Radiation Exposure of Dual-Source Cardiovascular Computed Tomography in Patients With Congenital Heart Disease

Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits, and Bioprosthetic Valves

“…Modern scanners have been shown to have far lower radiation exposure than historical standards when used in centers with expertise imaging CHD patients. 79 , 80 Two studies documented 85% to 90% dose reduction in the CHD patient population with adoption of dose optimization and newer scanner platforms. 81 , 82 A recent multi-institutional study of CCT performed in patients of all ages with CHD showed low radiation dose across the age range even for functional CT imaging.…”

“… 81 , 82 A recent multi-institutional study of CCT performed in patients of all ages with CHD showed low radiation dose across the age range even for functional CT imaging. 79 The average radiation dose estimate for an anatomic scan was < 1 millisievert (mSv) in 1,516 CCT scans in CHD patients from neonates to adult patients and the average radiation dose for a functional CCT scan in 226 studies across the age range was < 2 mSv. For reference, a commonly cited paper estimating cancer from CT in pediatric patients reported a radiation dose up to 69 mSV per scan, a dose over 20 mSv in approximately 8% of chest CT and the dose associated cancer risk was between 30 and 50 mSv.…”

“…Radiation doses for coronary angiography and for comprehensive CHD evaluation in the current era are significantly reduced over historical estimates. 79 , 104 Invasive coronary angiogram may also be performed at the time of TPVR in selected patients.…”

Preoperative Computed Tomographic Angiography Can Predict Need for Branch Pulmonary Artery Intervention in Patients With Ductal-Dependent Pulmonary Blood Flow

“…8 In the era of low radiation dual-source computed tomographic angiography (CTA), detailed anatomic assessments of the PDA and branch PAs are frequently performed for surgical or interventional planning. [9][10][11] For example, CTA has been used to assess PDA ductal length and tortuosity for guiding the interventional approach in neonates receiving a PDA stent. 12,13 The objective of this study was to identify novel CTA measures associated with increased risk of postoperative branch PA stenosis requiring reintervention in neonates with DD-PBF.…”

“…Results: Forty patients were included, 7 (18%) did not receive a PA intervention, 23 (58%) were in the initial PA intervention group, and 10 (25%) were in the remote PA intervention group. The distance from PA bifurcation to the largest diameter of the PA that receives the PDA showed a difference between the no-intervention group versus the initial and remote intervention groups (0.8 mm [IQR 0.7, 2.0], 8.2 mm [IQR 1.9, 13.7], 8.5 mm [IQR 6.5,11.1], respectively, P = .02). The receiver operating characteristic curve showed a distance >2.2 mm had a sensitivity = 91% and specificity = 86% in predicting the need for PA intervention.…”