Radiation dose reduction for 3D angiography images in pediatric and congenital cardiology

Published on Mar 1, 2021in Catheterization and Cardiovascular Interventions2.044
· DOI :10.1002/CCD.29272
Kenneth A. Fetterly18
Estimated H-index: 18
(Mayo Clinic),
Andrea Ferrero8
Estimated H-index: 8
(Mayo Clinic)
+ 3 AuthorsNathaniel W. Taggart14
Estimated H-index: 14
(Mayo Clinic)
Objectives The purpose of this study was to investigate the influence of simulated reduced-dose three-dimensional angiography (3DA) on the accuracy and precision of linear measurements derived from 3DA datasets. Background Three-dimensional angiography is performed during X-ray guided interventional procedures to aid diagnosis and inform treatment strategies for children and adults with congenital heart disease. However, 3DA contributes substantially to patient radiation dose and may lead to an increased radiation-induced cancer risk. Methods Reduced-dose patient 3DA images were simulated by adding quantum noise to the 2D projection angiograms, then reconstructing the projection angiograms into the 3DA dataset. Dose reduction in the range 33-72% was simulated. Five observers performed 46 vessel diameter measurements along prespecified axes within 23 vessel segments from 11 patient 3DA datasets. Statistical tests were performed to assess the influence of radiation dose reduction on the accuracy and precision of vessel diameter measurements. Results Vessel diameter measurements were in the range 5.9- 22.7 mm. Considering all vessel segments and observers, the influence of dose level on the accuracy of diameter measurements was in the range 0.02 - 0.15 mm (p .05-.8). Interobserver variability increased modestly with vessel diameter, but was not influence by dose level (p = .52). The statistical test for observer recall bias was negative (p = .51). Conclusions Simulated dose reduction up to 72% did not affect the accuracy or precision of the diameter measurements acquired from 3DA images. These findings may embolden 3DA radiation dose reduction for pediatric and congenital heart disease patients.
#1Femke van der Stelt (UU: Utrecht University)H-Index: 4
#2Sebastiaan N. Siegerink (UU: Utrecht University)H-Index: 1
Last. Johannes M.P.J. Breur (UU: Utrecht University)H-Index: 17
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Cardiac catheterization is a commonly used form of imaging and treatment in pediatric patients with congenital heart disease. Traditionally, two-dimensional conventional angiography was the method used, but since 2000 three-dimensional rotational angiography (3DRA) is increasingly used in the field of cardiology in both adult and pediatric patients. To investigate the use and applications of 3DRA in pediatric congenital cardiology, literature was systematically reviewed and 29 eligible articles ...
4 CitationsSource
#1Savine C. S. Minderhoud (UU: Utrecht University)H-Index: 1
#2Femke van der Stelt (UU: Utrecht University)H-Index: 4
Last. Johannes M.P.J. Breur (UU: Utrecht University)H-Index: 17
view all 6 authors...
Previously, median effective dose (ED) of 1.6 mSv per three-dimensional rotational angiography (3DRA) has been reported. This study evaluated ED and image quality in 3DRA after implementation of a simple dose reduction protocol in pediatric catheterizations. Simple conversion factors between 3DRA ED and readily available parameters at the cathlab were determined. The dose reduction protocol consisted of frame reduction (60–30 frames/s (f/s)), active collimation of the X-ray beam, usage of a read...
4 CitationsSource
#1Andrea Ferrero (Mayo Clinic)H-Index: 8
#2Ken Fetterly (Mayo Clinic)H-Index: 1
Last. Lifeng YuH-Index: 48
view all 4 authors...
Our institution routinely uses limited-angle cone-beam CT (CBCT) from a C-arm with 3D capabilities to diagnose and treat cardiovascular and orthopedic diseases in both adult and pediatric patients. While CBCT contributes to qualitative and quantitative assessment of both normal and abnormal patient anatomy, it also contributes substantially to patient radiation dose. Reducing the dose associated with CBCT exams while maintaining clinical utility can be considered to be of benefit to patients for...
2 CitationsSource
#1Osamah Aldoss (Boston Children's Hospital)H-Index: 4
#2Brian Fonseca (CU: University of Colorado Boulder)H-Index: 11
Last. Thomas Fagan (UTHSC: University of Tennessee Health Science Center)H-Index: 4
view all 8 authors...
We evaluated the diagnostic utility of the three modalities of three-dimensional rotational angiography (3DRA): rotational angiography (RA), multiplanar reformat (MPR) and three-dimensional angiographic reconstruction (3D-R) in pediatric cardiac catheterization. The 3DRA studies were classified by anatomy of interest based on our injection protocol: pulmonary arteries (PA), aorta, cavopulmonary connection (CPC), and others. Retrospective review of 3DRA images by two reviewers for each modality w...
20 CitationsSource
#1Lauren M. HaddadH-Index: 3
#2B. Rush WallerH-Index: 8
Last. Shyam SathanandamH-Index: 14
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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 procedure...
19 CitationsSource
#1Uyen Truong (Boston Children's Hospital)H-Index: 18
#2Thomas E. Fagan (Boston Children's Hospital)H-Index: 13
Last. Brian Fonseca (Boston Children's Hospital)H-Index: 11
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Objectives We are the first to describe the use of three-dimensional rotational angiography (3DRA) in creating multiplanar reconstruction (MPR) and volume rendering, in the catheterization suite, of airways at risk for compression by adjacent cardiac structures. Background 3DRA has emerged as a promising tool for improved visualization of cardiac and vascular structures in congenital heart disease. Methods This is a retrospective review of all available cases at our institution in which MPR from...
17 CitationsSource
#1Marjolein Peters (UU: Utrecht University)H-Index: 1
#1Marjolein Peters (UU: Utrecht University)H-Index: 51
Last. Johannes M.P.J. Breur (UU: Utrecht University)H-Index: 17
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Aims Three-dimensional rotational angiography (3DRA) is a relatively new but promising imaging technique in the paediatric catheterization laboratory. However, data on effective dose (ED) of this technique in children are lacking. The purpose of this study is to provide ED of 3DRA and to correlate this with parameters readily available in daily practice. Furthermore, the effect of dose-reducing techniques is evaluated. Methods and results Effective doses were calculated with Monte Carlo PCXMC 2....
19 CitationsSource
#1Sharon Borik (U of T: University of Toronto)H-Index: 3
#2Sabina Volodina (U of T: University of Toronto)H-Index: 1
Last. Lee N. Benson (U of T: University of Toronto)H-Index: 74
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The aim of the study was to examine the role of three-dimensional rotational angiography (3DRA) in assessing vascular and airway narrowing in children with a bidirectional cavopulmonary anastomosis (BCPA). The course of children with single ventricle physiology is often complicated by left pulmonary artery (LPA) and/or bronchial stenosis and may be related to aortic compression. 3DRA may be useful in evaluating this complex anatomy and possible mechanisms for the observed obstruction. Clinical d...
14 CitationsSource
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 car...
13 CitationsSource
#1Thomas E. Fagan (CU: University of Colorado Boulder)H-Index: 13
#2Uyen Truong (CU: University of Colorado Boulder)H-Index: 18
Last. Brian Fonseca (CU: University of Colorado Boulder)H-Index: 11
view all 8 authors...
Abstract Cardiac catheterization procedures for patients with congenital and structural heart disease are becoming more complex. New imaging strategies involving integration of 3-dimensional images from rotational angiography, magnetic resonance imaging (MRI), computerized tomography (CT), and transesophageal echocardiography (TEE) are employed to facilitate these procedures. We discuss the current use of these new 3D imaging technologies and their advantages and challenges when used to guide co...
42 CitationsSource
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