title: Standardizing radiation dose reporting in the pediatric cardiac catheterization laboratory-a multicenter study by the CCISC (Congenital Cardiovascular Interventional Study Consortium).
abstract: OBJECTIVE
  We examine normalized air Kerma area product (PKA ) by body weight (PKA /BW) as a reference value of radiation dose and benchmark PKA /BW in pediatric laboratories using a multicenter registry database.
  
  
  BACKGROUND
  Reduction of radiation dose is an important quality improvement task in pediatric cardiac catheterization laboratories. Physicians need to agree on a standard method of reporting radiation dose that would allow comparisons to be made between operators and institutions.
  
  
  METHODS
  This was a multicenter observational study of radiation dose in pediatric laboratories. Patient demographic, procedural and radiation data including fluoroscopic time and PKA (µGy m(2) ) were analyzed. PKA /BW was obtained by indexing PKA to body weight.
  
  
  RESULTS
  A total of 8,267 pediatric catheterization procedures (age <18 years) were included from 16 institutions. The procedures consisted of diagnostic (n = 2,827), transplant right ventricular (RV) biopsy (n = 1,172), and interventional catheterizations (n = 4268). PKA correlated with body weight better than with age and best correlated with weight-fluoroscopic time product. PKA /BW showed consistent values across pediatric ages. Interventional catheterizations had the highest PKA /BW (50th, 75th, and 90th percentiles: 72, 151, and 281 μGy m(2) /kg), followed by diagnostic (59, 105, and 175 μGy m(2) /kg) and transplant RV biopsy (27, 79, and 114 μGy m(2) /kg).
  
  
  CONCLUSIONS
  PKA /BW appeared to be the most reliable standard to report radiation dose across all procedure types and patient age. We recommend PKA /BW to be used as the standard unit in documenting radiation usage in pediatric laboratories and can be used to evaluate strategies to lower radiation dosage in pediatric patients undergoing cardiac catheterizations. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.forename: Jeffery
authors.initials: J
authors.lastname: Meadows
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Forbes
authors.forename: Phillip
authors.initials: P
authors.lastname: Moore
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Javois
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pedra
authors.forename: Wei
authors.initials: W
authors.lastname: Du
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Gruenstein
authors.forename: David F
authors.initials: DF
authors.lastname: Wax
authors.forename: James A
authors.initials: JA
authors.lastname: Hill
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Graziano
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Fagan
authors.forename: Walter Mosquera
authors.initials: WM
authors.lastname: Alvarez
authors.forename: David G
authors.initials: DG
authors.lastname: Nykanen
authors.forename: Abhay A
authors.initials: AA
authors.lastname: Divekar
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization / Q000592:standards*; D016507:Cardiology Service, Hospital; D002648:Child; D002675:Child, Preschool; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007223:Infant; D007755:Laboratories, Hospital; D061214:Patient Safety; D010372:Pediatrics / Q000379:methods; D011829:Radiation Dosage; D011835:Radiation Protection / Q000592:standards*; D015641:Radiography, Interventional / Q000592:standards*; D012042:Registries; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors
keywords: air Kerma area product; body weight; multicenter study; pediatric cardiac catheterization laboratory; radiation dose