title: Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States.
abstract: OBJECTIVE
  The aim of this study was to define age-stratified, procedure-specific benchmark radiation dose levels during interventional catheterization for congenital heart disease.
  
  
  BACKGROUND
  There is a paucity of published literature with regard to radiation dose levels during catheterization for congenital heart disease. Obtaining benchmark radiation data is essential for assessing the impact of quality improvement initiatives for radiation safety.
  
  
  METHODS
  Data were obtained retrospectively from 7 laboratories participating in the Congenital Cardiac Catheterization Project on Outcomes collaborative. Total air kerma, dose area product, and total fluoroscopy time were obtained for the following procedures: 1) patent ductus arteriosus closure; 2) atrial septal defect closure; 3) pulmonary valvuloplasty; 4) aortic valvuloplasty; 5) treatment of coarctation of aorta; and 6) transcatheter pulmonary valve placement.
  
  
  RESULTS
  Between January 2009 and July 2013, 2,713 cases were identified. Radiation dose benchmarks are presented including median, 75th percentile, and 95th percentile. Radiation doses varied widely between age groups and procedure types. Radiation exposure was lowest in patent ductus arteriosus closure and highest in transcatheter pulmonary valve placement. Total fluoroscopy time was a poor marker of radiation exposure and did not correlate well with total air kerma and dose area product.
  
  
  CONCLUSIONS
  This study presents age-stratified radiation dose values for 6 common congenital heart interventional catheterization procedures. Fluoroscopy time alone is not an adequate measure for monitoring radiation exposure. These values will be used as baseline for measuring the effectiveness of future quality improvement activities by the Congenital Cardiac Catheterization Project on Outcomes collaborative.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Sunil J
authors.initials: SJ
authors.lastname: Ghelani
authors.affiliation: Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Sthuthi
authors.initials: S
authors.lastname: David
authors.affiliation: Division of Cardiology, University of Louisville, Louisville, Kentucky.
authors.forename: Ryan
authors.initials: R
authors.lastname: Leahy
authors.affiliation: Cincinnati Children's Medical Center, Cincinnati, Ohio.
authors.forename: Russel
authors.initials: R
authors.lastname: Hirsch
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Laurie B
authors.initials: LB
authors.lastname: Armsby
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Trucco
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Holzer
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: lisa.bergersen@cardio.chboston.org.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D019985:Benchmarking / Q000592:standards*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061214:Patient Safety / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D015641:Radiography, Interventional / Q000009:adverse effects / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States
keywords: congenital heart disease; quality improvement; radiation dose