{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:28:20Z","timestamp":1787509700784,"version":"build-2736575974"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The C3PO-QI (Congenital Cardiac Catheterization Project on Outcomes \u2013 Quality Improvement), a multicenter registry launched in 2015, instituted quality improvement (QI) initiatives to reduce patient radiation exposure. Through regular collaboration, this initiative would allow for harmony among active participants, maximizing efforts and efficiency at achieving radiation best practices. This study sought to report these efforts with a detailed methodology for which institutions can target initiatives, reducing radiation exposure, and increasing patient safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Data were collected prospectively by 8 C3PO-QI institutions between January 1, 2015 and December 31, 2017. Radiation exposure was measured in dose area product per body weight (dose area product\/kg; \u00b5Gy*m\n                      <jats:sup>2<\/jats:sup>\n                      \/kg) and reported by expected radiation exposure categories (REC) and institution for 40 published unique procedure types. Targeted interventions addressing selected strategic domains for radiation reduction were implemented in the pediatric catheterization labs of the C3PO-QI institutions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study consisted of 15\u2009257 unique cases. Median exposure (dose area product\/kg) was decreased by 30% for all procedures. Dose area product\/kg was reduced in all 3 REC, with the greatest improvement observed in REC I (REC I, \u221237%; REC II, \u221223%; REC III, \u221227%). Although the baseline radiation exposures and exact percent decrease varied across all C3PO-QI sites, each institution demonstrated improvements in radiation dose over time. These improvements occurred with the implementation of institution-specific QI interventions accelerated by participation in the C3PO-QI multicenter collaborative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Substantial radiation dose reductions can be achieved using targeted QI methodology and interventions. Participation in a multicenter QI collaborative may accelerate improvement across all centers due to enhanced engagement and shared learning between sites.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.119.008172","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T05:08:06Z","timestamp":1589519286000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Longitudinal Improvements in Radiation Exposure in Cardiac Catheterization for Congenital Heart Disease"],"prefix":"10.1161","volume":"13","author":[{"given":"Brian P.","family":"Quinn","sequence":"first","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., P.C., A.G., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscila","family":"Cevallos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., P.C., A.G., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee","family":"Armstrong","sequence":"additional","affiliation":[{"name":"The Heart Center, Nationwide Children\u2019s Hospital, Columbus, OH (A.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Balzer","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, St. Louis Children\u2019s Hospital, St. Louis, MO (D.B., S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howaida","family":"El-said","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Rady Children\u2019s Hospital, San Diego, CA (H.E.-s)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Foerster","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s Hospital of Wisconsin, Milwaukee (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew C.","family":"Glatz","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (A.C.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., P.C., A.G., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Goldstein","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital and Department of Pediatrics, University of Cincinnati College of Medicine, OH (B.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hainstock","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University of Virginia Children\u2019s Hospital, University of Virginia, Charlottesville (M.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Janssen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt University Medical Center, Nashville, TN (D.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Kreutzer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s Hospital of Pittsburgh of UPMC, PA (J.K., S.T.). The Heart Institute, Joe DiMaggio Children\u2019s Hospital and Memorial Healthcare System, Hollywood, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry","family":"Latson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Leahy","sequence":"additional","affiliation":[{"name":"The Heart Institute, Children\u2019s Hospital of Colorado, Denver (R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Petit","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Children\u2019s Healthcare of Atlanta Sibley Heart Center, Atlanta, GA (C.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabana","family":"Shahanavaz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, St. Louis Children\u2019s Hospital, St. Louis, MO (D.B., S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Trucco","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s Hospital of Pittsburgh of UPMC, PA (J.K., S.T.). The Heart Institute, Joe DiMaggio Children\u2019s Hospital and Memorial Healthcare System, Hollywood, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Whiteside","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor (W.W., J.D.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Zampi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor (W.W., J.D.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Bergersen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., P.C., A.G., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","first-page":"1","volume-title":"Health Risks from Exposure to Low Levels of Ionizing Radiation, BEIR VII, Phase 2","author":"NAS\/NRC (National Academy of Sciences\/National Research Council)","year":"2006","unstructured":"NAS\/NRC (National Academy of Sciences\/National Research Council). Health Risks from Exposure to Low Levels of Ionizing Radiation, BEIR VII, Phase 2. Washington, DC: National Academy Press; 2006:1\u2013423."},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semnuclmed.2008.05.006"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.904458"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005425"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2008.160309"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000151098.52656.3A"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.70.830.9135445"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-53-626-100"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.10.074"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.23118"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-014-0869-7"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2014.04.013"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25467"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.045"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26098"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25058"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-016-1454-z"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.04.003"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26911"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.10.4466"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/19929794"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1088\/0952-4746\/36\/4\/R131"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-018-2024-3"},{"key":"e_1_3_5_25_2","volume-title":"The Health Care Data Guide: Learning From Data for Improvement","author":"Provost LP","year":"2011","unstructured":"Provost, LP, Murray, S.The Health Care Data Guide: Learning From Data for Improvement. San Francisco, CA: Jossey-Bass; 2011."},{"key":"e_1_3_5_26_2","unstructured":"Doyle T Bergersen L Armstrong A Latson L Owada C Nykanen D Everett A Holzer R Lock J Kreutzer J et al. Radiation dose metric. American College of Cardiology Adult Congenital Pediatric Cardiology Section Meeting; March 2010; Atlanta GA."},{"key":"e_1_3_5_27_2","unstructured":"Institute for Healthcare Improvement. The break through series: IHI\u2019s collaborative model for achieving breakthrough improvement. IHI Innovation Series white paper (2019 April). 2003. http:\/\/www.ihi.org\/resources\/pages\/ihiwhitepapers\/thebreakthroughseriesihiscollaborativemodelforachievingbreakthroughimprovement.aspx. Accessed April 1 2019."},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951118001257"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-018-2039-9"}],"container-title":["Circulation: Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCINTERVENTIONS.119.008172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T22:48:13Z","timestamp":1715554093000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCINTERVENTIONS.119.008172"}},"subtitle":["A Prospective Multicenter C3PO-QI Study"],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1161\/CIRCINTERVENTIONS.119.008172"],"URL":"https:\/\/doi.org\/10.1161\/circinterventions.119.008172","relation":{},"ISSN":["1941-7640","1941-7632"],"issn-type":[{"value":"1941-7640","type":"print"},{"value":"1941-7632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]},"assertion":[{"value":"2019-06-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e008172"}}