Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab
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...
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| Veröffentlicht in: | Congenital heart disease 2016-11, Vol.11 (6), p.637-646 |
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| creator | Haddad, Lauren Waller, B. Rush Johnson, Jason Choudhri, Asim McGhee, Vera Zurakowski, David Kuhls-Gilcrist, Andrew Sathanandam, Shyam |
| description | 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 |
| doi_str_mv | 10.1111/chd.12356 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826670087</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826670087</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3576-541502b33be7507a9df41a9dc0617e3937888c6c9b218c832fb4c82270a3bb703</originalsourceid><addsrcrecordid>eNpdkU1P3DAQhq0KVD7aQ_8AssSll4AdJ7FzRLuURVo-uqJqb5bjzLKGJF5sR7D8Df4wzi7soT54Xs0870gzg9APSk5ofKd6UZ_QlOXFF7RPecYTIgjb-dS8_LeHDrx_ICQrGBdf0V7KYzZjbB-9zVRtVDC2w7fOBqttg-fW4buFA0jGpoXOx6Jq8MyGNRflWXdv7L1Ty8UKB4unpjVhsGuoezeg257nL0vrewfYdDgsAN_CUHFG45FyUQ4x5gM487pxTFX1De3OVePh-0c8RH9-nd-NJsn05uJydDZNNMt5keQZzUlaMVYBzwlXZT3PaPw1KSgHVsZRhdCFLquUCi1YOq8yLdI4u2JVxQk7RD83fZfOPvXgg2yN19A0qgPbe0lFWhScEMEjevwf-mB7F3cxUFlWcpoKFqmjD6qvWqjl0plWuZX8XHcETjfAs2lgta1TIoc7ynhHub6jHE3GaxEdycZhfICXrUO5R1lwxnP59_pC_hYzTvLxlZywd4dWn0Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1844971283</pqid></control><display><type>article</type><title>Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Haddad, Lauren ; Waller, B. Rush ; Johnson, Jason ; Choudhri, Asim ; McGhee, Vera ; Zurakowski, David ; Kuhls-Gilcrist, Andrew ; Sathanandam, Shyam</creator><creatorcontrib>Haddad, Lauren ; Waller, B. Rush ; Johnson, Jason ; Choudhri, Asim ; McGhee, Vera ; Zurakowski, David ; Kuhls-Gilcrist, Andrew ; Sathanandam, Shyam</creatorcontrib><description>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.</description><identifier>ISSN: 1747-079X</identifier><identifier>EISSN: 1747-0803</identifier><identifier>DOI: 10.1111/chd.12356</identifier><identifier>PMID: 27079433</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>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 ; Effective Dose ; Female ; Heart Defects, Congenital - diagnostic imaging ; Humans ; Imaging, Three-Dimensional - adverse effects ; Imaging, Three-Dimensional - instrumentation ; Imaging, Three-Dimensional - methods ; Infant ; Intubation ; Male ; Medical imaging ; Monte-Carlo Sequencing ; NanoDots ; Patient Safety ; Pediatrics ; Phantom ; Phantoms, Imaging ; Radiation Dosage ; Radiation Exposure - adverse effects ; Radiation Exposure - prevention & control ; Radiation Protection ; Radiation Reduction ; Risk Assessment ; Risk Factors ; Rotational Angiography ; Young Adult</subject><ispartof>Congenital heart disease, 2016-11, Vol.11 (6), p.637-646</ispartof><rights>2016 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3576-541502b33be7507a9df41a9dc0617e3937888c6c9b218c832fb4c82270a3bb703</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fchd.12356$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fchd.12356$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27079433$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haddad, Lauren</creatorcontrib><creatorcontrib>Waller, B. Rush</creatorcontrib><creatorcontrib>Johnson, Jason</creatorcontrib><creatorcontrib>Choudhri, Asim</creatorcontrib><creatorcontrib>McGhee, Vera</creatorcontrib><creatorcontrib>Zurakowski, David</creatorcontrib><creatorcontrib>Kuhls-Gilcrist, Andrew</creatorcontrib><creatorcontrib>Sathanandam, Shyam</creatorcontrib><title>Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab</title><title>Congenital heart disease</title><addtitle>Congenital Heart Disease</addtitle><description>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.</description><subject>Adolescent</subject><subject>Age Factors</subject><subject>Body Surface Area</subject><subject>Cardiac Catheterization - adverse effects</subject><subject>Cardiac Catheterization - methods</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cineangiography - adverse effects</subject><subject>Cineangiography - instrumentation</subject><subject>Cineangiography - methods</subject><subject>Clinical Laboratory Techniques</subject><subject>Clinical Protocols</subject><subject>Contrast Media - administration & dosage</subject><subject>Coronary Angiography - adverse effects</subject><subject>Coronary Angiography - instrumentation</subject><subject>Coronary Angiography - methods</subject><subject>Effective Dose</subject><subject>Female</subject><subject>Heart Defects, Congenital - diagnostic imaging</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional - adverse effects</subject><subject>Imaging, Three-Dimensional - instrumentation</subject><subject>Imaging, Three-Dimensional - methods</subject><subject>Infant</subject><subject>Intubation</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Monte-Carlo Sequencing</subject><subject>NanoDots</subject><subject>Patient Safety</subject><subject>Pediatrics</subject><subject>Phantom</subject><subject>Phantoms, Imaging</subject><subject>Radiation Dosage</subject><subject>Radiation Exposure - adverse effects</subject><subject>Radiation Exposure - prevention & control</subject><subject>Radiation Protection</subject><subject>Radiation Reduction</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Rotational Angiography</subject><subject>Young Adult</subject><issn>1747-079X</issn><issn>1747-0803</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1P3DAQhq0KVD7aQ_8AssSll4AdJ7FzRLuURVo-uqJqb5bjzLKGJF5sR7D8Df4wzi7soT54Xs0870gzg9APSk5ofKd6UZ_QlOXFF7RPecYTIgjb-dS8_LeHDrx_ICQrGBdf0V7KYzZjbB-9zVRtVDC2w7fOBqttg-fW4buFA0jGpoXOx6Jq8MyGNRflWXdv7L1Ty8UKB4unpjVhsGuoezeg257nL0vrewfYdDgsAN_CUHFG45FyUQ4x5gM487pxTFX1De3OVePh-0c8RH9-nd-NJsn05uJydDZNNMt5keQZzUlaMVYBzwlXZT3PaPw1KSgHVsZRhdCFLquUCi1YOq8yLdI4u2JVxQk7RD83fZfOPvXgg2yN19A0qgPbe0lFWhScEMEjevwf-mB7F3cxUFlWcpoKFqmjD6qvWqjl0plWuZX8XHcETjfAs2lgta1TIoc7ynhHub6jHE3GaxEdycZhfICXrUO5R1lwxnP59_pC_hYzTvLxlZywd4dWn0Q</recordid><startdate>201611</startdate><enddate>201611</enddate><creator>Haddad, Lauren</creator><creator>Waller, B. Rush</creator><creator>Johnson, Jason</creator><creator>Choudhri, Asim</creator><creator>McGhee, Vera</creator><creator>Zurakowski, David</creator><creator>Kuhls-Gilcrist, Andrew</creator><creator>Sathanandam, Shyam</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>JQ2</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201611</creationdate><title>Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab</title><author>Haddad, Lauren ; Waller, B. Rush ; Johnson, Jason ; Choudhri, Asim ; McGhee, Vera ; Zurakowski, David ; Kuhls-Gilcrist, Andrew ; Sathanandam, Shyam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3576-541502b33be7507a9df41a9dc0617e3937888c6c9b218c832fb4c82270a3bb703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>Body Surface Area</topic><topic>Cardiac Catheterization - adverse effects</topic><topic>Cardiac Catheterization - methods</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cineangiography - adverse effects</topic><topic>Cineangiography - instrumentation</topic><topic>Cineangiography - methods</topic><topic>Clinical Laboratory Techniques</topic><topic>Clinical Protocols</topic><topic>Contrast Media - administration & dosage</topic><topic>Coronary Angiography - adverse effects</topic><topic>Coronary Angiography - instrumentation</topic><topic>Coronary Angiography - methods</topic><topic>Effective Dose</topic><topic>Female</topic><topic>Heart Defects, Congenital - diagnostic imaging</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional - adverse effects</topic><topic>Imaging, Three-Dimensional - instrumentation</topic><topic>Imaging, Three-Dimensional - methods</topic><topic>Infant</topic><topic>Intubation</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Monte-Carlo Sequencing</topic><topic>NanoDots</topic><topic>Patient Safety</topic><topic>Pediatrics</topic><topic>Phantom</topic><topic>Phantoms, Imaging</topic><topic>Radiation Dosage</topic><topic>Radiation Exposure - adverse effects</topic><topic>Radiation Exposure - prevention & control</topic><topic>Radiation Protection</topic><topic>Radiation Reduction</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Rotational Angiography</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haddad, Lauren</creatorcontrib><creatorcontrib>Waller, B. Rush</creatorcontrib><creatorcontrib>Johnson, Jason</creatorcontrib><creatorcontrib>Choudhri, Asim</creatorcontrib><creatorcontrib>McGhee, Vera</creatorcontrib><creatorcontrib>Zurakowski, David</creatorcontrib><creatorcontrib>Kuhls-Gilcrist, Andrew</creatorcontrib><creatorcontrib>Sathanandam, Shyam</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Computer Science Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Congenital heart disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haddad, Lauren</au><au>Waller, B. Rush</au><au>Johnson, Jason</au><au>Choudhri, Asim</au><au>McGhee, Vera</au><au>Zurakowski, David</au><au>Kuhls-Gilcrist, Andrew</au><au>Sathanandam, Shyam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab</atitle><jtitle>Congenital heart disease</jtitle><addtitle>Congenital Heart Disease</addtitle><date>2016-11</date><risdate>2016</risdate><volume>11</volume><issue>6</issue><spage>637</spage><epage>646</epage><pages>637-646</pages><issn>1747-079X</issn><eissn>1747-0803</eissn><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.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>27079433</pmid><doi>10.1111/chd.12356</doi><tpages>10</tpages></addata></record> |
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| ispartof | Congenital heart disease, 2016-11, Vol.11 (6), p.637-646 |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | 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 Effective Dose Female Heart Defects, Congenital - diagnostic imaging Humans Imaging, Three-Dimensional - adverse effects Imaging, Three-Dimensional - instrumentation Imaging, Three-Dimensional - methods Infant Intubation Male Medical imaging Monte-Carlo Sequencing NanoDots Patient Safety Pediatrics Phantom Phantoms, Imaging Radiation Dosage Radiation Exposure - adverse effects Radiation Exposure - prevention & control Radiation Protection Radiation Reduction Risk Assessment Risk Factors Rotational Angiography Young Adult |
| title | Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab |
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