When children have to undergo certain cardiac procedures, they benefit from the use of surgical fluoroscopes, X-ray-like machines that allow the surgeon to see, in real time, a moving image of the patient’s internal organs and structures. Unfortunately, fluoroscopy exposes the patient to significant levels of radiation.

A radiation overdose can cause problems ranging from mild skin damage to major issues such as skin injuries with progressive tissue necrosis. While the long-term consequences of radiation exposure during pediatric treatment is not fully known, most researchers agree that fluoroscopy radiation and other types of ionizing radiation increase the risk of cancer.

While the benefits of fluoroscopy generally outweigh the risks, it is critical to limit the radiation exposure in any procedure involving a fluoroscope or another medical device that emits ionizing radiation.

A study presented at the 2010 convention of the American Heart Association demonstrated that the addition of a few simple safety protocols can dramatically reduce radiation exposure in pediatric patients undergoing these procedures.

Hospital of Philadelphia Doctor Urges New Fluoroscopic Patient Safety Procedures

Doctor Akash Patel of the Hospital of Philadelphia presented evidence that a couple of deceptively simple changes in operating room procedures had a dramatic impact on reducing radiation exposure among pediatric cardiac patients, without compromising surgical outcomes.

The two safety protocols recommended by Dr. Patel and his research team were:

• Tell the surgeon when the child reaches an exposure level of 1,000 mGy. This by itself reduced overall radiation exposure by almost 50 percent.
• Reposition the camera and change the angle of focus to reduce the lateral camera skin-entrance dose. This resulted in an average radiation exposure reduction of more than 56 percent.

Overall, the two protocols resulted in a 22 percent reduction in the median average fluoroscopy time, as well as between 44 and 42 percent reductions in the dose of radiation used under various measurements — all without negatively affecting surgical outcomes.

Fluoroscopy is commonly used in cardiac procedures such as angiography, balloon ablation and the implantation of cardiac rhythm devices. It is also used a variety of other medical procedures such as barium swallow studies, investigations of the gastrointestinal tract, discographies, and many types of laparoscopic surgery. These interventions could become standard for all procedures involving fluoroscopy, serving to prevent illnesses, injuries and surgical malpractice claims.

Sources:

• DGDispatch, “Small Intervention Can Reduce Radiation Exposure in Children Undergoing Cardiac Procedures: Presented at AHA,” Ed Susman, November 19, 2010
• National Cancer Institute, “Interventional Fluoroscopy: Reducing Radiation Risks for Patients and Staff,” April 18, 2005