{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:53:45Z","timestamp":1781769225845,"version":"3.54.5"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Increased radiation exposure during congenital heart disease procedures may have a detrimental effect on patients, especially in the pediatric population. Advances in imaging systems and adherence to the ALARA (As Low As Reasonably Achievable) principle are paramount in minimizing radiation exposure. This is a single center, retrospective study designed to understand the degree of radiation reduction achievable with a novel ultra-low dose fluoroscopy protocol (ULDFP). Patients were included in the study if they underwent any one of the following procedures between 12\/1\/2021 and 12\/31\/2023: atrial septal defect (ASD) device closure, coarctation balloon or stent angioplasty, patent ductus arteriosus (PDA) closure, pulmonary valvuloplasty, and aortic valvuloplasty. Our radiation doses were compared to published benchmarks and current registry data. Phantom studies were done to evaluate the radiation reduction achieved by using the novel ULDFP as compared to our standard protocol. We report significant reduction in radiation exposure for pediatric patients undergoing interventional cardiac catheterization procedures achieved predominantly by near-complete elimination of cine angiography and use of ULDFP. Values reported in this study represent a dose reduction of greater than 90% compared to current benchmark doses by Cevallos [1] et al. and Lamers [2] et al., and greater than 85% compared to current CRISP registry data. Use of an ULDFP and the near elimination of cine angiography drastically reduces radiation dose in pediatric patients undergoing cardiac catheterization procedures even when compared to current registry data. Reducing radiation exposure in this vulnerable cohort may potentially play a significant role in lowering morbidity associated with cardiac catheterization.<\/jats:p>","DOI":"10.1007\/s00246-026-04332-x","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:19:43Z","timestamp":1781767183000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiation Reduction Through the Use of a Novel Ultra-Low Dose Fluoroscopy Imaging Protocol in Congenital Cardiac Catheterization"],"prefix":"10.1007","author":[{"given":"Kamel","family":"Shibbani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henri","family":"Justino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howaida","family":"El-Said","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent M.","family":"Gordon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"issue":"2","key":"4332_CR1","first-page":"269","volume":"90","author":"PC Cevallos","year":"2017","unstructured":"Cevallos PC et al (2017) Radiation dose benchmarks in pediatric cardiac catheterization: a prospective multi-center C3PO-QI study. Catheter Cardiovasc Interv 90(2):269\u2013280","journal-title":"Catheter Cardiovasc Interv"},{"key":"4332_CR2","doi-asserted-by":"publisher","first-page":"p7639754","DOI":"10.1155\/2019\/7639754","volume":"2019","author":"LJ Lamers","year":"2019","unstructured":"Lamers LJ et al (2019) Multicenter assessment of radiation exposure during pediatric cardiac catheterizations using a novel imaging system. J Interv Cardiol 2019:p7639754","journal-title":"J Interv Cardiol"},{"issue":"2","key":"4332_CR3","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1148\/radiol.10091269","volume":"257","author":"DL Miller","year":"2010","unstructured":"Miller DL et al (2010) Clinical radiation management for fluoroscopically guided interventional procedures. Radiology 257(2):321\u2013332","journal-title":"Radiology"},{"issue":"10","key":"4332_CR4","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1093\/eurheartj\/eht394","volume":"35","author":"E Picano","year":"2014","unstructured":"Picano E et al (2014) The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. Eur Heart J 35(10):665\u2013672","journal-title":"Eur Heart J"},{"issue":"11","key":"4332_CR5","doi-asserted-by":"publisher","first-page":"e006765","DOI":"10.1161\/CIRCINTERVENTIONS.118.006765","volume":"11","author":"N Journy","year":"2018","unstructured":"Journy N et al (2018) Projected future cancer risks in children treated with fluoroscopy-guided cardiac catheterization procedures. Circ Cardiovasc Interv 11(11):e006765","journal-title":"Circ Cardiovasc Interv"},{"issue":"10","key":"4332_CR6","doi-asserted-by":"publisher","first-page":"101239","DOI":"10.1016\/j.jacadv.2024.101239","volume":"3","author":"JR Wong-Siegel","year":"2024","unstructured":"Wong-Siegel JR et al (2024) Cumulative radiation exposure and lifetime cancer risk in patients with tetralogy of fallot requiring early intervention. JACC Adv 3(10):101239","journal-title":"JACC Adv"},{"issue":"2","key":"4332_CR7","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1007\/s00247-006-0194-2","volume":"36","author":"H Justino","year":"2006","unstructured":"Justino H (2006) The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose. Pediatr Radiol 36(2):146\u2013153","journal-title":"Pediatr Radiol"},{"issue":"6","key":"4332_CR8","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1111\/chd.12677","volume":"13","author":"SM Amdani","year":"2018","unstructured":"Amdani SM et al (2018) Reducing radiation exposure by lowering frame rate in children undergoing cardiac catheterization: a quality improvement study. Congenit Heart Dis 13(6):1028\u20131037","journal-title":"Congenit Heart Dis"},{"issue":"4","key":"4332_CR9","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1161\/CIRCINTERVENTIONS.114.001499","volume":"7","author":"S Agarwal","year":"2014","unstructured":"Agarwal S et al (2014) Measures to reduce radiation in a modern cardiac catheterization laboratory. Circ Cardiovasc Interv 7(4):447\u2013455","journal-title":"Circ Cardiovasc Interv"},{"key":"4332_CR10","doi-asserted-by":"publisher","first-page":"625873","DOI":"10.3389\/fcvm.2021.625873","volume":"8","author":"A Gupta","year":"2021","unstructured":"Gupta A et al (2021) Radiation exposure reduction and patient outcome by using very low frame rate fluoroscopy protocol (3.8\u2009+\u20097.5 fps) during percutaneous coronary intervention. Front Cardiovasc Med 8:625873","journal-title":"Front Cardiovasc Med"},{"issue":"5","key":"4332_CR11","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1136\/heartjnl-2016-309773","volume":"103","author":"RW Harbron","year":"2017","unstructured":"Harbron RW et al (2017) Survival adjusted cancer risks attributable to radiation exposure from cardiac catheterisations in children. Heart 103(5):341\u2013346","journal-title":"Heart"},{"issue":"13","key":"4332_CR12","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1161\/CIRCULATIONAHA.117.029138","volume":"137","author":"S Cohen","year":"2018","unstructured":"Cohen S et al (2018) Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease. Circulation 137(13):1334\u20131345","journal-title":"Circulation"},{"issue":"5","key":"4332_CR13","first-page":"888","volume":"89","author":"KD Hill","year":"2017","unstructured":"Hill KD et al (2017) Impact of imaging approach on radiation dose and associated cancer risk in children undergoing cardiac catheterization. Catheter Cardiovasc Interv 89(5):888\u2013897","journal-title":"Catheter Cardiovasc Interv"}],"container-title":["Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04332-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00246-026-04332-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04332-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:19:44Z","timestamp":1781767184000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00246-026-04332-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":13,"alternative-id":["4332"],"URL":"https:\/\/doi.org\/10.1007\/s00246-026-04332-x","relation":{},"ISSN":["0172-0643","1432-1971"],"issn-type":[{"value":"0172-0643","type":"print"},{"value":"1432-1971","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"assertion":[{"value":"20 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This should state that research was carried out in accordance with the appropriate ethical guidelines and after receiving appropriate IRB approval.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}}]}}