Wong-Siegel Jeannette R, Glatz Andrew C, Zampi Jeffrey D, McCracken Courtney E, Zhang Yun, Goldstein Bryan H, O'Byrne Michael L, Shahanavaz Shabana, Law Mark A, Evans Teresa, Qureshi Athar M, Petit Christopher J, Downing Tacy, Lee Choonsik
New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Vagelos College of Physicians & Surgeons, New York NY.
The Heart Center, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO.
Radiat Phys Chem Oxf Engl 1993. 2026 Jan;238. doi: 10.1016/j.radphyschem.2025.113097. Epub 2025 Jun 23.
Children with congenital heart disease (CHD) undergo procedures requiring ionizing radiation (IR). Estimation of organ-level radiation exposure is difficult due to differences in patient size and other technical parameters. Here, we utilized a dosimetry tool to estimate organ-level radiation doses from a sample of cardiac catheterizations performed in a neonatal cohort with tetralogy of Fallot (TOF), the most common form of cyanotic CHD, requiring early intervention.
An organ dose calculation program, the National Cancer Institute dosimetry system for Radiography and Fluoroscopy (NCIRF), was utilized to estimate absolute organ radiation doses (mGy) and effective dose (mSv). Beam spectra, exposure field configuration, distance from and direction of the X-ray beam, isocenter location, and dose-area-product (DAP, Gy-cm2) for each patient were used as input parameters for organ dose calculations collected from a multi-center clinical research collaborative.
Median posterior-to-anterior (PA) and lateral DAP from 44 cardiac catheterizations was 74.8 and 38.0 Gy-cm, respectively. Median effective dose was 1.35 mSv and 0.74 for PA and lateral projections, respectively. Organ doses were highest in the PA view for spinal cord (4.71 mGy), adrenal glands (4.26 mGy), and lung (3.90 mGy). Organ dose was highest for breast in the lateral view (2.8 mGy).
This is the first description of organ doses from cardiac catheterizations in a neonatal TOF population and will help to define the potential contribution of early childhood IR exposure to long-term radiation-related complications. As other neonates without TOF undergo similar interventions, these estimations may identify other CHD populations at risk for higher IR exposure, assist in quality improvement measures to reduce IR exposure in current clinical practice, and influence clinical pathway decision-making in this vulnerable population.
患有先天性心脏病（CHD）的儿童需接受使用电离辐射（IR）的手术。由于患者体型及其他技术参数存在差异，因此难以估算器官层面的辐射暴露量。在此，我们使用一种剂量测定工具，对患有法洛四联症（TOF）的新生儿队列进行的心脏导管插入术样本中的器官层面辐射剂量进行估算。TOF是青紫型CHD最常见的形式，需要早期干预。
使用一种器官剂量计算程序，即美国国家癌症研究所放射摄影和荧光透视剂量测定系统（NCIRF），来估算绝对器官辐射剂量（mGy）和有效剂量（mSv）。将每位患者的射束光谱、照射野配置、X射线束的距离和方向、等中心位置以及剂量面积乘积（DAP，Gy-cm²）用作从多中心临床研究协作中收集的器官剂量计算的输入参数。
44例心脏导管插入术的前后位（PA）和侧位DAP中位数分别为74.8和38.0 Gy-cm。PA位和侧位投照的有效剂量中位数分别为1.35 mSv和0.74 mSv。脊髓（4.71 mGy）、肾上腺（4.26 mGy）和肺（3.90 mGy）在PA位投照时器官剂量最高。乳房在侧位投照时器官剂量最高（2.8 mGy）。
这是首次对新生儿TOF人群心脏导管插入术的器官剂量进行描述，将有助于明确儿童早期IR暴露对长期辐射相关并发症的潜在影响。由于其他非TOF的新生儿也会接受类似干预，这些估算可能会识别出其他IR暴露风险较高的CHD人群，有助于采取质量改进措施以减少当前临床实践中的IR暴露，并影响这一脆弱人群的临床路径决策。
