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Cardiac computed tomography and conventional angiography in the diagnosis of congenital cardiac disease in children: recent trends and radiation doses

  • Guy G. Gherardi (a1), Gareth R. Iball (a2), Michael J. Darby (a3) and John D.R. Thomson (a4)

Abstract

Background

The use of imaging that employs ionising radiation is increasing in the setting of paediatric cardiology. Children's high radiosensitivity and the lack of contemporary radiation data warrant a review of the radiation doses from the latest “state-of-the-art” angiography and computed tomography systems.

Objectives

In children aged less than 16 years with congenital cardiac disease, we aimed to report: recent trends in the use of diagnostic angiography and cardiac dual-source computed tomography; the characteristics, lesions, and imaging histories of patients undergoing these procedures; and the average radiation doses imparted by each modality.

Study design

Retrospective review of consecutive cases undergoing cardiac computed tomography or diagnostic angiography in a teaching hospital between January, 2008 and December, 2009. Radiation doses were converted to effective doses (millisievert) using published conversion factors.

Results

Angiography was performed 3.7 times more often than computed tomography. Computed tomography examinations increased by 92.5%, whereas angiography decreased by 26.4% in 2009 compared with 2008. Patients undergoing computed tomography were younger and weighed less than those undergoing angiography, but lesions were similar between the 2 groups. Multiple lifetime angiography was more prevalent than multiple lifetime computed tomography (p < 0.001). The median procedural dose – range – from angiography and computed tomography was 5 (0.2–27.8) and 1.7 (0.5–9.5) millisieverts, respectively (p < 0.001).

Conclusion

Despite not being completely analogous investigations, computed tomography should be considered prior to angiography and not withheld on radiation dose concerns, given that it imparts lower and more consistent doses than conventional angiography.

Copyright

Corresponding author

Correspondence to: G.G. Gherardi, School of Medicine, University of Leeds, 7.09 Worsley Building, Leeds LS2 9JT, United Kingdom. Tel: 07763907615; Fax: 01133434375; E-mail: guygherardi@gmail.com

References

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1.Brenner, D, Hall, E. Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007; 357: 22772284.
2.Balmer, F, Rotter, M, Togni, M, et al. Percutaneous coronary interventions in Europe 2000. Int J Cardiol 2005; 101: 457463.
3.Lucas, F, DeLorenzo, M, Siewers, A, Wennberg, D. Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United States, 1993–2001. Circulation 2006; 113: 374379.
4.Ayanian, J. Rising rates of cardiac procedures in the United States and Canada: too much of a good thing? Circulation 2006; 113: 333335.
5.Patel, H, Hijazi, Z. Pediatric catheter interventions: a year in review 2004–2005. Curr Opin Pediatr 2005; 17: 568573.
6.Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation; Nuclear and Radiation Studies Board, Division on Earth and Life Studies, National Research Council of the National Academies. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. The National Academies Press, Washington, 2006.
7.Paterson, A, Frush, D. Dose reduction in paediatric MDCT: general principles. Clin Radiol 2007; 62: 507517.
8.Hall, E. Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 2002; 32: 700706.
9.Vock, P. CT dose reduction in children. Eur Radiol 2005; 15: 23302340.
10.International Commission on Radiological Protection (ICRP). The 2007 recommendations of ICRP (ICRP publication 103). Ann ICRP 2007; 37: 1332.
11.Strauss, K, Kaste, S. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients – a white paper executive summary. Pediatr Radiol 2006; 36(Suppl 2): 110112.
12.Leschka, S, Oechslin, E, Husmann, L, et al. Pre- and postoperative evaluation of congenital heart disease in children and adults with 64-section CT. Radiographics 2007; 27: 829846.
13.Bean, M, Pannu, H, Fishman, E. Three-dimensional computed tomographic imaging of complex congenital cardiovascular abnormalities. J Comput Assist Tomogr 2005; 29: 721724.
14.Lee, C, Haims, A, Monico, E, Brink, J, Forman, H. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 2004; 231: 393398.
15.Goo, H. State-of-the-art CT imaging techniques for congenital heart disease. Korean J Radiol 2010; 11: 418.
16.Morin, R, Gerber, T, McCollough, C. Radiation dose in computed tomography of the heart. Circulation 2003; 107: 917922.
17.Ait-Ali, L, Andreassi, M, Foffa, I, Spadoni, I, Vano, E, Picano, E. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart 2010; 96: 269274.
18.Karambatsakidou, A, Sahlgren, B, Hansson, B, Lidegran, M, Fransson, A. Effective dose conversion factors in paediatric interventional cardiology. Br J Radiol 2009; 82: 748755.
19.Shrimpton, P. Assessment of Patient Dose in CT. NRPB-PE/1/2004. NRPB, Chilton, 2004.
20.Puranik, R, Muthurangu, V, Celermajer, D, Taylor, A. Congenital heart disease and multi-modality imaging. Heart Lung Circ 2010; 19: 133144.
21.Ben Saad, M, Rohnean, A, Sigal-Cinqualbre, A, Adler, G, Paul, J. Evaluation of image quality and radiation dose of thoracic and coronary dual-source CT in 110 infants with congenital heart disease. Pediatr Radiol 2009; 39: 668676.
22.Dillman, J, Hernandez, R. Role of CT in the evaluation of congenital cardiovascular disease in children. AJR Am J Roentgenol 2009; 192: 12191231.
23.Cheng, Z, Wang, X, Duan, Y, et al. Low-dose prospective ECG-triggering dual-source CT angiography in infants and children with complex congenital heart disease: first experience. Eur Radiol 2010; 20: 25032511.
24.Kuettner, A, Gehann, B, Spolnik, J, et al. Strategies for dose-optimized imaging in pediatric cardiac dual source CT. Rofo 2009; 181: 339348.
25.Bacher, K, Bogaert, E, Lapere, R, De Wolf, D, Thierens, H. Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation 2005; 111: 8389.
26.Rassow, J, Schmaltz, A, Hentrich, F, Streffer, C. Effective doses to patients from paediatric cardiac catheterization. Br J Radiol 2000; 73: 172183.
27.Dragusin, O, Gewillig, M, Desmet, W, Smans, K, Struelens, L, Bosmans, H. Radiation dose survey in a paediatric cardiac catheterisation laboratory equipped with flat-panel detectors. Radiat Prot Dosimetry 2008; 129: 9195.

Keywords

Cardiac computed tomography and conventional angiography in the diagnosis of congenital cardiac disease in children: recent trends and radiation doses

  • Guy G. Gherardi (a1), Gareth R. Iball (a2), Michael J. Darby (a3) and John D.R. Thomson (a4)

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