Determination of Institutional Diagnostic Reference Levels for Paediatric Interventional Cardiology Procedures in Sri Lanka

Determining diagnostic reference levels (DRLs) for paediatric patients undergoing interventional cardiology (IC) procedures is essential, as these procedures involve high radiation exposure and require dose optimization to account for the unique anatomical and tissue characteristics of children compared to adults. Data from Right and left heart cardiac catheterization (RHCC/LHCC), patent ductus arteriosus (PDA) closure, and atrial septal defect (ASD) closure procedures conducted at Lady Ridgway Hospital (LRH) for children in Colombo, Sri Lanka, from April 2023 to April 2025 were collected and grouped based on weight and age, as recommended by the European guidelines in Radiation Protection Report Number 185. A total of 438 procedures were analysed, including 195 ASD closures, 159 RHCC/LHCC, and 84 PDA closures. Institutional DRLs (IDRLs) were calculated for the DRL quantities such as dose area product (DAP), cumulative air kerma (Ka), and cumulative fluoroscopy time (FT) as recommended by the International Commission of Radiation Protection (ICRP). Except for the IDRLs determined based on Ka for 1-<4 years age group in ASD closure and RHCC/LHCC procedures, all other IDRLs were lower than the previously published reference levels. The developed IDRLs can be used by LRH, Sri Lanka, as reference levels to identify unusual situations in case of abnormally low or higher values of these DRL quantities in IC procedures. This study highlights the need for the development of national DRLs for paediatric interventional cardiology procedures in Sri Lanka.