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New Combination Makes Cardiac CT Imaging Safer for Children
July 18, 2011
When pediatric patients have coronary artery anomalies or disease, or a reimplanted coronary artery, it is essential to get accurate images to help with clinical management. That has traditionally been done using catheter-based angiography, according to B. Kelly Han, MD, a pediatric cardiologist at Minneapolis Heart Institute® at Abbott Northwestern Hospital.
In this procedure, a catheter is threaded into the child’s heart to deliver contrast that is then detected by X rays.
“Catheter-based angiography is an invasive procedure with a significant radiation dose, requiring sedation or anesthesia for all patients,” says Dr. Han.
Radiation exposure is an especially serious issue for children, particularly when multiple diagnostic and therapeutic procedures are necessary to treat their condition.These complex patients often have a significant cumulative radiation exposure by the time they reach adolescence.
A Better Way
Another kind of coronary artery imaging does exist. It’s called coronary computed tomography angiography (coronary CTA) and it is used primarily with adults. This type of imaging does not involve catheterization—contrast is delivered through an IV—and uses less radiation than catheter-based angiography.
The problem with using CTA with children is that their normally fast heart rate can distort the images. However, Dr. Han and her colleagues at the Minneapolis Heart Institute Foundation have effectively used coronary CTA in children and they reported their findings July 17 at the Sixth Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography (SCCT).
The Findings
For their study, they conducted a retrospective review of all coronary CTAs performed on patients less than 18 years of age at the Minneapolis Heart Institute® in a 3.5 year period. They examined the effectiveness of medication to reduce heart rate, and the radiation dose and diagnostic accuracy of various CTA scan protocols. The goal was to compare the image quality and the radiation dose to minimize risk for future patients.
They found that all coronary CTA scan modes deliver less radiation than traditional angiography, and that newer scan techniques further reduce dose without loss of diagnostic quality.
“[By combining] medication to slow the heart rate and the new scanner technology, we have been able to obtain excellent images of the coronary arteries at a very low radiation dose in patients as young as five months of age,” says Dr. Han.
