Dose Optimization in Pediatric Cardiology

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

PURPOSE The number of pediatric interventional cardiology (PIC) procedures being performed has increased rapidly in recent years due to their reliability and cost effectiveness. However, interventional cardiology procedures have been reported to contribute to the highest doses of radiation to patients from medical examinations. Previous authors have estimated DRL for PIC and identified a wide variation of radiation exposure to the patient. METHOD AND MATERIALS A questionnaire study was used to investigate the PIC protocols currently used in clinical departments. Experimental studies were performed on anthropomorphic phantoms investigating these different variations in practice and the subsequent effect on image quality and radiation dose. A subsequent randomised controlled trial investigating these different protocols and their effect on image quality and dose is currently ongoing in the clinical environment. The effect of different scatter removal techniques on radiation dose and associated DNA damage was also investigated by quantifying γH2AX-foci as a biomarker of radiation-induced effect. RESULTS Wide variations in imaging protocols are currently being used across different hospitals. These variations in practice are having a significant impact on the resultant radiation dose to the patient. Results of experimental studies on anthropomorphic phantoms showed that radiation dose reductions of 30% to 50% could be achieved by removing the anti-scatter grid, introducing an air gap and decreasing the frame rate with minimal impact on image quality. Radiation induced DNA damage is evident in patients undergoing PIC procedures and mean γH2AX-foci can be significantly greater in different hospitals depending on the protocol used. CONCLUSION Great variation in radiation exposure exists across hospitals performing similar examinations on similar sized patients. There is a clear need for standardised protocols and guidelines.The anti-scatter grid should be removed routinely for newborn and infant patients undergoing PIC. The air gap should be introduced when possible. CLINICAL RELEVANCE/APPLICATION Simple modifications to clinical protocols will ensure the radiation dose to pediatric patients is kept ALARA without affecting image quality or diagnostic efficacy.Close
LanguageEnglish
Title of host publicationUnknown Host Publication
Number of pages1
Publication statusPublished - 1 Dec 2015
EventRSNA -
Duration: 1 Dec 2015 → …

Conference

ConferenceRSNA
Period1/12/15 → …

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Cardiology
Radiation
Pediatrics
DNA Damage
Air
Radiation Effects
Clinical Protocols
Cost-Benefit Analysis
Randomized Controlled Trials
Biomarkers
Newborn Infant
Guidelines

Keywords

  • dose optimisation
  • paedaitrics

Cite this

McFadden, S. L. (2015). Dose Optimization in Pediatric Cardiology. In Unknown Host Publication
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title = "Dose Optimization in Pediatric Cardiology",
abstract = "PURPOSE The number of pediatric interventional cardiology (PIC) procedures being performed has increased rapidly in recent years due to their reliability and cost effectiveness. However, interventional cardiology procedures have been reported to contribute to the highest doses of radiation to patients from medical examinations. Previous authors have estimated DRL for PIC and identified a wide variation of radiation exposure to the patient. METHOD AND MATERIALS A questionnaire study was used to investigate the PIC protocols currently used in clinical departments. Experimental studies were performed on anthropomorphic phantoms investigating these different variations in practice and the subsequent effect on image quality and radiation dose. A subsequent randomised controlled trial investigating these different protocols and their effect on image quality and dose is currently ongoing in the clinical environment. The effect of different scatter removal techniques on radiation dose and associated DNA damage was also investigated by quantifying γH2AX-foci as a biomarker of radiation-induced effect. RESULTS Wide variations in imaging protocols are currently being used across different hospitals. These variations in practice are having a significant impact on the resultant radiation dose to the patient. Results of experimental studies on anthropomorphic phantoms showed that radiation dose reductions of 30{\%} to 50{\%} could be achieved by removing the anti-scatter grid, introducing an air gap and decreasing the frame rate with minimal impact on image quality. Radiation induced DNA damage is evident in patients undergoing PIC procedures and mean γH2AX-foci can be significantly greater in different hospitals depending on the protocol used. CONCLUSION Great variation in radiation exposure exists across hospitals performing similar examinations on similar sized patients. There is a clear need for standardised protocols and guidelines.The anti-scatter grid should be removed routinely for newborn and infant patients undergoing PIC. The air gap should be introduced when possible. CLINICAL RELEVANCE/APPLICATION Simple modifications to clinical protocols will ensure the radiation dose to pediatric patients is kept ALARA without affecting image quality or diagnostic efficacy.Close",
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McFadden, SL 2015, Dose Optimization in Pediatric Cardiology. in Unknown Host Publication. RSNA, 1/12/15.

Dose Optimization in Pediatric Cardiology. / McFadden, S. L.

Unknown Host Publication. 2015.

Research output: Chapter in Book/Report/Conference proceedingConference contribution

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N2 - PURPOSE The number of pediatric interventional cardiology (PIC) procedures being performed has increased rapidly in recent years due to their reliability and cost effectiveness. However, interventional cardiology procedures have been reported to contribute to the highest doses of radiation to patients from medical examinations. Previous authors have estimated DRL for PIC and identified a wide variation of radiation exposure to the patient. METHOD AND MATERIALS A questionnaire study was used to investigate the PIC protocols currently used in clinical departments. Experimental studies were performed on anthropomorphic phantoms investigating these different variations in practice and the subsequent effect on image quality and radiation dose. A subsequent randomised controlled trial investigating these different protocols and their effect on image quality and dose is currently ongoing in the clinical environment. The effect of different scatter removal techniques on radiation dose and associated DNA damage was also investigated by quantifying γH2AX-foci as a biomarker of radiation-induced effect. RESULTS Wide variations in imaging protocols are currently being used across different hospitals. These variations in practice are having a significant impact on the resultant radiation dose to the patient. Results of experimental studies on anthropomorphic phantoms showed that radiation dose reductions of 30% to 50% could be achieved by removing the anti-scatter grid, introducing an air gap and decreasing the frame rate with minimal impact on image quality. Radiation induced DNA damage is evident in patients undergoing PIC procedures and mean γH2AX-foci can be significantly greater in different hospitals depending on the protocol used. CONCLUSION Great variation in radiation exposure exists across hospitals performing similar examinations on similar sized patients. There is a clear need for standardised protocols and guidelines.The anti-scatter grid should be removed routinely for newborn and infant patients undergoing PIC. The air gap should be introduced when possible. CLINICAL RELEVANCE/APPLICATION Simple modifications to clinical protocols will ensure the radiation dose to pediatric patients is kept ALARA without affecting image quality or diagnostic efficacy.Close

AB - PURPOSE The number of pediatric interventional cardiology (PIC) procedures being performed has increased rapidly in recent years due to their reliability and cost effectiveness. However, interventional cardiology procedures have been reported to contribute to the highest doses of radiation to patients from medical examinations. Previous authors have estimated DRL for PIC and identified a wide variation of radiation exposure to the patient. METHOD AND MATERIALS A questionnaire study was used to investigate the PIC protocols currently used in clinical departments. Experimental studies were performed on anthropomorphic phantoms investigating these different variations in practice and the subsequent effect on image quality and radiation dose. A subsequent randomised controlled trial investigating these different protocols and their effect on image quality and dose is currently ongoing in the clinical environment. The effect of different scatter removal techniques on radiation dose and associated DNA damage was also investigated by quantifying γH2AX-foci as a biomarker of radiation-induced effect. RESULTS Wide variations in imaging protocols are currently being used across different hospitals. These variations in practice are having a significant impact on the resultant radiation dose to the patient. Results of experimental studies on anthropomorphic phantoms showed that radiation dose reductions of 30% to 50% could be achieved by removing the anti-scatter grid, introducing an air gap and decreasing the frame rate with minimal impact on image quality. Radiation induced DNA damage is evident in patients undergoing PIC procedures and mean γH2AX-foci can be significantly greater in different hospitals depending on the protocol used. CONCLUSION Great variation in radiation exposure exists across hospitals performing similar examinations on similar sized patients. There is a clear need for standardised protocols and guidelines.The anti-scatter grid should be removed routinely for newborn and infant patients undergoing PIC. The air gap should be introduced when possible. CLINICAL RELEVANCE/APPLICATION Simple modifications to clinical protocols will ensure the radiation dose to pediatric patients is kept ALARA without affecting image quality or diagnostic efficacy.Close

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KW - paedaitrics

M3 - Conference contribution

BT - Unknown Host Publication

ER -

McFadden SL. Dose Optimization in Pediatric Cardiology. In Unknown Host Publication. 2015