Abstract 17697: Direct Physician Reporting Reduces Radiation Exposure in Pediatric Cardiac Catheterizations
Objectives: To quantify radiation dose in children undergoing cardiac catheterization and determine the impact of increased reporting transparency on total radiation exposure.
Background: Cardiac catheterization (cath) can result in significant radiation exposure in children. There is growing interest in quantifying and reducing radiation exposure in pediatric cath procedures. Our center joined a national registry in 2011 which required reporting of radiation exposure. In 2013, our center began participating in a second registry in which physicians directly entered radiation data. No specific educational or interventional radiation measures were taken during the study periods.
Methods/Results: We reviewed up to 20 cases across 3 time periods in each of 4 categories: post-heart transplant annual cath, unilateral pulmonary artery (PA) stent placement, pre-Fontan cath, and pre-Glenn cath. The 3 Eras were defined as: Era 1, 1/2009 - 1/2011; Era 2, 1/2011 - 9/2013; and Era 3, 9/2013 - 5/2014. In Era 3, the physician performing the cath was responsible for reporting the radiation data. Patients in each case category were matched for age, weight, and body surface area across 3 time periods.
Across the 3 Eras, there were significant decreases in cumulative air KERMA (mGy) among the unilateral PA stent placement (p < 0.01) and pre-Glenn evaluation (p = 0.01) cases. Although the decrease among the annual evaluation (p = 0.21) and pre-Fontan (p = 0.43) cases were not significant, the overall trend was a decrease in radiation exposure. From Era 2 to 3, there were significant decreases in dose area product (cGy·m2) in the annual evaluation (p = 0.01), PA stent placement (p = 0.02), and pre-Glenn (p = 0.01) cases. Dose area product information was not available in Era 1. In Era 1, 0 cases (0%) had a frame rate change during any individual cath, while in Era 2, 9 cases (11.25%), and in Era 3, 15 cases (23.4%) had frame rate changes (p < 0.01).
Conclusions: Increased physician awareness of radiation exposure significantly reduces radiation dose across a variety of procedures. This is seen not only by the overall reduction in radiation across case types, but also as the frame rate was more frequently changed during individual cases, indicating a change in physician behavior and practice.
Author Disclosures: G.T. Nicholson: None. D.W. Kim: None. R.N. Vincent: None. K. Gao: None. V. Balfour: None. C.J. Petit: None.
- © 2014 by American Heart Association, Inc.