Radiation Dose Reduction in Congenital Heart Disease Patients During Cardiac Catheterization by a Novel Protocol

Özet

Objective: Cardiac catheterization remains a major source of radiation exposure for patientswith congenital heart disease. This study reports the magnitude of radiation with a 3.75 frameper second (fps) pulse fluoroscopy rate and compares the reduction with the previous 15 fpsprotocol during cardiac catheterization for pediatric and adult congenital heart disease.Material and Methods: All diagnostic and interventional cardiac catheterization proceduresfrom a single tertiary center were analyzed from January 1, 2014 to December 31, 2015, one yearbefore and after implementing lower starting pulse fluoroscopy rates. The radiation dose wasquantified as air kerma dose (mGy) and dose-area product (DAP; μGy/m2). Radiation exposurewas analyzed for diagnostic and interventional procedures; the diagnostic group was subdividedinto cyanotic and acyanotic patients, whereas the interventional group was subdividedaccording to the most common indications.Results: A total of 786 procedures were analyzed. The median fluoroscopy times and contrastamounts did not show a statistically significant difference between both periods (487 vs. 456 secondsand 42.5 vs. 45.3 cm3). The median air kerma for all procedures showed an 88% reductionafter implementing lower pulse fluoroscopy rates (340-41 mGy). The doses were reduced significantlyfor diagnostic and interventional angiograms from 470 mGy and 162 mGy to 40 mGyand154 mGy. Among all patient groups, the most striking decrease was observed in the diagnosticprocedures we use, of which fluoroscopy is more prominent than cine angiography.Conclusion: We claim that novel radiation dose reduction protocols could be easily appliedwithout increasing fluoroscopy time or losing image quality.