Typical values for pediatric interventional cardiology catheterizations: A standardized approach towards Diagnostic Reference Level establishment

Purpose: To define weight-stratified Diagnostic Reference Levels (DRL) typical values for pediatric interventional cardiology (IC) procedures adopting standardized methodologies proposed by ICRP135 and RP185. Methods: Procedures performed at the pediatric catheterization room of the University-Hospital of Padua were analysed. Patients were stratified into body weight (BW) classes and DRL quantities were analysed for the most performed procedures. Typical values are defined as median PKA and Ka,r. For database consistency, sampling and exclusion methods were precisely defined. The DRL-curve methodology by means of quantile regression median curves was investigated to assess the relationship between PKA and weight. A like-to-like comparison with literature was made. Results: 385 procedures were analysed. A large PKA variability was observed in each weight group. PKA differences across BW groups were not always statistically significant. When stratifying by procedure, PKA variability decreased while correlations of PKA and PKA/FT with weight increased. The established typical values are generally lower than DRLs published data, whatever stratification method adopted. The highest PKA median values were observed for Angioplasty (4.9 and 11.6 Gycm2 for 5-<15 kg and 15-<30 kg, respectively). The DRL-curve approach shows promising results for Valvuloplasty and Angioplasty. Conclusions: Typical values for pediatric IC DRL quantities were determined according to ICRP135 and RP185 methodologies. Stratification by BW classification does not reduce the variability of the PKA values, unlike what happens when stratifying by procedure type. Results seem to corroborate that variability and exposure are more affected by procedure type and complexity than by patient weight. DRL-curve is a feasible approach.