title: Characterization of radiation exposure and effect of a radiation monitoring policy in a large volume pediatric cardiac catheterization lab.
abstract: OBJECTIVE
  This study aimed to characterize radiation dose during cardiac catheterization in congenital heart disease and to assess changes in dose after the introduction of a radiation monitoring policy.
  
  
  BACKGROUND
  Minimizing radiation exposure is an important patient safety initiative and relatively few data are available characterizing radiation dose for the broad spectrum of congenital cardiac catheter-based interventions.
  
  
  METHODS
  Radiation dose data were reviewed on all cases since 7/1/05 at a single large center. Procedures were classified according to 20 common case types then subdivided into five age categories. Groups with <20 cases were excluded. Radiation dose was estimated by cumulative air KERMA (mGy) and DAP (dose area product, μGym(2)) which were reported as median and interquartile range (IQR). We also examined differences in radiation dose before and after the implementation of a radiation policy.
  
  
  RESULTS
  Between 7/1/05 and 12/10/08, 3,365 cases were identified for inclusion. Radiation dose increased with age and procedural complexity. Patients were characterized into low, medium, and high dose categories relative to each other. "Low" dose cases included isolated pulmonary or aortic valvotomy, pre-Fontan assessment, and ASD closure. "High" dose cases involved multiple procedures in pulmonary arteries or veins. After introduction of a radiation policy, there was a significant decrease in radiation dose across a variety of case types, particularly among infants and young children.
  
  
  CONCLUSIONS
  Radiation dose in congenital cardiac catheterization varies by age and procedure type. A radiation monitoring and notification policy may have contributed to reduced radiation dose.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: George R
authors.initials: GR
authors.lastname: Verghese
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Strauss
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy / Q000592:standards*; D006291:Health Policy; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007755:Laboratories, Hospital; D008297:Male; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors