title: Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab.
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.
  
  
  METHODS
  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.
authors.affiliation: Pediatric Cardiology Associates, Baton Rouge, La, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Haddad
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Memphis, Tenn, USA.
authors.forename: B Rush
authors.initials: BR
authors.lastname: Waller
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Memphis, Tenn, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Department of Radiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tenn, USA.
authors.forename: Asim
authors.initials: A
authors.lastname: Choudhri
authors.affiliation: College of Medicine, University of Tennessee Health Science Center, Memphis, Tenn, USA.
authors.forename: Vera
authors.initials: V
authors.lastname: McGhee
authors.affiliation: Department of Biostatistics, Harvard Medical School, Associate Professor of Anesthesia and Biostatistics, Boston Children's Hospital, Boston, Mass, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Toshiba America Medical Systems, Toshiba Education Center, Irvine, Calif, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kuhls-Gilcrist
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Memphis, Tenn, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sathanandam
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001830:Body Surface Area; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002932:Cineangiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D019411:Clinical Laboratory Techniques; D002985:Clinical Protocols; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007223:Infant; D008297:Male; D061214:Patient Safety; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011835:Radiation Protection; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Effective Dose; Monte-Carlo Sequencing; NanoDots; Phantom; Radiation Reduction; Rotational Angiography