A Theoretical Framework for Optimising Radiation Dose in Paediatric Interventional Cardiology Procedures in Resource-Limited Nigerian Tertiary Centres

Paediatric interventional cardiology procedures deliver among the highest radiation doses in clinical practice, and the development of a theoretically grounded optimisation framework tailored to the specific constraints of Nigerian tertiary centres, where equipment, physics support, and clinical physics expertise are limited, represents a significant original contribution to the radiation protection literature. This study develops and validates an original theoretical framework for paediatric interventional cardiology dose optimisation in resource-limited Nigerian tertiary contexts. The framework is constructed through three phases: systematic literature synthesis of international dose optimisation evidence, empirical dose mapping at the three Nigerian centres with paediatric cardiac catheterisation capacity (University College Hospital Ibadan, National Hospital Abuja, University of Nigeria Teaching Hospital Enugu), and qualitative expert consensus using structured Delphi methodology with 25 paediatric cardiology and medical physics specialists across Nigeria, West Africa, and the United Kingdom. Dose maps generated from 180 paediatric cardiac procedures using organ dosimetry Monte Carlo simulations characterise the Nigerian dose baseline. Expert consensus refines the framework through three Delphi rounds. Available paediatric interventional dose literature from Nigerian tertiary centres identifies the absence of a systematic dose management programme specific to the paediatric cardiac catheterisation context as the primary gap. The ICRP Publication 121 paediatric fluoroscopy guidance and Dose Optimisation Theory by Shrimpton provide the theoretical reference. The original framework specifies dose optimisation protocols, staff training requirements, dose reference level targets, and governance structures adapted for the Nigerian resource context. Keywords: paediatric interventional cardiology, dose optimisation, theoretical framework, Nigeria, resource-limited settings.