Reduction of Radiation to Children
Our Responsibility to Change
Medical radiation from x-rays and nuclear medicine is the largest man-made source of radiation exposure in Western countries and accounts for a mean effective dose (ED) of 3.0 mSv/y per person, equivalent to a radiation dose of 150 chest x-rays. In the United States, cardiologists are responsible for 40% of the entire cumulative ED to the population from all sources, excluding radiotherapy.1 In pediatric patients with congenital heart disease (CHD), the annual ED is relatively low (<3 mSv/y), but this extra yearly exposure accrues over the lifetime and can reach high values (>100 mSv) in selected cohorts of pediatric chronic patients,2 especially those undergoing interventional fluoroscopy procedures and serial computerized tomography (CT) evaluations.3 The benefits of ionizing imaging in children, especially in those with CHD, are immense and often life-saving, even more so with the advent of invasive fluoroscopy and CT, yet the use of radiation in children raises special concerns and offers a unique challenge for the current generation of pediatric cardiologists.
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The Challenge of Radiation Damage in Children
For any given radiological ED, younger pediatric patients receive higher radiation doses than older children, and overall, pediatric patients receive higher radiation doses than adult patients. Thus, the risk is 3 to 4 times higher in children than in adults.4 Children are at a substantially higher risk than adults because they have more rapidly dividing cells and greater life expectancy, allowing the clinical manifestation of radiation-induced cancers with decades-long latency periods,5 although this is more often true for some organs, such as the brain, and less for others, such as the lungs.6,7 At the age of 15 to 20 years, grown-up patients with CHD have already accumulated an ED corresponding to 20 to 40 mSv, with an estimated lifetime attributable extrarisk of cancer of 1 …