Finke Talya, Mainzer Gur, Yitzhak Yonatan, Devadas Sunder, Mroczek Dariusz, Benson Lee N, Borik Sharon
Safra Children's Hospital, Sheba Medical Center, and the Tel Aviv University, Tel Hashomer, Israel.
Department of Pediatrics, Division of Cardiology, the Labatt Family Heart Centre, the Hospital for Sick Children and the University of Toronto School of Medicine, Toronto, Ontario, Canada.
CJC Pediatr Congenit Heart Dis. 2024 May 31;3(4):129-136. doi: 10.1016/j.cjcpc.2024.05.004. eCollection 2024 Aug.
Radiation reduction is an integral component in the management of a paediatric cardiac catheterization laboratory. Simple and easily implementable protocol changes and technical upgrades have been shown to significantly reduce radiation exposure.
Radiation exposures (2020-2022) at Safra Children's Hospital, Sheba Medical Center, Israel (unit A: n = 672) were retrospectively reviewed, including dose area product (DAP) (μGy m), DAP/kg, Air Kerma (mGy), and fluoroscopy time (minutes) for 16 procedural types. Median doses were compared with those measured (2011-2014) at the Hospital for Sick Children, Toronto, Canada (unit B: n = 2033). Radiation reduction techniques included fluoroscopy acquisition at 7.5 frames/s, removal of antiscatter grids for children <30 kg, limiting field of view, use of Philips ClarityIQ technology, and an institutional culture of radiation mindedness.
Exposure was significantly lower in unit A in 14 of 16 procedure types. Total median doses were lower in unit A (DAP: 91.4 [44.7-205.4] vs 387 [138.2-1339] μGy m [ < 0.001], DAP/kg: 9.33 [4.3-16.4] vs 29.22 [12.8-65.9] μGy m/kg [ < 0.001], and Air Kerma: 14.9 [7.8-29] vs 61 [23-176.4] mGy [ < 0.001]) despite higher fluoroscopy time (14.1 [4.2-24.6] vs 12.3 [6.8-23.3] minutes [ = 0.03]). DAP was lower for specific procedures including pulmonary valvuloplasty (46.3 [14.3-219.3] vs 127 [60-323] μGy m [ < 0.001]) and patent ductus arteriosus closure (51.9 [18.8-111.8] vs 178 [96-410] μGy m [ < 0.001]).
Enhanced radiation reduction techniques can lead to lower than previously published exposure levels across a wide range of procedure types when employing dose-limiting protocols and radiation reduction technology.
减少辐射是儿科心脏导管实验室管理的一个重要组成部分。已证明简单且易于实施的方案更改和技术升级可显著减少辐射暴露。
回顾性分析了以色列谢巴医疗中心萨夫拉儿童医院（A组：n = 672）2020 - 2022年的辐射暴露情况，包括16种手术类型的剂量面积乘积（DAP）（μGy m）、DAP/kg、空气比释动能（mGy）和透视时间（分钟）。将中位数剂量与加拿大多伦多病童医院（B组：n = 2033）2011 - 2014年测量的剂量进行比较。辐射减少技术包括以7.5帧/秒的速度进行透视采集、为体重<30 kg的儿童移除防散射格栅、限制视野、使用飞利浦ClarityIQ技术以及培养注重辐射的机构文化。
在16种手术类型中的14种中，A组的暴露显著更低。A组的总中位数剂量更低（DAP：91.4 [44.7 - 205.4] 对比 387 [138.2 - 1339] μGy m [P < 0.001]，DAP/kg：9.33 [4.3 - 16.4] 对比 29.22 [12.8 - 65.9] μGy m/kg [P < 0.001]，空气比释动能：14.9 [7.8 - 29] 对比 61 [23 - 176.4] mGy [P < 0.001]），尽管透视时间更长（14.1 [4.2 - 24.6] 对比 12.3 [6.8 - 23.3] 分钟 [P = 0.03]）。特定手术的DAP更低，包括肺动脉瓣成形术（46.3 [14.3 - 219.3] 对比 127 [60 - 323] μGy m [P < 0.001]）和动脉导管未闭封堵术（51.9 [18.8 - 111.8] 对比 178 [96 - 410] μGy m [P < 0.001]）。
当采用剂量限制方案和辐射减少技术时，增强的辐射减少技术可使多种手术类型的暴露水平低于先前公布的水平。
