Impact of imaging approach on radiation dose and associated cancer risk in children undergoing cardiac catheterization.
OBJECTIVE
To quantify the impact of image optimization on absorbed radiation dose and associated risk in children undergoing cardiac catheterization.


BACKGROUND
Various imaging and fluoroscopy system technical parameters including camera magnification, source-to-image distance, collimation, antiscatter grids, beam quality, and pulse rates, all affect radiation dose but have not been well studied in younger children.


METHODS
We used anthropomorphic phantoms (ages: newborn and 5 years old) to measure surface radiation exposure from various imaging approaches and estimated absorbed organ doses and effective doses (ED) using Monte Carlo simulations. Models developed in the National Academies' Biological Effects of Ionizing Radiation VII report were used to compare an imaging protocol optimized for dose reduction versus suboptimal imaging (+20 cm source-to-image-distance, +1 magnification setting, no collimation) on lifetime attributable risk (LAR) of cancer.


RESULTS
For the newborn and 5-year-old phantoms, respectively ED changes were as follows: +157% and +232% for an increase from 6-inch to 10-inch camera magnification; +61% and +59% for a 20 cm increase in source-to-image-distance; -42% and -48% with addition of 1-inch periphery collimation; -31% and -46% with removal of the antiscatter grid. Compared with an optimized protocol, suboptimal imaging increased ED by 2.75-fold (newborn) and fourfold (5 years old). Estimated cancer LAR from 30-min of posteroanterior fluoroscopy using optimized versus suboptimal imaging, respectively was 0.42% versus 1.23% (newborn female), 0.20% versus 0.53% (newborn male), 0.47% versus 1.70% (5-year-old female) and 0.16% versus 0.69% (5-year-old male).


CONCLUSIONS
Radiation-related risks to children undergoing cardiac catheterization can be substantial but are markedly reduced with an optimized imaging approach. © 2016 Wiley Periodicals, Inc.
Division of Pediatric Cardiology, Department of Pediatrics (K.D.H., J.S.L, G.A.F.) and the Department of Radiology (C.W., T.Y., N.J., G.N.), Duke University Medical Center, Durham, North Carolina, and the Duke Clinical Research Institute (K.D.H., J.S.L.), Durham, North Carolina and the Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York NY (A.J.E.).
Kevin D
KD
Hill
Division of Pediatric Cardiology, Department of Pediatrics (K.D.H., J.S.L, G.A.F.) and the Department of Radiology (C.W., T.Y., N.J., G.N.), Duke University Medical Center, Durham, North Carolina, and the Duke Clinical Research Institute (K.D.H., J.S.L.), Durham, North Carolina and the Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York NY (A.J.E.).
Chu
C
Wang
Division of Pediatric Cardiology, Department of Pediatrics (K.D.H., J.S.L, G.A.F.) and the Department of Radiology (C.W., T.Y., N.J., G.N.), Duke University Medical Center, Durham, North Carolina, and the Duke Clinical Research Institute (K.D.H., J.S.L.), Durham, North Carolina and the Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York NY (A.J.E.).
Andrew J
AJ
Einstein
Division of Pediatric Cardiology, Department of Pediatrics (K.D.H., J.S.L, G.A.F.) and the Department of Radiology (C.W., T.Y., N.J., G.N.), Duke University Medical Center, Durham, North Carolina, and the Duke Clinical Research Institute (K.D.H., J.S.L.), Durham, North Carolina and the Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York NY (A.J.E.).
Natalie
N
Januzis
Division of Pediatric Cardiology, Department of Pediatrics (K.D.H., J.S.L, G.A.F.) and the Department of Radiology (C.W., T.Y., N.J., G.N.), Duke University Medical Center, Durham, North Carolina, and the Duke Clinical Research Institute (K.D.H., J.S.L.), Durham, North Carolina and the Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York NY (A.J.E.).
Giao
G
Nguyen
Division of Pediatric Cardiology, Department of Pediatrics (K.D.H., J.S.L, G.A.F.) and the Department of Radiology (C.W., T.Y., N.J., G.N.), Duke University Medical Center, Durham, North Carolina, and the Duke Clinical Research Institute (K.D.H., J.S.L.), Durham, North Carolina and the Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York NY (A.J.E.).
Jennifer S
JS
Li
Division of Pediatric Cardiology, Department of Pediatrics (K.D.H., J.S.L, G.A.F.) and the Department of Radiology (C.W., T.Y., N.J., G.N.), Duke University Medical Center, Durham, North Carolina, and the Duke Clinical Research Institute (K.D.H., J.S.L.), Durham, North Carolina and the Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York NY (A.J.E.).
Gregory A
GA
Fleming
Division of Pediatric Cardiology, Department of Pediatrics (K.D.H., J.S.L, G.A.F.) and the Department of Radiology (C.W., T.Y., N.J., G.N.), Duke University Medical Center, Durham, North Carolina, and the Duke Clinical Research Institute (K.D.H., J.S.L.), Durham, North Carolina and the Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York NY (A.J.E.).
Terry K
TK
Yoshizumi
D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology*; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D018570:Risk Assessment / Q000379:methods*; D014481:United States / Q000453:epidemiology
cancer lifetime attributable risk; effective dose; fluoroscopy; image optimization