Radiation Dosing During Pediatric Cardiac Catheterization Using the “Air Gap Technique” and an Aggressive “As Low As Reasonably Achievable” Radiation Reduction Protocol in Patients Weighing 20-40 kg
Presenter
Lisa Goto, MD, Children’s Hospital at Montefiore, Bronx, NY
Lisa Goto, MD, Children’s Hospital at Montefiore, Bronx, NY and Nicole J. Sutton, M.D., FSCAI, Montefiore Medical Center, New York, NY
Keywords: Imaging & Physiology and Radiation Safety
Background
Cardiac catheterizations provide vital information and opportunity for intervention. Yet they come with the risk of high radiation exposure for the patient as well as staff. We have previously shown that adding air gap technique (AGT) to our “as low as reasonably achievable (ALARA)” radiation protocol reduces radiation exposure in patients weighing less than 20 kg. This study aimed to assess the radiation dosage using our AGT with ALARA protocol in patients weighing 20-40 kg. Methods
All patients under 21 years of age and weighing 20-40 kg who underwent cardiac catheterization at the Children’s Hospital at Montefiore in Bronx, New York from 1/1/2015 to 12/30/2020 were included. Transplant patients who underwent routine endomyocardial biopsy or biopsy with coronary angiography were excluded. The ALARA protocol was used with AGT by placing the flat panel detector 110 cm from the patient. Demographics, procedural data, and patient radiation exposure levels were analyzed. Results
95 catheterizations were performed in 77 patients. The median age was 9 years (range 3.4 - 19.4 years) and the median weight was 27.5 kg (range 20-40). 49 catheterizations were interventional. The median fluoro time was 11.9 minutes (range 0.4-92.4). The median total air Kerma (K) product was 38 mGy (range 0-635 mGy), the median dose area product (DAP) was 175 µGym2 (range 1.92-3413.85), and the DAP for weight (DAP/kg) was 7 (range 0.018 - 87.53). The most common intervention performed was ASD device closure (10), followed by Pulmonary Artery Dilation (6), PDA closure (6), there was a variety of stents placed and 2 Melody valves. There were 3 minor complications: 1 accelerated junctional rhythm, 2 broken balloons with stent placement and 1 hemoptysis that were all self-limited. Conclusions
Use of our novel ALARA protocol with Air Gap Technique led to reduced radiation levels compared to published values in patients between 20-40 kg with comparable image quality and without increased complication rates.