188 | DOI:10.1088/1361-6498/ad958e
