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Reduction in Radiation Dose in a Pediatric Cardiac Catheterization Lab Using the Philips AlluraClarity X-ray System

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Abstract

The objective of this study was to compare radiation doses and imaging quality using Philips AlluraClarity (Philips Healthcare, Best, The Netherlands) X-ray system and an older generation reference system. AlluraClarity is a new generation fluoroscopy system designed to reduce radiation without compromising image quality, but reports of its use in pediatric patients are limited. Dose area products (DAP, mGy cm2) and DAP/kg were compared in patients catheterized using Allura Xper and AlluraClarity systems over a year of use for each. Randomly selected studies from each system were assessed for image quality. The 430 patients imaged with Clarity were larger than the 332 imaged with Xper (median BSA: 0.74 vs. 0.64 m2, p = 0.06), and median total fluoroscopic times (TFT) were similar (15.8 vs. 16.1 min, p = 0.37). Median DAPs were 8661 mGy cm2 (IQR: 18,300 mGy cm2) and 4523 mGy cm2 (IQR: 11,596 mGy cm2) with Xper and Clarity, respectively (p < 0.001). There was a reduction in median DAP in all procedure categories. After adjustment for BSA, TFT, and procedure type, using Clarity was associated with a 57.5% (95% CI 51.5–62.8%, p < 0.001) reduction in DAP for all procedures. Reductions did not significantly differ by weight (<10 kg, 10–40 kg, ≥ 40 kg). There was an adjusted percent reduction in DAP for each procedure category ranging from 39.0% (95% CI 25.6–50.1%, p < 0.001) for cardiac biopsies with or without coronary angiography to 67.6% (95% CI 61.2–72.8%, p < 0.001) for device occlusions. Mean overall imaging quality scores (4.3 ± 0.8 with Clarity vs. 4.4 ± 0.6 with Xper, p = 0.62) and scores based on specific quality parameters were similar in the two groups. Use of AlluraClarity substantially reduced radiation doses compared to the older generation reference system without compromising imaging quality in a pediatric cardiac catheterization lab.

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Abbreviations

RADI:

Radiation physics/dosimetry

CONP:

Congenital heart disease, pediatrics

EPI:

Epidemiology

IAF:

Imaging, angiographic/fluoroscopic

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Acknowledgements

This work was supported by the Children’s Hospital Los Angeles Heart Ambassadors and the Hearst Foundation.

Funding

No funding was used specifically for this project

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Patrick M. Sullivan, Sarah Badran, Cheryl M. Takao & Frank F. Ing

  2. Division of General Pediatrics, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    David Harrison

  3. Children’s Hospital Los Angeles Heart Center, 4650 Sunset Blvd., #34, Los Angeles, CA, USA

    Patrick M. Sullivan

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  1. Patrick M. Sullivan
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Correspondence to Patrick M. Sullivan.

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None of the authors have any conflicts of interest relevant to the contents of this manuscript to disclose.

Ethical Approval

Research practices for this project were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was not required since this project was performed retrospectively on a deidentified database, as reviewed and approved by our Institutional Review Board.

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Sullivan, P.M., Harrison, D., Badran, S. et al. Reduction in Radiation Dose in a Pediatric Cardiac Catheterization Lab Using the Philips AlluraClarity X-ray System. Pediatr Cardiol 38, 1583–1591 (2017). https://doi.org/10.1007/s00246-017-1700-z

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