Reducing Fluoroscopic Radiation Exposure During Endomyocardial Biopsy in Pediatric Transplant Recipients

Endomyocardial biopsy (EMB) with fluoroscopy is used for rejection surveillance in pediatric heart transplantation. Lowering frame rate may reduce radiation, but decreases temporal resolution and image quality. We undertook a quality initiative reducing frame rate from 10 frames per second (FPS) to...

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Bibliographic Details
Published in:Pediatric cardiology 2017-02, Vol.38 (2), p.308-313
Main Authors: Gossett, Jeffrey G., Sammet, Christina L., Agrawal, Anya, Rychlik, Karen, Wax, David F.
Format: Article
Language:English
Subjects:
Adolescent
Biopsy - statistics & numerical data
Cardiac Catheterization
Cardiac Surgery
Cardiology
Child
Comparative analysis
Electronic Health Records
Female
Fluoroscopy
Heart
Heart Transplantation
Humans
Linear Models
Male
Medicine
Medicine & Public Health
Myocardium - pathology
Organ transplant recipients
Original Article
Pediatrics
Radiation
Radiation Dosage
Radiation Exposure - statistics & numerical data
Radiography, Interventional
Retrospective Studies
Risk Factors
Transplant Recipients
Transplantation
United States
Vascular Surgery
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Summary:Endomyocardial biopsy (EMB) with fluoroscopy is used for rejection surveillance in pediatric heart transplantation. Lowering frame rate may reduce radiation, but decreases temporal resolution and image quality. We undertook a quality initiative reducing frame rate from 10 frames per second (FPS) to 5 FPS. To assess whether lowering frame rate can reduce radiation exposure without compromising safety, data on EMBs from 9/2009 to 4/2013 without angiography or intervention were reviewed. Effective dose was calculated from dose area product (DAP) and fluoroscopy time. Complications were reviewed. Independent t test compared pre- and post-data and a general linear model were used to control for confounders. Paired t test of most proximate data was used for pts with EMB before and after our change. Eighty-six patients had 543 EMB. After adjusting for weight, attending, and presence of a fellow, the lower FPS group had a 60.3% reduction in DAP ( p  
ISSN:0172-0643
1432-1971
DOI:10.1007/s00246-016-1514-4