Lamers Luke J, Moran Martine, Torgeson Jenna N, Hokanson John S
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/516D Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA.
Pediatr Cardiol. 2016 Jan;37(1):24-9. doi: 10.1007/s00246-015-1233-2. Epub 2015 Jul 28.
The aims of this study were to quantify patient radiation exposure for a single interventional procedure during transition from an adult catheterization laboratory to a next-generation imaging system with pediatric settings, and to compare this radiation data to published benchmarks. Radiation exposure occurs with any X-ray-directed pediatric catheterization. Technologies and imaging techniques that limit dose while preserving image quality benefit patient care. Patient radiation dose metrics, air kerma, and dose-area product (DAP) were retrospectively obtained for patients <20 kg who underwent patent ductus arteriosus (PDA) closure on a standard imaging system (Group 1, n = 11) and a next-generation pediatric imaging system (Group 2, n = 10) with air-gap technique. Group 2 radiation dose metrics were then compared to published benchmarks. Patient demographics, procedural technique, PDA dimensions, closure devices, and fluoroscopy time were similar for the two groups. Air kerma and DAP decreased by 65-70% in Group 2 (p values <0.001). The average number of angiograms approached statistical significance (p value = 0.06); therefore, analysis of covariance (ANCOVA) was conducted that confirmed significantly lower dose measures in Group 2. This degree of dose reduction was similar when Group 2 data (Kerma 28 mGy, DAP 199 µGy m(2)) was compared to published benchmarks for PDA closure (Kerma 76 mGy, DAP 500 µGy m(2)). This is the first clinical study documenting the radiation reduction capabilities of a next-generation pediatric imaging platform. The true benefit of this dose reduction will be seen in patients requiring complex and often recurrent catheterizations.
本研究的目的是量化在从成人导管实验室过渡到具有儿科设置的下一代成像系统期间，单次介入手术中患者的辐射暴露情况，并将该辐射数据与已发表的基准进行比较。任何X射线引导的儿科导管插入术都会产生辐射暴露。在保持图像质量的同时限制剂量的技术和成像技术有利于患者护理。回顾性获取了体重<20 kg、在标准成像系统（第1组，n = 11）和采用气隙技术的下一代儿科成像系统（第2组，n = 10）上进行动脉导管未闭（PDA）封堵术的患者的辐射剂量指标、空气比释动能和剂量面积乘积（DAP）。然后将第2组的辐射剂量指标与已发表的基准进行比较。两组患者的人口统计学特征、手术技术、PDA尺寸、封堵装置和透视时间相似。第2组的空气比释动能和DAP降低了65 - 70%（p值<0.001）。血管造影的平均次数接近统计学显著性（p值 = 0.06）；因此，进行了协方差分析（ANCOVA），证实第2组的剂量测量值显著更低。当将第2组的数据（比释动能28 mGy，DAP 199 µGy m²）与已发表的PDA封堵基准（比释动能76 mGy，DAP 500 µGy m²）进行比较时，这种剂量降低程度相似。这是第一项记录下一代儿科成像平台辐射降低能力的临床研究。这种剂量降低的真正益处将在需要复杂且常常反复进行导管插入术的患者中显现出来。
