Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi-center C3PO-QI study.

Autor: Cevallos PC; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts., Armstrong AK; Department of Cardiology, Nationwide Children's Hospital, Columbus, Ohio., Glatz AC; Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Goldstein BH; Department of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio., Gudausky TM; Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin., Leahy RA; Department of Cardiology, Kosair Children's Hospital, Louisville, Kentucky., Petit CJ; Department of Cardiology, Children's Healthcare of Atlanta Sibley Heart Center, Atlanta., Shahanavaz S; Division of Pediatric Cardiology, St. Louis Children's Hospital, St. Louis, Missouri., Trucco SM; Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania., Bergersen LJ; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2017 Aug 01; Vol. 90 (2), pp. 269-280. Date of Electronic Publication: 2017 Feb 15.
DOI: 10.1002/ccd.26911
Abstrakt: Objectives: This study sought to update benchmark values to use a quality measure prospectively.
Background: Congenital Cardiac Catheterization Outcomes Project - Quality Improvement (C3PO-QI), a multi-center registry, defined initial radiation dose benchmarks retrospectively across common interventional procedures. These data facilitated a dose metric endorsed by the American College of Cardiology in 2014.
Methods: Data was collected prospectively by 9 C3PO-QI institutions with complete case capture between 1/1/2014 and 6/30/2015. Radiation was measured in total air kerma (mGy), dose area product (DAP) (µGy*M 2 ), DAP per body weight, and fluoroscopy time (min), and reported by age group as median, 75 th and 95 th %ile for the following six interventional procedures: (1) atrial septal defect closure; (2) aortic valvuloplasty; (3) treatment of coarctation of the aorta; (4) patent ductus arteriosus closure; (5) pulmonary valvuloplasty; and (6) transcatheter pulmonary valve implantation.
Results: The study was comprised of 1,680 unique cases meeting inclusion criteria. Radiation doses were lowest for pulmonary valvuloplasty (age <1 yrs, median mGy: 59, DAP: 249) and highest in transcatheter pulmonary valve implantation (age >15 yrs, median mGy: 1835, DAP: 17990). DAP/kg standardized outcome measures across weights within an age group and procedure type significantly more than DAP alone. Radiation doses decreased for all procedures compared to those reported previously by both median and median weight-based percentile curves. These differences in radiation exposure were observed without changes in median fluoroscopy time.
Conclusions: This study updates previously established benchmarks to reflect QI efforts over time. These thresholds can be applied for quality measurement and comparison. © 2017 Wiley Periodicals, Inc.
(© 2017 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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