Ubeda Carlos, Miranda Patricia, Vano Eliseo
Medical Technology Department, Radiological Sciences Center, Health Sciences Faculty, Tarapaca University, Arica 1000000, Chile.
Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago 7500539, Chile.
Med Phys. 2015 Feb;42(2):615-622. doi: 10.1118/1.4905116.
To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency.
Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs.
Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm for <1 yr; 1.74 and 1.90 Gy cm for 1 to <5 yr; 2.83 and 3.22 Gy cm for 5 to <10 yr; and 7.34 and 8.68 Gy cm for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm /kg) for diagnostic and therapeutic procedures.
The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there may be large differences in child size. These DRLs were obtained at the largest pediatric hospital in Chile, with an active optimization program, and could be used by other hospitals in the Latin America region to compare their current patient dose values and determine whether corrective action is appropriate.
展示儿科心脏病学患者剂量评估项目的结果，针对不同类型的手术和年龄范围提出当地的诊断参考水平（DRLs），并建议将患者剂量值与患者体重相关联的方法。本研究是在国际原子能机构的支持下，拉丁美洲首次针对儿科介入心脏病学开展的研究。
在三年时间里，收集了以下关于人口统计学和患者剂量值的数据：年龄、性别、体重、身高、电影序列数量、电影帧数总数、透视时间（FT），以及在患者入口参考点的两个剂量学量，剂量面积乘积（DAP）和累积剂量（CD）。FT、DAP、CD、电影序列数量以及DAP/体重比的第三个四分位数被提议作为用作当地DRLs的一组量。
517名患者被分为四个年龄组。各年龄组的样本量分别为：<1岁组120例；1至<5岁组213例；5至<10岁组82例；10至<16岁组102例。按诊断和治疗程序以及年龄范围获得的DAP的第三个四分位数分别为：<1岁组1.17和1.11 Gy cm；1至<5岁组1.74和1.90 Gy cm；5至<10岁组2.83和3.22 Gy cm；10至<16岁组7.34和8.68 Gy cm。整个手术样本的DAP/体重比的第三个四分位数，诊断和治疗程序均为0.17（Gy cm /kg）。
本文所呈现的数据是在儿科介入心脏病学中建立当地DRLs的初步尝试，数据来源于欧洲使用的标准年龄组的大量手术样本，并辅以DAP与患者体重之比的值。这使得能够对不同患者体重的DRLs进行粗略估计，并在儿童体型可能存在较大差异的年龄组中对这些值进行细化。这些DRLs是在智利最大的儿科医院获得的，该医院有积极的优化项目，拉丁美洲地区的其他医院可以使用这些DRLs来比较其当前的患者剂量值，并确定是否需要采取纠正措施。
