Radiation exposure in transcatheter patent ductus arteriosus closure: Time to tune?

Abstract

Transcatheter occlusion relying on X-ray imaging has become the treatment of choice for most patients with patent ductus arteriosus (PDA). Interventionists now work hardly to minimize radiation exposure in order to reduce risk of induced cancers. To describe radiation level at our institution and evaluate the components contributing to radiation exposure during transcatheter PDA closure. We retrospectively reviewed on all consecutive children who underwent transcatheter closure of PDA in our centre from January 2012 to January 2016. Clinical data, anatomical characteristics, and catheterization procedure parameters were reported. Radiation doses were analyzed for the following variables: (1) total air kerma, mGy; (2) dose area product (DAP), Gy/cm 2 ; (3) DAP per body weight, Gy/cm 2 /kg; and (4) total fluoroscopy time (FT). In total, 324 patients were included [median age = 1.51 (Q1–Q3: 0.62–4.23) years; weight = 10.3 (6.7–17.0) kg]. A total of 322/324 (99.4%) procedures were successful. The median radiation doses were: (1) total air kerma: 26 [14.5–49.3] mGy; (2) DAP: 1.01 [0.56–2.24] Gy/cm 2 ; (3) DAP/kg: 0.106 [0.061–0.185] Gy/cm 2 /kg; (4) FT: 2.8 [2–4] min. In multivariate analysis, the low weights, the DA width, complications during the procedure, and a high frame rate (15 fps) were risks factors for an extended exposure. The initial hemodynamic or anatomical status had no impact on the ionizing radiation duration. We have identified main parameters that have an impact on radiation exposure during the PDA closure in our population. Technical improvements are important to lower radiation exposure. Lower doses of radiation can be achieved with subsequent recommendations: reduction of frame rate and avoidance of biplane. A greater use of echocardiography might even lesser the exposure.