Cumulative radiation dose in children with congenital heart disease: national data 2000–2021, stratified by diagnosis, age, and imaging modality

Abstract

Background Pediatric congenital heart disease (CHD) patients often undergo procedures involving ionizing radiation for diagnosis, treatment, and follow-up. Their cumulative radiation burden may increase their risk of late effects. Purpose To assess radiation exposures from cardiac catheterization and thoracic imaging in pediatric CHD patients, stratified by diagnosis, age, and imaging modality. Material and Methods Radiation exposure (cardiac catheterization, thoracic computed tomography [CT] and radiography) was retrospectively collected for individuals aged <18 years (born 2000–2020) with at least one catheterization for CHD. Cumulative effective dose (CED) was estimated per patient by diagnosis. Age-based variation in examination frequency and exposure was examined. Results A total of 1574 patients underwent 23,558 radiographic examinations. The most common diagnoses, atrial septal defect (ASD; 31% of the cohort) and patent ductus arteriosus (PDA; 30%), had a median CED of 2.3 and 2.9 mSv, respectively. The diagnoses resulting in highest CEDs were hypoplastic left heart syndrome (HLHS; 2.6%, 37.5 mSv), double inlet left ventricle (DILV; 2.4%, 48.4 mSv), and double outlet right ventricle (DORV; 2.6%, 31.3 mSv). Cardiac catheterization, thoracic CT, and radiography contributed 94%, 4%, and 2% of CED, respectively. Effective doses per patient for each diagnosis varied with age. Doses from cardiac catheterizations tended to be higher for patients exposed at ≤30 versus 31–90 months old. Conclusion Most patients with ASD and PDA had low CED and patients with HLHS, DILV, and DORV received ≥30 mSv. Patients with severe CHD often required early catheterization, which, in turn, led to higher effective doses in these patients due to larger conversion coefficients between dose area product/dose length product and effective dose in individuals aged ≤30 months.