title: X-ray magnetic resonance fusion modality may reduce radiation exposure and contrast dose in diagnostic cardiac catheterization of congenital heart disease.
abstract: BACKGROUND
  Radiation exposure in the pediatric population may increase the risk of future malignancy. Children with congenital heart disease who often undergo repeated catheterizations are at risk. One possible strategy to reduce radiation is to use X-ray Magnetic Resonance Fusion (XMRF) to facilitate cardiac catheterization.
  
  
  METHODS
  Catheterization data of patients who underwent diagnostic XMRF procedures between January 1, 2009 and February 1, 2012 were reviewed. Cases were matched 1:1 to contemporary controls who did not undergo XMRF based on weight and diagnosis and were compared in radiation exposure, contrast dose, and procedural and anesthesia times.
  
  
  RESULTS
  Forty-four matched pairs were included. Baseline demographics were similar in both groups. Patients in the XMRF group had lower indices of radiation exposure measured by fluoroscopy time (14 vs. 16.4 vs. P = 0.047), dose-area product from fluoroscopy (513.2 vs. 589.1 µGy·m(2) , P = 0.042), total dose-area product (625.8 vs. 995.2 µGy·m(2) , P = 0.027), and total air kerma dose (94.5 vs. 153.8 mGy, P = 0.017). There was also a significant reduction in contrast dose (2 vs. 3.3 cc/kg, P <0.001). Procedural time tended to be shorter in the XMRF group but anesthesia time was significantly longer.
  
  
  CONCLUSIONS
  Select diagnostic cardiac catheterization cases that utilized XMRF used less radiation and contrast than similar cases where XMRF was not used. Future work is needed to determine whether similar benefits can be extended to other types of diagnostic and complex interventional procedures.
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Anas A
authors.initials: AA
authors.lastname: Abu Hazeem
authors.forename: Yoav
authors.initials: Y
authors.lastname: Dori
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Whitehead
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fogel
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gillespie
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011829:Radiation Dosage; D011830:Radiation Effects; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011834:Radiation Monitoring; D011835:Radiation Protection / Q000379:methods*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014965:X-Rays / Q000009:adverse effects
chemical_list: D003287:Contrast Media
keywords: cardiac MRI; pediatric interventions