Decreasing radiation exposure in interventional pediatric cardiology: a 10-year European single-center analysis of 3683 procedures.

BACKGROUND

To evaluate radiation exposure during pediatric cardiac catheterization over a 10-year period at a central European tertiary center and to establish contemporary, procedure-specific dose benchmarks and conversion factors for estimating effective dose (ED).

METHODS

All cardiac catheterization procedures in patients < 18 years performed between 2015 and 2024 were retrospectively reviewed. For procedures with multiple components, cumulative dose area product (DAP) was proportionally allocated using weight-adjusted (DAP/BW) median values from single-intervention cases. ED was estimated in silico in randomly selected examinations using Monte Carlo simulation. Dose conversion factors between DAP and ED were derived. Additionally, a structured review of the literature on recently published data on radiation doses was performed.

RESULTS

A total of 3683 procedures in 2494 patients (median age 3.8 years) were included. Body weight showed a stronger association with DAP than age. Median DAP/BW was 11.7 cGy·cm2/kg for diagnostic and 9.7 cGy·cm2/kg for interventional procedures. For most procedure types, DAP/BW was substantially lower than previously published benchmarks. Simulated conversion factors declined logarithmically with increasing body weight and differed only slightly between posterior-anterior and lateral projections. Only 0.9% of patients exceeded a cumulative ED of 30 mSv.

CONCLUSION

Radiation exposure in contemporary pediatric cardiac catheterization is markedly lower than in earlier reports, with procedure complexity being the primary determinant of effective dose.