Exposure to Low-Dose Ionizing Radiation From Cardiac Procedures in Patients With Congenital Heart Disease: 15-Year Data From a Population-Based Longitudinal Cohort
Background—The burden of low-dose ionizing radiation (LDIR) exposure from medical procedures among individuals with congenital heart disease (CHD) is unknown. In this longitudinal population-based study, we sought to determine exposure to LDIR-related cardiac imaging and therapeutic procedures in children and adults with CHD.
Methods and Results—Analyzing the Quebec CHD database, exposure to the following LDIR-related cardiac procedures was recorded: catheter-based diagnostic procedures; structural heart interventions; coronary interventions; CT-scans of the chest; nuclear procedures; and pacemaker/ICD insertion and repair. From 1990-2005, there were 16,253 LDIR-exposed CHD patients, with 317,988 patient-years of available follow-up. The total number of LDIR-related procedures increased from 18.5 to 51.9 per 1000 CHD patients per year (p<0.0001). This was due to increases in rates per 1000 CHD patients in: diagnostic cardiac catheterizations (11.7 per 1000 to 13.7 / 1000); structural heart interventions (1.0 per 1000 to 5.2 / 1000); coronary interventions (1.0 per 1000 to 2.4 /1000); pacemaker/ICD insertions (1.6 per 1000 to 4.4 / 1000); nuclear procedures (4.2 per 1000 to 13.8 / 1000); and CT-scans of the chest (2.5 per 1000 to 12.3 / 1000). Over time, among children with CHD, the median age at first LDIR procedure decreased from 5.0 years of age to 9.6 months of age. Severity of CHD significantly predicted extent of exposure.
Conclusions—From 1990-2005, patients with CHD were exposed to increasing numbers of LDIR-emitting cardiac procedures. This exposure occurred at progressively younger ages. These findings provide important perspective on longitudinal LDIR exposure in this at-risk population.
- Received August 24, 2015.
- Accepted October 13, 2015.