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.