Patient-Specific Dose and Radiation Risk Estimation in Pediatric Cardiac Catheterization

TLDR

Infants and children are more radiosensitive than adults, making dose evaluation in pediatric cardiac catheterization essential, and high exposure underscores the need for dose monitoring and filtration to minimize stochastic risk. The study aimed to estimate patient‑specific effective dose using Monte Carlo simulations in 60 congenital heart disease patients and to assess the dose‑saving effect of extra copper filtration. Effective dose was calculated with a patient‑specific Monte Carlo model for 28 diagnostic and 32 therapeutic catheterizations, and the impact of additional copper filtration on dose was evaluated. Median effective doses were 4.6 mSv for diagnostic and 6.0 mSv for therapeutic procedures, copper filtration reduced dose by 18 % without compromising image quality, dose‑area product correlated strongly with effective dose (r = 0.95), and the overall median lifetime stochastic risk was 0.08 %.

Abstract

Because of the higher radiosensitivity of infants and children compared with adults, there is a need to evaluate the doses delivered to pediatric patients who undergo interventional cardiac procedures. However, knowledge of the effective dose in pediatric interventional cardiology is very limited.For an accurate risk estimation, a patient-specific Monte Carlo simulation of the effective dose was set up in 60 patients with congenital heart disease who underwent diagnostic (n=28) or therapeutic (n=32) cardiac catheterization procedures. The dose-saving effect of using extra copper filtration in the x-ray beam was also investigated. For diagnostic cardiac catheterizations, a median effective dose of 4.6 mSv was found. Therapeutic procedures resulted in a higher median effective dose of 6.0 mSv because of the prolonged use of fluoroscopy. The overall effect of inserting extra copper filtration into the x-ray beam was a total effective dose reduction of 18% with no detrimental effect on image quality. An excellent correlation between the dose-area product and effective patient dose was found (r=0.95). Hence, dose-area product is suitable for online estimation of the effective dose with good accuracy. With all procedures included, the resulting median lifetime risk for stochastic effects was 0.08%.Because of the high radiation exposure, it is important to monitor patient dose by dose-area product instrumentation and to use additional beam filtration to keep the effective dose as low as possible in view of the sensitivity of the pediatric patients.