title: Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi-center C3PO-QI study.
abstract: OBJECTIVE
  This study sought to update benchmark values to use a quality measure prospectively.
  
  
  BACKGROUND
  Congenital Cardiac Catheterization Outcomes Project - Quality Improvement (C3PO-QI), a multi-center registry, defined initial radiation dose benchmarks retrospectively across common interventional procedures. These data facilitated a dose metric endorsed by the American College of Cardiology in 2014.
  
  
  METHODS
  Data was collected prospectively by 9 C3PO-QI institutions with complete case capture between 1/1/2014 and 6/30/2015. Radiation was measured in total air kerma (mGy), dose area product (DAP) (µGy*M2), DAP per body weight, and fluoroscopy time (min), and reported by age group as median, 75thand 95th%ile for the following six interventional procedures: (1) atrial septal defect closure; (2) aortic valvuloplasty; (3) treatment of coarctation of the aorta; (4) patent ductus arteriosus closure; (5) pulmonary valvuloplasty; and (6) transcatheter pulmonary valve implantation.
  
  
  RESULTS
  The study was comprised of 1,680 unique cases meeting inclusion criteria. Radiation doses were lowest for pulmonary valvuloplasty (age <1 yrs, median mGy: 59, DAP: 249) and highest in transcatheter pulmonary valve implantation (age >15 yrs, median mGy: 1835, DAP: 17990). DAP/kg standardized outcome measures across weights within an age group and procedure type significantly more than DAP alone. Radiation doses decreased for all procedures compared to those reported previously by both median and median weight-based percentile curves. These differences in radiation exposure were observed without changes in median fluoroscopy time.
  
  
  CONCLUSIONS
  This study updates previously established benchmarks to reflect QI efforts over time. These thresholds can be applied for quality measurement and comparison. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Priscila C
authors.initials: PC
authors.lastname: Cevallos
authors.affiliation: Department of Cardiology, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Armstrong
authors.affiliation: Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.affiliation: Department of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Goldstein
authors.affiliation: Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Gudausky
authors.affiliation: Department of Cardiology, Kosair Children's Hospital, Louisville, Kentucky.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Leahy
authors.affiliation: Department of Cardiology, Children's Healthcare of Atlanta Sibley Heart Center, Atlanta.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
authors.affiliation: Division of Pediatric Cardiology, St. Louis Children's Hospital, St. Louis, Missouri.
authors.forename: Shabana
authors.initials: S
authors.lastname: Shahanavaz
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Trucco
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Lisa J
authors.initials: LJ
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; D008297:Male; D061214:Patient Safety / Q000592:standards; D010372:Pediatrics / Q000592:standards*; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control / Q000592:standards*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000592:standards*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
keywords: angiographic/fluoroscopic; comparative effectiveness/patient centered outcomes research; congenital heart disease; health care outcomes; imaging; pediatric intervention; pediatrics