Radiation Risks in Pediatric Heart Disease Treatments

Radiation from CT Scans and Cardiac Catheterization in Infants with Congenital Heart Disease

Hello Dr.
Yeh,
My daughter was diagnosed with congenital heart disease (absence of the right pulmonary artery) right after birth.
At just 5 days old, she underwent a cardiac CT angiography in hopes of locating the right pulmonary artery, but it could not be found.
The following day, she had a cardiac catheterization procedure that lasted about 4 hours, which included attempts to locate the right pulmonary artery and reopening her ductus arteriosus to place a stent for blood flow.
Subsequently, she experienced nearly 3 weeks of cardiac instability, leading to heart failure that affected other organs.
During this time, she had several chest and gastrointestinal X-rays.
Ultimately, at one month old, she underwent open-heart surgery to reconnect the right pulmonary artery.
After the surgery, her condition improved, but a follow-up echocardiogram two weeks post-surgery revealed a thrombus.
She underwent another cardiac CT angiography to ensure there were no other thrombi affecting blood flow.
One year post-surgery (when she turned one), to ensure that the right pulmonary artery was not narrowing, she had to undergo another cardiac CT angiography.
As a mother, I am exhausted and grateful that her life was saved, but I am very concerned about the potential consequences of the radiation she has been exposed to.

In summary, within her first year of life, my daughter underwent the following radiological examinations and surgeries: one cardiac catheterization, three cardiac CT angiographies, and approximately 10 chest and gastrointestinal X-rays.
I kindly ask for your guidance on the following:
1.
Given the above circumstances, does this increase her risk of developing cancer in the future?
2.
Since her right pulmonary artery will need continuous monitoring for narrowing as she grows, I am very worried about the necessity of ongoing cardiac CT angiographies.
If this continues every 1-2 years until she reaches adulthood, will it have a significant impact?
3.
What diseases or cancers are generally associated with the radiation exposure from cardiac imaging?
Thank you!

Gan'en Mama, 30~39 year old female. Ask Date: 2020/05/15

Dr. Ye Weicheng reply Radiology

Dear Great Mom,
The harmful effects of ionizing radiation on human health can be categorized into deterministic effects and stochastic effects.
Deterministic effects refer to harmful tissue reactions resulting from excessive radiation exposure; as the dose increases, the severity of the damage also escalates.
Examples of deterministic effects include reduced hematopoietic function and decreased blood cell counts, skin erythema and desquamation, cataract formation and vision impairment, as well as organ inflammation.
Of course, if the dose is excessively high, it may lead to severe organ inflammation and even death.
This means that when the dose reaches a certain threshold, corresponding bodily harm will occur, with higher doses resulting in greater damage.
There is a threshold dose value; according to the International Commission on Radiological Protection (ICRP) report 103, doses below 100 millisieverts (including single or multiple exposures) do not cause clinically significant functional impairment.
Another radiation effect is the stochastic effect, which may induce cellular mutations leading to cancer.
Since the occurrence of cancer is probabilistic, this effect is referred to as a stochastic effect.
The probability of cancer occurrence is related to the dose, with the risk increasing as the dose rises, and there is no threshold dose for this effect.
For example, exposure to high doses of radiation may lead to leukemia, lung cancer, liver cancer, ovarian cancer, and colorectal cancer, among others.
Your daughter has undergone various radiation-related examinations, including cardiac catheterization, cardiac CT scans, chest X-rays, and gastrointestinal studies since birth.
From the perspective of stochastic radiation effects, her risk of developing cancer is naturally higher than that of the general population.
However, there is no need for excessive concern, as the human body has a certain level of tolerance to radiation; the risk is simply elevated.
Given that your daughter has congenital heart disease, the medical decision-making process naturally follows the principle that benefits outweigh the risks.
I believe that under the assessment of a professional medical team, the radiation exposure will be minimized while completing the entire medical plan.
Additionally, the heart is relatively less sensitive to radiation compared to other organs, which means the radiation risk to the heart is lower.
Medical radiation is essential for diagnosis and treatment, and I trust that the physician's recommendations are made after careful consideration.
In Taiwan, professional radiologists are trained to adhere to the principle of reasonable minimization of exposure.
Physiological testing combined with medical imaging diagnostics is necessary to obtain detailed medical information, enabling accurate medical judgments and appropriate medical interventions.
Delaying treatment due to concerns about medical radiation exposure could result in greater harm, which would be counterproductive.
Wishing you and your daughter health and happiness in the future.

Reply Date: 2020/05/15

More Info

When considering the radiation risks associated with pediatric heart disease treatments, especially in the context of your daughter's congenital heart condition, it is essential to understand both the immediate and long-term implications of the diagnostic and therapeutic procedures she has undergone.
1. Increased Cancer Risk: The concern about increased cancer risk due to radiation exposure from medical imaging is valid, particularly in children. Pediatric patients are more sensitive to radiation than adults because their tissues are still developing, and they have a longer life expectancy, which increases the time for potential radiation-induced effects to manifest. Studies have shown that exposure to ionizing radiation can increase the risk of developing certain types of cancer later in life, including leukemia and solid tumors. However, the actual risk depends on several factors, including the total dose of radiation received, the age at exposure, and the specific type of imaging performed. In your daughter's case, while she has undergone multiple imaging studies, the cumulative radiation dose from these procedures is what needs to be assessed. It is crucial to discuss with her healthcare team about the estimated radiation dose from each procedure and how it compares to established safety thresholds.

2. Ongoing Monitoring and Future Imaging: Given that your daughter’s right pulmonary artery requires ongoing monitoring for potential narrowing, it is understandable to be concerned about the frequency of imaging studies, particularly CT scans, which involve higher radiation doses compared to other modalities like echocardiography or MRI. If her condition necessitates regular imaging, it may be beneficial to explore alternative imaging techniques that do not involve ionizing radiation. For example, echocardiography can be a valuable tool for assessing heart function and anatomy without the associated risks of radiation. Additionally, if CT scans are necessary, the use of advanced techniques such as dose modulation and iterative reconstruction can help minimize radiation exposure. It is essential to have a thorough discussion with her cardiologist about the necessity and frequency of these scans, weighing the benefits of monitoring against the potential risks.

3. Potential Health Effects of Radiation: The types of cancers associated with radiation exposure can vary, but the most commonly cited risks include leukemia, thyroid cancer, and breast cancer, among others. The risk of developing these conditions is dose-dependent, meaning higher doses correlate with a greater risk. For pediatric patients, the risk is particularly concerning because their cells are more susceptible to the damaging effects of radiation. It is also important to note that while the risk of developing cancer from medical imaging is real, it is often outweighed by the benefits of accurate diagnosis and treatment of serious conditions like congenital heart disease.
In summary, while there is a legitimate concern regarding the potential long-term effects of radiation exposure from multiple imaging studies, it is crucial to balance this with the need for effective monitoring and treatment of your daughter's heart condition. Engaging in open discussions with her healthcare providers about the risks and benefits of each procedure, exploring alternative imaging options, and ensuring that any necessary imaging is performed with the lowest possible radiation dose can help mitigate these concerns. Regular follow-ups and a tailored approach to her care will be essential in managing her health while minimizing risks.

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