Radiation Safety Improvement Program in Pediatric Cardiac Catheterization Laboratory (PCCL)

Abstract Description

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Authors (including presenting author) :

So KL(1), Chen HS(1), Chow PC(1), Pong HC(2), Au WK(1), Tsui PCB(1), Yung TC(1)

Affiliation :

(1)Department of Paediatric Cardiology, Queen Mary Hospital (2)Department of Radiology, Grantham Hospital

Introduction :

Cardiac catheterization procedures are commonly performed for congenital heart disease in children. In some patients repeated procedures may be required and they are exposed to high levels of radiation, which has potential hazardous impact on health and the well-being of both patients and the operating cardiologists. Therefore, minimizing radiation exposure is important during cardiac catheterization. In our Paediatric Cardiac Catheterization Laboratory, an improvement program was initiated in December 2017.

Objectives :

To reduce the radiation during cardiac catheterization based on ALARA (as low as reasonably achievable) principle.

Methodology :

1.The acquisition frame rate was reduced from 30 frames per sec to 15 frames per sec. 2.The X-ray beam was coned to the field of an adequate image for the procedures. 3.The data of 54 procedures (Patent Ductus Arteriosus (PDA) occlusion = 33, Atrial Septal Defect (ASD) occlusion = 21) before was compared to those of 64 procedures (PDA occlusion = 33, ASD occlusion = 31) after implementation of the program.

Result & Outcome :

1.For patients with PDA occlusion, age (2.52±2.59 years vs 2.53±2.14 years), body surface area (BSA) (0.51±0.19m2 vs 0.49±0.16m2) and sex ratio (M:F) (10:23 vs 15:18) were similar before and after implementation. The procedure time was similar before (60±39min) and after (63±26min) the implementation. The fluoroscopy time was also similar before (10±6min) and after (12±6min) implementation of the program. The mean dose area product (DAP) showed reducing trend (8.59±5.29Gycm2 vs 7.62±5.42Gycm2) before and after implementation (p=0.23). 2.For patients with ASD occlusion, age (8.55±3.47 years vs 9.16±3.51 years), BSA (0.75±0.25m2 vs 1.01±0.31m2) and sex ratio (M:F) (8:13 vs 13:18) before and after the program. The procedure time was similar before (57±18min) and after (60±22min) the implementation of the program. The fluoroscopy time was also similar before (14±7min) and after (15±7min) the implementation. The mean DAP showed decreasing trend (30.79±59.69 Gycm2 vs 22.34±19.10 Gycm2) after the implementation (p=0.27). 3.The radiation dose of PDA occlusion and ASD occlusion in our cohorts are similar to the Congenital Cardiac Catheterization Project on Outcomes database (Ghelani et al.,JACC 2014;7(9):1060-1069). 4.Image quality during the procedure was unaffected by implementation of the program. In conclusion, the radiation safety improvement program was conducted successfully to help reduce the radiation dosage without jeopardizing the duration of the procedure and image quality.