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Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi‐center C3PO‐QI study
Author(s) -
Cevallos Priscila C.,
Armstrong Aimee K.,
Glatz Andrew C.,
Goldstein Bryan H.,
Gudausky Todd M.,
Leahy Ryan A.,
Petit Christopher J.,
Shahanavaz Shabana,
Trucco Sara M.,
Bergersen Lisa J.
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26911
Subject(s) - medicine , fluoroscopy , cardiac catheterization , ductus arteriosus , dose area product , kerma , nuclear medicine , prospective cohort study , single center , percentile , surgery , dosimetry , statistics , mathematics
Objectives This study sought to update benchmark values to use a quality measure prospectively. Background Congenital Cardiac Catheterization Outcomes Project – Quality Improvement (C3PO‐QI), a multi‐center registry, defined initial radiation dose benchmarks retrospectively across common interventional procedures. These data facilitated a dose metric endorsed by the American College of Cardiology in 2014. Methods Data was collected prospectively by 9 C3PO‐QI institutions with complete case capture between 1/1/2014 and 6/30/2015. Radiation was measured in total air kerma (mGy), dose area product (DAP) (µGy* M 2 ), DAP per body weight, and fluoroscopy time (min), and reported by age group as median, 75 th and 95 th %ile for the following six interventional procedures: (1) atrial septal defect closure; (2) aortic valvuloplasty; (3) treatment of coarctation of the aorta; (4) patent ductus arteriosus closure; (5) pulmonary valvuloplasty; and (6) transcatheter pulmonary valve implantation. Results The study was comprised of 1,680 unique cases meeting inclusion criteria. Radiation doses were lowest for pulmonary valvuloplasty (age <1 yrs, median mGy: 59, DAP: 249) and highest in transcatheter pulmonary valve implantation (age >15 yrs, median mGy: 1835, DAP: 17990). DAP/kg standardized outcome measures across weights within an age group and procedure type significantly more than DAP alone. Radiation doses decreased for all procedures compared to those reported previously by both median and median weight‐based percentile curves. These differences in radiation exposure were observed without changes in median fluoroscopy time. Conclusions This study updates previously established benchmarks to reflect QI efforts over time. These thresholds can be applied for quality measurement and comparison. © 2017 Wiley Periodicals, Inc.