Diagnostic reference levels for paediatric interventional cardiology in Paraguay

Paediatric interventional cardiology procedures guided by fluoroscopy imaging can impart substantial radiation doses, making dose optimisation essential for younger patients. This study aims to establish the first national diagnostic reference levels for common paediatric interventional cardiology procedures using multicentre patient dose data. A retrospective analysis was performed of 196 procedures in patients younger than 16 years and weighing less than 80 kg, conducted over 12 months in three Paraguayan hospitals. Kerma-area product, P_ka , and cumulative air kerma at the patient entrance reference point, K_a,r , were extracted from system dose reports. Diagnostic reference levels were defined as the {75ᵗʰ} percentile of P_ka , and K_a,r , stratified by recommended age and weight groups. The P_ka , values increased 4.2-35.8 Gycm? across age bands and from 4.3-49.8 Gycm? across weight bands. Corresponding K_a,r , {75ᵗʰ} percentile values ranged from 83.9-456.1 mGy by age and from 87.7-530.0 mGy by weight. For the most frequent procedures, P_ka {75ᵗʰ} percentile values were 8.0-10.2 Gycm?. These national values were consistent with previously reported Latin American data. These values provide a basis for optimisation, quality assurance and regional comparison in paediatric interventional cardiology in Paraguay.