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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Iannotta M, d'Aiello FA, Van De Bruaene A, Caruso R, Conte G, Ferrero P, Bassareo PP, Pasqualin G, Chiarello C, Militaru C, Giamberti A, Bognoni L, Chessa M. Modern tools in congenital heart disease imaging and procedure planning: a European survey. J Cardiovasc Med (Hagerstown) 2024; 25:76-87. [PMID: 38079284 PMCID: PMC10754484 DOI: 10.2459/jcm.0000000000001569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/04/2023] [Accepted: 10/07/2023] [Indexed: 12/18/2023]
Abstract
AIMS Congenital heart diseases (CHDs) often show a complex 3D anatomy that must be well understood to assess the pathophysiological consequences and to guide therapy. Three-dimensional imaging technologies have the potential to enhance the physician's comprehension of such spatially complex anatomies. Unfortunately, due to the new introduction in clinical practice, there is no evidence on the current applications. We conducted a survey to examine how 3D technologies are currently used among CHD European centres. METHODS Data were collected using an online self-administered survey via SurveyMonkey. The questionnaire was sent via e-mail and the responses were collected between January and June 2022. RESULTS Ninety-eight centres correctly completed the survey. Of these, 22 regularly perform 3D rotational angiography, 43 have the availability to print in-silico models, and 22 have the possibility to visualize holographic imaging/virtual reality. The costs were mostly covered by the hospital or the department of financial resources. CONCLUSION From our survey, it emerges that these technologies are quite spread across Europe, despite not being part of a routine practice. In addition, there are still not enough data supporting the improvement of clinical management for CHD patients. For this reason, further studies are needed to develop clinical recommendations for the use of 3D imaging technologies in medical practice.
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Affiliation(s)
- Marvin Iannotta
- Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Fabio Angelo d'Aiello
- Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Ferrero
- Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Pier Paolo Bassareo
- University College of Dublin, School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Giulia Pasqualin
- Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carmelina Chiarello
- Congenital Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Constantin Militaru
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- Vita Salute San Raffaele University
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Salavitabar A, Zampi JD, Thomas C, Zanaboni D, Les A, Lowery R, Yu S, Whiteside W. Augmented Reality Visualization of 3D Rotational Angiography in Congenital Heart Disease: A Comparative Study to Standard Computer Visualization. Pediatr Cardiol 2023:10.1007/s00246-023-03278-8. [PMID: 37725124 DOI: 10.1007/s00246-023-03278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/12/2023] [Indexed: 09/21/2023]
Abstract
Augmented reality (AR) visualization of 3D rotational angiography (3DRA) provides 3D representations of cardiac structures with full visualization of the procedural environment. The purpose of this study was to evaluate the feasibility of converting 3DRAs of congenital heart disease patients to AR models, highlight the workflow for 3DRA optimization for AR visualization, and assess physicians' perceptions of their use. This single-center study prospectively evaluated 30 retrospectively-acquired 3DRAs that were converted to AR, compared to Computer Models (CM). Median patient age 6.5 years (0.24-38.8) and weight 20.6 kg (3.4-107.0). AR and CM quality were graded highly. RV pacing was associated with higher quality of both model types (p = 0.02). Visualization and identification of structures were graded as "very easy" in 81.1% (n = 73) and 67.8% (n = 61) of AR and CM, respectively. Fifty-nine (66%) grades 'Agreed' or 'Strongly Agreed' that AR models provided superior appreciation of 3D relationships; AR was found to be least beneficial in visualization of aortic arch obstruction. AR models were thought to be helpful in identifying pathology and assisting in interventional planning in 85 assessments (94.4%). There was significant potential seen in the opportunity for patient/family counseling and trainee/staff education with AR models. It is feasible to convert 3D models of 3DRAs into AR models, which are of similar image quality as compared to CM. AR models provided additional benefits to visualization of 3D relationships in most anatomies. Future directions include integration of interventional simulation, peri-procedural counseling of patients and families, and education of trainees and staff with AR models.
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Affiliation(s)
- Arash Salavitabar
- Cardiac Catheterization & Interventional Therapies, The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Jeffrey D Zampi
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Courtney Thomas
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Dominic Zanaboni
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Andrea Les
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Ray Lowery
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Wendy Whiteside
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
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Salavitabar A, Boe BA, Berman DP, Harrison A, Swinning J, Baptista K, Eisner M, Bai S, Armstrong AK. Optimizing 3D Rotational Angiography for Congenital Cardiac Catheterization. Pediatr Cardiol 2023; 44:132-140. [PMID: 36029321 DOI: 10.1007/s00246-022-02994-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
The aim of the study was to determine the variables associated with high-quality (HQ) versus low-quality (LQ) three-dimensional rotational angiography (3DRA) and create guides for optimization of approach to 3DRA in congenital cardiac catheterization (CCC). CCC has adopted 3DRA as a mainstay, but there has not been systematic analysis of approach to and factors associated with HQ 3DRA. This was a single-center, retrospective study of 3DRAs using Canon Infinix-I platform. Reconstructions were graded by 3 interventionalists. Quality was dichotomized into HQ and LQ. Univariable analyses and multivariable logistic regression models were performed. From 8/2016 to 12/2018, 208 3DRAs were performed in 195 CCCs; median age 7 years (2, 16), weight 23 kg (12, 57). The majority of 3DRAs were performed in patients with biventricular physiology (N = 137, 66%) and in pulsatile sites (N = 144, 69%). HQ 3DRA (N = 182, 88%) was associated with greater total injection volume [2.20 mL/kg (1.44, 3.29) vs. 1.62 mL/kg (1.10, 1.98), p = 0.005] and more dilute contrast solution [60% (50, 100) vs. 100% (60, 100), p = 0.007], but not with contrast volume administered (p = 0.2) on univariable analysis. On multivariable logistic regression, HQ 3DRA was significantly associated with patient weight [OR 0.97 (95% CI (0.94, 0.99), p = 0.018], total injection volume [OR 1.04 (95% CI 1.01, 1.07) p = 0.011], and percent contrast solution [OR 0.97 (95% CI 0.95, 1.00), p = 0.022]. These data resulted in creation of scatter plots and a novel 3DRA Nomogram for estimating the probability of HQ 3DRA. This is the first study to create evidence-based contrast dose guides and nomogram for 3DRA in CCC. HQ 3DRA was associated with lower weight, higher total injection volumes, and more dilute contrast solution.
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Affiliation(s)
- Arash Salavitabar
- Nationwide Children's Hospital, The Heart Center, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Brian A Boe
- Nationwide Children's Hospital, The Heart Center, 700 Children's Drive, Columbus, OH, 43205, USA
| | | | - Andrew Harrison
- Nationwide Children's Hospital, The Heart Center, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jason Swinning
- Nationwide Children's Hospital, The Heart Center, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Kristine Baptista
- Nationwide Children's Hospital, The Heart Center, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Shasha Bai
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Aimee K Armstrong
- Nationwide Children's Hospital, The Heart Center, 700 Children's Drive, Columbus, OH, 43205, USA
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Variation in Advanced Diagnostic Imaging Practice Patterns and Associated Risks Prior to Superior Cavopulmonary Connection: A Multicenter Analysis. Pediatr Cardiol 2022; 43:497-507. [PMID: 34812909 DOI: 10.1007/s00246-021-02746-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022]
Abstract
Single ventricle patients typically undergo some form of advanced diagnostic imaging prior to superior cavopulmonary connection (SCPC). We sought to evaluate variability of diagnostic practice and associated comprehensive risk. A retrospective evaluation across 4 institutions was performed (1/1/2010-9/30/2016) comparing the primary modalities of cardiac catheterization (CC), cardiac magnetic resonance (CMR), and cardiac computed tomography (CT). Associated risks included anesthesia/sedation, vascular access, total room time, contrast agent usage, radiation exposure, and adverse events (AEs). Of 617 patients undergoing SCPC, 409 (66%) underwent at least one advanced diagnostic imaging study in the 60 days prior to surgery. Seventy-eight of these patients (13%) were analyzed separately because of a concomitant cardiac intervention during CC. Of 331 (54%) with advanced imaging and without catheterization intervention, diagnostic CC was most common (59%), followed by CT (27%) and CMR (14%). Primary modality varied significantly by institution (p < 0.001). Median time between imaging and SCPC was 13 days (IQR 3-33). Anesthesia/sedation varied significantly (p < 0.001). Pre-procedural vascular access did not vary significantly across modalities (p = 0.111); procedural access varied between CMR/CT and CC, in which central access was used in all procedures. Effective radiation dose was significantly higher for CC than CT (p < 0.001). AE rate varied significantly, with 12% CC, 6% CMR, and 1% CT (p = 0.004). There is significant practice variability in the use of advanced diagnostic imaging prior to SCPC, with important differences in associated procedural risk. Future studies to identify differences in diagnostic accuracy and long-term outcomes are warranted to optimize diagnostic protocols.
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Shen YC, Chen CH, Tu CY. Advances in Diagnostic Bronchoscopy. Diagnostics (Basel) 2021; 11:diagnostics11111984. [PMID: 34829331 PMCID: PMC8620115 DOI: 10.3390/diagnostics11111984] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022] Open
Abstract
The increase in incidental discovery of pulmonary nodules has led to more urgent requirement of tissue diagnosis. The peripheral pulmonary nodules are especially challenging for clinicians. There are various modalities for diagnosis and tissue sampling of pulmonary lesions, but most of these modalities have their own limitations. This has led to the development of many advanced technical modalities, which have empowered pulmonologists to reach the periphery of the lung safely and effectively. These techniques include thin/ultrathin bronchoscopes, radial probe endobronchial ultrasound (RP-EBUS), and navigation bronchoscopy—including virtual navigation bronchoscopy (VNB) and electromagnetic navigation bronchoscopy (ENB). Recently, newer technologies—including robotic-assisted bronchoscopy (RAB), cone-beam CT (CBCT), and augmented fluoroscopy (AF)—have been introduced to aid in the navigation to peripheral pulmonary nodules. Technological advances will also enable more precise tissue sampling of smaller peripheral lung nodules for local ablative and other therapies of peripheral lung cancers in the future. However, we still need to overcome the CT-to-body divergence, among other limitations. In this review, our aim is to summarize the recent advances in diagnostic bronchoscopy technology.
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Affiliation(s)
- Yi-Cheng Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40447, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40447, Taiwan
- School of Medicine, China Medical University, Taichung 40447, Taiwan
- Correspondence: (C.-H.C.); (C.-Y.T.); Tel.: +886-4-22052121 (ext. 2623) (C.-H.C.); +886-4-22052121 (ext. 3485) (C.-Y.T.); Fax: +886-4-22038883 (C.-H.C. & C.-Y.T.)
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40447, Taiwan
- School of Medicine, China Medical University, Taichung 40447, Taiwan
- Correspondence: (C.-H.C.); (C.-Y.T.); Tel.: +886-4-22052121 (ext. 2623) (C.-H.C.); +886-4-22052121 (ext. 3485) (C.-Y.T.); Fax: +886-4-22038883 (C.-H.C. & C.-Y.T.)
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Use of rotational angiography in congenital cardiac catheterisations to generate three-dimensional-printed models. Cardiol Young 2021; 31:1407-1411. [PMID: 33597057 DOI: 10.1017/s1047951121000275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Three-dimensional printing is increasingly utilised for congenital heart defect procedural planning. CT or MR datasets are typically used for printing, but similar datasets can be obtained from three-dimensional rotational angiography. We sought to assess the feasibility and accuracy of printing three-dimensional models of CHD from rotational angiography datasets. METHODS Retrospective review of CHD catheterisations using rotational angiography was performed, and patient and procedural details were collected. Imaging data from rotational angiography were segmented, cleaned, and printed with polylactic acid on a Dremel® 3D Idea Builder (Dremel, Mount Prospect, IL, USA). Printing time and materials' costs were captured. CT scans of printed models were compared objectively to the original virtual models. Two independent, non-interventional paediatric cardiologists provided subjective ratings of the quality and accuracy of the printed models. RESULTS Rotational angiography data from 15 catheterisations on vascular structures were printed. Median print time was 3.83 hours, and material costs were $2.84. The CT scans of the printed models highly matched with the original digital models (root mean square for Hausdorff distance 0.013 ± 0.003 mesh units). Independent reviewers correctly described 80 and 87% of the models (p = 0.334) and reported high quality and accuracy (5 versus 5, p = NS; κ = 0.615). CONCLUSION Imaging data from rotational angiography can be converted into accurate three-dimensional-printed models of CHD. The cost of printing the models was negligible, but the print time was prohibitive for real-time use. As the speed of three-dimensional printing technology increases, novel future applications may allow for printing patient-specific devices based on rotational angiography datasets.
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8
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Bruckheimer E, Goreczny S. Advanced imaging techniques to assist transcatheter congenital heart defects therapies. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Chen T, Liu G, Mu Y, Xu WH, Guo YT, Guo J, Chen YD. Application of cardiac computed tomographic imaging and fluoroscopy fusion for guiding left atrial appendage occlusion. Int J Cardiol 2021; 331:289-295. [PMID: 33529659 DOI: 10.1016/j.ijcard.2021.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Evaluate the value of 3D computed tomography (CT) and CT-integrating fluoroscopy for procedural guidance during WATCHMAN implantation. METHODS This observational study compared the clinical and procedural parameters for LAAO with and without fusion imaging. Forty-one pairs of patients-matched by procedure month and with or without the use of the image fusion system-were enrolled. Using the image fusion Advanced Workstation 4.6 software (GE Healthcare), we identified the 3D cardiac anatomy and safe zones for septal punch. The LAA orifice anatomy outlines were then projected onto the real-time fluoroscopy image during the procedure to guide all the steps of LAAO. RESULTS The use of image fusion significantly reduced the procedural time, compared to the time required for the control group (44.73 ± 20.03 min vs. 63.73 ± 26.10 min, respectively; P < 0.001). When compared to the standard procedure, the use of image fusion significantly reduced both the total radiation dose (448.80 ± 556.35 mGy vs. 798.42 ± 616.34 mGy; P = 0.004) and dose area product (DAP) (38.03 ± 47.15 Gy∙cm2 vs. 67.66 ± 52.23 Gy∙cm2, P = 0.004). Corresponding to the radiation dose, the contrast volume was also reduced (67.32 ± 18.65 vs. 90.98 ± 25.03 ml; P = 0.0004). During short-term follow-up at 6 months, there was only one femoral hematoma and incomplete LAA sealing (>3 mm) in either group. CONCLUSIONS Automated real-time integration of cardiac CT and fluoroscopy is feasible, safe, and applicable in LAAO. It may significantly reduce the radiation exposure, procedure duration, and volume of contrast media. Following these results, the potential of merging reconstructed 3D CT scans with real-time coronary angiography should be fully exploited in LAAO.
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Affiliation(s)
- Tao Chen
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China.
| | - Ge Liu
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
| | - Yang Mu
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
| | - Wei-Hao Xu
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu-Tao Guo
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
| | - Jun Guo
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China.
| | - Yun-Dai Chen
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
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Setser R, Chintalapani G, Bhadra K, Casal RF. Cone beam CT imaging for bronchoscopy: a technical review. J Thorac Dis 2020; 12:7416-7428. [PMID: 33447430 PMCID: PMC7797816 DOI: 10.21037/jtd-20-2382] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cone beam computed tomography (CBCT) is a well-established imaging modality with numerous proven applications across multiple clinical disciplines. More recently, CBCT has emerged as an important imaging tool for bronchoscopists, primarily used during transbronchial biopsy of peripheral pulmonary lesions (PPLS). For this application CBCT has proved useful in navigating devices to a target lesion, in confirming device tool-in-lesion, as well as during tissue acquisition. In addition, CBCT is poised to play an important role in trials evaluating bronchoscopic ablation by helping to determine the location of the ablative probe relative to the target lesion. Before adopting this technology, it is key for bronchoscopists to learn some basic concepts that will allow them to have a safer and more successful experience with CBCT. Hence, in the current manuscript, we will focus on both technical and practical aspects of CBCT imaging, ranging from systems considerations, image quality, radiation dose and dose-reduction strategies, procedure room set-up, and best practices for CBCT image acquisition.
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Affiliation(s)
| | | | - Krish Bhadra
- Department of Pulmonology and Critical Care, CHI Memorial Medical Group, Chattanooga, TN, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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11
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Fetterly KA, Ferrero A, Lewis BR, Anderson JH, Hagler DJ, Taggart NW. Radiation dose reduction for 3D angiography images in pediatric and congenital cardiology. Catheter Cardiovasc Interv 2020; 97:E502-E509. [PMID: 33016648 DOI: 10.1002/ccd.29272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the influence of simulated reduced-dose three-dimensional angiography (3DA) on the accuracy and precision of linear measurements derived from 3DA datasets. BACKGROUND Three-dimensional angiography is performed during X-ray guided interventional procedures to aid diagnosis and inform treatment strategies for children and adults with congenital heart disease. However, 3DA contributes substantially to patient radiation dose and may lead to an increased radiation-induced cancer risk. METHODS Reduced-dose patient 3DA images were simulated by adding quantum noise to the 2D projection angiograms, then reconstructing the projection angiograms into the 3DA dataset. Dose reduction in the range 33-72% was simulated. Five observers performed 46 vessel diameter measurements along prespecified axes within 23 vessel segments from 11 patient 3DA datasets. Statistical tests were performed to assess the influence of radiation dose reduction on the accuracy and precision of vessel diameter measurements. RESULTS Vessel diameter measurements were in the range 5.9- 22.7 mm. Considering all vessel segments and observers, the influence of dose level on the accuracy of diameter measurements was in the range 0.02 - 0.15 mm (p .05-.8). Interobserver variability increased modestly with vessel diameter, but was not influence by dose level (p = .52). The statistical test for observer recall bias was negative (p = .51). CONCLUSIONS Simulated dose reduction up to 72% did not affect the accuracy or precision of the diameter measurements acquired from 3DA images. These findings may embolden 3DA radiation dose reduction for pediatric and congenital heart disease patients.
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Affiliation(s)
- Kenneth A Fetterly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Andrea Ferrero
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Brad R Lewis
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Jason H Anderson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Donald J Hagler
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Söder S, Wällisch W, Dittrich S, Cesnjevar R, Pfammatter JP, Glöckler M. Three-Dimensional Rotational Angiography during Catheterization of Congenital Heart Disease - A ten Years' experience at a single center. Sci Rep 2020; 10:6973. [PMID: 32332807 PMCID: PMC7181762 DOI: 10.1038/s41598-020-63903-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/06/2020] [Indexed: 11/13/2022] Open
Abstract
This paper aims to assess the usability and advantages of three-dimensional rotational angiography (3DRA) in patients with congenital heart disease (CHD) and its application in the cath lab. Up to now, its use in CHD is not widespread or standardized. We analyzed all patients with CHD who underwent a 3DRA at our facility between January 2010 and May 2019. The 3DRAs were evaluated for radiation exposure, contrast dye consumption, diagnostic utility and image quality. We performed 872 3DRAs. 3DRA was used in 67.1% of the cases for interventional procedures and in 32.9% for diagnostic purposes. Two different acquisition programs were applied. The median dose-area product (DAP) for all 872 rotations was 54.1 µGym2 (21.7–147.5 µGym2) and 1.6 ml/kg (0.9–2.07 ml/kg) of contrast dye was used. Diagnostic utility of the generated 3D-model was rated superior to the native 3D angiography in 94% (819/872). 3DRA is an excellent and save diagnostic and interventional tool. However, 3DRA has not become a standard imaging procedure in pediatric cardiology up to now. Effort and advantage seems to be unbalanced, but new less invasive techniques may upgrade this method in future.
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Affiliation(s)
- Stefanie Söder
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Wolfgang Wällisch
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Robert Cesnjevar
- Department of Congenital Heart Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Jean-Pierre Pfammatter
- Department of Cardiology, Pediatric Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Glöckler
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany. .,Department of Cardiology, Pediatric Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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13
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Kang SL, Armstrong A, Krings G, Benson L. Three-dimensional rotational angiography in congenital heart disease: Present status and evolving future. CONGENIT HEART DIS 2019; 14:1046-1057. [PMID: 31483574 DOI: 10.1111/chd.12838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/23/2019] [Accepted: 08/16/2019] [Indexed: 01/17/2023]
Abstract
Three-dimensional rotational angiography (3D-RA) enables volumetric imaging through rotation of the C-arm of an angiographic system and real-time 3D reconstruction during cardiac catheterization procedures. In the field of congenital heart disease (CHD), 3D-RA has gained considerable traction, owing to its capability for enhanced visualization of spatial relationships in complex cardiac morphologies and real time image guidance in an intricate interventional environment. This review provides an overview of the current applications, strengths, and limitations of 3D-RA acquisition in the management of CHD and potential future directions. In addition, issues of dosimetry, radiation exposure, and optimization strategies will be reviewed. Further implementation of 3D-RA will be driven by patient benefits relative to existing 3D imaging capabilities and fusion techniques balanced against radiation exposure.
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Affiliation(s)
- Sok-Leng Kang
- Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Canada
| | - Aimee Armstrong
- The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Gregor Krings
- Children's Heart Center, Utrecht University, Utrecht, Netherlands
| | - Lee Benson
- Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Canada
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14
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van der Stelt F, Siegerink SN, Krings GJ, Molenschot MMC, Breur JMPJ. Three-Dimensional Rotational Angiography in Pediatric Patients with Congenital Heart Disease: A Literature Review. Pediatr Cardiol 2019; 40:257-264. [PMID: 30680421 PMCID: PMC6399168 DOI: 10.1007/s00246-019-02052-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/07/2019] [Indexed: 12/02/2022]
Abstract
Cardiac catheterization is a commonly used form of imaging and treatment in pediatric patients with congenital heart disease. Traditionally, two-dimensional conventional angiography was the method used, but since 2000 three-dimensional rotational angiography (3DRA) is increasingly used in the field of cardiology in both adult and pediatric patients. To investigate the use and applications of 3DRA in pediatric congenital cardiology, literature was systematically reviewed and 29 eligible articles were found. Those showed that 3DRA is already a greatly valued diagnostic and therapeutic technique in pediatric cardiology. However, the literature misses well-designed clinical, homogeneous, multicenter, prospective studies recording data in a standardized manner. These studies are necessary to ensure proper data analysis and to investigate the true advantages of 3DRA and how it exactly benefits the patients.
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Affiliation(s)
- Femke van der Stelt
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
| | - Sebastiaan N. Siegerink
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
| | - Gregor J. Krings
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
| | - Mirella M. C. Molenschot
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
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15
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Abstract
Purpose of the Review The purpose of this review is to illustrate specific challenges and opportunities in the building of an adult congenital heart disease (ACHD) program and to highlight critical components and important allies. Recent Findings With more than 1.4 million adults with congenital heart disease in the USA alone, access to specialized, compassionate, high-quality comprehensive care requires a shift toward more aggressive expansion of ACHD care, especially in the context of sparse ACHD provider representation in the vast majority of adult medical centers. Summary The effective build of an ACHD program requires measured escalation in management of ACHD complexity matched with cultivation of key resources and clinical services ranging from congenital cardiac surgery and interventional cardiology to acquired heart disease as well as partnerships with non-cardiac specialists. By reframing ACHD care as a shared goal between patients, providers, hospitals, pharmaceutical and device industry, and payers, a potent business model can be built around the developing ACHD program to facilitate acquisition of these key resources.
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16
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Fresse-Warin K, Plessis J, Benelhadj H, Guérin P. Impact of fused computed tomography and fluoroscopy in the catheterization laboratory. Arch Cardiovasc Dis 2018; 111:449-455. [DOI: 10.1016/j.acvd.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 12/31/2022]
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17
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A new approach of three-dimensional guidance in paediatric cath lab: segmented and tessellated heart models for cardiovascular interventions in CHD. Cardiol Young 2018; 28:661-667. [PMID: 29345604 DOI: 10.1017/s1047951117002840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Optimal imaging is essential for catheter-based interventions in CHD. The three-dimensional models in volume-rendering technique currently in use are not standardised. This paper investigates the feasibility and impact of novel three-dimensional guidance with segmented and tessellated three-dimensional heart models in catheterisation of CHD. In addition, a nearly radiation-free two- to three-dimensional registration and a biplane overlay were used.Methods and resultsWe analysed 60 consecutive cases in which segmented tessellated three-dimensional heart models were merged with live fluoroscopy images and aligned using the tracheal bifurcation as a fiducial mark. The models were generated from previous MRI or CT by dedicated medical software. We chose the stereo-lithography format, as this promises advantage over volume-rendering-technique models regarding visualisation. Prospects, potential benefits, and accuracy of the two- to three-dimensional registration were rated separately by two paediatric interventionalists on a five-point Likert scale. Fluoroscopy time, radiation dose, and contrast dye consumption were evaluated. Over a 10-month study period, two- to three-dimensional image fusion was applied to 60 out of 354 cases. Of the 60 catheterisations, 73.3% were performed in the context of interventions. The accuracy of two- to three-dimensional registration was sufficient in all cases. Three-dimensional guidance was rated superior to conventional biplane imaging in all 60 cases. We registered significantly smaller amounts of used contrast dye (p<0.01), lower levels of radiation dose (p<0.02), and less fluoroscopy time (p<0.01) during interventions concerning the aortic arch compared with a control group. CONCLUSIONS Two- to three-dimensional image fusion can be applied successfully in most catheter-based interventions of CHD. Meshes in stereo-lithography format are accurate and base for standardised and reproducible three-dimensional models.
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18
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Wiley BM, Eleid MF, Thaden JJ. Técnicas de fusión de imagen en los procedimientos intervencionistas. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Zampi JD, Whiteside W. Innovative interventional catheterization techniques for congenital heart disease. Transl Pediatr 2018; 7:104-119. [PMID: 29770292 PMCID: PMC5938250 DOI: 10.21037/tp.2017.12.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/01/2017] [Indexed: 11/06/2022] Open
Abstract
Since 1929, when the first cardiac catheterization was safely performed in a human by Dr. Werner Forssmann (on himself), there has been a rapid progression of cardiac catheterization techniques and technologies. Today, these advances allow us to treat a wide variety of patients with congenital heart disease using minimally invasive techniques; from fetus to infants to adults, and from simple to complex congenital cardiac lesions. In this article, we will explore some of the exciting advances in cardiac catheterization for the treatment of congenital heart disease, including transcatheter valve implantation, hybrid procedures, biodegradable technologies, and magnetic resonance imaging (MRI)-guided catheterization. Additionally, we will discuss innovations in imaging in the catheterization laboratory, including 3D rotational angiography (3DRA), fusion imaging, and 3D printing, which help to make innovative interventional approaches possible.
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Affiliation(s)
- Jeffrey D Zampi
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Wendy Whiteside
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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20
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Abstract
The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety.
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Affiliation(s)
- Sok-Leng Kang
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada.,Department of Pediatric Cardiology, Bristol Royal Hospital for Children, Bristol, BS2 OJJ, UK
| | - Lee Benson
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada
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21
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Auyang PL, Chinnadurai P, MacGillivray T, Lumsden AB, Breinholt JP, Lin CH. Intraoperative cone beam computed tomography-guided endovascular recanalization of an interrupted aorta. J Vasc Surg 2018; 67:1292-1296. [PMID: 29463459 DOI: 10.1016/j.jvs.2017.11.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/18/2017] [Indexed: 11/30/2022]
Abstract
A 42-year-old man sustained a stroke secondary to malignant hypertension and was found to have complete aortic interruption. We report a case of real-time image-guided endovascular repair to highlight the value of preprocedural planning and intraprocedural cone beam computed tomography. Two-dimensional fluoroscopy enhanced with three-dimensional landmarks from cone beam computed tomography was used to direct a Nykanen radiofrequency wire (Baylis Medical, Montreal, Quebec, Canada) through the interruption, avoiding critical adjacent structures. A covered Cheatham-Platinum stent (NuMED, Inc, Hopkinton, NY) was deployed successfully, recanalizing the thoracic aorta. The pressure gradient normalized, and the patient was discharged on postoperative day 1. At 10-month follow-up, the patient was on an antihypertensive regimen of two minimum-dose drugs.
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Affiliation(s)
- Philip L Auyang
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex.
| | | | | | - Alan B Lumsden
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex
| | - John P Breinholt
- University of Texas Health Science Center, Houston, Tex; Division of Pediatric Cardiology, Children's Memorial Hermann Hospital, Houston, Tex
| | - C Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex
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22
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Acord M, Shellikeri S, Vatsky S, Srinivasan A, Krishnamurthy G, Keller MS, Cahill AM. Reduced-dose C-arm computed tomography applications at a pediatric institution. Pediatr Radiol 2017; 47:1817-1824. [PMID: 28983677 DOI: 10.1007/s00247-017-3964-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/24/2017] [Accepted: 08/09/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Reduced-dose C-arm computed tomography (CT) uses flat-panel detectors to acquire real-time 3-D images in the interventional radiology suite to assist with anatomical localization and procedure planning. OBJECTIVE To describe dose-reduction techniques for C-arm CT at a pediatric institution and to provide guidance for implementation. MATERIALS AND METHODS We conducted a 5-year retrospective study on procedures using an institution-specific reduced-dose protocol: 5 or 8 s Dyna Rotation, 248/396 projection images/acquisition and 0.1-0.17 μGy/projection dose at the detector with 0.3/0.6/0.9-mm copper (Cu) filtration. We categorized cases by procedure type and average patient age and calculated C-arm CT and total dose area product (DAP). RESULTS Two hundred twenty-two C-arm CT-guided procedures were performed with a dose-reduction protocol. The most common procedures were temporomandibular and sacroiliac joint injections (48.6%) and sclerotherapy (34.2%). C-arm CT was utilized in cases of difficult percutaneous access in less common applications such as cecostomy and gastrostomy placement, foreign body retrieval and thoracentesis. C-arm CT accounted for between 9.9% and 80.7% of the total procedural DAP. CONCLUSION Dose-reducing techniques can preserve image quality for intervention while reducing radiation exposure to the child. This technology has multiple applications within pediatric interventional radiology and can be considered as an adjunctive imaging tool in a variety of procedures, particularly when percutaneous access is challenging despite routine fluoroscopic or ultrasound guidance.
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Affiliation(s)
- Michael Acord
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Sphoorti Shellikeri
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Seth Vatsky
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Abhay Srinivasan
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Ganesh Krishnamurthy
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Marc S Keller
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Anne Marie Cahill
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
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23
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Wiley BM, Eleid MF, Thaden JJ. Fusion Imaging for Procedural Guidance. ACTA ACUST UNITED AC 2017; 71:373-381. [PMID: 29191779 DOI: 10.1016/j.rec.2017.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/16/2017] [Indexed: 11/15/2022]
Abstract
The field of percutaneous structural heart interventions has grown tremendously in recent years. This growth has fueled the development of new imaging protocols and technologies in parallel to help facilitate these minimally-invasive procedures. Fusion imaging is an exciting new technology that combines the strength of 2 imaging modalities and has the potential to improve procedural planning and the safety of many commonly performed transcatheter procedures. In this review we discuss the basic concepts of fusion imaging along with the relative strengths and weaknesses of static vs dynamic fusion imaging modalities. This review will focus primarily on echocardiographic-fluoroscopic fusion imaging and its application in commonly performed transcatheter structural heart procedures.
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Affiliation(s)
- Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States.
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24
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Surendran S, Waller BR, Elijovich L, Agrawal V, Kuhls-Gilcrist A, Johnson J, Fagan T, Sathanandam SK. Use of 3-D digital subtraction rotational angiography during cardiac catheterization of infants and adults with congenital heart diseases. Catheter Cardiovasc Interv 2017; 90:618-625. [PMID: 28707365 DOI: 10.1002/ccd.27180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/29/2017] [Accepted: 06/08/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare image quality, radiation and contrast doses required to obtain 3D-Digital subtraction rotational angiography (3D-DSRA) with 3D-Digital rotational angiography (3D-DRA) in infants (children ≤ 2 years of age) and adults with congenital heart diseases (ACHD). BACKGROUND 3D-DRA can be performed with radiation doses comparable to bi-plane cine-angiography. However, 3D-DRA in infants requires a large contrast volume. The resolution of 3D-DRA performed in ACHD patients is limited by their soft tissue density. We hypothesized that the use of 3D-DSRA could help alleviate these concerns. METHODS Radiation (DAP) and contrast doses required to obtain 3D-DSRA was compared with 3D-DRA in 15 age-, size-, and intervention-matched infants and 15 ACHD patients. The diagnostic quality and utility of these two modalities were scored by 4 qualified independent observers. RESULTS Both in infants and adults, the median contrast volume for 3D-DSRA was lower than 3D-DRA (0.98 vs. 1.81 mL/kg; P < 0.001 and 0.92 vs. 1.4 mL/kg; P < 0.001, respectively) with an increased DAP (median: 188 vs. 128 cGy cm2 ; P = 0.068 and 659 vs. 427 cGy cm2 ; P = 0.045, respectively). The diagnostic quality and utility scores for rotational-angiography, and 3D-reconstruction were superior for 3D-DSRA (score = 94 vs. 80%, P = 0.03 and 90 vs.79%, P = 0.01, respectively) and equivalent for multi-planar-reformation and 3D-roadmapping in ACHD patients compared with 3D-DRA. All scores for both modalities were equivalent for infants. CONCLUSIONS 3D-DSRA can be acquired using lower contrast volume with a mildly higher radiation dose than 3D-DRA in infants and ACHD patients. The diagnostic quality and utility scores for 3D-DSRA were higher in ACHD patients and equivalent for infants compared with 3D-DRA.
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Affiliation(s)
- Sushitha Surendran
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.,Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - B Rush Waller
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.,Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Lucas Elijovich
- Division of Neurosurgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Vijaykumar Agrawal
- Department of Radiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | | | - Jason Johnson
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.,Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Thomas Fagan
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.,Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Shyam K Sathanandam
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.,Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
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25
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Goreczny S, Dryzek P, Morgan GJ, Lukaszewski M, Moll JA, Moszura T. Novel Three-Dimensional Image Fusion Software to Facilitate Guidance of Complex Cardiac Catheterization : 3D image fusion for interventions in CHD. Pediatr Cardiol 2017; 38:1133-1142. [PMID: 28551818 DOI: 10.1007/s00246-017-1627-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
We report initial experience with novel three-dimensional (3D) image fusion software for guidance of transcatheter interventions in congenital heart disease. Developments in fusion imaging have facilitated the integration of 3D roadmaps from computed tomography or magnetic resonance imaging datasets. The latest software allows live fusion of two-dimensional (2D) fluoroscopy with pre-registered 3D roadmaps. We reviewed all cardiac catheterizations guided with this software (Philips VesselNavigator). Pre-catheterization imaging and catheterization data were collected focusing on fusion of 3D roadmap, intervention guidance, contrast and radiation exposure. From 09/2015 until 06/2016, VesselNavigator was applied in 34 patients for guidance (n = 28) or planning (n = 6) of cardiac catheterization. In all 28 patients successful 2D-3D registration was performed. Bony structures combined with the cardiovascular silhouette were used for fusion in 26 patients (93%), calcifications in 9 (32%), previously implanted devices in 8 (29%) and low-volume contrast injection in 7 patients (25%). Accurate initial 3D roadmap alignment was achieved in 25 patients (89%). Six patients (22%) required realignment during the procedure due to distortion of the anatomy after introduction of stiff equipment. Overall, VesselNavigator was applied successfully in 27 patients (96%) without any complications related to 3D image overlay. VesselNavigator was useful in guidance of nearly all of cardiac catheterizations. The combination of anatomical markers and low-volume contrast injections allowed reliable 2D-3D registration in the vast majority of patients.
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Affiliation(s)
- Sebastian Goreczny
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Rzgowska Street 281/289, 93-338, Lodz, Poland.
| | - Pawel Dryzek
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Rzgowska Street 281/289, 93-338, Lodz, Poland
| | - Gareth J Morgan
- Heart Institute, Children's Hospital of Colorado & Department of Adult Congenital Heart Disease, University of Colorado Hospital, Denver, CO, USA
| | - Maciej Lukaszewski
- Department of Radiology, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| | - Jadwiga A Moll
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Rzgowska Street 281/289, 93-338, Lodz, Poland
| | - Tomasz Moszura
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Rzgowska Street 281/289, 93-338, Lodz, Poland
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26
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Narayan SA, Qureshi S. Multimodality medical image fusion: applications in congenital cardiology. Future Cardiol 2017. [PMID: 28631508 DOI: 10.2217/fca-2017-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Shakeel Qureshi
- Evelina London Children's Hospital, Guy's and St Thomas Hospital, London, UK
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27
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Cardiac Catheterization and Intervention in Pediatric Cardiac Disease: A Narrative Review of Current Indications, Techniques, and Complications. JOURNAL OF PEDIATRICS REVIEW 2017. [DOI: 10.5812/jpr.10815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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28
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Dydynski PB, Kiper C, Kozik D, Keller BB, Austin E, Holland B. Three-Dimensional Reconstruction of Intracardiac Anatomy Using CTA and Surgical Planning for Double Outlet Right Ventricle: Early Experience at a Tertiary Care Congenital Heart Center. World J Pediatr Congenit Heart Surg 2017; 7:467-74. [PMID: 27358302 DOI: 10.1177/2150135116651399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although transthoracic echocardiography (TTE) routinely establishes the diagnosis of double outlet right ventricle (DORV), it can be suboptimal for depicting exact ventricular septal defect (VSD) position, especially with respect to the outflow tracts. Advanced imaging with computed tomography angiography (CTA) can help visualize structures and relationships not easily seen by echo. Using computer-aided design, we have the ability to create three-dimensional (3D) models of the intracardiac anatomy, which can be helpful for better depicting the overall anatomy to assist surgical planning. METHODS Patients with a diagnosis of DORV were retrospectively reviewed at our institution from October 2013 to April 2015. Patients who preoperatively underwent both TTE and CTA with 3D reconstruction of the intracardiac anatomy were included. Computed tomography angiography findings with 3D intracardiac model creation were compared to the surgical findings. RESULTS Twenty-five patients underwent surgical repair of DORV during the study period. Five patients had CTA with 3D reconstruction, in addition to the standard TTE images, and were included in the study. In all five cases, CTA with 3D reconstruction of the intracardiac anatomy accurately depicted the VSD position relative to important adjacent structures, including the outflow tracts. CONCLUSION Three-dimensional reconstruction of the intracardiac anatomy using CTA data can provide accurate data for presurgical planning of DORV repair and has the potential for being especially useful in patients for whom intracardiac anatomy and VSD position cannot be well seen by TTE. A larger prospective analysis is warranted to help validate this approach.
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Affiliation(s)
- Philip B Dydynski
- Department of Pediatric Radiology, Kosair Children's Hospital, Norton Healthcare, Louisville, KY, USA
| | - Carmen Kiper
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - Deborah Kozik
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Bradley B Keller
- Department of Pediatrics, University of Louisville, Louisville, KY, USA Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
| | - Erle Austin
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Brian Holland
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
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29
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Schwein A, Lu T, Chinnadurai P, Kitkungvan D, Shah DJ, Chakfe N, Lumsden AB, Bismuth J. Magnetic resonance venography and three-dimensional image fusion guidance provide a novel paradigm for endovascular recanalization of chronic central venous occlusion. J Vasc Surg Venous Lymphat Disord 2016; 5:60-69. [PMID: 27987612 DOI: 10.1016/j.jvsv.2016.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Endovascular recanalization is considered first-line therapy for chronic central venous occlusion (CVO). Unlike arteries, in which landmarks such as wall calcifications provide indirect guidance for endovascular navigation, sclerotic veins without known vascular branching patterns impose significant challenges. Therefore, safe wire access through such chronic lesions mostly relies on intuition and experience. Studies have shown that magnetic resonance venography (MRV) can be performed safely in these patients, and the boundaries of occluded veins may be visualized on specific MRV sequences. Intraoperative image fusion techniques have become more common to guide complex arterial endovascular procedures. The aim of this study was to assess the feasibility and utility of MRV and intraoperative cone-beam computed tomography (CBCT) image fusion technique during endovascular CVO recanalization. METHODS During the study period, patients with symptomatic CVO and failed standard endovascular recanalization underwent further recanalization attempts with use of intraoperative MRV image fusion guidance. After preoperative MRV and intraoperative CBCT image coregistration, a virtual centerline path of the occluded segment was electronically marked in MRV and overlaid on real-time two-dimensional fluoroscopy images. Technical success, fluoroscopy times, radiation doses, number of venograms before recanalization, and accuracy of the virtual centerline overlay were evaluated. RESULTS Four patients underwent endovascular CVO recanalization with use of intraoperative MRV image fusion guidance. Mean (± standard deviation) time for image fusion was 6:36 ± 00:51 mm:ss. The lesion was successfully crossed in all patients without complications. Mean fluoroscopy time for lesion crossing was 12.5 ± 3.4 minutes. Mean total fluoroscopy time was 28.8 ± 6.5 minutes. Mean total radiation dose was 15,185 ± 7747 μGy/m2, and mean radiation dose from CBCT acquisition was 2788 ± 458 μGy/m2 (18% of mean total radiation dose). Mean number of venograms before recanalization was 1.6 ± 0.9, whereas two lesions were crossed without any prior venography. On qualitative analysis, virtual centerlines from MRV were aligned with actual guidewire trajectory on fluoroscopy in all four cases. CONCLUSIONS MRV image fusion is feasible and may improve success, safety, and the surgeon's confidence during CVO recanalization. Similar to arterial interventions, three-dimensional MRV imaging and image fusion techniques could foster innovative solutions for such complex venous interventions and have the potential to affect a great number of patients.
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Affiliation(s)
- Adeline Schwein
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - Tony Lu
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | | | - Danai Kitkungvan
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Dipan J Shah
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Alan B Lumsden
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Jean Bismuth
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
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Goreczny S, Morgan GJ, Dryzek P, Moll J, Moszura T. Initial experience with live three-dimensional image overlay for ductal stenting in hypoplastic left heart syndrome. EUROINTERVENTION 2016; 12:1527-1533. [DOI: 10.4244/eij-d-15-00101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nguyen HH, Balzer DT, Murphy JJ, Nicolas R, Shahanavaz S. Radiation Exposure by Three-Dimensional Rotational Angiography (3DRA) During Trans-catheter Melody Pulmonary Valve Procedures (TMPV) in a Pediatric Cardiac Catheterization Laboratory. Pediatr Cardiol 2016; 37:1429-1435. [PMID: 27452802 DOI: 10.1007/s00246-016-1453-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
This retrospective study aims to evaluate radiation exposure by three-dimensional rotational angiography (3DRA) during trans-catheter Melody pulmonary valve (TMPV) procedures. 3DRA has been reported to have added value in the management of complex congenital heart disease aiding in the performance of interventional procedures albeit with concerns of higher radiation exposure. We test the hypothesis that 3DRA does not cause additional radiation exposure during TMPV procedures. We analyzed all 81 TMPV procedures performed at St. Louis Children's Hospital, MO, USA, from January 1, 2011 to December 31, 2014. Dose-area product (DAP), DAP indexed to body weight (DAP/BW), fluoroscopy time (FT), and weight-fluoroscopy time product of each procedure were recorded. We reviewed each procedure's images to determine whether additional interventions were performed (e.g., pulmonary artery angioplasty or treatment of conduit pseudo-aneurysm). 3DRA was used in 36 % of the procedures. 3DRA group had a higher number of additional procedures performed. The 3DRA group did not differ from the non-3DRA group in DAP, DAP/BW, and weight-fluoroscopy time product. 3DRA does not cause greater radiation exposure during TMPV procedures.
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Affiliation(s)
- Hoang H Nguyen
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., Campus Box 8116-NWT, St. Louis, MO, 63110-1093, USA. .,Division of Cardiology, Department of Pediatrics, Rush University Medical College, Chicago, IL, 60612, USA.
| | - David T Balzer
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., Campus Box 8116-NWT, St. Louis, MO, 63110-1093, USA
| | - Joshua J Murphy
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., Campus Box 8116-NWT, St. Louis, MO, 63110-1093, USA.,Division of Cardiology, Department of Pediatrics, Rush University Medical College, Chicago, IL, 60612, USA
| | - Ramzi Nicolas
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., Campus Box 8116-NWT, St. Louis, MO, 63110-1093, USA
| | - Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., Campus Box 8116-NWT, St. Louis, MO, 63110-1093, USA
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Aldoss O, Fonseca BM, Truong UT, Bracken J, Darst JR, Guo R, Jones TL, Fagan TE. Diagnostic Utility of Three-Dimensional Rotational Angiography in Congenital Cardiac Catheterization. Pediatr Cardiol 2016; 37:1211-21. [PMID: 27278632 DOI: 10.1007/s00246-016-1418-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/20/2016] [Indexed: 12/19/2022]
Abstract
We evaluated the diagnostic utility of the three modalities of three-dimensional rotational angiography (3DRA): rotational angiography (RA), multiplanar reformat (MPR) and three-dimensional angiographic reconstruction (3D-R) in pediatric cardiac catheterization. The 3DRA studies were classified by anatomy of interest based on our injection protocol: pulmonary arteries (PA), aorta, cavopulmonary connection (CPC), and others. Retrospective review of 3DRA images by two reviewers for each modality was conducted with grading as inferior, similar, or superior in comparison with the diagnostic quality of fixed-plane angiography (FPA). The percentages of grades for each modality were averaged. Weighted kappa statistic was used to evaluate inter-rater reliability. In total, 114 3DRA studies were performed on 87 patients between August 2010 and March 2012. Median age was 2.7 years (1 day-48.4 years) and median weight 12.1 kg (3.6-106.5 kg). For RA: 79.4 % of the studies were of diagnostic quality and 52.2 % were superior; 3D-R: 82 % were of diagnostic quality and 65.8 % were superior; and MPR: 83.5 % were of diagnostic quality and 63 % were superior. Overall 3DRA technologies (RA, 3D-R, MPR) were of diagnostic quality or better in 111/114 (97.4 %) studies and 103/114 (90.4 %) were judged superior. Most common reasons for inferior grading were limited opacification and metallic artifact. In pediatric cardiac catheterization, 3DRA imaging was of diagnostic quality and frequently provided additional clinically relevant data when compared to FPA.
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Affiliation(s)
- Osamah Aldoss
- Division of Cardiology, Department of Pediatrics, University of Iowa and Children's Hospital of Iowa, Iowa City, IA, 52242, USA
| | - Brian M Fonseca
- Division of Cardiology, Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Uyen T Truong
- Division of Cardiology, Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - John Bracken
- Philips Research North America, Briarcliff Manor, NY, 10510, USA
- Division of Cardiology, Department of Internal Medicine, University of Colorado and University of Colorado Hospital, Aurora, CO, 80045, USA
| | - Jeffrey R Darst
- Division of Cardiology, Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Ruixin Guo
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, 80045, USA
| | - Tamekia L Jones
- Department of Pediatrics, Children's Foundation Research Institute, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, 38103, USA
| | - Thomas E Fagan
- Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, 49 N. Dunlap Street, Floor 3, Memphis, TN, 38103, USA.
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Starmans NLP, Krings GJ, Molenschot MMC, van der Stelt F, Breur JMPJ. Three-dimensional rotational angiography in children with an aortic coarctation. Neth Heart J 2016; 24:666-674. [PMID: 27659792 PMCID: PMC5065539 DOI: 10.1007/s12471-016-0899-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Children with aortic coarctations (CoA) are increasingly percutaneously treated. Good visualisation of the CoA is mandatory and can be obtained with three-dimensional rotational angiography (3DRA). This study aims to compare the diagnostic and therapeutic additional value of 3DRA with conventional biplane angiography (CA) in children with a CoA. Methods Patients undergoing percutaneous treatment of CoA with balloon angioplasty (BA) or stent between 2003 and 2015, were retrospectively reviewed on success rate, complications, radiation and technical settings. Diagnostic quality of CA and 3DRA and additional value of 3DRA were scored. Results In total, 134 patients underwent 183 catheterisations, 121 CA and 62 3DRA-guided. Median age was 0.52 years in the BA group and 11.19 years in the stent group. 3DRA was superior to CA in displaying the left ventricle (p = 0.008), ascending aorta (p < 0.001), aortic arch (p = 0.005) and coronary arteries (p < 0.001). In the BA group, 3DRA had a significantly higher success rate than CA (100.0 % versus 68.9 %, p = 0.016). All stent interventions were successful. Complication rates did not differ significantly. The median total dose area product did not significantly differ between CA and 3DRA in the BA (27.88 μGym2/kg versus 15.81 μGym2/kg, p = 0.275) or stent group (37.34 μGym2/kg versus 45.24 μGym2/kg, p = 0.090). 3DRA was of additional value in 96.8 % of the interventions. Conclusions 3DRA is superior to CA in diagnostic quality and not associated with increased radiation exposure. It provides high additional value in guiding CoA related interventions. Electronic supplementary material The online version of this article (doi: 10.1007/s12471-016-0899-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N L P Starmans
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J Krings
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M M C Molenschot
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F van der Stelt
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M P J Breur
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Plessis J, Warin Fresse K, Cahouch Z, Manigold T, Letocart V, Le Gloan L, Guyomarch B, Guerin P. Value of Image Fusion in Coronary Angiography for the Detection of Coronary Artery Bypass Grafts. J Am Heart Assoc 2016; 5:JAHA.115.002233. [PMID: 27287701 PMCID: PMC4937242 DOI: 10.1161/jaha.115.002233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Coronary angiography is more complex in patients with coronary artery bypass grafts (CABG). Image fusion is a new technology that allows the overlay of a computed tomography (CT) three-dimension (3D) model with fluoroscopic images in real time. METHODS AND RESULTS This single-center prospective study included 66 previous CABG patients undergoing coronary and bypass graft angiography. Image fusion coronary angiographies (fusion group, 20 patients) were compared to conventional coronary angiographies (control group, 46 patients). The fusion group included patients for whom a previous chest CT scan with contrast was available. For patients in this group, aorta and CABG were reconstructed in 3D from CT acquisitions and merged in real time with fluoroscopic images. The following parameters were compared: time needed to localize the CABG; procedure duration; air kerma (AK); dose area product (DAP); and volume of contrast media injected. Results are expressed as median. There were no significant differences between the 2 groups in patient demographics and procedure characteristics (access site, number of bypass to be found, and interventional cardiologist's experience). The time to localize CABG was significantly shorter in the fusion group (7.3 versus 12.4 minutes; P=0.002), as well as the procedure duration (20.6 versus 25.6 minutes; P=0.002), AK (610 versus 814 mGy; P=0.02), DAP (4390 versus 5922.5 cGy·cm(2); P=0.02), and volume of iodinated contrast media (85 versus 116 cc; P=0.002). CONCLUSIONS 3D image fusion improves the CABG detection in coronary angiography and reduces the time necessary to localize CABG, total procedure time duration, radiation exposure, and volume of contrast media.
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Affiliation(s)
- Julien Plessis
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Karine Warin Fresse
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Zachary Cahouch
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Thibaut Manigold
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Vincent Letocart
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Laurianne Le Gloan
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Béatrice Guyomarch
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Patrice Guerin
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
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Coserria-Sánchez F, Moruno-Tirado A, Valverde-Pérez I. Utilidad de la angiografía rotacional 3D en el diagnóstico de origen anómalo de arteria coronaria izquierda en tronco pulmonar. An Pediatr (Barc) 2016; 84:350-1. [DOI: 10.1016/j.anpedi.2015.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022] Open
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Haddad L, Waller BR, Johnson J, Choudhri A, McGhee V, Zurakowski D, Kuhls-Gilcrist A, Sathanandam S. Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab. CONGENIT HEART DIS 2016; 11:637-646. [DOI: 10.1111/chd.12356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - B. Rush Waller
- Department of Pediatrics; Division of Pediatric Cardiology; Memphis Tenn USA
| | - Jason Johnson
- Department of Pediatrics; Division of Pediatric Cardiology; Memphis Tenn USA
| | - Asim Choudhri
- Department of Radiology; University of Tennessee Health Science Center, Le Bonheur Children's Hospital; Memphis Tenn USA
| | - Vera McGhee
- College of Medicine; University of Tennessee Health Science Center; Memphis Tenn USA
| | - David Zurakowski
- Department of Biostatistics; Harvard Medical School, Associate Professor of Anesthesia and Biostatistics, Boston Children's Hospital; Boston Mass USA
| | | | - Shyam Sathanandam
- Department of Pediatrics; Division of Pediatric Cardiology; Memphis Tenn USA
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Three-Dimensional Rotational Angiography in the Pediatric Cath Lab: Optimizing Aortic Interventions. Pediatr Cardiol 2016; 37:528-36. [PMID: 26667957 DOI: 10.1007/s00246-015-1310-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/21/2015] [Indexed: 12/22/2022]
Abstract
The aim of this study was to evaluate usability and accuracy of three-dimensional rotational angiography (3DRA) during interventions of the aorta in congenital heart disease (CHD). 3DRA is an accurate, encompassing and fast imaging technique in the cath lab. However, there is only few published data about its use during interventions in CHD. Between January 2010 and January 2014, 3DRA was performed in 77 patients with aortic issues: in 65 % cases, an intervention was performed, of which 72 % had aortic isthmus stenosis. Data were obtained retrospectively. The accuracy of 3DRA was evaluated on the basis of comparative measurements (n = 60) of the aortic diameter between 3DRA and conventional biplane angiography. Measurements presented a high accuracy with an average deviation of 3.89 % [±3 %] and a significant correlation of r = 0.99 after Pearson (p < 0.0001). Clinical benefit was assessed using a five-point Likert scale and could be shown in 98 %. Comparison with a control group showed a reduced fluoroscopy time from 10.2 to 8.30 min (median, p < 0.01) and decreased radiation dose of 0.18 compared to 0.56 Gy cm(2)/kg (median, p < 0.02). The use of 3DRA in patients with aortic anomalies has advantages in comparison with conventional angiography. It improves diagnostic accuracy, and 3D guidance enables a faster and simplified intervention with enhanced patients' safety and the potential to reduce radiation dose.
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Hascoët S, Warin-Fresse K, Baruteau AE, Hadeed K, Karsenty C, Petit J, Guérin P, Fraisse A, Acar P. Cardiac imaging of congenital heart diseases during interventional procedures continues to evolve: Pros and cons of the main techniques. Arch Cardiovasc Dis 2016; 109:128-42. [DOI: 10.1016/j.acvd.2015.11.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022]
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Fagan TE, Truong UT, Jone PN, Bracken J, Quaife R, Hazeem AAA, Salcedo EE, Fonseca BM. Multimodality 3-dimensional image integration for congenital cardiac catheterization. Methodist Debakey Cardiovasc J 2015; 10:68-76. [PMID: 25114757 DOI: 10.14797/mdcj-10-2-68] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cardiac catheterization procedures for patients with congenital and structural heart disease are becoming more complex. New imaging strategies involving integration of 3-dimensional images from rotational angiography, magnetic resonance imaging (MRI), computerized tomography (CT), and transesophageal echocardiography (TEE) are employed to facilitate these procedures. We discuss the current use of these new 3D imaging technologies and their advantages and challenges when used to guide complex diagnostic and interventional catheterization procedures in patients with congenital heart disease.
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Affiliation(s)
| | | | | | - John Bracken
- University of Colorado, Aurora, Colorado ; Philips Research North America, Briarcliff Manor, New York
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Presnell LB, Blankenship A, Cheatham SL, Owens GE, Staveski SL. An Overview of Pulmonary Atresia and Major Aortopulmonary Collateral Arteries. World J Pediatr Congenit Heart Surg 2015; 6:630-9. [DOI: 10.1177/2150135115598559] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) is a rare and complex congenital cardiac lesion that has historically carried a poor prognosis. With advancements in surgical management, we have seen an improvement in the outcomes for children affected by this disease. However, this population continues to present challenges due to the complex anatomy and physiology associated with PA/VSD/MAPCA. This summary of material presented during one of the nursing sessions of the 2014 Meeting of the Pediatric Cardiac Intensive Care Society provides an overview for those in cardiac intensive care units who do not have a large experience with this lesion. We will review the anatomy, physiology, surgical approach, postoperative management strategies, and cardiac catheter intervention options for PA/VSD/MAPCAs. We will also discuss recent innovations that may lead to continued improvement in outcomes for this challenging patient population.
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Affiliation(s)
- Laura B. Presnell
- Pediatric Cardiac Intensive Care Unit, Lucile Packard Children’s Hospital, Palo Alto, CA, USA
| | | | | | - Gabe E. Owens
- C.S. Mott Children’s Hospital, University of Michigan Congenital Heart Center, Hospital Drive, Ann Arbor, MI, USA
| | - Sandra L. Staveski
- Research in Patient Services and Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Abstract
As pediatric imaging capabilities have increased in scope, so have the complexities of providing procedural sedation in this environment. While efforts by many organizations have dramatically increased the safety of pediatric procedural sedation in general, radiology sedation creates several special challenges for the sedation provider. These challenges require implementation of additional safeguards to promote safety during sedation while maintaining effective and efficient care. Multiple agent options are available, and decisions regarding which agent(s) to use should be determined by both patient needs (i.e., developmental capacities, underlying health status, and previous experiences) and procedural needs (i.e., duration, need for immobility, and invasiveness). Increasingly, combinations of agents to either achieve the conditions required or mitigate/counterbalance adverse effects of single agents are being utilized with success. To continue to provide effective imaging sedation, it is incumbent on sedation providers to maintain familiarity with continuing evolutions within radiology environments, as well as comfort and competence with multiple sedation agents/regimens. This review discusses the challenges associated with radiology sedation and outlines various available agent options and combinations, with the intent of facilitating appropriate matching of agent(s) with patient and procedural needs.
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Affiliation(s)
- John W Berkenbosch
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville, Kosair Children's Hospital, 571 S. Floyd, Ste 332, Louisville, KY, 40202, USA.
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Truong UT, Fagan TE, Deterding R, Ing RJ, Fonseca BM. Use of rotational angiography in assessing relationship of the airway to vasculature during cardiac catheterization. Catheter Cardiovasc Interv 2015; 86:1068-77. [DOI: 10.1002/ccd.26004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Uyen T. Truong
- Department of Pediatric, Division of Cardiology; Children's Hospital; Aurora Colorado
| | - Thomas E. Fagan
- Department of Pediatric, Division of Cardiology; Children's Hospital; Aurora Colorado
| | - Robin Deterding
- Department of Pediatrics, Division of Pulmonary; Children's Hospital; Aurora Colorado
| | - Richard J. Ing
- Department of Anesthesia; Children's Hospital; Aurora Colorado
| | - Brian M. Fonseca
- Department of Pediatric, Division of Cardiology; Children's Hospital; Aurora Colorado
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Borik S, Volodina S, Chaturvedi R, Lee KJ, Benson LN. Three-dimensional rotational angiography in the assessment of vascular and airway compression in children after a cavopulmonary anastomosis. Pediatr Cardiol 2015; 36:1083-9. [PMID: 25762468 DOI: 10.1007/s00246-015-1130-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 02/27/2015] [Indexed: 12/21/2022]
Abstract
The aim of the study was to examine the role of three-dimensional rotational angiography (3DRA) in assessing vascular and airway narrowing in children with a bidirectional cavopulmonary anastomosis (BCPA). The course of children with single ventricle physiology is often complicated by left pulmonary artery (LPA) and/or bronchial stenosis and may be related to aortic compression. 3DRA may be useful in evaluating this complex anatomy and possible mechanisms for the observed obstruction. Clinical data and imaging (2D angiography and 3DRA) of children with a BCPA were reviewed retrospectively. Measurements were taken at similar locations along the pulmonary arteries in both modalities and in the airways on 3DRA. Twenty-five children with a previous BCPA were assessed at mean age of 3.1 ± 2.0 years and weight of 13.6 ± 3.6 kg. Excellent correlation was found between 3DRA and 2D angiographic LPA measurements (r = 0.89, p < 0.0001). Twelve children had qualitative LPA stenosis on 3DRA, with a stenotic dimension of 6.6 ± 2.2 mm on 2D angiography and 6.8 ± 1.9 mm on 3DRA (r = 0.94, p < 0.0001). Ten cases with LPA stenosis also had bronchial stenosis (83 %). Qualitative airway assessment correlated with quantitative bronchial dimensions from 3DRA-derived tomographic images: Bronchial stenosis measured 4.4 ± 1.6 versus 5.9 ± 1.1 mm in those with a normal appearing bronchus (p = 0.009). Hybrid patients (initial palliation with bilateral pulmonary artery banding and arterial ductal stenting, n = 5) and all patients with a Damus-Kaye-Stansel (DKS) anastomosis (n = 9) were more likely to have LPA and left bronchial stenosis (OR 7.7, p = 0.04). 3DRA is a useful and accurate tool in assessment of LPA and airway narrowing after BCPA. Hybrid and DKS patients are more prone to LPA and bronchial stenosis, and 3DRA can provide insight into the mechanism.
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Affiliation(s)
- Sharon Borik
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto School of Medicine, 555 University Ave, Toronto, ON, M5G 1X8, Canada,
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Manica JLL, Borges MS, de Medeiros RF, Fischer LDS, Broetto G, Rossi RI. A comparison of radiation dose between standard and 3D angiography in congenital heart disease. Arq Bras Cardiol 2015; 103:131-7. [PMID: 25211313 PMCID: PMC4150664 DOI: 10.5935/abc.20140118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/17/2014] [Indexed: 11/22/2022] Open
Abstract
Background The use of three-dimensional rotational angiography (3D-RA) to assess patients
with congenital heart diseases appears to be a promising technique despite the
scarce literature available. Objectives The objective of this study was to describe our initial experience with 3D-RA and
to compare its radiation dose to that of standard two-dimensional angiography
(2D-SA). Methods Between September 2011 and April 2012, 18 patients underwent simultaneous 3D-RA
and 2D-SA during diagnostic cardiac catheterization. Radiation dose was assessed
using the dose-area-product (DAP). Results The median patient age and weight were 12.5 years and 47.5 Kg, respectively. The
median DAP of each 3D-RA acquisition was
1093µGy.m2 and
190µGy.m2 for each 2D-SA acquisition
(p<0.01). In patients weighing more than 45Kg (n=7), this difference was
attenuated but still significant (1525 µGy.m2
vs.413µGy.m2, p=0.01). No difference
was found between one 3D-RA and three 2D-SA
(1525µGy.m2 vs.1238
µGy.m2, p = 0.575) in this population. This
difference was significantly higher in patients weighing less than 45Kg (n=9)
(713µGy.m2
vs.81µGy.m2, P = 0.008), even when comparing
one 3D-RA with three 2D-SA (242µGy.m2,
respectively, p<0.008). 3D-RA was extremely useful for the assessment of
conduits of univentricular hearts, tortuous branches of the pulmonary artery, and
aorta relative to 2D-SA acquisitions. Conclusions The radiation dose of 3D-RA used in our institution was higher than those
previously reported in the literature and this difference was more evident in
children. This type of assessment is of paramount importance when starting to
perform 3D-RA.
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Affiliation(s)
- João Luiz Langer Manica
- Mailing Address: João Luiz Langer Manica, Av. Princesa Isabel,
370, Santana. Postal Code 90620-000, Porto Alegre, RS - Brazil.
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Corredoira E, Vañó E, Ubeda C, Gutiérrez-Larraya F. Patient doses in paediatric interventional cardiology: impact of 3D rotational angiography. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2015; 35:179-195. [PMID: 25632824 DOI: 10.1088/0952-4746/35/1/179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to calculate the contribution of 3D rotational angiography to radiation doses received by paediatric patients in a cardiac catheterisation laboratory. The percentage increase in the median value of air kerma-area product due to cone beam CT was 33 and 16% for diagnostic and therapeutic procedures, respectively. Results are presented separately for five age groups and ten weight groups. Several methods for reducing radiation from 3D rotational angiography are suggested and patient doses are compared with previously published values.
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Affiliation(s)
- E Corredoira
- Medical Physics and Radiation Protection Service, Hospital Universitario La Paz, Madrid, Spain
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Cumulative medical radiation exposure throughout staged palliation of single ventricle congenital heart disease. Pediatr Cardiol 2015; 36:190-5. [PMID: 25096904 DOI: 10.1007/s00246-014-0984-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/22/2014] [Indexed: 01/25/2023]
Abstract
Patients with single ventricle heart disease undergoing staged palliation are exposed to ionizing radiation from multiple medical sources. We sought to quantify typical radiation burden in this population and identify risk factors for increased exposure. A retrospective review was performed of single ventricle patients surgically palliated at our institution, in which all studies utilizing ionizing radiation occurring from birth through Fontan completion were compiled. Thirty-eight patients were followed for a median of 33 months. A median of 59 radiation events occurred during follow-up, with a median cumulative effective dose of 25.7 milliSieverts (mSv). On average, cardiac catheterization accounted for 4% of radiation encounters but comprised 78% of total radiation exposure. In a multivariate model, factors associated with increased total radiation exposure included pulmonary artery (PA) stenosis requiring intervention (p = 0.005) and systemic right ventricle (p = 0.02). Risk factors for increased exposure from catheterization included heterotaxy syndrome (p = 0.007), re-coarctation (p = 0.003), and PA stenosis (p = 0.02). At our institution, many single ventricle patients are exposed to substantial radiation throughout staged palliation, most of which derives from cardiac catheterization. PA stenosis was identified as a risk factor for increased total and catheterization-based exposure. As patient survival improves, awareness of this scale of radiation exposure at a vulnerable period is imperative.
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Radiation safety protocol using real-time dose reporting reduces patient exposure in pediatric electrophysiology procedures. Pediatr Cardiol 2014; 35:1116-23. [PMID: 24801673 DOI: 10.1007/s00246-014-0904-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/25/2014] [Indexed: 12/21/2022]
Abstract
Radiation exposure during pediatric catheterization is significant. We sought to describe radiation exposure and the effectiveness of radiation safety protocols in reducing exposure during catheter ablations with electrophysiology studies in children and patients with congenital heart disease. We additionally sought to identify at-risk patients. We retrospectively reviewed all interventional electrophysiology procedures performed from April 2009 to September 2011 (6 months preceding intervention, 12 months following implementation of initial radiation safety protocol, and 8 months following implementation of modified protocol). The protocols consisted of low pulse rate fluoroscopy settings, operator notification of skin entrance dose every 1,000 mGy, adjusting cameras by >5 at every 1,000 mGy, and appropriate collimation. The cohort consisted of 291 patients (70 pre-intervention, 137 after initial protocol implementation, 84 after modified protocol implementation) at a median age of 14.9 years with congenital heart disease present in 11 %. Diagnoses included atrioventricular nodal reentrant tachycardia (25 %), atrioventricular reentrant tachycardia (61 %), atrial tachycardias (12 %), and ventricular tachycardia (2 %). There were no differences between groups based on patient, arrhythmia, and procedural characteristics. Following implementation of the protocols, there were significant reductions in all measures of radiation exposure: fluoroscopy time (17.8 %), dose area product (80.2 %), skin entry dose (81.0 %), and effective dose (76.9 %), p = 0.0001. Independent predictors of increased radiation exposure included larger patient weight, longer fluoroscopy time, and lack of radiation safety protocol. Implementation of a radiation safety protocol for pediatric and congenital catheter ablations can drastically reduce radiation exposure to patients without affecting procedural success.
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Glatz AC, Patel A, Zhu X, Dori Y, Hanna BD, Gillespie MJ, Rome JJ. Patient radiation exposure in a modern, large-volume, pediatric cardiac catheterization laboratory. Pediatr Cardiol 2014; 35:870-8. [PMID: 24442220 DOI: 10.1007/s00246-014-0869-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/03/2014] [Indexed: 01/21/2023]
Abstract
Radiation exposure from pediatric cardiac catheterization may be substantial, although published estimates vary. We sought to report patient radiation dose across a range of diagnostic and interventional cases in a modern, high-volume pediatric catheterization laboratory. We retrospectively reviewed diagnostic and interventional cases performed in our pediatric catheterization laboratory from 1 April 2009 to 30 September 2011 for which radiation usage data were available as reported by the Artis Zee(®) (Siemens Medical Solutions) system. Electrophysiology cases were excluded. Radiation dose was quantified as air kerma dose (mGy) and dose-area product (DAP; μGy m(2)). The DAP was converted to an effective dose millisievert (mSv) using the Monte Carlo method. Radiation usage data were available from 2,265 diagnostic and interventional cases with an overall median air kerma dose of 135 mGy [interquartile range (IQR) 59-433], median DAP of 760 μGy m(2) (IQR 281-2,810), of which 75 % (IQR 59-90 %) was derived from fluoroscopy, and median effective dose of 6.2 mSv (IQR 2.7-14.1). Air kerma dose from a single camera >2,000 mGy occurred in 1.8 % of cases. Significant differences in all measures of radiation exposure existed based on procedural and interventional types (p = 0.0001), with interventional cases associated with the highest effective dose after adjusting for patient weight category (p < 0.001). Patient weight, age, fluoroscopy time, and proportional use of digital acquisition were independent predictors of exposure (p ≤ 0.001; R (2) = 0.59-0.64). In a modern, large-volume pediatric catheterization laboratory, the median effective dose is 6.2 mSv with a wide range of exposure based on patient- and procedure-specific factors. Radiation monitoring is an important component of a pediatric laboratory and further dose reduction strategies are warranted.
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Affiliation(s)
- Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, 6th Floor, Main Building, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA,
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Glatz AC, Purrington KS, Klinger A, King AR, Hellinger J, Zhu X, Gruber SB, Gruber PJ. Cumulative exposure to medical radiation for children requiring surgery for congenital heart disease. J Pediatr 2014; 164:789-794.e10. [PMID: 24321535 DOI: 10.1016/j.jpeds.2013.10.074] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/23/2013] [Accepted: 10/28/2013] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe cumulative radiation exposure in a large single-center cohort of children with congenital heart disease (CHD) and identify risk factors for greater exposure. STUDY DESIGN A detailed medical radiation exposure history was collected retrospectively for patients aged <18 years who underwent surgery for CHD between January 1, 2001, and July 22, 2009. Cumulative per patient exposure was quantified as the effective dose in millisieverts (mSv) and annualized (mSv/year). RESULTS A total of 4132 patients were subjected to 134,715 radiation examinations at a median follow-up of 4.3 years (range, 0-8.6 years). Exposure clustered around the time of surgery. The median exposure was 14 radiologic tests (the majority of which were plain film radiographs) at an effective dose of 0.96 mSv (the majority of which was from cardiac catheterization), although this distribution had a very wide range. Almost three-quarters (73.7%) were exposed to <3 mSv/year, and 5.3% were exposed to >20 mSv/year. Neonates, children with genetic syndromes, and children requiring surgery for cardiomyopathy, pulmonary valve, single ventricle, or tricuspid valve diseases were more likely to have higher exposure levels, and those requiring surgery for aortic arch anomalies or atrioventricular septal defects were more likely to have lower levels. CONCLUSION Children with CHD requiring surgery are exposed to numerous medical forms of ionizing radiation. Although the majority of patients receive <3 mSv/year, there are identifiable risk factors for higher exposure levels. This may have important health implications as these patients age.
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Affiliation(s)
- Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Jeffrey Hellinger
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Xiaowei Zhu
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephen B Gruber
- Departments of Epidemiology, Internal Medicine, and Human Genetics, University of Michigan, Ann Arbor, MI
| | - Peter J Gruber
- Section of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, UT
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Valente AM, Cook S, Festa P, Ko HH, Krishnamurthy R, Taylor AM, Warnes CA, Kreutzer J, Geva T. Multimodality Imaging Guidelines for Patients with Repaired Tetralogy of Fallot: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2014; 27:111-41. [DOI: 10.1016/j.echo.2013.11.009] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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