A Comparison of Radiation Dose Between Standard and 3D Angiography in Congenital Heart Disease

Abstract

Background The use of three-dimensional rotational angiography (3D-RA) to assess patients with congenital heart diseases appears to be a promising technique despite the scarce literature available. Objectives The objective of this study was to describe our initial experience with 3D-RA and to compare its radiation dose to that of standard two-dimensional angiography (2D-SA). Methods Between September 2011 and April 2012, 18 patients underwent simultaneous 3D-RA and 2D-SA during diagnostic cardiac catheterization. Radiation dose was assessed using the dose-area-product (DAP). Results The median patient age and weight were 12.5 years and 47.5 Kg, respectively. The median DAP of each 3D-RA acquisition was 1093µGy.m2 and 190µGy.m2 for each 2D-SA acquisition (p<0.01). In patients weighing more than 45Kg (n=7), this difference was attenuated but still significant (1525 µGy.m2 vs.413µGy.m2, p=0.01). No difference was found between one 3D-RA and three 2D-SA (1525µGy.m2 vs.1238 µGy.m2, p = 0.575) in this population. This difference was significantly higher in patients weighing less than 45Kg (n=9) (713µGy.m2 vs.81µGy.m2, P = 0.008), even when comparing one 3D-RA with three 2D-SA (242µGy.m2, respectively, p<0.008). 3D-RA was extremely useful for the assessment of conduits of univentricular hearts, tortuous branches of the pulmonary artery, and aorta relative to 2D-SA acquisitions. Conclusions The radiation dose of 3D-RA used in our institution was higher than those previously reported in the literature and this difference was more evident in children. This type of assessment is of paramount importance when starting to perform 3D-RA.

Radiation Dosimetry of 3D Rotational Neuroangiography and 2D-DSA in Children

“…Comparing measured and reported radiation dose surrogates is a common practice in fluoroscopic and interventional applications. [24][25][26] There is considerable utility in capturing and analyzing these metrics for use in quality programs and to establish notification and substantial radiation dose levels. 27 Assessing the impact of K a,r and air kerma area product between interventions can be complicated as it does not account for geometric factors, colli- mation, obstacles in the path of radiation (table, pad, head support, etc) and differences in beam quality.…”

Pros, cons and future perspectives – three questions on three dimensional guidance for cardiac catheterization in congenital heart disease

“…Gregor Krings: With the new imaging system at the Heart Center in Utrecht, introduced in 2011, we had the opportunity to start with this 3DRA technique. Our experience so far is some 700-800 cases over the last years [19,20,[30][31][32]. From the interventions we do in our institution I would say that probably 70-80% are based on 3DRA or imported previous CTs.…”

“…Like many disruptive technologies, its introduction has divided opinion. Cost, benefit, radiation and contrast exposure have fed the natural resistance to change and whilst the potential harm is low the benefits have also been difficult to quantify [18][19][20][21].…”

“…These structured interviews recorded during the 21 st Pediatric and Adult Interventional Cardiac Symposium (PICS, November 2018) illustrate the challenges and sticking points as well as giving an insight into the direction of travel for 3D imaging and fusion techniques. Covering a wide range of career development, seniority and experience, the interviewees in this article are probably responsible for the majority of the published literature on invasive 3D imaging in congenital heart disease [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. They each collaborate with a broad range of industry partners to map out the future direction of invasive imaging with specific reference to our complex patient group.…”

Dramatic Dose Reduction in Three-Dimensional Rotational Angiography After Implementation of a Simple Dose Reduction Protocol

“…Many studies directly estimate ED from DAP [10–12]. However, the relation between DAP and ED for 3DRA has never been strongly confirmed [13].…”