Comparison of X-ray Doses for Child and Adult Patients Undergoing ASD Procedure

Abstract

Objectives: Transcatheter atrial septal defect (ASD) closure is a well-established practice and has become the method of choice, being safe and effective even in small children. Despite the fact that the radiation exposure during percutaneous closure of ASD is comparatively low and the deterministic effects are rather impossible, the potential stochastic effects (especially on young organisms) enforce a constant dose reduction. Material and Methods: The study compares the radiation exposure during ASD percutaneous closure procedures performed in one tertiary centre in both children and adults with use of two angiographs: Artis Zee made by Siemens and Allura Clarity made by Philips. The procedures were performed in a routine fashion by a single well-experienced team. X-ray doses were evaluated experimentally using thermoluminescent (TL) dosemeters made by Ladis Laboratory (Krakow, Poland). Patients during exposure were imitating by the physical antropomorphic phantoms (CIRS, USA) representing adult man and 5-year old child, respectively. Results: As the results of measurements the doses absorbed in the volumes corresponding to particular organs and body parts have been evaluated. Obtaining that, the effective doses (as a measure of future health effects probability) were also computed according ICRP recommendations. The results were statistically analyzed using non-parametric Wilcoxon' test sum of rank. Conclusion: While the whole collection of organ doses from both angiographs do not differ significantly as well for children as for adult patients, doses absorbed by certain organs differed visibly from one angiograph to the other : namely, exposure by the Artis Zee in comparison to Allura caused higher absorbed doses in organs located deeply in the trunk. Although ASD procedure belongs to low-dose ones among interventional cardiology procedures, the doses to the lungs and the thoracic spine for small children (ab. 5-years old) are higher than these for adult patients.