Practice changes can reduce radiation exposure in pediatric cardiac cath lab

Issue: April 2015

Implementation of certain technical and clinical practice changes resulted in reduced patient and provider radiation exposure during pediatric cardiac catheterization procedures, according to data presented at Cardiology 2015: The 18th Annual Update on Pediatric and Congenital Cardiovascular Disease.

Perspective from David Goldberg, MD

Researchers at Children’s Mercy Hospital in Kansas City, Missouri, assessed the effect of technical and clinical practice changes made at their institution as part of an initiative to reduce exposure to ionizing radiation.

After a 30-day trial and implementation period, changes to the X-ray system and clinical practice were made as part of a quality improvement project to keep “as low as reasonably achievable” principles, said Nichole Gubbins, MD, a resident at Children’s Mercy. Changes included weight-based reductions in preset fluoroscopy and angiography frame rates, more consistent use of collimators and shields, and increased use of stored fluoroscopy and virtual magnification, according to the researchers.

Gubbins and colleagues analyzed cardiac catheterization procedures performed from 6 months before the changes were made (n = 164) to 8 months after implementation (n = 189). Electrophysiology and hybrid procedures, pericardiocentesis and biopsies were excluded. According to results presented, procedure mix (48% interventions before the changes; 52% interventions after the changes) and fluoroscopy times (before changes, 18.3 minutes; after changes, 19.8 minutes; P = .38) were not significantly different after the changes.

However, the mean cumulative skin dose of radiation fluoroscopy time declined from 91.3 cGy-cm²/min before the changes to 58.42 cGy-cm²/min after the changes (P = .02). The reduction was consistent across all age and weight subgroups.

The researchers also reported a 46% reduction in physician radiation exposure from 2011 to 2012.

“We were also able to show sustained improvement throughout” the study period, Gubbins said. – by Erik Swain

Reference:

Gubbins N, et al. Abstract 878. Presented at: Cardiology 2015: The 18th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 11-15, 2015; Scottsdale, Ariz.

Disclosure: Gubbins reports no relevant financial disclosures.

Perspective

David Goldberg, MD

Around the country, more and more centers are doing similar quality improvement projects. Everything we do in the medical world, in terms of testing, carries with it some element of risk or exposure for the patient. Radiation exposure should be monitored, and eliminated whenever possible. The cardiac cath lab is a place where patients can be exposed to relatively high doses of radiation, so a focus on figuring out how to reduce the radiation exposure can have real, profound, long-term positive consequences for our patients in terms of decreasing their risk for developing malignancies later on. That risk is quite low, but anything we can do to make it even lower is obviously of great benefit. The idea that people are paying attention to ways to limit radiation and other potentially noxious exposures in the medical world is important.

David Goldberg, MD

Attending Cardiologist, Children’s Hospital of Philadelphia

Disclosures: Goldberg reports no relevant financial disclosures.