Lifetime radiation exposure for paediatric orthotopic heart transplant (OHT) patients is significant with cardiac catheterisation as the dominant source. Interventional cardiac magnetic resonance is utilised to obtain simultaneous, radiation-free haemodynamics and flow/function measurements. We sought to compare invasive haemodynamic measurements and radiation exposure in traditional cardiac catheterisation, to comprehensive interventional cardiac magnetic resonance.

Twenty-eight OHT patients who underwent 67 interventional cardiac magnetic resonance procedures at Children’s National Hospital were identified. Both invasive oximetry with peripheral oxygen saturation (Fick) and cardiac magnetic resonance phase contrast measurements of pulmonary and systemic blood flow were performed. Systemic and pulmonary blood flow from the two modalities was compared using Bland–Altman, concordance analysis, and inter-reader correlation. A mixed model was implemented to account for confounding variables and repeat encounters. Radiation dosage data were collected for a contemporaneous cohort of orthotopic heart transplant patients undergoing standard, X-ray-guided catheterisation.

Simultaneous cardiac magnetic resonance and Fick have poor agreement in our study based on Lin’s correlation coefficient of 0.68 and 0.73 for pulmonary and systemic blood flow, respectively. Bland–Altman analysis demonstrated a consistent over estimation of cardiac magnetic resonance cardiac output by Fick. The average indexed dose area product for patients undergoing haemodynamics with endomyocardial biopsy was 0.73 (SD ±0.6) Gy*m2/kg. With coronary angiography added, the indexed dose area product was 14.6 (SD ± 7.8) Gy*m2/kg.

Cardiac magnetic resonancemeasurements of cardiac output/index in paediatric orthotopic heart transplant patients have poor concordance with Fick estimates; however, cardiac magnetic resonance has good internal validity and inter-reader reliability. Radiation doses are small for haemodynamics with biopsy and increase exponentially with angiography, identifying a new target for cardiac magnetic resonance imaging.

Research demonstrates that children receive twice as much medical radiation from Computed Tomography (CT) scans performed at non-pediatric facilities as equivalent CTs performed at pediatric trauma centers (PTCs). In 2014, AFMC outreach staff educated Emergency Department (ED) staff on appropriate CT imaging utilization to reduce unnecessary medical radiation exposure. We set out to determine the educational campaign’s impact on injured children received radiation dose.

All injured children who underwent CT imaging and were transferred to a Level I PTC during 2010 to 2013 (pre-campaign) and 2015 (post-campaign) were reviewed. Patient demographics, mode of transportation, ED length of stay, scanned body region, injury severity score, and trauma center level were analyzed. Median effective radiation dose (ERD) controlled for each variable, pre-campaign and post-campaign, was compared using Wilcoxon rank sum test.

Three hundred eighty-five children under 17 years were transferred from 45 and 48 hospitals, pre- and post-campaign. Most (43%) transferring hospitals were urban or critical access hospitals (30%). Pre- and post-campaign patient demographics were similar. We analyzed 482 and 398 CT scans pre- and post-campaign. Overall, median ERD significantly decreased from 3.80 to 2.80. Abdominal CT scan ERD declined significantly from 7.2 to 4.13 (P-value 0.03). Head CT scan ERD declined from 3.27 to 2.45 (P-value < 0.0001).

A statewide, CT scan educational campaign contributed to ERD decline (lower dose scans and fewer repeat scans) among transferred injured children seen at PTCs. State-level interventions are feasible and can be effective in changing radiology provider practices.

The aim of this study was to understand how the regulatory requirements for functioning radiotherapy practices in India to control risk were conceptualised, perceived and applied accordingly in the radiotherapy facilities. It further examined how the social factors influenced the decision-making process for implementing regulatory requirements in the radiotherapy facilities.

This study was carried out in nine radiotherapy facilities located in the northeastern Indian states of Manipur, Assam, Meghalaya, Tripura and Mizoram. The study adopted both the semi-structured and in-depth questionnaire, developed on the basis of multidisciplinary fields.

The study found that the facilities in the northeastern regions were commissioned in line with the regulatory requirements. The facilities had adequate structural shielding rooms to protect workers, patients and the public from the risk of ionising radiation. However, in the operational phase of the facilities, majority of the facilities had the improper management of existing resources and non-implementation of regulatory requirements on time. It was observed that workers in some facilities continued the practice, despite the failure of specific safety functions, or not meeting regulatory requirements. Such practices led to the suspension of patient treatment in three of the facilities by the regulator. The existence of a varying nature of risk perceptions among oncologists, medical physicists, radiological safety officers, radiotherapy technologists in the facilities were observed and these influenced the decision-making process of the facilities on the implementation of regulatory requirements.

The study found that the facilities needed to explore various means, including to narrow the gap that existed in respects of perceived risk (within the facilities), communication to enhance work coordination and mutual trust among workers. The adoption of the institutional policy for conducting an internal audit of working practices, encouragement of workers to participate in continuing education programs would enhance effective utilisation of already existing infrastructure/equipment and work procedures including quality assurance programs.