【体外膜肺ECMO精品课件】 Overview of Progress in Pediatric Cardiology.pptVIP

Tal Geva 2/04 Echocardiography Laboratory Annual Case Volume Cardiovascular MRI Program Annual Case Volume Tal Geva 2/04 Tal Geva 2/04 Safety Issues in Pediatric Cardiac Imaging Sedation Inherent risks of invasive dx. procedures Ionizing radiation exposure Contrast agents Radiopharmaceuticals Auditory trauma Pharmacological testing Improper use of imaging technology, including an unfavorable risk/benefit ratio Tal Geva 2/04 Safety Issues in Pediatric Cardiac Imaging Sedation Inherent risks of invasive dx. procedures Ionizing radiation exposure (cath, CT) Contrast agents (cath, echo, CT, MRI) Radiopharmaceuticals (nuclear medicine) Auditory trauma (MRI) Pharmacological testing (cath, echo, MRI, nuclear) Proper use of imaging technology, including a favorable risk/benefit ratio Tal Geva 2/04 Tal Geva 2/04 Estimated Lifetime Attributable Risk of Fatal Cancer in Pediatric CT Age at CT Examination Source: Brenner. Pediatr Radiol 2002; 32: 228 % Risk Brenner et al, 2003* “Above doses of 50-100mSv (protracted exposure) or 10-50 mSv (acute exposure), direct epidemiologic evidence from human populations demonstrate the exposure to ionizing radiation increases the risk of some cancer.” /cgi/doi/10.1073/pnas.2235592100 Tal Geva 2/04 Tal Geva 2/04 Cancer Following Cardiac Cath in Childhood Modan et al. Int J of Epidemiology 2002;29:424 674 children; cath between 1950-1970 28.6% had 1 cath; mean age at cath 8.96 Mean age at f/u 37.5 years Expected number of malignancies = 4.75 Observed number of malignancies = 11.0 Standardized incidence ratio = 2.3 (95% CI 1.2-4.1) Of the 11 malignancies, 4 were lymphomas and 3 were melanomas Summary Advances in diagnosis and management of CHD have led to a dramatic decline in mortality (3%) Rapidly expanding population of patients with CHD (currently 1-2 million and growing) Patients rarely cured; frequent anatomic and hemodynamic abnormalities requiring surveillance (e.g., imaging) ? use of tran