TY - JOUR
T1 - Trends in Radiation Exposure With the Refinement of Radiation Exposure Categories in Congenital Cardiac Catheterization
T2 - Insights From the CRISP Registry
AU - Hiremath, Gurumurthy
AU - Samayoa, Juan Carlos
AU - Javois, Alexander
AU - Aldoss, Osamah
AU - Leahy, Ryan
AU - Chamberlain, Reid
AU - Amin, Elena
AU - Vezmar, Marko
AU - Ebeid, Makram
AU - Sathanandam, Shyam
AU - Nykanen, David
AU - Forbes, Thomas
AU - Curzon, Christopher
AU - Bocks, Martin
AU - Kobayashi, Daisuke
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/8
Y1 - 2025/8
N2 - 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.
AB - 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.
KW - cardiac catheterization
KW - cardiac risk score for pediatrics registry
KW - radiation exposure category
UR - https://www.scopus.com/pages/publications/105013350220
UR - https://www.scopus.com/pages/publications/105013350220#tab=citedBy
U2 - 10.1016/j.jscai.2025.103727
DO - 10.1016/j.jscai.2025.103727
M3 - Article
C2 - 41019894
AN - SCOPUS:105013350220
SN - 2772-9303
VL - 4
JO - Journal of the Society for Cardiovascular Angiography and Interventions
JF - Journal of the Society for Cardiovascular Angiography and Interventions
IS - 8
M1 - 103727
ER -