Introduction

Paediatric interventional cardiology procedures have grown in recent years. The main disadvantage of these procedures is the high dose of radiation that patients receive. Such methods include the fluoroscopy mode, which allows real-time visualization, and the cine mode, which allows the documentation of images. The dosimetric quantities recommended currently for these procedures are: kerma-area product (P_KA), air kerma at the patient entrance reference point (K_a,r), fluoroscopy time (t_Fl) and number of acquired images (IN). While P_KA and K_a,r characterize total irradiation during the examination, IN and t_Fl describe the contribution of fluoroscopy and cine modes separately. These characteristics are indirect and presume that the radiation exposure is proportional to them. Such a choice is made because most of the equipment do not supply information about the contribution of fluoroscopy and cine modes to the P_KA or K_a,r separately.

Objectives

The primary objective of this work is to evaluate the contribution of the fluoroscopy and cine modes to the total exposure; we study to what extent these contributions can be characterized by fluoroscopy and cine time and number of acquired images. We also propose local diagnostic reference levels for quantities that separately describe the contribution of fluoroscopy and cine modes.

Methods

In a period of 3 years (2019–2021), data on 135 procedures were evaluated; the study included 53% of male patients (72) and 47% of female patients (63). Cardiac catheterization procedures were considered for diagnostic (59%) and therapeutic (41%) purposes. The average weight of patients was 21.4 ± 1.7 kg (2.0–112.0 kg), and the average age was 5.3 ± 0.4 years (0.0–17.1 years). Interventional cardiology procedures were performed using a GE Innova IGS 530 equipment (GE Healthcare, Milwaukee, WI, USA), manufactured in 2016 and installed in 2017, dedicated to the paediatric population. The necessary data on each procedure was extracted from the Radiation Dose Structure Reports, generated by the equipment at the end of the procedure. This report presents the P_KA values for the fluoroscopy mode and the cine mode, total P_KA, the fluoroscopy time, the cine time, and IN, as well as other data related to the procedure. The diagnostic reference levels (DRLs) proposed in this study were calculated as the 3-rd quartile of the corresponding distribution.

Results

The contribution of the cine mode to the total kerma-area product is, on average, 50% though this mode lasted about 4% of the procedure time. Only the fluoroscopy time may be used among the indirect quantities to characterize the contribution of the fluoroscopy and cine modes.

Conclusions

The following local DRLs values are proposed: 2.0 Gy⋅cm² for kerma-area product in fluoroscopy mode, 1.9 Gy⋅cm² for kerma-area product in cine mode and 22 min (26 min for therapeutic procedures) for fluoroscopy time. For diagnostic and therapeutic procedures, the local DRLs values may be chosen as 1.5 Gy⋅cm² and 2.5 Gy⋅cm² correspondingly in both modes.

中文翻译：

---

透视和电影模式对儿科介入心脏病学程序中患者暴露的贡献

介绍

近年来，儿科介入心脏病学程序有所增长。这些程序的主要缺点是患者接受的高剂量辐射。此类方法包括允许实时可视化的透视模式和允许记录图像的电影模式。目前为这些程序推荐的剂量学量是：比表面积乘积 (P _KA )、患者入口参考点处的空气比释动能 (K _a,r )、透视时间 (t _Fl ) 和采集图像的数量 (IN)。虽然 P _KA和 K _a,r表示检查期间的总辐照量，但 IN 和 t _Fl分别描述透视和电影模式的贡献。这些特征是间接的，并假定辐射暴露与它们成正比。做出这样的选择是因为大多数设备没有分别提供有关透视和电影模式对 P _KA或 K _a,r的贡献的信息。

目标

这项工作的主要目的是评估透视和电影模式对总曝光的贡献；我们研究了这些贡献在多大程度上可以通过透视和电影时间以及获取的图像数量来表征。我们还提出了分别描述透视和电影模式贡献的数量的局部诊断参考水平。

方法

在 3 年（2019-2021 年）期间，评估了 135 个程序的数据；该研究包括 53% 的男性患者 (72) 和 47% 的女性患者 (63)。心导管插入术被考虑用于诊断（59%）和治疗（41%）目的。患者平均体重21.4±1.7公斤（2.0-112.0公斤），平均年龄5.3±0.4岁（0.0-17.1岁）。使用 2016 年制造并于 2017 年安装的专用于儿科人群的 GE Innova IGS 530 设备（GE Healthcare，密尔沃基，威斯康星州，美国）进行介入心脏病学程序。每个程序的必要数据是从设备在程序结束时生成的辐射剂量结构报告中提取的。本报告介绍了 P _KA透视模式和电影模式的值、总 P _KA、透视时间、电影时间和 IN 以及与程序相关的其他数据。本研究中提出的诊断参考水平 (DRL) 计算为相应分布的第三四分位数。

结果

尽管这种模式持续了大约 4% 的手术时间，但电影模式对总 kerma-area 产品的贡献平均为 50%。在间接量中只能使用透视时间来表征透视和电影模式的贡献。

结论

建议以下局部 DRL 值：透视模式下的 kerma-area 产品为 2.0 Gy⋅cm ² ，电影模式下的 kerma-area 产品为1.9 Gy⋅cm ²，透视时间为 22 分钟（治疗程序为 26 分钟）。对于诊断和治疗程序，在两种模式下，局部 DRLs 值可以分别选择为 1.5 Gy⋅cm ²和 2.5 Gy⋅cm ²。