title: Cardiac three-dimensional rotational angiography can be performed with low radiation dose while preserving image quality.
abstract: OBJECTIVE
  The effective radiation dose (ED) of three-dimensional rotational angiography (3DRA) is 5-8 mSv, leading to reticence on its use. We evaluated the potential of 3DRA with a reduced number of frames (RNF) and a reduced dose per frame.
  
  
  RESULTS
  Three-dimensional rotational angiography was performed in 60 patients (52.5 ± 9.6 years, 16 females) referred for ablation in the right (RA; n = 10) and left atrium (LA; n = 50). In a simulation group (n = 20), the effect of dropping frames from a conventional 248 frames 3DRA LA acquisition was simulated. In a prospective group (n = 40), RNF 3DRA were acquired of LA (n = 30) and RA (n = 10) with 67 frames (0.24 Gy/frame) and 45 frames (0.12 μGy/frame), respectively. Accuracy was evaluated qualitatively and quantitatively. Effective radiation dose was determined by Monte Carlo simulation on every frame. In the simulation group, surface errors increased minimally and non-significantly when reducing frames from 248 to 124, 83, 62, 50, 42, and 31: 0.49 ± 0.51, 0.52 ± 0.46, 0.61 ± 0.49, 0.62 ± 0.47, 0.71 ± 0.48, and 0.81 ± 0.47 mm, respectively (Pearson coefficient 0.20). All 3D LA images were clinically useful, even with only 31 frames. In the prospective group, good or optimal 3D image quality was achieved in 80% of LA and all of RA reconstructions. These accurate models were obtained with ED of 2.6 ± 0.4 mSv for LA and 1.2 ± 0.5 mSv for RA.
  
  
  CONCLUSIONS
  Three-dimensional rotational angiography is possible with a significant reduction in ED (to the level of prospectively gated cardiac computed X-ray tomography) without compromising image quality. Low-dose 3DRA could become the preferred online 3D imaging modality for pulmonary vein isolation and other anatomy-dependent ablations.
authors.affiliation: Department of Cardiovascular Sciences, Section of Arrhythmology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium, Europe.
authors.forename: Stijn
authors.initials: S
authors.lastname: De Buck
authors.forename: Becker S N
authors.initials: BS
authors.lastname: Alzand
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Wielandts
authors.forename: Christophe
authors.initials: C
authors.lastname: Garweg
authors.forename: Thomas
authors.initials: T
authors.lastname: Phlips
authors.forename: Joris
authors.initials: J
authors.lastname: Ector
authors.forename: Dieter
authors.initials: D
authors.lastname: Nuyens
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods*; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000601:surgery; D017115:Catheter Ablation; D003198:Computer Simulation; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D025321:Surgery, Computer-Assisted
keywords: Atrial fibrillation; Catheter ablation; Effective dose; Imaging; Radiation risk; Rotational angiography