Moderate and severe congenital heart disease (CHD) occurs in approximately 6 of 1,000 births,1,2 and more severe forms of CHD may require surgical or transcatheter interventions early in life. Owing to patient and procedural complexity, computed tomography imaging and cardiac catheterizations are increasingly used; however, these procedures are not without risk. Epidemiologic studies have shown an approximately linear relation between ionizing radiation exposure and cancer.1,3,4 Efforts to limit healthcare provider exposure to radiation have already been implemented; however, patients continue to be exposed to low-dose radiation with each imaging study.3,5 Patients with CHD require frequent imaging in the diagnosis and management of their care, often starting early in life when rapid growth and cell division are occurring.1 Given the frequency of imaging and radiation exposure, the relation to radiation-associated cancers (RAC) in this patient population is important to characterize and understand. We hypothesized that RAC occur in adults with CHD at greater frequencies than in those without CHD. Given the rarity of RAC in the CHD population, we sought to use an administrative database to study this association...
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