Survival adjusted cancer risks attributable to radiation exposure from cardiac catheterisations in children.

OBJECTIVES: To estimate the risk of developing cancer in relation to the typical radiation doses received from a range of X-ray guided cardiac catheterisations in children, taking variable survival into account. METHODS: Radiation doses were estimated for 2749 procedures undertaken at five UK hospitals using Monte Carlo simulations. The lifetime attributable risk (LAR) of cancer incidence was estimated using models developed by the Biological Effects of Ionising Radiation committee, based on both normal life expectancy, and as a function of attained age, from 20 to 80 years, to take reduced life expectancy into account. RESULTS: The radiation-related risks from these procedures are dominated by lung and breast cancer (for females). Assuming normal life expectancy, central LAR estimates for cancer incidence, based on median doses, ranged from <1 in 2000 for atrial septal defect occlusions to as high as 1 in 150 for valve replacements. For a reduced life expectancy of 50 years, estimated risks are lower by a factor of around 7. For conditions with especially poor survival (age 20 years), such as hypoplastic left heart syndrome, estimated cancer risks attributable to radiation were <1 in 20 000. CONCLUSIONS: Based on recent UK radiation dose levels, the risk of cancer following cardiac catheterisations is relatively low and strongly modified by survival and the type of procedure. The risk of breast cancer, especially following pulmonary artery angioplasty and valve replacements, is the greatest concern.

Estimation of radiation dose and risk to children undergoing cardiac catheterization for the treatment of a congenital heart disease using Monte Carlo simulations.

BACKGROUND: Children diagnosed with congenital heart disease often undergo cardiac catheterization for their treatment, which involves the use of ionizing radiation and therefore a risk of radiation-induced cancer. OBJECTIVE: The purpose of this study was to calculate the effective and equivalent organ doses (H(T)) in those children and estimate the risk of exposure-induced death. MATERIALS AND METHODS: Fifty-three children were divided into three groups: atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). In all procedures, the exposure conditions and the dose-area product meters readings were recorded for each individual acquisition. Monte Carlo simulations were run using the PCXMC 2.0 code and mathematical phantoms simulating a child's anatomy. The H(T) values to all irradiated organs and the resulting E and risk of exposure-induced death values were calculated. RESULTS: The average dose-area product values were, respectively, 40 ± 12 Gy·cm(2) for the ASD, 17.5 ± 0.7 Gy·cm(2) for the VSD and 9.5 ± 1 Gy·cm(2) for the PDA group. The average E values were 40 ± 12, 22 ± 2.5 and 17 ± 3.6 mSv for ASD, VSD and PDA groups, respectively. The respective estimated risk of exposure-induced death values per procedure were 0.109, 0.106 and 0.067%. CONCLUSION: Cardiac catheterizations in children involve a considerable risk for radiation-induced cancer that has to be further reduced.

Peripheral arterial interventions: trends in market share and outcomes by specialty, 1998-2005.

OBJECTIVE: Vascular surgeons (VS), interventional cardiologists (IC), and interventional radiologists (IR) perform peripheral arterial interventions (PAI). In this study, we reviewed market share trends and compared outcomes for each specialty using the National Inpatient Sample (NIS). METHODS: Patient discharges for PAI (1998-2005) were identified based on ICD9-CM procedure codes. The provider's specialty was identified by a specialty-specific algorithm and analyzed using SAS 9.1 (SAS Institute, Cary, NC). Market share trends and distribution of cases at teaching versus non-teaching hospitals were evaluated. Primary outcome measures were in-hospital mortality and iatrogenic arterial injuries (IAI). Multivariate logistic regression was performed to identify independent predictors of post-procedure morbidity and mortality. RESULTS: The number of cases identified was 23,825. From 1998 to 2005, IR's market share decreased six-fold (1998: 33% to 2005: 5.6%) whereas VS market share increased from 27% to 43% and IC from 10% to 29% (P < .05). A similar but more pronounced trend was observed at teaching hospitals. In-hospital mortality rate was highest for IR (2.1 IR% vs 1.2% VS and 0.6% IC; P < .001). Post-procedure IAI was highest in the IC group (1.3% vs IR 0.9% and 0.5% VS; P < .05). Compared with VS, the mortality rate was 1.62 times higher for IR patients (odds ratio [OR]: 1.62, 95% confidence interval [CI]: 1.16-2.24) and IAI was 2.44 times higher for IC (OR: 2.44, 95% CI: 1.63-3.66) and 1.75 times higher for IR (OR: 1.75, 95% CI: 1.08-2.81) patients. CONCLUSIONS: IR market share of PAI has precipitously declined while those of VS and IC have increased significantly. Vascular surgeons had the lowest overall morbidity and mortality of all groups. Increase in the number of endovascularly-trained VS with better access to fluoroscopy units may further increase VS's market share.

[Comparative assessment of percutaneous transhepatic cholangiodrainage under roentgenoscopy and ultrasound guidance]. / Sravnitel'naia otsenka chreskozhnogo kholangiodrenirovaniia pod rentgenoskopiei i ul'trazvukovym kontrolem.

In 1990-2000, percutaneous transhepatic cholangiodrainage was performed in 89 patients with obstructive jaundice of tumoral etiology: Groups A (n = 21) under roentgenoscopic guidance and Group B (n = 68) under ultrasound guidance (USG). The efficiency and safety of puncture of the biliary tract were comparatively evaluated in these groups. The technical success of the procedure was achieved in 81.0% of Group A patients and in 98.5% of Group B ones. USG decreased radiation load on the patient and medical staff by three times and the number of needle passes by two times. External-and-internal cholangiodrainages under USG and roentgenoscopy were performed in 55.2 and 23.8%, respectively. The incidence of complications and mortality were 5.9 and 1.5% in Group B and versus 17.6% and 4.8% in Group A. It is concluded that transhepatic cholangiodrainage under USG has some advantage over puncture of the biliary tract under roentgenoscopy.

[Quality assessment using AGIR: results and experience]. / Qualitätsmanagement mittels AGIR: Ergebnisse und Erfahrungen.

PURPOSE: To evaluate whether a new software from the working group for interventional radiology (AGIR) is an appropriate tool for quality assurance in interventional radiology, and presentation of results acquired within the quality improvement process in 1999. PATIENTS AND METHODS: AGIR-defined parameters such as patient data, risk profile, given interventions as well as complications were registered by a recently developed software. Based on monthly data analyses, possible complications were identified and discussed in morbidity and mortality conferences. RESULTS: 1014 interventions were performed in our institution in 1999. According to criteria established by AGIR, the complication rate was 2.7%. In addition and according to SCVIR criteria, complications were distinguished quantitatively in five classes and semiquantitatively in minor and major groups. The result was a minor complication rate of 1.8%, and a major rate of 0.9%. There were no cases of death associated with the intervention. Further strategies were developed in order to reduce the complication rate. CONCLUSION: Extensive quality assurance methods can be integrated in daily routine work. These methods lead to an intensive transparency of treatment results, and allow the implementation of continuous quality improvements. The development of the software is a first step in establishing a nation-wide quality assurance system. Nevertheless, modification and additional definition of the AGIR predefined parameters are required, for example, to avoid unnecessary procedures.