Trends in radiation exposure with the refinement of radiation exposure categories in congenital cardiac catheterization: Insights from the CRISP registry

Authors

Gurumurthy Hiremath, Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota.
Juan Carlos Samayoa, Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota.
Alexander Javois, Advocate Health - MidwestFollow
Osamah Aldoss, Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.
Ryan Leahy, Department of Cardiology, Children's Hospital of Colorado, University of Colorado, Aurora, Colorado.
Reid Chamberlain, Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
Elena Amin, Division of Pediatric Cardiology, UCSF Benioff Children's Hospitals, University of California, San Francisco, San Francisco, California.
Marko Vezmar, Children's Minnesota, Minneapolis, Minnesota.
Makram Ebeid, Department of Pediatric Cardiology, University of Mississippi Medical Center, Jackson, Mississippi.
Shyam Sathanandam, Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.
David Nykanen, Division of Cardiology, Arnold Palmer Hospital, Orlando, Florida.
Thomas Forbes, Division of Cardiology, Joe DiMaggio Children's Hospital, Hollywood, Florida.
Christopher Curzon, Division of Cardiology, Children's Nebraska, Omaha, Nebraska.
Martin Bocks, Division of Cardiology, Case Western Reserve University, University Hospitals, Cleveland, Ohio.
Daisuke Kobayashi, Division of Cardiology, Department of Pediatrics, St. Louis Children's Hospital/Washington University School of Medicine, St. Louis, Missouri.

Recommended Citation

Hiremath G, Samayoa JC, Javois A, et al. Trends in Radiation Exposure With the Refinement of Radiation Exposure Categories in Congenital Cardiac Catheterization: Insights From the CRISP Registry. J Soc Cardiovasc Angiogr Interv. 2025;4(8):103727. Published 2025 Jul 23. doi:10.1016/j.jscai.2025.103727

Affiliations

Advocate Children's Hospital

Abstract

Background: The Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry proposed 3-tier radiation exposure categories (REC: I [low], II [medium], and III [high]) consisting of 40 procedure types. This study sought to evaluate the recent trend of radiation exposure in the Catheterization Risk Score for Pediatrics (CRISP) registry organized by the Congenital Cardiovascular Interventional Study Consortium.

Methods: The analysis was conducted on a comprehensive data set from the CRISP registry, covering 13 institutions from January 1, 2016, to December 31, 2020. Radiation dosage in μGym²/kg was evaluated by REC, time, and institutions. The study period was divided into the first half (S1: 1/2016-6/2018) and the second half (S2: 7/2018-12/2020). Radiation dosage was compared between S1 and S2. Radiation reduction practices were assessed at participating centers through a questionnaire.

Results: Among 20,524 cases, the majority (n = 18,603, 90.2%) were assigned to C3PO REC procedure types. From S1 (n = 8956) to S2 (n = 9647), median radiation dosage significantly improved in all 3 tiers (P < .001): (1) REC I, -18%; (2) REC II, -33%; and (3) REC III, -30%. REC successfully stratified cases by median radiation dosage: (1) REC I, 18.2 μGym²/kg (n = 14,234); (2) REC II, 49.8 μGym²/kg (n = 3012); and (3) REC III, 67.0 μGym²/kg (n = 1357) but showed significant intraclass variability and heterogeneity. REC I exhibited the most variability in radiation dosage. To address these limitations, the procedures were organized into 6 updated REC categories (CRISP REC).

Conclusions: A significant reduction in radiation dosage was observed in the CRISP registry, although a few centers showed a trend of increasing radiation dosage. Despite its limitations, the C3PO REC provides a practical way to stratify cases for reporting dosage. We propose the CRISP REC as a refined alternative to the C3PO REC to improve stratification and decrease variability in radiation exposure across different categories.

Type

Article

PubMed ID

41019894