Pediatric computed tomographic angiography: imaging the cardiovascular system gently.
Whether congenital or acquired, timely recognition and management of disease is imperative, as hemodynamic alterations in blood flow, tissue perfusion, and cellular oxygenation can have profound effects on organ function, growth and development, and quality of life for the pediatric patient. Ensuring safe computed tomographic angiography (CTA) practice and "gentle" pediatric imaging requires the cardiovascular imager to have sound understanding of CTA advantages, limitations, and appropriate indications as well as strong working knowledge of acquisition principles and image post processing. From this vantage point, CTA can be used as a useful adjunct along with the other modalities. This article presents a summary of dose reduction CTA methodologies along with techniques the authors have employed in clinical practice to achieve low-dose and ultralow-dose exposure in pediatric CTA. CTA technical principles are discussed with an emphasis on the low-dose methodologies and safe contrast medium delivery strategies. Recommended parameters for currently available multidetector-row computed tomography scanners are summarized alongside recommended radiation and contrast medium parameters. In the second part of the article an overview of pediatric CTA clinical applications is presented, illustrating low-dose and ultra-low dose techniques, with an emphasis on the specific protocols.
Hellinger
Jeffrey C
JC
Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. jeffrey.hellinger@yahoo.com
Pena
Andres
A
Poon
Michael
M
Chan
Frandics P
FP
Epelman
Monica
M
D000005:Abdomen / Q000098:blood supply; D000293:Adolescent; D000792:Angiography / Q000379:methods; D002319:Cardiovascular System / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods; D005121:Extremities / Q000098:blood supply / Q000000981:diagnostic imaging; D006257:Head / Q000098:blood supply / Q000000981:diagnostic imaging; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D009333:Neck / Q000098:blood supply / Q000000981:diagnostic imaging; D010372:Pediatrics / Q000379:methods*; D010388:Pelvis / Q000098:blood supply / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods; D011860:Radiography, Abdominal / Q000379:methods; D013902:Radiography, Thoracic / Q000379:methods; D013909:Thorax / Q000098:blood supply; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging / Q000379:methods
D003287:Contrast Media