Comparison of rotational with conventional coronary angiography

Dual-axis rotational coronary angiography versus conventional coronary angiography: a randomized comparison

BACKGROUND

Dual-axis of rotational coronary angiography (RA), with one single cine acquisition during continuous C-arm motion along a pre-described path, is an alternative to conventional coronary angiography (CA). We assessed the performance of RA versus CA in a modern, experienced cath lab setting.

METHODS

Sixty-seven patients with suspected coronary artery disease undergoing invasive coronary angiography were randomized to CA (n = 35) or dual-axis RA (n = 32). CA was performed with four left and two right coronary artery acquisitions with manual contrast medium injection. In RA, one cine acquisition each was performed for the left (5 projections) and right coronary artery (3 projections) with a fixed amount of contrast medium applied by a power injector. In both groups, single cine acquisitions in additional angulations were performed to fully interpret the coronary system, if necessary. Procedural parameters and outcome were compared.

RESULTS

Mean age was 63 ± 12 years (64% males). Six additional projections were required in the RA group compared to 13 in the CA group (p = 0.173). Fluoroscopy duration (CA: 3 ± 3 min, RA: 3 ± 2 min, p = 0.748) and dose area product (CA: 1291 ± 761 µGym², RA: 1476 ± 679 µGym², p = 0.235) did not differ significantly between both groups. For CA, the amount of contrast medium (42 ± 13 vs. 46 ± 8 ml, p = 0.022) and procedure time (8 ± 5 vs. 11 ± 3 min, p < 0.001) were significantly lower. No major adverse event occurred during hospital stay.

CONCLUSIONS

Dual-axis RA represents a feasible and safe alternative method to CA for obtaining coronary angiograms. However, no superiority was observed when performed by an experienced interventionalist with a modern system.

Comparison of diagnostic accuracy of dual-axis rotational versus standard coronary angiography

The data about the accuracy of dual-axis rotational coronary angiography (DARCA) in detecting coronary artery disease (CAD) is scare. This study aimed to compare the diagnostic accuracy of DARCA versus standard coronary angiography (SA). 70 patients with possible CAD underwent SA following by DARCA were prospectively enrolled. The primary endpoint was the non-inferiority comparison of the two modalities regarding diagnosis of CAD. Coronary lesion assessment, quantitative coronary angiography (QCA) analysis, and screening adequacy comparisons were performed. All images were analyzed by two independent reviewers except QCA analysis that was analyzed by the third independent reviewer. Radiation dose, contrast usage and procedural time were recorded. This trial is registered with ClinicalTrials.gov, Number NCT01776866. 63 of 70 patients were analyzed. DARCA was non-inferior to SA regarding the diagnosis of CAD (reviewer one-positive agreement: 100%, negative agreement: 100%, p = 1; p = 0.003 for non-inferiority; reviewer two-positive agreement: 96%, negative agreement: 95%, p = 1; p = 0.016 for non-inferiority). All reviewers showed good agreement between the two modalities for the diagnosis of CAD, coronary lesion assessment, QCA analysis, and screening adequacy, as reflected by kappa coefficients between 0.61 and 1.00. DARCA was associated with 41% reduction in radiation dose, 30% in contrast usage and 29% in procedure time (all p < 0.001). DARCA is clinically comparable to SA concerning the diagnostic accuracy for CAD, while markedly reduces radiation dose, contrast usage and procedure time.

Comparison of the Effect of Dual-Axis Rotational Coronary Angiography Versus Conventional Coronary Angiography on Frequency of Acute Kidney Injury, X-Ray Exposure Time, and Quantity of Contrast Medium Injected

Dual-axis rotational coronary angiography (DARCA) has already been shown to reduce both the amount of contrast medium and radiation exposure compared with conventional coronary angiography (CCA). However, a clinical benefit of such imaging modality has never been demonstrated. The aim of this study was to evaluate the efficacy of DARCA to prevent acute kidney injury (AKI) compared with CCA. Consecutive patients who underwent coronary angiography were enrolled to DARCA (n = 80) or CCA (n = 80). Patients presenting with ST-segment elevation myocardial infarction or previously underwent coronary artery bypass graft were excluded. The 2 groups were homogeneous in terms of both clinical and procedural characteristics. Total x-ray time and total amount of contrast medium were significantly lower in the DARCA group compared with the CCA group (x-ray time 3.2 minutes [1.8 to 7.0] vs 5.1 minutes [2.6 to 9.9], p = 0.002; contrast medium amount 40 ml [31 to 116] vs 80 ml [50 to 150], p <0.001). AKI more often occurred in the CCA group compared with the DARCA group (16 [20%] vs 4 [5%], p = 0.007). Moreover, in patients presenting with acute coronary syndrome (ACS) or who underwent percutaneous coronary intervention (PCI), AKI more often occurred in the CCA group compared with the DARCA group (ACS patients, 6 [29%] vs 2 [6%], p = 0.04, and PCI patients, 11 [33%] vs 0 [0%], p <0.001). In addition, in patients with high pretest probability of coronary artery disease, AKI more often occurred in the CCA group compared with the DARCA group (11 [55%] vs 2 [6%], p <0.001). In conclusion, DARCA significantly reduces both x-ray exposure and amount of contrast medium usage, thereby reducing the occurrence of AKI compared with CCA.

Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes

Background

Adverse events from Melody valve implantation may be catastrophic. To date a role for three dimensional rotational angiography of the aortic root (3DRAA) during Melody valve implantation has not been established.

Objectives

To describe the role of 3DRAA in the assessment of Melody valve candidacy and to demonstrate that it may improve outcomes.

Methods

All patients who underwent cardiac catheterisation for Melody valve implantation and 3DRAA between August 2013 and February 2015 were reviewed.

Results

31 patients had 3DRAA with balloon sizing. Ten were deemed not Melody candidates (5 coronary compression, 2 aortic root distortion with cusp flattening, 2 RVOT was too large, and 1 had complex branch stenosis and a short landing zone). Of the 21 patients who were Melody candidates, 12 had conduits, 6 prosthetic valves and 3 native RVOTs. In patients with conduits, the technique of stenting the conduit prior to dilation was used after measuring the distance between the conduit and the coronary arteries on 3DRAA. In the Melody patients, we had 100% procedural success and no serious adverse events (coronary compression, tears, stent fracture or endocarditis).

Conclusion

As a tool for case selection, 3DRAA may facilitate higher procedural success and decreased risk of serious adverse events. Furthermore, 3D rotational angiography allows stenting of the conduit prior to dilation, which may prevent tears and possibly endocarditis.

Correlation between dual-axis rotational coronary angiography and intravascular ultrasound in a coronary lesion assessment

The purpose of this study was to evaluate the accuracy of dual-axis rotational coronary angiography (DARCA) for coronary lesion assessment by directly comparing with intravascular ultrasound (IVUS). From October 2014 to December 2015, 40 patients (58 lesions) who had undergone both DARCA and IVUS were included in the image analysis. The minimum lumen diameter (MLD), lesion length, reference vessel diameter (RVD) and percent diameter stenosis at the same lesion, were identified and assessed. Significant correlation with IVUS was found for DARCA in either lesion length (r = 0.90, P < 0.001) or RVD (r = 0.81, P < 0.001) comparison. DARCA had fair correlation with IVUS for both MLD (r = 0.65, P < 0.001) and diameter stenosis (r = 0.48, P < 0.001). From the Bland-Altman plots, there was a good agreement between DARCA and IVUS regarding MLD (mean difference: -0.23 mm, 95 % limits of agreement: -0.96 to 0.50 mm) and RVD (mean difference: -0.15 mm, 95 % limits of agreement: -0.85 to 0.55 mm), while lesser agreement was found on lesion length (mean difference: -3.39 mm, 95 % limits of agreement: -12.63 to 5.85 mm) and diameter stenosis (mean difference: 4.82 %, 95 % limits of agreement: -17.05 to 26.68 %). There is an adequate correlation and agreement between DARCA and IVUS in coronary lesion assessment.

Dual-Axis Rotational Angiography is Safe and Feasible to Detect Coronary Allograft Vasculopathy in Pediatric Heart Transplant Patients: A Single-Center Experience

Coronary allograft vasculopathy (CAV) is the leading cause of graft failure in pediatric heart transplant recipients, also adding to mortality in this patient population. Coronary angiography is routinely performed to screen for CAV, with conventional single-plane or bi-plane angiography being utilized. Dual-axis rotational coronary angiography (RA) has been described, mostly in the adult population, and may offer reduction in radiation dose and contrast volume. Experience with this in the pediatric population is limited. This study describes a single-institution experience with RA for screening for CAV in pediatric patients. The catheterization database at our institution was used to identify pediatric heart transplant recipients having undergone RA to screen for CAV. Procedural data including radiation dose, fluoroscopy time, contrast volume, and procedure time were collected for each catheterization. The number of instances in which RA was not successful, ECG changes were present, and CAV was detected were also collected for each catheterization. A total of 97 patients underwent 345 catheterizations utilizing RA. Median radiation dose-area product per kilogram was found to be 341.7 (mGy cm(2)/kg), total air kerma was 126.8 (mGy), procedure time was 69 min, fluoroscopy time was 9.9 min, and contrast volume was 13 ml. A total of 17 (2 %) coronary artery injections out of 690 could not be successfully imaged using RA. A total of 14 patients had CAV noted at any point, 10 of whom had progressive CAV. Electrocardiographic changes were documented in a total of 10 (3 %) RA catheterizations. Procedural characteristics did not differ between serial catheterizations. RA is safe and feasible for CAV screening in pediatric heart transplant recipients while offering coronary imaging in multiple planes compared to conventional angiography.

Comparison of Contrast Volume, Radiation Dose, Fluoroscopy Time, and Procedure Time in Previously Published Studies of Rotational Versus Conventional Coronary Angiography

Conventional coronary angiography (CA) with static imaging is limited by the ability to properly select the optimal acquisition angle, vessel foreshortening, and significant radiation exposure. Rotational coronary angiography (RA) acquires coronary images in a multitude of viewing angles during a single injection by means of a moving gantry that rapidly completes a predefined arc. This study compares procedural characteristics of CA and RA. Electronic search of databases such as OVID, Medline, and PubMed was conducted to identify studies comparing procedural characteristics of CA and RA. End points for analysis included contrast volume, radiation dose by dose area product, radiation dose by air kerma, fluoroscopy time, and procedure time. Studies were assessed for quality and bias and were included if they compared coronary imaging of both the right and left coronary systems with CA and RA, included one of the end points of interest, and were in English. A total of 11 studies consisting of 940 patients who underwent RA and 976 who underwent CA were included in the final analysis. Contrast volume, radiation dose by dose area product, and radiation dose by air kerma were all found to be significantly lower with RA compared with CA. There was a statistically significant increase in fluoroscopy time, although this was not clinically significant, and there was no difference in procedure time. RA angiography is a feasible alternative to CA and offers reductions in contrast used and radiation exposure.

When is rotational angiography superior to conventional single-plane angiography for planning coronary angioplasty?

Objectives

To investigate the value of rotational coronary angiography (RoCA) in the context of percutaneous coronary intervention (PCI) planning.

Background

As a diagnostic tool, RoCA is associated with decreased patient irradiation and contrast use compared with conventional coronary angiography (CA) and provides superior appreciation of three‐dimensional anatomy. However, its value in PCI remains unknown.

Methods

We studied stable coronary artery disease assessment and PCI planning by interventional cardiologists. Patients underwent either RoCA or conventional CA pre‐PCI for planning. These were compared with the referral CA (all conventional) in terms of quantitative lesion assessment and operator confidence. An independent panel reanalyzed all parameters.

Results

Six operators performed 127 procedures (60 RoCA, 60 conventional CA, and 7 crossed‐over) and assessed 212 lesions. RoCA was associated with a reduction in the number of lesions judged to involve a bifurcation (23 vs. 30 lesions, P < 0.05) and a reduction in the assessment of vessel caliber (2.8 vs. 3.0 mm, P < 0.05). RoCA improved confidence assessing lesion length (P = 0.01), percentage stenosis (P = 0.02), tortuosity (P < 0.04), and proximity to a bifurcation (P = 0.03), particularly in left coronary artery cases. X‐ray dose, contrast agent volume, and procedure duration were not significantly different.

Conclusions

Compared with conventional CA, RoCA augments quantitative lesion assessment, enhances confidence in the assessment of coronary artery disease and the precise details of the proposed procedure, but does not affect X‐ray dose, contrast agent volume, or procedure duration. © 2015 Wiley Periodicals, Inc.

Novel X-ray imaging technology enables significant patient dose reduction in interventional cardiology while maintaining diagnostic image quality

Objectives

The purpose of this study was to quantify the reduction in patient radiation dose during coronary angiography (CA) by a new X‐ray technology, and to assess its impact on diagnostic image quality.

Background

Recently, a novel X‐ray imaging technology has become available for interventional cardiology, using advanced image processing and an optimized acquisition chain for radiation dose reduction.

Methods

70 adult patients were randomly assigned to a reference X‐ray system or the novel X‐ray system. Patient demographics were registered and exposure parameters were recorded for each radiation event. Clinical image quality was assessed for both patient groups.

Results

With the same angiographic technique and a comparable patient population, the new imaging technology was associated with a 75% reduction in total kerma‐area product (KAP) value (decrease from 47 Gycm² to 12 Gycm², P < 0.001). Clinical image quality showed an equivalent detail and contrast for both imaging systems. On the other hand, the subjective appreciation of noise was more apparent in images of the new image processing system, acquired at lower doses, compared to the reference system. However, the higher noise content did not affect the overall image quality score, which was adequate for diagnosis in both systems.

Conclusions

For the first time, we present a new X‐ray imaging technology, combining advanced noise reduction algorithms and an optimized acquisition chain, which reduces patient radiation dose in CA drastically (75%), while maintaining diagnostic image quality. Use of this technology may further improve the radiation safety of cardiac angiography and interventions. © 2015 Wiley Periodicals, Inc.

ECG-gated coronary angiography enables submillisievert imaging in invasive cardiology

BACKGROUND

The median dose area products (DAP) and effective doses (ED) of patients arising from coronary angiography (CA) are considerable: According the 2013 National German Registry, they amount to 19.8 Gy × cm(2) and 4.0 mSv, respectively.

METHODS

We investigated the feasibility of prospective electrocardiogram (ECG)-gated coronary angiography (CA)-a novel technique in invasive cardiology-with respect to possible reduction in irradiation effects. Instead of universally fix-rated radiographic acquisition within 7.5-15 frames/s, one single frame/heartbeat was triggered toward the diastolic moment immediately before atrial contraction (77 % of ECG-RR interval) most likely to provide motion-free and hence optimized resolution of the coronary tree. For 200 patients (body mass index 27.8 kg/m(2), age 67.5 years, male 55 %, 68 bpm) undergoing ECG-gated CA, we measured various median (interquartile range) parameters for radiation exposure.

RESULTS

The total DAP was 0.64 (0.46-1.00), radiographic fraction was 0.30 (0.19-0.43), and fluoroscopic fraction was 0.35 (0.21-0.57) Gy × cm(2). Radiographic imaging occurred within 21.7 s (17.1-26.3), with 25 frames (20-30) over the course of 7 runs (6-8). Fluoroscopy time was 119 s (94-141). Radiographic DAP was 12.6 mGy × cm(2)/frame and 13.8 mGy × cm(2)/s. Fluoroscopic DAP was 0.8 mGy × cm(2)/pulse and 3.1 mGy × cm(2)/s. Patient reference point air kerma was 17.0 mGy (11.1-28.1) and contrast volume was 70 ml (60-85).

CONCLUSION

In conclusion, invasive ECG-gated coronary imaging is feasible in clinical routine and enables patient EDs of approx. 3 % of typical values in invasive cardiology: 0.13 mSv (0.09-0.20).

Three-dimensional rotational X-ray acquisition technique is reducing patients' cancer risk in coronary angiography

OBJECTIVES

The purpose of this study was to assess patient-specific organ doses and cancer risk with 3D-rotational acquisitions versus the current standard of multiple single-plane coronary angiography (CA).

BACKGROUND

Catheter-based CA remains one of the most commonly performed diagnostic invasive procedures delivering a relatively high radiation dose to the patient. With the introduction of flat-panel technology, three-dimensional rotational angiography became an alternative for the conventional two-dimensional angiography. However, limited information is available on the difference in patient radiation exposure with both acquisition techniques.

METHODS

Eighty adult patients (45 males, age 38-93 years) were randomly assigned to the rotational or standard angiography group. Exposure parameters were registered and skin dose distribution was measured during the procedure. Patient-specific organ doses and related cancer risks were assessed with dedicated software.

RESULTS

Rotational angiograms were associated with 33% lower KAP-values (decrease from 49.99 Gycm(2) to 33.37 Gycm(2), P < 0.001). A significant (P < 0.001) lower peak skin dose was measured with rotational acquisitions (80 mGy, median) versus planar imaging (172 mGy, median). Moreover, the skin dose was smoothed over the whole chest of the patient. Contrast medium consumption decreased from 104 mL to 73 mL (P < 0.001) with the use of 3D-imaging. The reduction in radiation exposure resulted in a corresponding decrease of organ doses. The latter contributed to an overall cancer risk reduction of 21% for males and 50% for females.

CONCLUSIONS

The current study demonstrates that in CA radiation risk reduction is feasible by using a rotational acquisition technique.

Can we talk? Reflections on effective communication between imager and interventionalist in congenital heart disease

The rapid proliferation of catheter-mediated treatments for congenital heart defects has brought with it a critical need for cooperation and communication among the numerous physicians supporting these new and complex procedures. New interdependencies between physicians in specialties including cardiac imaging, interventional cardiology, pediatric cardiology, anesthesia, cardiothoracic surgery, and radiology have become apparent, as centers have strived to develop the best systems to foster success. Best practices for congenital heart disease interventions mandate confident and timely input from an individual with excellent adjunctive imaging skills and a thorough understanding of the devices and procedures being used. The imager and interventionalist must share an understanding of what each offers for the procedure, use a common terminology and spatial orientation system, and convey concise and accurate information about what is needed, what is seen, and what cannot be seen. The goal of this article is to review how the cardiovascular imaging specialists and interventionalists can work together effectively to plan and execute catheter interventions for congenital heart disease.

Benefits of dual-axis rotational coronary angiography in routine clinical practice

Dual-axis rotational coronary angiography (DARCA) is a new imaging technique involving three-dimensional rotation of the gantry around the patient with simultaneous left to right and craniocaudal movements. This allows complete imaging of the left or right coronary tree with a single acquisition run. Previous small studies have indicated that DARCA is associated with reduced radiation dose and contrast use in comparison with standard coronary angiography (SCA). We conducted a registry of unselected patients undergoing DARCA or SCA. DARCA was used in 107 patients and SCA in 105 patients. Mean number of acquisition runs was 2.6 for DARCA and 6.9 for SCA (P < 0.0001). Mean radiation dose (dose-area product, DAP) was 30.4 Gy cm(2) for SCA and 15.9 Gy cm(2) for DARCA (P < 0.0001). Mean contrast volume was 41.7 ml for SCA and 25.7 ml for DARCA (P < 0.0001). Case time for DARCA in the first half of the study was 20.8 ± 1.4 min compared with 15.2 ± 2.0 min in the second half of the study (P = 0.0015), suggesting a learning curve. In the DARCA group, 64 % of patients required only two acquisition runs for complete and satisfactory imaging. There were no adverse effects resulting from DARCA. Two cases are presented to illustrate the diagnostic ability of DARCA. DARCA was associated with a 48 % reduction in radiation dose and 36 % reduction in contrast volume in comparison with SCA, with comparable diagnostic ability.

Dual-axis rotational coronary angiography: a new technique for detecting graft coronary vasculopathy in pediatric heart transplant recipients

Annual surveillance coronary angiograpyhy to screen for graft coronary vasculopathy is routine practice after orthotopic heart transplantation. Traditionally, this is performed with direct coronary angiography using static single-plane or biplane angiography. Recently, technological advances have made it possible to perform dual-axis rotational coronary angiography (RA). This technique differs from standard static single-plane or biplane angiography in that a single detector is preprogrammed to swing through a complex 80° arc during a single injection. It has the advantage of providing a perspective of the vessels from a full arc of images rather than from one or two static images per contrast injection. The current study evaluated two coronary angiography techniques used consecutively at a single center to evaluate pediatric heart transplant recipients for graft coronary vasculopathy. A total of 23 patients underwent routine coronary angiography using both biplane static coronary angiography (BiP) and RA techniques at the Children's Hospital of Wisconsin from February 2009 to September 2010. Demographic and procedure data were collected from each procedure and analyzed for significance utilizing a Wilcoxon rank sum test. No significant demographic or procedural differences between the BiP and the RA procedures were noted. Specific measures of radiation dose including fluoroscopy time and dose area product were similar among the imaging techniques. The findings show that RA can be performed safely and reproducibly in pediatric heart transplant recipients. Compared with standard BiP, RA does not increase radiation exposure or contrast use and in our experience has provided superior angiographic imaging for the evaluation of graft coronary vasculopathy.

Coronary lesions quantification with dual-axis rotational coronary angiography

BACKGROUND

Coronary angiography (CA) has been the gold standard technique for studying coronary artery disease. It is based on the analysis of bidimensional orthogonal projections that may not be optimal to estimate determinate coronary segments. Rotational angiography "Xperswing" (DARCA) is a new technique that allows the visualization of the coronary arteries from multiple views, with a single contrast injection. The aim of this study is to evaluate the coronary lesions quantification with DARCA.

METHODS

Quantitative coronary analysis of significant coronary stenosis (>50%) was performed. Every lesion was measured in two different projections: the "optimal projection", obtained by DARCA and defined by the operator as the one with a better lesion qualification, and the "standard projection", corresponding to the usual projection closer to the optimal one in obliquity and angulation. Measures were performed twice and by two independent operators. Intra- and inter-observer correlation was estimated by Kappa index and variables were compared with t Student test (SPSS 14.0).

RESULTS

205 lesions in 147 patients were analyzed. Kappa coefficient intra-observer was 0.80 and 0.86 respectively with an inter-observer correlation index of 0.72. Lesion length and maximal diameter of the vessel were significantly greater in the group of RA. In the segments analysis, calculated length was longer for the first diagonal branch, first marginal obtuse artery, middle circumflex, middle and distal RCA and posterior descending artery, with greater reference diameters for proximal LAD and distal RCA. There were no significant differences for coronary stenosis grade.

CONCLUSIONS

RA XperSwing provides a better visualization of coronary arteries improving lesions characterization, with longer measured lesions length and greater vessel diameters, especially in coronary segments with more angulation.

Comparison of dual-axis rotational coronary angiography (XPERSWING) versus conventional technique in routine practice

INTRODUCTION AND OBJECTIVES

Coronary angiography is the gold standard for the study of coronary artery disease. This technique requires several orthogonal projections. Rotational angiography is a new technique which involves pre-set rotation of the X-ray tube around the patient and allows visualization of each coronary artery in different views, using a single contrast injection. The purpose of this study was to compare conventional coronary angiography (A) vs rotational angiography (B), focusing on radiation dose, amount of contrast administered, and total procedure time for both diagnostic and therapeutic percutaneous coronary interventions.

METHODS

Prospective study of 104 consecutive patients undergoing coronary angiography who were randomized to one of these techniques.

RESULTS

We found a significant reduction in the amount of contrast administered (A vs B, 93.1 [41.7] vs 50.9 [14.7] mL; P<.0001) and radiation exposure (27.6 [11.5] vs 18 [6.4] mGycm(2); P<.0001). A significant increase in total procedure time was noted in the rotational angiography arm. However, when only the last 50 patients were analyzed, we found no difference in procedure time between the groups, probably related to the learning curve of the operators. Angioplasty was performed in 29 patients in group A and 28 patients in group B. Contrast reduction was maintained in the rotational angiography group compared to the conventional technique (A vs B, 335.1 [192.1] vs 238.5 [114.4] mL; P=.02).

CONCLUSIONS

The rotational angiography technique leads to a significant decrease in radiation exposure and contrast dose administered for diagnostic procedures when compared to conventional coronary angiography. In patients who undergo percutaneous coronary intervention, contrast reduction remains significant.

A comparison between dual axis rotational coronary angiography and conventional coronary angiography

BACKGROUND

Coronary angiography remains the gold standard for the investigation of coronary artery disease, and is carried out in multiple, predefined stationary views, at different angulations around the patient, for both left and right coronary arteries. Dual axis rotational coronary angiography (DARA) is an alternative technique wherein the c-arm rotates around the patient in a preprogrammed single acquisition, exposing the entire coronary artery at different angulations. The DARA system has been recently installed in the Cardiac Catheterisation Suite at Mater Dei Hospital, Malta, where a monoplane and a biplane machine are available. This study was carried out in order to compare DARA with conventional single and biplane coronary imaging, with respect to radiation dose, contrast loads, and procedure time.

METHODS

This study was carried out over the period from September to December 2010. Four hundred sixty-three patients were studied. Patients referred for the investigation of native coronary anatomy, for whatever indication, were consented and included, and randomly assigned to one of four groups depending on which machine and modality was used: monoplane conventional, monoplane DARA, biplane conventional, and biplane DARA.

RESULTS

DARA was statistically significantly superior in dose area product, fluoroscopy time, amount of contrast used, and procedure time. These reductions ranged between 12 (contrast used) and 71% (procedure time).

CONCLUSIONS

The advantages of such systems are obvious to both patient and healthcare provider, and DARA may prove to be an important and useful tool in the refinement of diagnostic coronary angiography by reducing patient contrast and radiation doses and reducing procedure time.

Potential role of three-dimensional rotational angiography and C-arm CT for valvular repair and implantation

Imaging modalities utilized in the interventional cardiology suite have seen an impressive evolution and expansion recently, particularly with regard to the recent interest in three-dimensional (3D) imaging. Despite this, the backbone of visualization in the catheterization laboratory remains two-dimensional (2D) X-ray fluoroscopy and cine-angiography. New imaging techniques under development, referred to as three-dimensional rotational angiography (RA) and C-arm CT, hold great promise for improving current device implantation and understanding of cardiovascular anatomy. This paper reviews the evolution of rotational angiography and advanced 3D X-ray imaging applications to interventional cardiology.