Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization.
BACKGROUND
Because of the higher radiosensitivity of infants and children compared with adults, there is a need to evaluate the doses delivered to pediatric patients who undergo interventional cardiac procedures. However, knowledge of the effective dose in pediatric interventional cardiology is very limited.


RESULTS
For an accurate risk estimation, a patient-specific Monte Carlo simulation of the effective dose was set up in 60 patients with congenital heart disease who underwent diagnostic (n=28) or therapeutic (n=32) cardiac catheterization procedures. The dose-saving effect of using extra copper filtration in the x-ray beam was also investigated. For diagnostic cardiac catheterizations, a median effective dose of 4.6 mSv was found. Therapeutic procedures resulted in a higher median effective dose of 6.0 mSv because of the prolonged use of fluoroscopy. The overall effect of inserting extra copper filtration into the x-ray beam was a total effective dose reduction of 18% with no detrimental effect on image quality. An excellent correlation between the dose-area product and effective patient dose was found (r=0.95). Hence, dose-area product is suitable for online estimation of the effective dose with good accuracy. With all procedures included, the resulting median lifetime risk for stochastic effects was 0.08%.


CONCLUSIONS
Because of the high radiation exposure, it is important to monitor patient dose by dose-area product instrumentation and to use additional beam filtration to keep the effective dose as low as possible in view of the sensitivity of the pediatric patients.
Bacher
Klaus
K
Department of Medical Physics and Radiation Protection, Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium. klaus.bacher@Ugent.be
Bogaert
Evelien
E
Lapere
Régine
R
De Wolf
Daniël
D
Thierens
Hubert
H
D006328:Cardiac Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D003300:Copper; D004307:Dose-Response Relationship, Radiation; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009010:Monte Carlo Method; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D015642:Radiology, Interventional; D011874:Radiometry; D012306:Risk; D018570:Risk Assessment; D012867:Skin / Q000528:radiation effects; D013269:Stochastic Processes; D013819:Thermoluminescent Dosimetry
D003300:Copper