Author + information
- Received March 13, 2017
- Revision received April 25, 2017
- Accepted April 28, 2017
- Published online May 6, 2017.
- Kevin D. Hill, MD, MSa,
- Donald P. Frush, MDb,
- B. Kelly Han, MDc,
- Brian G. Abbott, MDd,
- Aimee K. Armstrong, MDe,
- Robert A. DeKemp, PhDf,
- Andrew C. Glatz, MD, MSCEg,
- S. Bruce Greenberg, MDh,
- Alexander Sheldon Herbert, RTi,
- Henri Justino, MDj,
- Douglas Mah, MDk,
- Mahadevappa Mahesh, PhDl,
- Cynthia K. Rigsby, MDm,
- Timothy C. Slesnick, MDn,
- Keith J. Strauss, MSco,
- Sigal Trattner, PhDp,
- Mohan N. Viswanathan, MDq,
- Andrew J. Einstein, MD, PhDr,∗ (, )
- Image Gently Alliance
- aDepartment of Pediatrics, Duke University Medical Center, (Image Gently Alliance representative)
- bDepartment of Radiology, Duke University Medical Center (Image Gently Alliance and SPR representative)
- cDepartment of Pediatric Cardiology, Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota and the Minneapolis Heart Institute (SCCT representative)
- dDepartment of Medicine, Warren Alpert Medical School of Brown University (ASNC representative)
- eDepartment of Pediatrics, Nationwide Children’s Hospital, Ohio State University (ACC representative)
- fDepartment of Medicine, University of Ottawa Heart Institute (SNMMI representative)
- gDepartment of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania (Image Gently Alliance representative)
- hDepartment of Radiology, Arkansas Children's Hospital, (NASCI representative), Little Rock, Arkansas
- iDepartment of Radiology, New York-Presbyterian Morgan Stanley Children’s Hospital Image (ASRT representative)
- jDepartment of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine (SCAI representative)
- kDepartment of Pediatrics, Boston Children’s Hospital (PACES representative)
- lDepartment of Radiology and Radiological Science, The Johns Hopkins University School of Medicine (AAPM representative)
- mDepartment of Medical Imaging, Ann & Robert H Lurie Children’s Hospital of Chicago and Department of Radiology, Northwestern University Feinberg School of Medicine (ACR representative)
- nDepartment of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine (AAP representative)
- oDepartment of Radiology, Cincinnati Children’s Hospital Medical Center (Image Gently Alliance Representative)
- pDivision of Cardiology, Department of Medicine, Columbia University Medical Center (Image Gently Alliance representative)
- qDepartment of Internal Medicine, Stanford University (HRS representative)
- rDivision of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital (Image Gently Alliance representative)
- ↵∗Correspondence to
Andrew J. Einstein, MD, PhD; Columbia University Medical Center, 622 West 168th Street PH 10-203, New York, NY 10032; phone: 212-305-6812; fax: 212-305-4648
There is a need for consensus recommendations for ionizing radiation dose optimization during multi-modality medical imaging in children with congenital and acquired heart disease (CAHD). These children often have complex diseases and may be exposed to a relatively high cumulative burden of ionizing radiation from medical imaging procedures including cardiac computed tomography, nuclear cardiology studies and fluoroscopically guided diagnostic and interventional catheterization and electrophysiology procedures. Although these imaging procedures are all essential to the care of children with CAHD and have contributed to meaningfully improved outcomes in these patients, exposure to ionizing radiation is associated with potential risks, including an increased lifetime attributable risk of cancer. The goal of these recommendations is to encourage informed imaging to achieve appropriate study quality at the lowest achievable dose. Other strategies to improve care include a patient-centered approach to imaging, emphasizing education and informed decision making and programmatic approaches to ensure appropriate dose monitoring. Looking ahead, there is a need for standardization of dose metrics across imaging modalities, so as to encourage comparative effectiveness studies across the spectrum of CAHD in children.
Endorsed by the American College of Cardiology (ACC), American College of Radiology (ACR), American Academy of Pediatrics (AAP), American Association of Physicists in Medicine (AAPM), American Society of Nuclear Cardiology (ASNC), American Society of Radiologic Technologists (ASRT), Heart Rhythm Society (HRS), North American Society for Cardiovascular Imaging(NASCI), Pediatric and Congenital Electrophysiology Society (PACES), Society for Cardiovascular Angiography and Interventions (SCAI), Society for Cardiovascular Computed Tomography (SCCT), Society for Pediatric Radiology (SPR), and Society of Nuclear Medicine and Molecular Imaging (SNMMI).
Disclosures: KDH receives support from grant UL1 TR001117 from the National Center for Advancing Translational Sciences. AKA is a member of the Siemens Healthcare AX Advisory Board in Pediatric Cardiology and Interventional Radiology. RdK receives royalty revenues from imaging technologies licensed to Jubilant DraxImage, and INVIA Medical Imaging. CKR is supported by grant R01 HL115828 from the National Heart Lung and Blood Institute. KJS is a member of Philips Healthcare’s medical physicist advisory board. ST has received institutional research grants for other investigator-initiated studies from Philips Healthcare. AJE is supported in part by grant R01 HL10971 from the National Heart Lung and Blood Institute, and has received research grants to Columbia University from GE Healthcare, Philips Healthcare, and Toshiba America Medical Systems.
- Received March 13, 2017.
- Revision received April 25, 2017.
- Accepted April 28, 2017.