Abstract
Previously, median effective dose (ED) of 1.6 mSv per three-dimensional rotational angiography (3DRA) has been reported. This study evaluated ED and image quality in 3DRA after implementation of a simple dose reduction protocol in pediatric catheterizations. Simple conversion factors between 3DRA ED and readily available parameters at the cathlab were determined. The dose reduction protocol consisted of frame reduction (60–30 frames/s (f/s)), active collimation of the X-ray beam, usage of a readily available low dosage program, and a pre-3DRA run check. EDs were calculated with Monte Carlo PCXMC 2.0. Three observers blindly assessed 3DRA image quality of the dose reduction and normal-dose cohort. Between October 2014 and October 2015, 84 patients (median age 4.3 years) underwent 100 3DRAs with a median ED of 0.54 mSv (0.12–2.2) using the dose reduction protocol. Median ED in the normal-dose cohort (17 3DRAs) was 1.6 mSv (1.2–4.9). Image quality in the dose reduction cohort remained excellent. Correlations between ED and dose area product (DAP) and ED and skin dose were found with a ρ of 0.82 and 0.83, respectively. ED exposure of the entire catheterization was reduced to 2.64 mSv. Introduction of a simple protocol led to 66% dose reduction in 3DRA and 79% in the entire catheterization. 3DRA image quality in this group remained excellent. In 3DRA ED correlates well with DAP and skin dose, parameters readily available at the cathlab.
Highlights
In pediatric cardiology imaging is essential for diagnostic and interventional purposes
Insufficient contrast leads to less radiation exposure. 3DRAs made with a central venous catheter or because of a non-cardiac diagnosis were excluded from image quality assessment
We show that standardized use of traditional 2D angiography dose-lowering techniques leads to a 66% dose reduction in 3DRA with preserved image quality
Summary
In pediatric cardiology imaging is essential for diagnostic and interventional purposes. For this reason, patients with congenital heart disease regularly and increasingly receive radiation over the years [1]. Radiation exposure during childhood is more harmful than during adulthood. Reasons for this are the longer life span children have and the more harmful effects radiation has on developing tissue. Children’s lifetime cancer risks will increase [2,3,4,5]. Catheterizations contribute to the majority of radiation burden in patients with congenital heart disease [6]
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