Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab

Congenit Heart Dis. 2016 Dec;11(6):637-646. doi: 10.1111/chd.12356. Epub 2016 Apr 14.

Abstract

Background: Three-dimensional rotational angiography (3DRA) offers more detailed anatomic information than 2D digital acquisition (2DDA). Concerns over potentially higher contrast and radiation doses have limited its routine use.

Objective: The primary objective of this study was to compare radiation doses required to obtain 3DRA using a customized low dose radiation protocol with 2DDA. The secondary objective was to compare total procedural radiation in pediatric cardiac catheterization procedures utilizing 3DRA to those that do not.

Study design: Phantom studies were conducted to establish customized 3DRA protocols for radiation reduction. Comparison of 3DRA and non-3DRA procedures in age-, size- and diagnosis-matched controls was performed. Radiation doses were indexed to body surface area (BSA) to account for differing body habitus as validated from the phantom study.

Results: Study (n = 100) and control (n = 100) groups were matched for age (10.2 vs. 9.98 years; P = .239) and BSA (1.23 vs. 1.09 m2 ; P = .103). The dose area product (DAP) to acquire a 3DRA was similar to a 5 s, 15 frames/second 2DDA (278 vs. 241 cGy/cm2 ; P = .14). Despite the 3DRA group consisting of more complex interventions, no difference was found in the total procedural Air Kerma and DAP indexed to BSA (244 vs. 249 mGy/m2 ; P = .79 and 3348 vs. 3176 cGy/cm2 /m2 ; P = .48, respectively). The contrast volume to acquire a 3DRA compared to a 2DDA was greater (1.59 vs. 1.01 mL/kg; P < .001). However, no difference was found for the entire procedure (3.8 vs. 4 mL/kg, P = .494). This could have resulted from the need to obtain multiple 2DDAs to achieve the detail of a single 3DRA (11 vs. 7 per study; P < .001).

Conclusions: When 3DRA, using the proposed protocols is employed, total procedural contrast and radiation doses are comparable with the sole use of biplane cine-angiograms. These protocols may allow for routine use of 3DRA for congenital cardiac catheterizations.

Keywords: Effective Dose; Monte-Carlo Sequencing; NanoDots; Phantom; Radiation Reduction; Rotational Angiography.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Factors
  • Body Surface Area
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / methods*
  • Child
  • Child, Preschool
  • Cineangiography / adverse effects
  • Cineangiography / instrumentation
  • Cineangiography / methods*
  • Clinical Laboratory Techniques*
  • Clinical Protocols
  • Contrast Media / administration & dosage
  • Coronary Angiography / adverse effects
  • Coronary Angiography / instrumentation
  • Coronary Angiography / methods*
  • Female
  • Heart Defects, Congenital / diagnostic imaging*
  • Humans
  • Imaging, Three-Dimensional / adverse effects
  • Imaging, Three-Dimensional / instrumentation
  • Imaging, Three-Dimensional / methods*
  • Infant
  • Male
  • Patient Safety*
  • Phantoms, Imaging
  • Radiation Dosage*
  • Radiation Exposure / adverse effects
  • Radiation Exposure / prevention & control*
  • Radiation Protection
  • Risk Assessment
  • Risk Factors
  • Young Adult

Substances

  • Contrast Media