title: Cumulative exposure to medical radiation for children requiring surgery for congenital heart disease.
abstract: OBJECTIVE
  To describe cumulative radiation exposure in a large single-center cohort of children with congenital heart disease (CHD) and identify risk factors for greater exposure.
  
  
  METHODS
  A detailed medical radiation exposure history was collected retrospectively for patients aged <18 years who underwent surgery for CHD between January 1, 2001, and July 22, 2009. Cumulative per patient exposure was quantified as the effective dose in millisieverts (mSv) and annualized (mSv/year).
  
  
  RESULTS
  A total of 4132 patients were subjected to 134,715 radiation examinations at a median follow-up of 4.3 years (range, 0-8.6 years). Exposure clustered around the time of surgery. The median exposure was 14 radiologic tests (the majority of which were plain film radiographs) at an effective dose of 0.96 mSv (the majority of which was from cardiac catheterization), although this distribution had a very wide range. Almost three-quarters (73.7%) were exposed to <3 mSv/year, and 5.3% were exposed to >20 mSv/year. Neonates, children with genetic syndromes, and children requiring surgery for cardiomyopathy, pulmonary valve, single ventricle, or tricuspid valve diseases were more likely to have higher exposure levels, and those requiring surgery for aortic arch anomalies or atrioventricular septal defects were more likely to have lower levels.
  
  
  CONCLUSIONS
  Children with CHD requiring surgery are exposed to numerous medical forms of ionizing radiation. Although the majority of patients receive <3 mSv/year, there are identifiable risk factors for higher exposure levels. This may have important health implications as these patients age.
authors: Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors: Andrew C
authors: AC
authors: Glatz
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Kristen S
authors: KS
authors: Purrington
authors: New York University School of Medicine, New York, NY.
authors: Amanda
authors: A
authors: Klinger
authors: University of Pennsylvania, Philadelphia, PA.
authors: Amanda R
authors: AR
authors: King
authors: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Jeffrey
authors: J
authors: Hellinger
authors: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Xiaowei
authors: X
authors: Zhu
authors: Departments of Epidemiology, Internal Medicine, and Human Genetics, University of Michigan, Ann Arbor, MI.
authors: Stephen B
authors: SB
authors: Gruber
authors: Section of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, UT.
authors: Peter J
authors: PJ
authors: Gruber
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery*; D006331:Heart Diseases / Q000151:congenital* / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011829:Radiation Dosage; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors