title: Direct physician reporting is associated with reductions in radiation exposure in pediatric cardiac catheterizations.
abstract: OBJECTIVE
  The objective is to quantify radiation dose in children undergoing cardiac catheterization and determine the impact of increased reporting transparency on total radiation exposure.
  
  
  BACKGROUND
  Cardiac catheterization (cath) can result in significant radiation exposure in children. There has been growing interest in quantifying and reducing radiation exposure in pediatric cath procedures. Our center underwent a slight change in practice recently that resulted in direct physician reporting of radiation dose following every case.
  
  
  METHODS
  We reviewed cath procedures across three different eras in four cath categories: post-heart transplant annual cath, unilateral pulmonary artery (PA) stent placement, pre-Fontan cath, and pre-Glenn cath. The eras were defined as: Era 1, 1/2009-1/2011; Era 2, 1/2011-9/2013; and Era 3, 9/2013-5/2014. In Era 3, the physician performing the cath was responsible for reporting the radiation data.
  
  
  RESULTS
  Across the three eras, there were significant decreases in cumulative air KERMA (mGy) among all four cath categories. From Era 2 to Era 3, the greatest decreases in radiation were noted, particularly in dose area product (cGy·cm2) in the transplant annual evaluation and pre-Glenn cases. In Era 1, 2 cases (1.2%) had a frame rate reduction, while in Era 2, 22 cases (12.0%), and in Era 3, 83 cases (21.6%) had frame rate changes (P<0.01).
  
  
  CONCLUSIONS
  Increased physician awareness of radiation exposure is associated with a significant reduction in radiation dose across a variety of cath procedures. This is seen not only by the overall reduction in radiation across case types, but also as the frame rate was more frequently changed during individual cases, indicating an important change in physician behavior and practice.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia.
authors.forename: George T
authors.initials: GT
authors.lastname: Nicholson
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Gao
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Sung In
authors.initials: SI
authors.lastname: Kim
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Vincent
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Balfour
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001291:Attitude of Health Personnel; D006328:Cardiac Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000009:adverse effects; D005845:Georgia; D007722:Health Knowledge, Attitudes, Practice; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007223:Infant; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011834:Radiation Monitoring / Q000379:methods*; D011835:Radiation Protection; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: adaptive; behavior; congenital heart defects; pediatrics