| Objectives: The development of pediatric cardiology has led to an increase in the number of interventional procedures for the diagnosis and treatment of congenital heart diseases. These interventions may involve high doses of radiation, which can pose a risk of stochastic effects. The International Commission on Radiological Protection recommends the use of reference levels for each institution and suggests strategies to reduce radiation exposure, including the use of reference images. In Latin America, there is limited information on this topic, and the aim of this study is to analyze the effects of using reference images in a pediatric population at a referral center in Colombia. Methods and Results: Retrospective study analyzing pediatric patients undergoing cardiac catheterization between January/2022 and December/2023. Cases with appropriate previous images for use as references during the intervention were included. 8 patients were evaluated, 5 males (62.5%), with a mean age of 41.4 months (CI: 1.4-102) and 14.7 kg (CI: 2.95-22). The main diagnosis was aortic coarctation (n=4, 50%), treated with balloon angioplasty (n=4, 50%), followed by patent ductus arteriosus (n=3, 37.5%), managed with stent angioplasty (n=3, 37.5%), and transposition of great vessels (n=1, 12.5%), intervened with Rashkind atrioseptostomy (n=1, 12.5%). Reported total dose product values were 2028.5 mGy (CI: 0.024-226.25), 38.5 mGy (CI: 0-455), and 160.6 mGy, respectively. On the other hand, fluoroscopy times were 6.8 min (CI: 6.155-7.375) for balloon angioplasty, 17.8 min for stent angioplasty, and 18.6 min for Rashkind atrioseptostomy. Conclusion: According to the reference standards established in our institution and supported by previous studies, using reference images during balloon angioplasty to address aortic coarctation showed a significant reduction in fluoroscopy duration and radiation exposure examined. However, although a similar decrease in radiological exposure time is anticipated in other endovascular interventions, this cannot be concluded as specific reference values for these procedures are lacking, hindering adequate comparison. Further studies with larger cohorts are needed to determine the efficacy of reference images specifically for this procedure. |