title: Reducing Fluoroscopic Radiation Exposure During Endomyocardial Biopsy in Pediatric Transplant Recipients.
abstract: Endomyocardial biopsy (EMB) with fluoroscopy is used for rejection surveillance in pediatric heart transplantation. Lowering frame rate may reduce radiation, but decreases temporal resolution and image quality. We undertook a quality initiative reducing frame rate from 10 frames per second (FPS) to 5 FPS. To assess whether lowering frame rate can reduce radiation exposure without compromising safety, data on EMBs from 9/2009 to 4/2013 without angiography or intervention were reviewed. Effective dose was calculated from dose area product (DAP) and fluoroscopy time. Complications were reviewed. Independent t test compared pre- and post-data and a general linear model were used to control for confounders. Paired t test of most proximate data was used for pts with EMB before and after our change. Eighty-six patients had 543 EMB. After adjusting for weight, attending, and presence of a fellow, the lower FPS group had a 60.3% reduction in DAP (p < 0.0001) and 53.8% drop in effective dose (p < 0.0001). Fluoroscopy time did not differ. Twenty-eight pts had EMBs both before and after the FPS change. Pair-wise analysis of this group demonstrated a 33% reduction in DAP (p < 0.05) and 37% drop in effective dose (p < 0.01), without difference in fluoroscopy time. No patient had an increase in TR > 1 grade by ECHO. There were no deaths or perforations. Lowering the frame rate reduces radiation exposure by >50% without compromising safety. Efforts to further minimize radiation exposure of this vulnerable population should be considered.
authors.affiliation: Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, 225 E Chicago Ave Box 21, Chicago, IL, 60611, USA. JGossett@alumni.princeton.edu.|Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. JGossett@alumni.princeton.edu.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Gossett
authors.affiliation: Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, 225 E Chicago Ave Box 21, Chicago, IL, 60611, USA.|Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Sammet
authors.affiliation: Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, 225 E Chicago Ave Box 21, Chicago, IL, 60611, USA.|Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Anya
authors.initials: A
authors.lastname: Agrawal
authors.affiliation: Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, 225 E Chicago Ave Box 21, Chicago, IL, 60611, USA.|Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Rychlik
authors.affiliation: Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, 225 E Chicago Ave Box 21, Chicago, IL, 60611, USA.|Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Wax
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000706:statistics & numerical data; D006328:Cardiac Catheterization; D002648:Child; D057286:Electronic Health Records; D005260:Female; D005471:Fluoroscopy; D016027:Heart Transplantation; D006801:Humans; D016014:Linear Models; D008297:Male; D009206:Myocardium / Q000473:pathology; D010372:Pediatrics; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D014481:United States
keywords: Biopsy; Catheterization; Children; Fluoroscopy; Heart transplant; Radiation