Radiation Reduction Through the Use of a Novel Ultra-Low Dose Fluoroscopy Imaging Protocol in Congenital Cardiac Catheterization

Increased radiation exposure during congenital heart disease procedures may have a detrimental effect on patients, especially in the pediatric population. Advances in imaging systems and adherence to the ALARA (As Low As Reasonably Achievable) principle are paramount in minimizing radiation exposure. This is a single center, retrospective study designed to understand the degree of radiation reduction achievable with a novel ultra-low dose fluoroscopy protocol (ULDFP). Patients were included in the study if they underwent any one of the following procedures between 12/1/2021 and 12/31/2023: atrial septal defect (ASD) device closure, coarctation balloon or stent angioplasty, patent ductus arteriosus (PDA) closure, pulmonary valvuloplasty, and aortic valvuloplasty. Our radiation doses were compared to published benchmarks and current registry data. Phantom studies were done to evaluate the radiation reduction achieved by using the novel ULDFP as compared to our standard protocol. We report significant reduction in radiation exposure for pediatric patients undergoing interventional cardiac catheterization procedures achieved predominantly by near-complete elimination of cine angiography and use of ULDFP. Values reported in this study represent a dose reduction of greater than 90% compared to current benchmark doses by Cevallos [1] et al. and Lamers [2] et al., and greater than 85% compared to current CRISP registry data. Use of an ULDFP and the near elimination of cine angiography drastically reduces radiation dose in pediatric patients undergoing cardiac catheterization procedures even when compared to current registry data. Reducing radiation exposure in this vulnerable cohort may potentially play a significant role in lowering morbidity associated with cardiac catheterization.