New Strategy Reduces Children's Radiation Exposure during Cardiac Procedures

A protocol that uses continuous real-time radiation monitoring, low-dose imaging programs, and requires physician awareness of radiation dose, considerably reduced radiation exposure during electrophysiology procedures and catheter ablations to diagnose and treat heart arrhythmias in children.

Invasive cardiac electrophysiology is used to diagnose and treat abnormal heart rhythms, or arrhythmias, which can vary from the benign to the life threatening.

In the study, researchers looked at boys and girls at an average age of 14.5 years who underwent electrophysiology procedures to diagnose and treat arrhythmias. In these procedures, doctors use fluoroscopy to guide visually catheters in the heart, which are inserted through blood vessels in the groin or neck that lead to the heart.

The disadvantage of this imaging is that it exposes patients to a continuous flow of radiation, according to Akash R. Patel, MD, lead author of the study and an electrophysiology fellow in the division of cardiology at the Children's Hospital of Philadelphia (PA, USA). "Radiation exposure in pediatric electrophysiology procedures is not insignificant. We compared the radiation exposure of 70 children who had undergone the procedures before we began the protocol to that of 61 children who had the procedures after we instituted the protocol.”

The new protocol uses a low dose fluoroscopy setting and continuous real-time monitoring of radiation exposure. When the radiation dose registers at specific levels, the physician is notified so that the fluoroscopy cameras may be adjusted to minimize exposure.

The researchers found considerably reduced radiation exposure among children whose procedures were done using the new protocol, including: 22% reduction in the time that the X-ray machine was on; 52% reduction in the dose of X-ray entering the skin, which helps to prevent skin injury; and 51% reduction in median effective dose, which correlates with the lifetime increased risk of cancer from radiation exposure.

"While we did not measure what these lower doses mean in the long run, we presume, for example, that reducing the effective dose will decrease the child's lifetime increased cancer risk from radiation exposure,” Dr. Patel said. "The public should be aware of radiation exposure from electrophysiology procedures, and physicians and hospitals should be vigilant in implementing protocols aimed at reducing radiation exposure from these procedures. This is especially important in children to minimize their risk of radiation-induced cancer because they should live for many decades after their procedures.”

The study's findings were presented at the American Heart Association's Scientific Sessions 2010, held in Chicago, IL, USA.

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Children's Hospital of Philadelphia