Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T17:07:13.006Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiation exposure in transcatheter patent ductus arteriosus closure: time to tune?

Published online by Cambridge University Press:  19 January 2018

Olivier Villemain ,
Sophie Malekzadeh-Milani ,
Fidelio Sitefane ,
Meriem Mostefa-Kara  and
Younes Boudjemline
Olivier Villemain
Affiliation:
M3C-Necker Enfants malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Sophie Malekzadeh-Milani
Affiliation:
M3C-Necker Enfants malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Fidelio Sitefane
Affiliation:
M3C-Necker Enfants malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Meriem Mostefa-Kara
Affiliation:
M3C-Necker Enfants malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Younes Boudjemline*
Affiliation:
M3C-Necker Enfants malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
*
Author for correspondence: Y. Boudjemline, MD, PhD, M3C-Necker Enfants malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Tel: (33) 1 44 49 43 44; Fax: (33) 1 44 49 43 40; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The aims of this study were to describe radiation level at our institution during transcatheter patent ductus arteriosus occlusion and to evaluate the components contributing to radiation exposure.

Background

Transcatheter occlusion relying on X-ray imaging has become the treatment of choice for patients with patent ductus arteriosus. Interventionists now work hard to minimise radiation exposure in order to reduce risk of induced cancers.

Methods

We retrospectively reviewed all consecutive children who underwent transcatheter closure of patent ductus arteriosus from January 2012 to January 2016. Clinical data, anatomical characteristics, and catheterisation procedure parameters were reported. Radiation doses were analysed for the following variables: total air kerma, mGy; dose area product, Gy.cm2; dose area product per body weight, Gy.cm2/kg; and total fluoroscopic time.

Results

A total of 324 patients were included (median age=1.51 [Q1–Q3: 0.62–4.23] years; weight=10.3 [6.7–17.0] kg). In all, 322/324 (99.4%) procedures were successful. The median radiation doses were as follows: total air kerma: 26 (14.5–49.3) mGy; dose area product: 1.01 (0.56–2.24) Gy.cm2; dose area product/kg: 0.106 (0.061–0.185) Gy.cm2/kg; and fluoroscopic time: 2.8 (2–4) min. In multivariate analysis, a weight >10 kg, a ductus arteriosus width <2 mm, complications during the procedure, and a high frame rate (15 frames/second) were risk factors for an increased exposure.

Conclusion

Lower doses of radiation can be achieved with subsequent recommendations: technical improvement, frame rate reduction, avoidance of biplane cineangiograms, use of stored fluoroscopy as much as possible, and limitation of fluoroscopic time. A greater use of echocardiography might even lessen the exposure.

Keywords

paediatricscardiac catheterisationpatent ductus arteriosusradiation exposure
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 5 , May 2018 , pp. 653 - 660
Check for updates
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Baruteau, A-E, Hascoët, S, Baruteau, J, et al. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis 2014; 107: 122–132.Google Scholar
2. Backes, CH, Rivera, BK, Bridge, JA, et al. Percutaneous patent ductus arteriosus (PDA) closure during infancy: a meta-analysis. Pediatrics 2017; 139: pii:e20162927.Google Scholar
3. Ghelani, SJ, Glatz, AC, David, S, et al. Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States. JACC Cardiovasc Interv 2014; 7: 1060–10609.Google Scholar
4. Brenner, DJ, Doll, R, Goodhead, DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A 2003; 100: 13761–13766.Google Scholar
5. Chen, J, Einstein, AJ, Fazel, R, et al. Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: a population-based analysis. J Am Coll Cardiol 2010; 56: 702–711.CrossRefGoogle ScholarPubMed
6. Johnson, JN, Hornik, C, Li, JS, et al. Cumulative radiation exposure and cancer risk estimation in children with heart disease. Circulation 2014; 130: 161–167.Google Scholar
7. Cevallos, PC, Rose, MJ, Armsby, LB, et al. Implementation of methodology for quality improvement in pediatric cardiac catheterization: a multi-center initiative by the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI). Pediatr Cardiol 2016; 37: 1436–1445.CrossRefGoogle ScholarPubMed
8. Jones, T, Brennan, PC, Mello-Thoms, C, Ryan, E. Contemporary Australian dose area product levels in the fluoroscopic investigation of paediatric congenital heart disease. Radiat Prot Dosimetry 2017; 173: 374–379.Google Scholar
9. Yan, C, Zhao, S, Jiang, S, et al. Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults. Heart 2007; 93: 514–518.Google Scholar
10. Al-Haj, AN, Lobriguito, AM, Rafeh, W. Variation in radiation doses in paediatric cardiac catheterisation procedures. Radiat Prot Dosimetry 2008; 129: 173–178.CrossRefGoogle ScholarPubMed
11. Borik, S, Devadas, S, Mroczek, D, Jin Lee, K, Chaturvedi, R, Benson, LN. Achievable radiation reduction during pediatric cardiac catheterization: How low can we go? Catheter Cardiovasc Interv 2015; 86: 841–848.Google Scholar
12. El Sayed, MH, Roushdy, AM, El Farghaly, H, El Sherbini, A. Radiation exposure in children during the current era of pediatric cardiac intervention. Pediatr Cardiol 2012; 33: 27–35.Google Scholar
13. Glatz, AC, Patel, A, Zhu, X, et al. Patient radiation exposure in a modern, large-volume, pediatric cardiac catheterization laboratory. Pediatr Cardiol 2014; 35: 870–878.Google Scholar
14. Harbron, RW, Pearce, MS, Salotti, JA, et al. Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study. Br J Radiol 2015; 88: 20140852.CrossRefGoogle Scholar
15. Kobayashi, D, Meadows, J, Forbes, TJ, et al. Standardizing radiation dose reporting in the pediatric cardiac catheterization laboratory-A multicenter study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). Catheter Cardiovasc Interv 2014; 84: 785–793.Google Scholar
16. Smith, BG, Tibby, SM, Qureshi, SA, Rosenthal, E, Krasemann, T. Quantification of temporal, procedural, and hardware-related factors influencing radiation exposure during pediatric cardiac catheterization. Catheter Cardiovasc Interv 2012; 80: 931–936.Google Scholar
17. Song, S, Liu, C, Zhang, M. Radiation dose and mortality risk to children undergoing therapeutic interventional cardiology. Acta Radiol 2015; 56: 867–872.Google Scholar
18. Ubeda, C, Vano, E, Miranda, P, Leyton, F. Pilot program on patient dosimetry in pediatric interventional cardiology in Chile. Med Phys 2012; 39: 2424–2430.Google Scholar
19. Ubeda, C, Miranda, P, Vano, E. Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values. Med Phys 2015; 42: 615–622.Google Scholar
20. Verghese, GR, McElhinney, DB, Strauss, KJ, Bergersen, L. Characterization of radiation exposure and effect of a radiation monitoring policy in a large volume pediatric cardiac catheterization lab. Catheter Cardiovasc Interv 2012; 79: 294–301.CrossRefGoogle Scholar
21. Yakoumakis, E, Kostopoulou, H, Makri, T, Dimitriadis, A, Georgiou, E, Tsalafoutas, I. Estimation of radiation dose and risk to children undergoing cardiac catheterization for the treatment of a congenital heart disease using Monte Carlo simulations. Pediatr Radiol 2013; 43: 339–346.Google Scholar
22. Harbron, RW, Dreuil, S, Bernier, M-O, et al. Patient radiation doses in paediatric interventional cardiology procedures: a review. J Radiol Prot 2016; 36: R131–R144.Google Scholar
23. Justino, H. The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose. Pediatr Radiol 2006; 36 (S2): 146–153.Google Scholar
24. Ewert, P, Berger, F, Daehnert, I, et al. Transcatheter closure of atrial septal defects without fluoroscopy: feasibility of a new method. Circulation 2000; 101: 847–849.CrossRefGoogle ScholarPubMed
25. Pan, X-B, Ouyang, W-B, Wang, S-Z, et al. Transthoracic echocardiography-guided percutaneous Patent ductus arteriosus occlusion: a new strategy for interventional treatment. Echocardiography 2016; 33: 1040–1045.CrossRefGoogle ScholarPubMed