Quantification of Temporal, Procedural, and Hardware-Related Factors Influencing Radiation Exposure During Pediatric Cardiac Catheterization

Purpose
To quantify the impact of relocation to a purpose built pediatric cardiac catheterization laboratory, on patient radiation dose and fluoroscopy time. To provide guide values for radiation exposure during common structural interventions.

Material and methods
Design: A retrospective review of common structural cardiac interventions performed over 10-years. The era comprised two 5-year periods before and after relocation using different catheter laboratories. Multivariable analysis adjusted for the following variables: era (pre- and post-move), year, operator seniority, patient age, procedure type. Setting: A quaternary referral congenital cardiac centre. Patients: All patients <18 yrs (n = 756) in whom one of 6 common structural interventions were undertaken between 2000 and 2009. Main outcome measures: Radiation dose and fluoroscopy time.

Results
The move to the new laboratory (latter era) was associated with a dramatic reduction in multivariable-adjusted radiation dose, ranging from 64% (aortic coarctation stenting) to 87% (patent arterial duct closure). There was also a year upon year increase in radiation dose of 5.2% [95% confidence interval (CI): 0.6–10.0%], which persisted after the relocation. However, this was associated with a 5.1% yearly decrease in fluoroscopy time (95% CI: −7.9 to −2.2%).

Conclusion
Use of state-of-the-art catheter equipment is associated with a dramatic reduction in radiation exposure. However, the surprising finding of year upon year increase in exposure (despite the new equipment) combined with decreased fluoroscopy time suggests a temporal decrease in hardware efficiency. This has major implications for hardware replacement.