title: Quantification of temporal, procedural, and hardware-related factors influencing radiation exposure during pediatric cardiac catheterization.
abstract: OBJECTIVE
  To quantify the impact of relocation to a purpose built pediatric cardiac catheterization laboratory, on patient radiation dose and fluoroscopy time. To provide guide values for radiation exposure during common structural interventions.
  
  
  METHODS
  
  
  
  METHODS
  A retrospective review of common structural cardiac interventions performed over 10-years. The era comprised two 5-year periods before and after relocation using different catheter laboratories. Multivariable analysis adjusted for the following variables: era (pre- and post-move), year, operator seniority, patient age, procedure type.
  
  
  METHODS
  A quaternary referral congenital cardiac centre.
  
  
  METHODS
  All patients <18 yrs (n = 756) in whom one of 6 common structural interventions were undertaken between 2000 and 2009.
  
  
  METHODS
  Radiation dose and fluoroscopy time.
  
  
  RESULTS
  The move to the new laboratory (latter era) was associated with a dramatic reduction in multivariable-adjusted radiation dose, ranging from 64% (aortic coarctation stenting) to 87% (patent arterial duct closure). There was also a year upon year increase in radiation dose of 5.2% [95% confidence interval (CI): 0.6-10.0%], which persisted after the relocation. However, this was associated with a 5.1% yearly decrease in fluoroscopy time (95% CI: -7.9 to -2.2%).
  
  
  CONCLUSIONS
  Use of state-of-the-art catheter equipment is associated with a dramatic reduction in radiation exposure. However, the surprising finding of year upon year increase in exposure (despite the new equipment) combined with decreased fluoroscopy time suggests a temporal decrease in hardware efficiency. This has major implications for hardware replacement.
authors.affiliation: Department of Paediatric Cardiology, Evelina Children's Hospital London, United Kingdom.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Smith
authors.forename: Shane M
authors.initials: SM
authors.lastname: Tibby
authors.forename: Shakeel A
authors.initials: SA
authors.lastname: Qureshi
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenthal
authors.forename: Thomas
authors.initials: T
authors.lastname: Krasemann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D002648:Child; D002675:Child, Preschool; D004739:England; D004867:Equipment Design; D004868:Equipment Failure; D005160:Facility Design and Construction; D005471:Fluoroscopy; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007755:Laboratories, Hospital; D016014:Linear Models; D015999:Multivariate Analysis; D011829:Radiation Dosage; D011834:Radiation Monitoring; D015641:Radiography, Interventional / Q000009:adverse effects*; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors