Radiation Safety in Children With Congenital and Acquired Heart Disease A Scientific Position Statement on Multimodality Dose Optimization From the Image Gently Alliance

• Type of Material: Article
• Authors: Kevin D. Hill, Duke University; Donald P. Frush, Duke University; B. Kelly Han, Children’s Heart Clinic at The Children’s Hospitals and Clinics of Minnesota and the Minneapolis Heart Institute; Brian G. Abbott, Brown University; Aimee K. Armstrong, Ohio State University; Robert A. DeKemp, University of Ottawa; Andrew C. Glatz, University of Pennsylvania; S. Bruce Greenberg, Arkansas Children's Hospital; Alexander Sheldon Herbert, New York-Presbyterian Morgan Stanley Children’s Hospital; Henri Justino, Texas Children's Hospital; Douglas Mah, Boston Children's Hospital; Mahadevappa Mahesh, Johns Hopkins University; Cynthia K. Rigsby, Ann & Robert H Lurie Childrens Hosp Chicago; Timothy C. Slesnick, Emory University; Keith J. Strauss, Cincinnati Children's Hospital Medical Center; Sigal Trattner, Columbia University; Mohan N. Viswanathan, Stanford University; Andrew J. Einstein, Columbia University
• Language: English
• Date: 2017-07-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcmg.2017.04.003
• Title of Journal or Parent Work: JACC: Cardiovascular Imaging
• ISSN: 1936-878X
• Volume: 10
• Issue: 7
• Start Page: 797
• End Page: 818
• Grant/Funding Information: Dr. Rigsby is supported by grant R01 HL115828 from the National Heart, Lung, and Blood Institute.; Dr. Einstein is supported in part by grant R01 HL109711 from the National Heart, Lung, and Blood Institute.; Dr. Han has received institutional research funding from Siemens Medical; and is a consultant for the core lab at Edwards Lifesciences.; Dr. Hill has received support from grant UL1 TR001117 from the National Center for Advancing Translational Sciences; and is a consultant for Myocardia and Kowa Pharmaceuticals.
• Keywords: EXPERT CONSENSUS DOCUMENT; PEDIATRIC CARDIAC-CATHETERIZATION; TASK-FORCE; ionizing radiation; Cardiac & Cardiovascular Systems; CARDIOVASCULAR COMPUTED-TOMOGRAPHY; CANCER-RISK; DUAL-SOURCE CT; cardiovascular interventions; Life Sciences & Biomedicine; children; APPROPRIATE USE CRITERIA; CORONARY-ARTERY-DISEASE; NUCLEAR CARDIOLOGY; Cardiovascular System & Cardiology; cardiovascular imaging; TUBE CURRENT MODULATION; Radiology, Nuclear Medicine & Medical Imaging; Science & Technology; radiation safety
• Research Categories: Health Sciences, Radiology; Health Sciences, Medicine and Surgery

Abstract

There is a need for consensus recommendations for ionizing radiation dose optimization during multimodality medical imaging in children with congenital and acquired heart disease (CAHD). These children often have complex diseases and may be exposed to a relatively high cumulative burden of ionizing radiation from medical imaging procedures, including cardiac computed tomography, nuclear cardiology studies, and fluoroscopically guided diagnostic and interventional catheterization and electrophysiology procedures. Although these imaging procedures are all essential to the care of children with CAHD and have contributed to meaningfully improved outcomes in these patients, exposure to ionizing radiation is associated with potential risks, including an increased lifetime attributable risk of cancer. The goal of these recommendations is to encourage informed imaging to achieve appropriate study quality at the lowest achievable dose. Other strategies to improve care include a patient-centered approach to imaging, emphasizing education and informed decision making and programmatic approaches to ensure appropriate dose monitoring. Looking ahead, there is a need for standardization of dose metrics across imaging modalities, so as to encourage comparative effectiveness studies across the spectrum of CAHD in children.