Radiation doses and associated risks from x-ray guided cardiac catheterization procedures in children and young adults

Abstract

Cardiac catheterizations are an essential procedure in the management of patients with congenital and acquired heart conditions. However, associated radiation doses are often high, raising concerns over potentially increased cancer risks. Neither the radiation doses, nor the associated risks, have been adequately investigated in young people undergoing these procedures. A cohort was established of around 13,500 patients aged under 22 years who have undergone cardiac catheterizations in England. Organ doses were estimated based on a dosimetry system utilising data from Monte Carlo simulations. Doses were highest for the lungs (median: 17.6 millisieverts, mSv) and heart (13.6 mSv), while doses to bone marrow (2.6 mSv) and the thyroid (0.7 mSv) were relatively low. Radiation doses have fallen by a factor of up to ten during the study period. The results were compared to equivalent figures derived from physical measurements. Uncertainties in dose estimates were calculated. These were around ±30%, though were potentially much higher for breast dose. The risk of cancer in relation to estimated doses was calculated using BEIR VII risk models. For examinations conducted using modern equipment, these risks are around 1 in 1700. A small epidemiological analysis was performed, suggesting a nearly threefold increased risk of cancer in the cohort, compared to the general UK population. There are a number of reasons to suggest that this increase was primarily not related to radiation exposure, most notably the large impact of transplantation and likely associated immunosuppressant use. Despite the high cancer incidence, the overall survival in the cohort was high, at around 91% after 30 years. Conclusion: The study provides the first large scale estimation of organ doses from cardiac catheterizations among this age group. Rates of cancer among this patient group are high, although this is appears to be mostly due to factors other than radiation exposure.