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Pediatr Cardiol. 2019 Mar;40(3):638-649. doi: 10.1007/s00246-018-2039-9. Epub 2018 Dec 12.

Reducing Radiation Exposure in Cardiac Catheterizations for Congenital Heart Disease.

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Pediatric Cardiology, Yale School of Medicine, 333 Cedar St, LLCI 302, New Haven, CT, 06510, USA.
Pediatrics, Yale School of Medicine, New Haven, CT, USA.
Department of Pediatrics, Yale University, New Haven, CT, USA.
Pediatric Cardiology, Yale School of Medicine, 333 Cedar St, LLCI 302, New Haven, CT, 06510, USA.


Ionizing radiation exposure is a necessary risk entailed during congenital cardiac catheterizations. The congenital catheterization lab at Yale New Haven Children's Hospital employed quality improvement strategies to minimize radiation exposure in this vulnerable population. In two phases, we implemented six interventions, which included adding and utilizing lower fluoroscopy and digital angiography (DA) doses, increasing staff and physician radiation awareness, focusing on tighter collimation, and changing the default fluoroscopy and DA doses to lower settings. Post-intervention data were collected prospectively for all procedures in the congenital catheterization lab and compared to pre-intervention radiation data collected retrospectively. Radiation exposure was measured in total air kerma (mGy), dose area product per body weight (DAP/kg) (µGy m2/kg), and fluoroscopy time (min). Data were collected for a total of 312 cases. In considering all procedures, the DAP/kg decreased by 67.6% and air kerma decreased by 63%. Fluoroscopy time did not change over the study period. Significant decreases in radiation exposure (DAP/kg) by procedure type were seen for atrial septal defect, patent ductus arteriosus, and transcatheter pulmonary valve procedures with a 45%, 42% and 83% decrease, respectively. Air kerma decreased significantly for ASD and PDA procedures with an 80% and 72% decrease, respectively. When compared to national benchmarks, the median DAP/kg and air kerma for these procedures are lower at our institution. The decreases continue to be sustained 2 years post-interventions. Systems-based interventions can be readily implemented in the congenital cardiac catheterization lab with dramatic and sustainable radiation dose reduction for patients.


Congenital heart disease; Pediatric catheterization; Radiation exposure

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