title: Use of a dose-dependent follow-up protocol and mechanisms to reduce patients and staff radiation exposure in congenital and structural interventions.
abstract: BACKGROUND
  Increasingly complex structural/congenital cardiac interventions require efforts at reducing patient/staff radiation exposure. Standard follow-up protocols are often inadequate in detecting all patients that may have sustained radiation burns.
  
  
  METHODS
  Single-center retrospective chart review divided into four intervals. Phase 1 (07/07-06/08, 413 procedures (proc)): follow-up based on fluoroscopy time only; frame rate for digital acquisition (DA) 30 fps, and fluoroscopy (FL) 30 fps. Dose-based follow-up was used for phase 2-4. Phase 2 (07/08-08/09, 458 proc): DA: 30 fps, FL: 15 fps. Phase 3 (09/09-06/10, 350 proc): DA: 15-30 fps, FL: 15 fps, use of added radiation protection drape. Phase 4 (07/10-10/10, 89 proc): DA: 15-30 fps, FL: 15 fps, superior noise reduction filter (SNRF) with high-quality fluoro-record capabilities.
  
  
  RESULTS
  There was a significant reduction in the median cumulative air kerma between the four study periods (710 mGy vs. 566 mGy vs. 498 mGy vs. 241 mGy, P < 0.001), even though the overall fluoroscopy times remained very similar (25 min vs. 26 min vs. 26 min vs. 23 min, P = 0.957). There was a trend towards lower physician radiation exposure over the four study periods (137 mrem vs. 126 mrem vs. 108 mrem vs. 59 mrem, P = 0.15). Fifteen patients with radiation burns were identified during the study period. When changing to a dose-based follow-up protocol (phase 1 vs. phase 2), there was a significant increase in the incidence of detected radiation burns (0.5% vs. 2%, P = 0.04).
  
  
  CONCLUSIONS
  Dose-based follow-up protocols are superior in detecting radiation burns when compared to fluoroscopy time-based protocols. Frame rate reduction of fluoroscopy and cine acquisition and use of modified imaging equipment can achieve a significant reduction to patient/staff exposure.
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA.
authors.forename: Jaclynn M
authors.initials: JM
authors.lastname: Sawdy
authors.forename: Tanya Maria
authors.initials: TM
authors.lastname: Kempton
authors.forename: Vincent
authors.initials: V
authors.lastname: Olshove
authors.forename: Mark
authors.initials: M
authors.lastname: Gocha
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Chisolm
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hill
authors.forename: Amy
authors.initials: A
authors.lastname: Kirk
authors.forename: John P
authors.initials: JP
authors.lastname: Cheatham
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Holzer
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D004307:Dose-Response Relationship, Radiation; D005471:Fluoroscopy / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control*; D016273:Occupational Exposure; D009820:Ohio; D011829:Radiation Dosage; D011855:Radiodermatitis / Q000209:etiology / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors