Regional diagnostic reference levels in paediatric interventional cardiology in Latin America and the Caribbean countries

The aim of the present study was to present an updated set of regional diagnostic reference levels (DRLs) for paediatric interventional cardiology procedures in Latin America and the Caribbean countries using the quantity kerma area-product (P_ka) and P_ka per body weigth, classified by age and weight groups within the framework of OPRIPALC international programme. Data based on diagnostic and therapeutic procedures were collected between December 2020 and December 2023. Regional DRLs have been set as the 3rd quartile of P_ka collected in 23 hospitals from 11 countries in a final sample of 2906 procedures. DRLs have been set for four age groups and five weight groups. The proposed set of regional DRLs for different diagnostic and therapeutic procedures by age and weight groups for P_ka quantity, were 4.3-5.4 Gy cm² (<1 yr) to 20.6-34.8 Gy cm² (10 to <16 yrs) and 3.4-4.5 Gy cm² (<5 kg) to 26.9-63.9 Gy cm² (50-< 80 kg), respectively. The proposed set of regional DRLs for P_ka /weight values were 0.885-1.181 Gy cm² kg⁻¹ (<1 yr) to 0.510-0.838 Gy cm² kg⁻¹ (10 to <16 yrs) and 0.984-1.333 Gy cm² kg⁻¹ (<5 kg) to 0.448-1.196 Gy cm² kg⁻¹ (50-< 80 kg), respectively. The values proposed as DRLs in OPRIPALC can be adopted by other countries and centers performing paediatric interventional cardiology procedures to compare their own dose values. The OPRIPALC methodology for establishing DRLs, with its variations and limitations, can also be considered in other regions of the world to develop their own regional DRLs.