Níveis de referência diagnósticos para procedimentos de cardiologia intervencionista pediátrica: uma revisão de literatura

Abstract

Interventional radiology involves multiple image acquisitions and the use of fluoroscopy for diagnosing and treating various pathologies. Its use in interventional cardiology is essential for the success of procedures, enabling minimally invasive interventions associated with lower complication rates compared to conventional surgeries. However, it is one of the radiology modalities that exposes patients to the highest levels of ionizing radiation, resulting in significant doses—especially for pediatric patients, who are more susceptible to radiation effects. According to radiation protection principles, the dose should be optimized to levels as low as reasonably achievable without compromising image quality. Despite the extensive literature on the subject, there is still a lack of specific national Pediatric Diagnostic Reference Levels (DRLs) for interventional cardiology. Therefore, this study aims to synthesize and analyze recent research that proposes or contributes to the establishment of pediatric DRLs in interventional cardiology. The research method consisted of a literature review using the keywords: pediatric, interventional cardiology, radiation dose, diagnostic reference levels, and kerma-area product, searched in the ScienceDirect and PubMed databases. The search was limited to articles published between 2020 and 2025 that addressed the topic directly. After full reading, points of convergence and divergence among the selected studies were identified. The results revealed methodological trends that generally follow the recommendations of ICRP 135 and allowed for the analysis of variations in DRL values in relation to local contexts. Advances were identified in local, national, and regional initiatives, especially in Latin America. There was consensus regarding patient stratification by weight groups and divergence in the presentation of dosimetric data, with stratifications by diagnostic, therapeutic, and procedure complexity. In general, extreme weight ranges had lower sample consistency, but all studies showed progressive increases in dose metrics within each study. It is concluded that the definition of pediatric DRLs in interventional cardiology is essential for dose optimization and must consider variables such as body weight, procedure type, and technical parameters, in addition to requiring interinstitutional collaboration and continuous updates of reference values based on real clinical practice.