Ubeda C, Vano E, Miranda P, et al. Patient And Staff Doses In Paediatric Interventional Cardiology Derived From Experimental Measurements With Phantoms. Phys Med. 2016 Jan;32(1):176-81.

The aim of this paper was to determine experimentally the entrance surface air kerma (ESAK) and kerma-area product (KAP) levels to patients and scatter doses at the cardiologist’s eyes during paediatric interventional cardiology (IC) procedures for Chile, on the basis of measurements taken from X-ray systems characterization for different thicknesses of polymethyl methacrylate, together with the average values of fluoroscopy time and number of cine frames for ten paediatric IC procedures.

Ubeda C, et al. Entrance Surface Air Kerma In X-Ray Systems For Paediatric Interventional Cardiology: A National Survey. Radiat Protect Dosimetry. 2015 Jul;165(1-4):107-110.

The aims of this work were to report the results of a national surveyon entrance surface air kerma (ESAK) values for different phantom thicknesses and operation modes in paediatric interventional cardiology (IC) systems and to compare them with previous values. For low fluoroscopy mode (FM), ESAK rates ranged from 0.11 to 33.1 mGy min21 and for high FM from 0.34 to 61.0 mGy min21. Forcine mode, values of ESAK per frame were from 1.9 to 78.2 mGyfr21.

Sullivan PM, Harrison D, Badran S, et al. Reduction in Radiation Dose in a Pediatric Cardiac Catheterization Lab Using the Philips AlluraClarity X-ray System. Pediatr Cardiol. 2017 Dec;38(8):1583-1591.

The objective of this study was to compare radiation doses and imaging quality using Philips AlluraClarity (Philips Healthcare, Best, The Netherlands) X-ray system and an older generation reference system. AlluraClarity is a new generation fluoroscopy system designed to reduce radiation without compromising image quality, but reports of its use in pediatric patients are limited. Dose area products (DAP, mGy cm2) and DAP/kg were compared in patients catheterized using Allura Xper and AlluraClarity systems over a year of use for each. Randomly selected studies from each system were assessed for image quality.

Stec S, Śledź J, Mazij M, et al. Feasibility of implementation of a “simplified, No-X-Ray, no-lead apron, two-catheter approach” for ablation of supraventricular arrhythmias in children and adults. J Cardiovasc Electrophysiol. 2014 Aug;25(8):866-874.

Although the “near-zero-X-Ray” or “No-X-Ray” catheter ablation (CA) approach has been reported for treatment of various arrhythmias, few prospective studies have strictly used “No-X-Ray,” simplified 2-catheter approaches for CA in patients with supraventricular tachycardia (SVT). We assessed the feasibility of a minimally invasive, nonfluoroscopic (MINI) CA approach in such patients.

Patel C, Grossman M, Shabanova V, Asnes J. Reducing Radiation Exposure in Cardiac Catheterizations for Congenital Heart Disease. Pediatr Cardiol. 2019 Mar;40(3):638-649.

Ionizing radiation exposure is a necessary risk entailed during congenital cardiac catheterizations. The congenital catheterization lab at Yale New Haven Children’s Hospital employed quality improvement strategies to minimize radiation exposure in this vulnerable population. In two phases, we implemented six interventions, which included adding and utilizing lower fluoroscopy and digital angiography (DA) doses, increasing staff and physician radiation awareness, focusing on tighter collimation, and changing the default fluoroscopy and DA doses to lower settings. Post-intervention data were collected prospectively for all procedures in the congenital catheterization lab and compared to pre-intervention radiation data collected retrospectively.

Manu S, Suntharos P, Boyle GJ, et al. Radiation Reduction in the Pediatric Catheterization Laboratory Using a Novel Imaging System. J Invasive Cardiol. 2018 Jan;30(1):28-33.

Radiation dose was compared between two modern imaging systems with different x-ray tube technology (Megalix vs Gigalix) and detector type (amorphous vs crystalline silicon) at the same institution. Further reduction in radiation dose than currently reported may be achievable with advances in x-ray tube and detector technology.

Hiremath G, Meadows J, Moore P. How Slow Can We Go? 4 Frames Per Second (fps) Versus 7.5 fps Fluoroscopy for Atrial Septal Defects (ASDs) Device Closure. Pediatr Cardiol. 2015 Jun;36(5):1057-61.

Radiation exposure remains a significant concern for ASD device closure. In an effort to reduce radiation exposure, the default fluoroscopy frame rate in our Siemens biplane pediatric catheterization laboratory was reduced to 4 fps in November 2013 from an earlier 7.5 fps fluoro rate. This study aims to evaluate the components contributing to total radiation exposure and compare the procedural success and radiation exposure during ASD device closure using 4 versus 7.5 fps fluoroscopy rates. T

Hill KD, Carboni MP, Doyle TP, et al. Variability in Radiation Dose and Image Quality: A Comparison Across Fluoroscopy-system Vendors and Generations of Equipment. Circulation. 2016 Nov 11;134(suppl_1):A12670.

To evaluate differences in radiation dose and image quality across institutions, fluoroscope vendors and generations of fluoroscopes for pediatric cardiac catheterization. There is currently little understanding of variability in the dose-image quality relationship across institutions, fluoroscope vendor and/or generation of equipment. We evaluated latest generation fluoroscopes from Phillips, Siemens, GE, and Toshiba, and an older generation Phillips fluoroscope (release date 2003) at three different institutions. Radiation dose was measured using an anthropomorphic dose-assessment phantom with effective dose in mSv estimated from Monte Carlo simulations. Image quality phantom images were scored on a 12-point scale by three blinded reviewers.

Habib Geryes B, Bak A, Lachaux J, et al. Patient radiation doses and reference levels in pediatric interventional radiology. Eur Radiol. 2017 Sep;27(9):3983-3990.

From January 2012 to March 2015, children scheduled for an interventional radiological procedure in two French tertiary centres were retrospectively included and divided into four groups according to age: children younger than 2 years (A1), aged 2-7 years (A5), 8-12 years (A10) and 13-18 years (A15). Three procedures were identified: cerebral digital subtraction angiography (DSA), brain arteriovenous malformation (bAVM) embolization, and head and neck superficial vascular malformation (SVM) percutaneous sclerotherapy. Demographic and dosimetric data, including dose area product (DAP), were collected.