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 P and K. 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 P and weight. A like-to-like comparison with literature was made.

Results: 385 procedures were analysed. A large P variability was observed in each weight group. P differences across BW groups were not always statistically significant. When stratifying by procedure, P variability decreased while correlations of P and P/FT with weight increased. The established typical values are generally lower than DRLs published data, whatever stratification method adopted. The highest P median values were observed for Angioplasty (4.9 and 11.6 Gycm 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 P 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.