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Reducing Fluoroscopic Radiation Exposure During Endomyocardial Biopsy in Pediatric Transplant Recipients

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Abstract

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 < 0.0001) and 53.8% drop in effective dose (p < 0.0001). Fluoroscopy time did not differ. Twenty-eight pts had EMBs both before and after the FPS change. Pair-wise analysis of this group demonstrated a 33% reduction in DAP (p < 0.05) and 37% drop in effective dose (p < 0.01), without difference in fluoroscopy time. No patient had an increase in TR > 1 grade by ECHO. There were no deaths or perforations. Lowering the frame rate reduces radiation exposure by >50% without compromising safety. Efforts to further minimize radiation exposure of this vulnerable population should be considered.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital, 225 E Chicago Ave Box 21, Chicago, IL, 60611, USA

    Jeffrey G. Gossett, Christina L. Sammet, Anya Agrawal, Karen Rychlik & David F. Wax

  2. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jeffrey G. Gossett, Christina L. Sammet, Anya Agrawal, Karen Rychlik & David F. Wax

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  1. Jeffrey G. Gossett
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  2. Christina L. Sammet
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Correspondence to Jeffrey G. Gossett.

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Gossett, J.G., Sammet, C.L., Agrawal, A. et al. Reducing Fluoroscopic Radiation Exposure During Endomyocardial Biopsy in Pediatric Transplant Recipients. Pediatr Cardiol 38, 308–313 (2017). https://doi.org/10.1007/s00246-016-1514-4

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  • DOI: https://doi.org/10.1007/s00246-016-1514-4

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