Standardizing radiation dose reporting in the pediatric cardiac catheterization laboratory - A multicenter study by the CCISC (congenital cardiovascular interventional study consortium)

Objectives: We examine normalized air Kerma area product (P_KA) by body weight (P_KA/BW) as a reference value of radiation dose and benchmark P_KA/BW in pediatric laboratories using a multicenter registry database.

Background: Reduction of radiation dose is an important quality improvement task in pediatric cardiac catheterization laboratories. Physicians need to agree on a standard method of reporting radiation dose that would allow comparisons to be made between operators and institutions.

Methods: This was a multicenter observational study of radiation dose in pediatric laboratories. Patient demographic, procedural and radiation data including fluoroscopic time and P_KA (μGy m²) were analyzed. P_KA/BW was obtained by indexing P_KA to body weight.

Results: A total of 8,267 pediatric catheterization procedures (age <18 years) were included from 16 institutions. The procedures consisted of diagnostic (n = 2,827), transplant right ventricular (RV) biopsy (n =1,172), and interventional catheterizations (n=4268). P_KA correlated with body weight better than with age and best correlated with weight-fluoroscopic time product. P_KA/BW showed consistent values across pediatric ages. Interventional catheterizations had the highest P_KA/BW (50th, 75th, and 90th percentiles:72, 151, and 281 μGy m²/kg), followed by diagnostic (59, 105, and 175 μGy m²/kg) and transplant RV biopsy (27, 79, and 114 μGy m²/kg).

Conclusion: P_KA/BW appeared to be the most reliable standard to report radiation dose across all procedure types and patient age. We recommend P_KA/BW to be used as the standard unit in documenting radiation usage in pediatric laboratories and can be used to evaluate strategies to lower radiation dosage in pediatric patients undergoing cardiac catheterizations.