Radiation exposure in patients with congenital heart disease varies widely among types of interventional procedures and age groups, according to a study published Sept. 15 in JACC: Cardiovascular Interventions. As such, fluoroscopy time alone is not an adequate measure for monitoring radiation exposure.

Additional Resources ACC's IMPACT Registry  Adult Congenital and Pediatric Cardiology Member Section

The study, based on 2,713 cases between January 2009 and July 2013 from seven laboratories participating in the Congenital Cardiac Catheterization Project on Outcomes collaborative, looked at total air kerma, dose area product, and total fluoroscopy time for six common congenital cardiology interventional procedures.  Of the six – patent ductus arteriosus closure, atrial septal defect closure, pulmonary valvuloplasty, aortic valvuloplasty, treatment of coarctation of aorta and transcatheter pulmonary valve placement – radiation doses varied widely between procedures and age groups.

According to the study investigators, patent ductus arteriosus closure measured the lowest radiation exposure and transcatheter pulmonary valve placement measured the highest. Total fluoroscopy time appeared to be a poor marker of radiation exposure and did not correlate well with total air kerma and dose area product.

The investigators recommend “the use of DAP and Ka,r, but not fluoroscopy time, as measures of radiation exposure that are readily available and have shown good correlation with effective radiation dose in patients.” They also suggest “following procedure-specific benchmarks over a common reference value for all interventional procedures.” They note that the benchmarks outlined in the study are meant to serve as a guide for interventional cardiologists attempting to achieve radiation doses as low as reasonably attainable.

"Reducing radiation exposure to patients (and staff) is a quality issue the demands attention," said Robert N. Vincent, MD, CM, FACC, chair of the IMPACT Registry Steering Committee. "This study sets benchmark data for specific procedures using measurements (air kerma and DAP) which correlate better with effective radiation dose than does fluoroscopy time. The Reducing Radiation Risk Quality Improvement program launched by ACC's IMPACT Registry not only collects data to allow comparison of physician and center data but through a series of webinars strives to further educate physicians on ways of minimizing radiation exposure without compromising the quality of the study. The goal is to reduce radiation by 25 percent in one year."

Keywords: Quality Improvement, Registries, Fluoroscopy, Heart Septal Defects, Atrial, Cardiac Catheterization, Reference Values, Pulmonary Valve, Radiation Dosage, Ductus Arteriosus, Patent

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