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Estimating radiation exposure during paediatric cardiac catheterisation: a potential for radiation reduction with air gap technique

Published online by Cambridge University Press:  04 November 2019

Reid C. Chamberlain Open the ORCID record for Reid C. Chamberlain [Opens in a new window] ,
Alexis C. Shindhelm ,
Chu Wang ,
Gregory A. Fleming  and
Kevin D. Hill
Reid C. Chamberlain*
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
Alexis C. Shindhelm
Affiliation:
Department of Bioengineering, Duke University Pratt School of Engineering, Durham, NC, USA
Chu Wang
Affiliation:
University of Pittsburgh, Radiation Safety Office, Pittsburgh, PA, USA
Gregory A. Fleming
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
Kevin D. Hill
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
*
Author for correspondence: R. C. Chamberlain, MD, Department of Pediatrics, Division of Pediatric Cardiology, Duke University Hospital, DUMC Box 3090, Durham, NC 27710, USA. Tel: +1 919 681 6340; E-mail: [email protected]
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Abstract

Introduction:

The air gap technique (AGT) is an approach to radiation dose optimisation during fluoroscopy where an “air gap” is used in place of an anti-scatter grid to reduce scatter irradiation. The AGT is effective in adults but remains largely untested in children. Effects are expected to vary depending on patient size and the amount of scatter irradiation produced.

Methods:

Fluoroscopy and cineangiography were performed using a Phillips Allura Fluoroscope on tissue simulation anthropomorphic phantoms representing a neonate, 5-year-old, and teenager. Monte Carlo simulations were then used to estimate effective radiation dose first using a standard recommended imaging approach and then repeated using the AGT. Objective image quality assessments were performed using an image quality phantom.

Results:

Effective radiation doses for the neonate and 5-year-old phantom increased consistently (2–92%) when the AGT was used compared to the standard recommended imaging approaches in which the anti-scatter grid is removed at baseline. In the teenage phantom, the AGT reduced effective doses by 5–59%, with greater dose reductions for imaging across the greater thoracic dimension of lateral projection. The AGT increased geometric magnification but with no detectable change in image blur or contrast differentiation.

Conclusions:

The AGT is an effective approach for dose reduction in larger patients, particularly for lateral imaging. Compared to the current dose optimisation guidelines, the technique may be harmful in smaller children where scatter irradiation is minimal.

Keywords

Scatteringradiationheart defectscongenitalangiography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1474 - 1480
Copyright
© Cambridge University Press 2019 

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