Establishing Local Diagnostic Reference Levels for Radiation Dose in Pediatric Interventional Cardiology Procedures in Brazil: A Study on Image Quality Optimization

A. Yagui¹, H. Schelin¹, B. Vargas¹, J. Santos¹, A. Legnani¹, P. Vosiak¹, R. Mello¹, S. Pachuk², V. Denyak²_, H. Khoury³

¹Pelé Pequeno Principe Research Institute, Pequeno Principe Faculty, Brazil

²Federal University of Technology - Paraná, Brazil

³Federal University of Pernambuco, Recife, Brazil

e-mail: schelin2@gmail.com

The present study aimed to establish local Diagnostic Reference Levels (DRL) within an interventional cardiology unit at an exclusively pediatric hospital in Brazil. DRL values were derived from dose reports generated by post-procedure equipment [1]. Data from 215 procedures conducted over a 5-year period (2019-2023) were analyzed, categorizing them into therapeutic and diagnostic interventions and further delineating them by clinical procedures. Local DRLs were identified as the third quartile of patient dose data distributions, encompassing both product kerma area (P_KA) and kerma at the reference point (K_a,r) across various age groups and weight ranges. A linear correlation between patient weight and age facilitated age-based weight estimation. Despite its significant contribution to P_KA, cine mode accounted for only approximately 4% of the total procedure time. While noteworthy, fluoroscopy time was not deemed the most reliable predictor of P_KA. Mean fluoroscopy time and cine mode image count remained consistent across all procedures, irrespective of patient weight or age. Significantly, therapeutic procedures demonstrated elevated radiation dose values in contrast to diagnostic procedures.

Acknowledgement: This work was supported by the Brazilian agencies: Comissão Nacional de Energia Nuclear (CNEN), Fundação Araucária and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).