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Campolo J, Annoni G, Vignati G, Peretti A, Papa M, Colombo PE, Muti G, Parolini M, Borghini A, Giaccardi M, Ait-Alì L, Picano E, Andreassi MG. The burden of radiation exposure in congenital heart disease: the Italian cohort profile and bioresource collection in HARMONIC project. Ital J Pediatr 2024; 50:100. [PMID: 38760836 PMCID: PMC11102118 DOI: 10.1186/s13052-024-01663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/28/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The European-funded Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) project aims to improve knowledge on the effects of medical exposure to ionizing radiation (IR) received during childhood. One of its objectives is to build a consolidated European cohort of pediatric patients who have undergone cardiac catheterization (Cath) procedures, with the goal of enhancing the assessment of long-term radiation-associated cancer risk. The purpose of our study is to provide a detailed description of the Italian cohort contributing to the HARMONIC project, including an analysis of cumulative IR exposure, reduction trend over the years and an overview of the prospective collection of biological samples for research in this vulnerable population. METHODS In a single-center retrospective cohort study, a total of 584 patients (323 males) with a median age of 6 (2-13) years, referred at the Pediatric Cardiology in Niguarda Hospital from January 2015 to October 2023, were included. Biological specimens from a subset of 60 patients were prospectively collected for biobanking at baseline, immediately post-procedure and after 12 months. RESULTS Two hundred fifty-nine (44%) patients were under 1 year old at their first procedure. The median KAP/weight was 0.09 Gy·cm2/kg (IQR: 0.03-0.20), and the median fluoroscopy time was 8.10 min (IQR: 4.00-16.25). KAP/weight ratio showed a positive correlation with the fluoroscopy time (Spearman's rho = 0.679, p < 0.001). Significant dose reduction was observed either after implementation of an upgraded technology system and a radiation training among staff. The Italian cohort includes 1858 different types of specimens for Harmonic biobank, including blood, plasma, serum, clot, cell pellet/lymphocytes, saliva. CONCLUSIONS In the Italian Harmonic cohort, radiation dose in cardiac catheterization varies by age and procedure type. An institution's radiological protection strategy has contributed to a reduction in radiation dose over time. Biological samples provide a valuable resource for future research, offering an opportunity to identify potential early biomarkers for health surveillance and personalized risk assessment.
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Affiliation(s)
- Jonica Campolo
- CNR Institute of Clinical Physiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Giuseppe Annoni
- Pediatric Cardiology, Regina Margherita Children's Hospital, Turin, Italy
| | - Gabriele Vignati
- Pediatric Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessio Peretti
- Pediatric Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Papa
- Pediatric Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gaia Muti
- Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marina Parolini
- CNR Institute of Clinical Physiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | | | - Marzia Giaccardi
- Department of Internal Medicine, Electrophysiology Unit, Santa Maria Annunziata Hospital, Florence, Italy
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Cotrim N, Café HM, Guardado J, Cordeiro P, Cotrim H, Martins R, Baquero L, Cotrim C. Clinical Application of Exercise Stress Echocardiography in an Outpatient Pediatric Population. J Clin Med 2024; 13:2191. [PMID: 38673464 PMCID: PMC11050833 DOI: 10.3390/jcm13082191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Exercise stress echocardiography (ESE) is commonly employed in adults, but its applicability in pediatric populations remains to be clarified. Methods: A total of 309 consecutive children (C), with a mean age of 14.1 ± 2.6 years (range 6-17 years), underwent treadmill ESE starting in 2002. They were divided into two groups: Group I comprised 258 children, including 237 with symptoms related to exercise (such as chest pain, fatigue, lipothymia/syncope, or one aborted sudden death), 15 with electrocardiogram (ECG) abnormalities, and 6 with a positive ECG stress test showing ST changes. Group II consisted of 10 asymptomatic children whose parents requested routine screening, 11 with symptoms unrelated to exercise, 12 with a family history of sudden death, and 17 with known pathologies (including 10 with hypertrophic cardiomyopathy, 2 with aortic coarctation, and the remainder with various conditions, such as Cortriatriatum sinister, pulmonary stenosis, subaortic stenosis, bicuspid aortic valve, left ventricular hypertrophy related to arterial hypertension, and aortic switch operation). Regional wall motion abnormalities (RWMAs) and transvalvular or intraventricular (IVG) gradients were assessed using 2D and continuous-wave Doppler, respectively, in all cases. Results: The success rate was 100% (309/309). Stress-induced RWMAs were observed in two children. A significant IVG (>30 mmHg) was detected in 101 out of the 258 children (39%) in Group I, who presented with exercise-related symptoms, ECG abnormalities, or positive stress ECG. In Group I, the odds ratio (OR) of ESE reproducing the symptoms in children with IVG compared to those without IVG was 8.22 (95% CI: 4.84-13.99, p < 0.001). Conclusions: Treadmill ESE is both feasible and safe for pediatric populations. RWMAs demonstrated limited utility in our cohort of children, while IVG induced by exercise was frequently observed in symptomatic children.
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Affiliation(s)
- Nuno Cotrim
- Hospital Distrital de Santarém, 2005-177 Santarém, Portugal;
- Heart Center do Hospital da Cruz Vermelha, 1500-048 Lisboa, Portugal; (J.G.); (L.B.)
- Unidade Cardiovascular, 2350-325 Torres Novas, Portugal
| | - Hugo M. Café
- Hospital Particular do Algarve, 8005-226 Faro, Portugal (P.C.)
| | - Jorge Guardado
- Heart Center do Hospital da Cruz Vermelha, 1500-048 Lisboa, Portugal; (J.G.); (L.B.)
- Unidade Cardiovascular, 2350-325 Torres Novas, Portugal
| | - Pedro Cordeiro
- Hospital Particular do Algarve, 8005-226 Faro, Portugal (P.C.)
| | | | - Rui Martins
- Faculdade de Ciências de Lisboa, Universidade de Lisboa, 1749-016 Lisboa, Portugal;
| | - Luís Baquero
- Heart Center do Hospital da Cruz Vermelha, 1500-048 Lisboa, Portugal; (J.G.); (L.B.)
| | - Carlos Cotrim
- Heart Center do Hospital da Cruz Vermelha, 1500-048 Lisboa, Portugal; (J.G.); (L.B.)
- Unidade Cardiovascular, 2350-325 Torres Novas, Portugal
- Hospital Particular do Algarve, 8005-226 Faro, Portugal (P.C.)
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Gould SW, Harty MP, Cartoski M, Krishnan V, Givler N, Ostrowski J, Tsuda T. Efficacy and safety of coronary computed tomography angiography in diagnosing coronary lesions in children. Cardiol Young 2024; 34:838-845. [PMID: 37877254 DOI: 10.1017/s1047951123003438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Identification of paediatric coronary artery abnormalities is challenging. We studied whether coronary artery CT angiography can be performed safely and reliably in children. MATERIALS Retrospective analysis of consecutive coronary CT angiography scans was performed for image quality and estimated radiation dose. Both factors were assessed for correlation with electrocardiographic-gating technique that was protocoled on a case-by-case basis, radiation exposure parameters, image noise artefact parameters, heart rate, and heart rate variability. RESULTS Sixty scans were evaluated, of which 96.5% were diagnostic for main left and right coronaries and 91.3% were considered diagnostic for complete coronary arteries. Subjective image quality correlated significantly with lower heart rate, increasing patient age, and higher signal-to-noise ratio. Estimated radiation dose only correlated significantly with choice of electrocardiographic-gating technique with median doses as follows: 2.42 mSv for electrocardiographic-gating triggered high-pitch spiral technique, 5.37 mSv for prospectively triggered axial sequential technique, 3.92 mSv for retrospectively gated technique, and 5.64 mSv for studies which required multiple runs. Two scans were excluded for injection failure and one for protocol outside the study scope. Five non-diagnostic cases were attributed to breathing motion, scanning prior to peak contrast enhancement, or scan acquisition during the incorrect portion of the R-R interval. CONCLUSIONS Diagnostic-quality coronary CT angiography can be performed reliably with a low estimated radiation exposure by tailoring each scan protocol to the patient's body habitus and heart rate. We propose coronary CT angiography is a safe and effective diagnostic modality for coronary artery abnormalities in children.
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Affiliation(s)
- Sharon W Gould
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - M Patricia Harty
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Mark Cartoski
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Vijay Krishnan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA
| | - Nicole Givler
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - John Ostrowski
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
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Toscan M, de Araújo BF, Martini JC, Ravazio R, de Souza VC. Our estimates of neonatal radiation exposure fall short of reality. Eur J Pediatr 2024; 183:1911-1916. [PMID: 38334796 DOI: 10.1007/s00431-024-05466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
The purpose of this study is to evaluate radiation exposure in newborns undergoing imaging tests during the first 30 days of neonatal intensive care unit (NICU) hospitalization. A retrospective cohort study was conducted from November 2018 to April 2019 with newborns admitted to the NICU. Thermoluminescent dosimeters (TLD-100™) measured radiation emitted during imaging exams over 1 month, with a comparison between measured and estimated radiation. The cohort exhibited a median gestational age of 33.0 (31.0, 37.0) weeks, a median birth weight of 1840 (1272, 2748) g, and a median length of stay of 25.5 (11.7, 55.0) days. Eighty-four patients underwent 314 imaging tests, with an estimated radiation dose (ERD) per patient of 0.116 mSv and a measured radiation dose (MDR) of 0.158 mSv. ERD consistently underestimated MDR, with a mean difference of -0.043 mSv (-0.049 to -0.036) in the Bland-Altman analysis. The regression equation was as follows: difference MRD - ERD = -1.7 × (mean (MRD + ERD)) + 0.056. The mean estimated radiation dose per exam was 0.030 mSv, and the chest X-rays accounted for 63.26% of total exams. The median number of radiographic incidences per patient was 2 (1, 4), with 5 patients undergoing three or more exams in a single day. CONCLUSION Radiation exposure in these newborns was underestimated, emphasizing the need for awareness regarding associated risks and strict criteria for requesting radiological exams. Lung ultrasound is a radiation-free and effective option in managing respiratory diseases in newborns, reducing the reliance on chest X-rays. WHAT IS KNOWN • Radiation used in diagnostic exams is not risk-free. • Radiation risk is much higher in small Infants due to the exposure area and the prolonged expectance of life. WHAT IS NEW • Radiation exposure is underestimated in the neonatal population. • The study found a mean radiation exposure in neonates about 5% of the mean annual dose in the general population.
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Affiliation(s)
- Michelle Toscan
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil.
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Breno Fauth de Araújo
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
| | - Júlio César Martini
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafaela Ravazio
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Programa de Pós Graduação em Ciências da Computação, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vandréa Carla de Souza
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
- Programa de Pós Graduação em Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
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Krmek N, Környei L, Kralik I, Delić-Brkljačić D, Milošević M, Rode M, Kocsis F, Radeljić V. X-ray Doses in Relation to Body Mass, Indication, and Substrate During Pediatric Electrophysiological Procedures on the Heart. Pediatr Cardiol 2024; 45:804-813. [PMID: 38411709 DOI: 10.1007/s00246-024-03428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/21/2024] [Indexed: 02/28/2024]
Abstract
The main goal of this study is to determine typical values of dose area product (DAP) and difference in the effective dose (ED) for pediatric electrophysiological procedures on the heart in relation to patient body mass. This paper also shows DAP and ED in relation to the indication, the arrhythmia substrate determined during the procedure, and in relation to the reason for using radiation. Organ doses are described as well. The subjects were children who have had an electrophysiological study done with a 3D mapping system and X-rays in two healthcare institutions. Children with congenital heart defects were excluded. There were 347 children included. Significant difference was noted between mass groups, while heavier children had higher values of DAP and ED. Median DAP in different mass groups was between 4.00 (IQR 1.00-14.00) to 26.33 (IQR 8.77-140.84) cGycm2. ED median was between 23.18 (IQR 5.21-67.70) to 60.96 (IQR 20.64-394.04) µSv. The highest DAP and ED in relation to indication were noted for premature ventricular contractions and ventricular tachycardia-27.65 (IQR 12.91-75.0) cGycm2 and 100.73 (IQR 53.31-258.10) µSv, respectively. In arrhythmia substrate groups, results were similar, and the highest doses were in ventricular substrates with DAP 29.62 (IQR 13.81-76.0) cGycm2 and ED 103.15 (IQR 60.78-266.99) µSv. Pediatric electrophysiology can be done with very low doses of X-rays when using 3D mapping systems compared to X-rays-based electrophysiology, or when compared to pediatric interventional cardiology or adult electrophysiology.
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Affiliation(s)
- Nikola Krmek
- University of Zagreb, School of Medicine, Zagreb, Croatia.
| | - László Környei
- Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary
| | | | | | | | - Mirta Rode
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Flóra Kocsis
- Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary
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Headrick A, Ou Z, Asaki SY, Etheridge SP, Hammond B, Gakenheimer-Smith L, Pilcher T, Niu M. Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications. Europace 2024; 26:euae047. [PMID: 38366154 PMCID: PMC10898927 DOI: 10.1093/europace/euae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
AIMS Common to adult electrophysiology studies (EPSs), intracardiac echocardiography (ICE) use in paediatric and congenital heart disease (CHD) EPS is limited. The purpose of this study was to assess the efficacy of ICE use and incidence of associated complications in paediatric and CHD EPS. METHODS AND RESULTS This single-centre retrospective matched cohort study reviewed EPS between 2013 and 2022. Demographics, CHD type, and EPS data were collected. Intracardiac echocardiography cases were matched 1:1 to no ICE controls to assess differences in complications, ablation success, fluoroscopy exposure, procedure duration, and arrhythmia recurrence. Cases and controls with preceding EPS within 5 years were excluded. Intracardiac echocardiography cases without an appropriate match were excluded from comparative analyses but included in the descriptive cohort. We performed univariable and multivariable logistic regression to assess associations between variables and outcomes. A total of 335 EPS were reviewed, with ICE used in 196. The median age of ICE cases was 15 [interquartile range (IQR) 12-17; range 3-47] years, and median weight 57 [IQR 45-71; range 15-134] kg. There were no ICE-related acute or post-procedural complications. There were 139 ICE cases matched to no ICE controls. Baseline demographics and anthropometrics were similar between cases and controls. Fluoroscopy exposure (P = 0.02), procedure duration (P = 0.01), and arrhythmia recurrence (P = 0.01) were significantly lower in ICE cases. CONCLUSION Intracardiac echocardiography in paediatric and CHD ablations is safe and reduces procedure duration, fluoroscopy exposure, and arrhythmia recurrence. However, not every arrhythmia substrate requires ICE use. Thoughtful selection will ensure the judicious and strategic application of ICE to enhance outcomes.
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Affiliation(s)
- Andrew Headrick
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - S Yukiko Asaki
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Susan P Etheridge
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Benjamin Hammond
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Lindsey Gakenheimer-Smith
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Thomas Pilcher
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
| | - Mary Niu
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA
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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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Besson FL, Treglia G, Bucerius J, Anagnostopoulos C, Buechel RR, Dweck MR, Erba PA, Gaemperli O, Gimelli A, Gheysens O, Glaudemans AWJM, Habib G, Hyafil F, Lubberink M, Rischpler C, Saraste A, Slart RHJA. A systematic review for the evidence of recommendations and guidelines in hybrid nuclear cardiovascular imaging. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06597-x. [PMID: 38221570 DOI: 10.1007/s00259-024-06597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVES This study aimed to evaluate the level of evidence of expert recommendations and guidelines for clinical indications and procedurals in hybrid nuclear cardiovascular imaging. METHODS From inception to August 2023, a PubMed literature analysis of the latest version of guidelines for clinical hybrid cardiovascular imaging techniques including SPECT(/CT), PET(/CT), and PET(/MRI) was performed in two categories: (1) for clinical indications for all-in primary diagnosis; subgroup in prognosis and therapy evaluation; and for (2) imaging procedurals. We surveyed to what degree these followed a standard methodology to collect the data and provide levels of evidence, and for which topic systematic review evidence was executed. RESULTS A total of 76 guidelines, published between 2013 and 2023, were included. The evidence of guidelines was based on systematic reviews in 7.9% of cases, non-systematic reviews in 47.4% of cases, a mix of systematic and non-systematic reviews in 19.7%, and 25% of guidelines did not report any evidence. Search strategy was reported in 36.8% of cases. Strengths of recommendation were clearly reported in 25% of guidelines. The notion of external review was explicitly reported in 23.7% of cases. Finally, the support of a methodologist was reported in 11.8% of the included guidelines. CONCLUSION The use of evidence procedures for developing for evidence-based cardiovascular hybrid imaging recommendations and guidelines is currently suboptimal, highlighting the need for more standardized methodological procedures.
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Affiliation(s)
- Florent L Besson
- Department of Nuclear Medicine-Molecular Imaging, DMU SMART IMAGING, Hôpitaux Universitaires Paris-Saclay, AP-HP, CHU Bicêtre, Le Kremlin Bicetre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicetre, France
- Commissariat À L'énergie Atomique Et Aux Énergies Alternatives (CEA), Centre National de La Recherche Scientifique (CNRS), Inserm, BioMaps, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Jan Bucerius
- Department of Nuclear Medicine, Georg-August University Göttingen, Universitätsmedizin Göttingen, Gottingen, Germany
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Paula A Erba
- Department of Medicine and Surgery, University of Milan Bicocca, and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
| | - Fabian Hyafil
- Department of Nuclear Medicine, DMU IMAGINA, Georges-Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, F75015, Paris, France
| | - Mark Lubberink
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Antti Saraste
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
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9
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Buytaert D, Vandekerckhove K, Panzer J, Campens L, Bacher K, De Wolf D. Multimodality 3D image fusion with live fluoroscopy reduces radiation dose during catheterization of congenital heart defects. Front Cardiovasc Med 2024; 10:1292039. [PMID: 38274314 PMCID: PMC10808650 DOI: 10.3389/fcvm.2023.1292039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Imaging fusion technology is promising as it is radiation and contrast sparing. Herein, we compare conventional biplane angiography to multimodality image fusion with live fluoroscopy using two-dimensional (2D)-three-dimensional (3D) registration (MMIF2D-3D) and assess MMIF2D-3D impact on radiation exposure and contrast volume during cardiac catheterization of patients with congenital heart disease (CHD). Methods We matched institutional MMIF2D-3D procedures and controls according to patient characteristics (body mass index, age, and gender) and the seven procedure-type subgroups. Then, we matched the number of tests and controls per subgroup using chronological ordering or propensity score matching. Subsequently, we combined the matched subgroups into larger subgroups of similar procedure type, keeping subgroups with at least 10 test and 10 control cases. Air kerma (AK) and dose area product (DAP) were normalized by body weight (BW), product of body weight and fluoroscopy time (BW × FT), or product of body weight and number of frames (BW × FR), and stratified by acquisition plane and irradiation event type (fluoroscopy or acquisition). Three senior interventionists evaluated the relevance of MMIF2D-3D (5-point Likert scale). Results The Overall group consisted of 54 MMIF2D-3D cases. The combined and matched subgroups were pulmonary artery stenting (StentPUL), aorta angioplasty (PlastyAO), pulmonary artery angioplasty (PlastyPUL), or a combination of the latter two (Plasty). The FT of the lateral plane reduced significantly by 69.6% for the Overall MMIF2D-3D population. AKBW and DAPBW decreased, respectively, by 43.9% and 39.3% (Overall group), 49.3% and 54.9% (PlastyAO), and 36.7% and 44.4% for the Plasty subgroup. All the aforementioned reductions were statistically significant except for DAPBW in the Overall and Plasty (sub)groups. The decrease of AKBW and DAPBW in the StentPUL and PlastyPUL subgroups was not statistically significant. The decrease in the median values of the weight-normalized contrast volume (CMCBW) in all five subgroups was not significant. Cardiologists considered MMIF2D-3D very useful with a median score of 4. Conclusion In our institution, MMIF2D-3D overall enabled significant AKBW reduction during the catheterization of CHD patients and was mainly driven by reduced FT in the lateral plane. We observed significant AKBW reduction in the Plasty and PlastyAO subgroups and DAPBW reduction in the PlastyAO subgroup. However, the decrease in CMCBW was not significant.
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Affiliation(s)
- Dimitri Buytaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | | | - Joseph Panzer
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Laurence Campens
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Klaus Bacher
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Daniël De Wolf
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
- Department of Paediatric Cardiology, Brussels University Hospital, Jette, Belgium
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Afroz S, Østerås BH, Thevathas US, Dohlen G, Stokke C, Robsahm TE, Olerud HM. Use of ionizing radiation in a Norwegian cohort of children with congenital heart disease: imaging frequency and radiation dose for the Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) study. Pediatr Radiol 2023; 53:2502-2514. [PMID: 37773444 PMCID: PMC10635954 DOI: 10.1007/s00247-023-05774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The European-funded Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) project is a multicenter cohort study assessing the long-term effects of ionizing radiation in patients with congenital heart disease. Knowledge is lacking regarding the use of ionizing radiation from sources other than cardiac catheterization in this cohort. OBJECTIVE This study aims to assess imaging frequency and radiation dose (excluding cardiac catheterization) to patients from a single center participating in the Norwegian HARMONIC project. MATERIALS AND METHODS Between 2000 and 2020, we recruited 3,609 patients treated for congenital heart disease (age < 18 years), with 33,768 examinations categorized by modality and body region. Data were retrieved from the radiology information system. Effective doses were estimated using International Commission on Radiological Protection Publication 60 conversion factors, and the analysis was stratified into six age categories: newborn; 1 year, 5 years, 10 years, 15 years, and late adolescence. RESULTS The examination distribution was as follows: 91.0% conventional radiography, 4.0% computed tomography (CT), 3.6% diagnostic fluoroscopy, 1.2% nuclear medicine, and 0.3% noncardiac intervention. In the newborn to 15 years age categories, 4-12% had ≥ ten conventional radiography studies, 1-8% underwent CT, and 0.3-2.5% received nuclear medicine examinations. The median effective dose ranged from 0.008-0.02 mSv and from 0.76-3.47 mSv for thoracic conventional radiography and thoracic CT, respectively. The total effective dose burden from thoracic conventional radiography ranged between 28-65% of the dose burden from thoracic CT in various age categories (40% for all ages combined). The median effective dose for nuclear medicine lung perfusion was 0.6-0.86 mSv and for gastrointestinal fluoroscopy 0.17-0.27 mSv. Because of their low frequency, these procedures contributed less to the total effective dose than thoracic radiography. CONCLUSION This study shows that CT made the largest contribution to the radiation dose from imaging (excluding cardiac intervention). However, although the dose per conventional radiograph was low, the large number of examinations resulted in a substantial total effective dose. Therefore, it is important to consider the frequency of conventional radiography while calculating cumulative dose for individuals. The findings of this study will help the HARMONIC project to improve risk assessment by minimizing the uncertainty associated with cumulative dose calculations.
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Affiliation(s)
- Susmita Afroz
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Grønland 58, Drammen, Norway.
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway.
| | - Bjørn H Østerås
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Utheya S Thevathas
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Grønland 58, Drammen, Norway
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Gaute Dohlen
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Caroline Stokke
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Trude E Robsahm
- Research Department, Cancer Registry of Norway, Oslo, Norway
| | - Hilde M Olerud
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Grønland 58, Drammen, Norway
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Andreassi MG, Haddy N, Harms-Ringdahl M, Campolo J, Borghini A, Chevalier F, Schwenk JM, Fresneau B, Bolle S, Fuentes M, Haghdoost S. A Longitudinal Study of Individual Radiation Responses in Pediatric Patients Treated with Proton and Photon Radiotherapy, and Interventional Cardiology: Rationale and Research Protocol of the HARMONIC Project. Int J Mol Sci 2023; 24:ijms24098416. [PMID: 37176123 PMCID: PMC10178896 DOI: 10.3390/ijms24098416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
The Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy (photon and proton) in Pediatrics (HARMONIC) is a five-year project funded by the European Commission that aimed to improve the understanding of the long-term ionizing radiation (IR) risks for pediatric patients. In this paper, we provide a detailed overview of the rationale, design, and methods for the biological aspect of the project with objectives to provide a mechanistic understanding of the molecular pathways involved in the IR response and to identify potential predictive biomarkers of individual response involved in long-term health risks. Biological samples will be collected at three time points: before the first exposure, at the end of the exposure, and one year after the exposure. The average whole-body dose, the dose to the target organ, and the dose to some important out-of-field organs will be estimated. State-of-the-art analytical methods will be used to assess the levels of a set of known biomarkers and also explore high-resolution approaches of proteomics and miRNA transcriptomes to provide an integrated assessment. By using bioinformatics and systems biology, biological pathways and novel pathways involved in the response to IR exposure will be deciphered.
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Affiliation(s)
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Mats Harms-Ringdahl
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden
| | - Jonica Campolo
- CNR National Research Council Institute of Clinical Physiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Andrea Borghini
- CNR National Research Council Institute of Clinical Physiology, 56125 Pisa, Italy
| | - François Chevalier
- UMR6252 CIMAP, CEA-CNRS-ENSICAEN-University of Caen Normandy, 14000 Caen, France
- Advanced Resource Center for HADrontherapy in Europe (ARCHADE), 14000 Caen, France
| | - Jochen M Schwenk
- Affinity Proteomics, SciLifeLab, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH-Royal Institute of Technology, 10044 Stockholm, Sweden
| | - Brice Fresneau
- Department of Children and Adolescents Oncology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Stephanie Bolle
- Department of Radiation Therapy, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Manuel Fuentes
- Deparment of Medicine and General Service of Cytometry, Proteomics Unit, Cancer Research Centre-IBMCC, CSIC-USAL, IBSAL, Campus Miguel de Unamuno s/n, University of Salamanca-CSIC, 37007 Salamanca, Spain
| | - Siamak Haghdoost
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden
- UMR6252 CIMAP, CEA-CNRS-ENSICAEN-University of Caen Normandy, 14000 Caen, France
- Advanced Resource Center for HADrontherapy in Europe (ARCHADE), 14000 Caen, France
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12
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Shelly E, Waldron MG, Field E, Moore N, Young R, Scally A, England A, Maher M, McEntee MF. Cumulative Radiation Dose from Medical Imaging in Children with Congenital Heart Disease: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040645. [PMID: 37189893 DOI: 10.3390/children10040645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
Children with congenital heart disease are exposed to repeated medical imaging throughout their lifetime. Although the imaging contributes to their care and treatment, exposure to ionising radiation is known to increase one's lifetime attributable risk of malignancy. A systematic search of multiple databases was performed. Inclusion and exclusion criteria were applied to all relevant papers and seven were deemed acceptable for quality assessment and risk of bias assessment. The cumulative effective dose (CED) varied widely across the patient cohorts, ranging from 0.96 mSv to 53.5 mSv. However, it was evident across many of the included studies that a significant number of patients were exposed to a CED >20 mSv, the current annual occupational exposure limit. Many factors affected the dose which patients received, including age and clinical demographics. The imaging modality which contributed the most radiation dose to patients was cardiology interventional procedures. Paediatric patients with congenital heart disease are at an increased risk of receiving an elevated cumulative radiation dose across their lifetime. Further research should focus on identifying risk factors for receiving higher radiation doses, keeping track of doses, and dose optimisation where possible.
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Affiliation(s)
- Emer Shelly
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Michael G Waldron
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
| | - Erica Field
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Andy Scally
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
| | - Michael Maher
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
- Department of Medicine, University College Cork, T12 AK54 Cork, Ireland
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, T12AK54 Cork, Ireland
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13
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Dobutamine Stress Cardiac MRI in Pediatric Patients with Suspected Coronary Artery Disease. Pediatr Cardiol 2023; 44:451-462. [PMID: 36129514 DOI: 10.1007/s00246-022-03007-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Abstract
Following current practice, pediatric patients with treated congenital coronary malformations or acquired coronary disease undergo Cardio-Pulmonary Exercise Test (CPET), stress Echocardiography and Electrocardiography (sEcho, sEKG), and Coronary Angiography (CA). Stress cMRI can assess cardiac function, myocardial viability, and stress/rest perfusion deficit-without radiation exposure, general anesthesia, and hospitalization-in a single non-invasive exam. The aim of our pilot study is to assess the feasibility and diagnostic accuracy of Dobutamine stress cMRI compared to the current procedures (sEcho, CPET, CA). The prospective study is focused on pediatric patients, at risk for or with previously diagnosed coronary artery disease: d-looped TGA after arterial Switch, Kawasaki disease, and anomalous origin of left coronary artery from pulmonary artery (ALCAPA) after coronary artery reimplantation. We have compared the results of MRI coronary angiography, and Dobutamine stress cMRI with traditional tests. All these diagnostic exams were acquired in a timeframe of 3 month, in a blinded fashion. All the 13 patients (age: 12 ± 2 years, median 12,7 y) recruited, completed the study without major adverse events. The mean heart rate-pressure product was 25,120 ± 5110 bpm x mm Hg. The target heart rate of 85% of the maximal theoretical was reached by 10 (77%) patients. The comparison between cardiac MRI coronarography versus the gold standard Coronary Angiography to identify the patency of the origin and the proximal pathway of the coronary arteries shows a sensitivity of 100% (confidence interval: 2,5-100%), specificity 92% (confidence interval: 64-100%). The stress test was well tolerated for the 77% of the patients and completed by the totality of patients (Table 3). Three patients (23%) had mild symptoms: nausea, vomiting, or general discomfort. In pediatric patients with a potential or definite diagnosis of coronary artery disease, stress cMRI combines an effective assessment of proximal coronary arteries anatomy with cardiac function, myocardial perfusion, and viability in a single examination. Stress cMRI can be proposed as alternative, standalone test.
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14
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Kravchenko D, Hart C, Garbe S, Luetkens JA, Isaak A, Mesropyan N, Vergnat M, Leyens J, Attenberger U, Kuetting D. Image quality and radiation dose of dual source high pitch computed tomography in pediatric congenital heart disease. Sci Rep 2022; 12:9934. [PMID: 35705551 PMCID: PMC9200716 DOI: 10.1038/s41598-022-13404-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
To explore the image quality and radiation dose of dual source high-pitch cardiac computed tomography with tailored contrast injection protocols for pediatric congenital heart disease patients (CHD). In total, 27 infants with CHD (median age 109 days [IQR 6-199]) were retrospectively analyzed regarding dose length product (DLP) and effective dose (ED) after undergoing cardiothoracic CT imaging. Scan parameters were adjusted on a dual source/detector CT (DSCT) to minimize radiation dose while maintaining adequate quality. Image acquisition was performed at 70% of the R-R interval. Dose reducing measures included prospective electrocardiogram gating, utilizing slow injection velocities and foregoing bolus tracking during contrast injection. Image quality was assessed for artefacts, vessel definition, and noise on a 5-point scale (1 non-diagnostic, 5 excellent). Series were scored on a 0-to-3-point scale regarding answered clinical questions (0 non-diagnostic, 3 all clinical questions could be answered). The median DLP was 5.2 mGy*cm (IQR 3.5-7.8) leading to a median ED of 0.20 mSv (IQR 0.14-0.30). On average the acquired images scored 13.3 ± 2.1 (SD) out of a maximum 15 points with an intraclass correlation coefficient (ICC) of 0.94. All acquired series were able to fully answer all clinical questions scoring maximum points (ICC 1.0). Dual source high pitch CT protocols combined with custom contrast agent injection protocols in pediatric patients with CHD delivered sufficiently high diagnostic imaging quality combined with low submilisievert radiation doses. Prospective high pitch imaging is a reliable method for depiction of cardiac anatomy even in very young pediatric CHD patients with elevated heart rates.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department for Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Mathieu Vergnat
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Judith Leyens
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
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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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Prognostic Relevance of Thyroid Disorders in Adults With Congenital Heart Disease. Am J Cardiol 2022; 166:107-113. [PMID: 34930612 DOI: 10.1016/j.amjcard.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022]
Abstract
Adults with congenital heart disease (ACHD) are frequently affected by thyroid diseases (TDs). However, the clinical relevance of TD in ACHD remains unknown. We aimed to describe the prevalence of TD in the ACHD population and to ascertain whether TD are associated with worse outcome. Patients with ACHD >18 years attending our tertiary center for a day-case between 2014 and 2019 were included. Clinical data between patients' first visit and December 2020 were collected. Primary end point was a combination of death, hospitalization for heart failure (HF), and new-onset of arrhythmic events. Secondary end points were each part of the primary outcome as separate end points. A total of 495 patients with ACHD (32.2 [24.5 to 45.6] years; 54% women) were included. Median follow-up was 9.4 (4.5 to 13.1) years. The prevalence of TD was 30%. TD group showed worse clinical status, as demonstrated by N-terminal pro b-type natriuretic peptide values (243.5 [96.5 to 523] vs 94 [45 to 207] pg/ml, p <0.001) and New York Heart Association class (27% vs 13% in class III to IV, p <0.0001) with higher incident rate of adverse events at follow-up (4.45 [3.43 to 5.69] % vs 1.29[0.94 to 1.75] % per person-year, p <0.001). TD were independently associated with higher risk of death (hazard ratio [HR] 4.1, p = 0.009), arrhythmic events (HR 3.8, p <0.0001), and hospitalization for HF (HR 8.02, p <0.0001). There was a fourfold increased risk of primary end point in the TD group even after propensity score matching for clinical variables including age, gender, disease complexity, physiological stage, previous palliative surgery, ventricular function, pulmonary arterial hypertension, cyanosis, and presence of systemic right ventricle (HR 4.47, p <0.0001). In conclusion, TD are predictive of adverse outcome in the ACHD population. Routine screening of thyroid function during follow-up in this population may be helpful to identify those with higher risk of death, arrhythmias, and HF.
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Cotrim CA, Café H, João I, Cotrim N, Guardado J, Cordeiro P, Cotrim H, Baquero L. Exercise stress echocardiography: Where are we now? World J Cardiol 2022; 14:64-82. [PMID: 35316975 PMCID: PMC8900523 DOI: 10.4330/wjc.v14.i2.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/04/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
Exercise stress echocardiography (ESE) is a widely used diagnostic test in cardiology departments. ESE is mainly used to study patients with coronary artery disease; however, it has increasingly been used in other clinical scenarios including valve pathology, congenital heart disease, hypertrophic and dilated cardiomyopathies, athlete evaluations, diastolic function evaluation, and pulmonary circulation study. In our laboratories, we use an established methodology in which cardiac function is evaluated while exercising on a treadmill. After completing the exercise regimen, patients remain in a standing position or lie down on the left lateral decubitus, depending on the clinical questions to be answered for further evaluation. This method increases the quality and quantity of information obtained. Here, we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail. We also present alternatives to ESE that may be used and their advantages and disadvantages. We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.
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Affiliation(s)
| | - Hugo Café
- Faculdade de Medicina, Algarve University, Faro 8005-139, Portugal
| | - Isabel João
- Department of Cardiology, Garcia de Orta Hospital, Almada 2805-267, Portugal
| | - Nuno Cotrim
- Department of Medicine, Garcia de Orta Hospital, Almada 2805-267, Portugal
| | - Jorge Guardado
- Cardiovascular Unit, UCARDIO, Centro Clinico, Riachos 2350-325, Portugal
| | - Pedro Cordeiro
- Department of Cardiology, Hospital Particular do Algarve, Faro 8005-226, Portugal
| | - Hortense Cotrim
- Faculdade de Medicina, Algarve University, Faro 8005-139, Portugal
| | - Luis Baquero
- Heart Center, Hospital da Cruz Vermelha Portuguesa, Lisboa 1549-008, Portugal
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Evaluating dysphagia in infants with congenital heart disease using Fiberoptic Endoscopic Evaluation of Swallowing. Int J Pediatr Otorhinolaryngol 2022; 152:111004. [PMID: 34902666 DOI: 10.1016/j.ijporl.2021.111004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 12/05/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Dysphagia is common in infants with congenital heart disease (CHD). However, there is minimal published data regarding its management outside of the perioperative period. The objective of this study is to describe the role of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in the diagnosis and management of dysphagia in infants with CHD. METHODS Infants with CHD who underwent FEES exam for evaluation of swallowing dysfunction between February 2015 and February 2021 at a university-based, tertiary care urban pediatric hospital were studied. Demographic data, presenting symptoms, medical history, and dysphagia history were examined. The validated Dysphagia Outcome and Severity Scale (DOSS) was used to standardize and compare dysphagia severity. RESULTS 62 FEES exams were performed on 48 patients. All 48 patients were diagnosed with dysphagia and had a mean dysphagia severity score (DOSS) of 2.68. Patients with wet laryngeal congestion on presentation had worse mean DOSS score and were more likely to demonstrate aspiration on FEES exam (p < 0.01). There was no significant difference in mean DOSS or presence of aspiration when comparing infants who had cardiothoracic surgery, vocal cord paralysis, or lower respiratory tract illness with those who had not (p > 0.05). CONCLUSION A FEES exam is an effective and well-tolerated procedure for evaluating swallowing dysfunction in pediatric patients with CHD and its use reduces radiation exposure for this vulnerable population. Wet laryngeal congestion was found to be predictive of more severe dysphagia and aspiration. There is no significant association between severity of dysphagia or aspiration on FEES exam and history of cardiac surgery, vocal cord paralysis, or lower respiratory tract illness.
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19
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:e279-e289. [DOI: 10.1093/ehjci/jeac048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 11/14/2022] Open
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Thangathurai J, Kalashnikova M, Takahashi M, Shinbane JS. Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential Diagnosis. Radiol Cardiothorac Imaging 2021; 3:e200550. [PMID: 34778780 DOI: 10.1148/ryct.2021200550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/21/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
Kawasaki disease (KD) is an inflammatory autoimmune vasculitis affecting the coronary arteries of very young patients, which can result in coronary artery aneurysms (CAAs) with lifelong manifestations. Accurate identification and assessment of CAAs in the acute phase and sequentially during the chronic phase of KD is fundamental to the treatment plan for these patients. The differential diagnosis of CAA includes atherosclerosis, other vasculitic processes, connective tissue disorders, fistulas, mycotic aneurysms, and procedural sequelae. Understanding of the initial pathophysiology and evolutionary arterial changes is important to interpretation of imaging findings. There are multiple applicable imaging modalities, each with its own strengths, limitations, and role at various stages of the disease process. Coronary CT angiography is useful for evaluation of CAAs as it provides assessment of the entire coronary tree, CAA size, structure, wall, and lumen characteristics and visualization of other cardiothoracic vasculature. Knowledge of the natural history of KD, the spectrum of other conditions that can cause CAA, and the strengths and limitations of cardiovascular imaging are all important factors in imaging decisions and interpretation. Keywords: Pediatrics, Coronary Arteries, Angiography, Cardiac © RSNA, 2021.
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Affiliation(s)
- Jenica Thangathurai
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Mariya Kalashnikova
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Masato Takahashi
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Jerold S Shinbane
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
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21
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Tretter JT, Izawa Y, Spicer DE, Okada K, Anderson RH, Quintessenza JA, Mori S. Understanding the Aortic Root Using Computed Tomographic Assessment: A Potential Pathway to Improved Customized Surgical Repair. Circ Cardiovasc Imaging 2021; 14:e013134. [PMID: 34743527 DOI: 10.1161/circimaging.121.013134] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is continued interest in surgical repair of both the congenitally malformed aortic valve, and the valve with acquired dysfunction. Aortic valvar repair based on a geometric approach has demonstrated improved durability and outcomes. Such an approach requires a thorough comprehension of the complex 3-dimensional anatomy of both the normal and congenitally malformed aortic root. In this review, we provide an understanding of this anatomy based on the features that can accurately be revealed by contrast-enhanced computed tomographic imaging. We highlight the complimentary role that such imaging, with multiplanar reformatting and 3-dimensional reconstructions, can play in selection of patients, and subsequent presurgical planning for valvar repair. The technique compliments other established techniques for perioperative imaging, with echocardiography maintaining its central role in assessment, and enhances direct surgical evaluation. This additive morphological and functional information holds the potential for improving selection of patients, surgical planning, subsequent surgical repair, and hopefully the subsequent outcomes.
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Affiliation(s)
- Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH (J.T.T.)
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine (Y.I.), Kobe University Graduate School of Medicine, Japan
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL (D.E.S., J.A.Q.)
| | - Kenji Okada
- Department of Cardiovascular Surgery (K.O.), Kobe University Graduate School of Medicine, Japan
| | - Robert H Anderson
- Cardiovascular Research Centre, Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (R.H.A.)
| | - James A Quintessenza
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL (D.E.S., J.A.Q.)
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA (S.M.)
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22
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Lu G, Ye W, Ou J, Li X, Tan Z, Li T, Liu H. Coronary Computed Tomography Angiography Assessment of High-Risk Plaques in Predicting Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:743538. [PMID: 34660742 PMCID: PMC8517134 DOI: 10.3389/fcvm.2021.743538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/07/2021] [Indexed: 01/07/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) is a comprehensive, non-invasive and cost-effective imaging assessment approach, which can provide the ability to identify the characteristics and morphology of high-risk atherosclerotic plaques associated with acute coronary syndrome (ACS). The development of CCTA and latest advances in emerging technologies, such as computational fluid dynamics (CFD), have made it possible not only to identify the morphological characteristics of high-risk plaques non-invasively, but also to assess the hemodynamic parameters, the environment surrounding coronaries and so on, which may help to predict the risk of ACS. In this review, we present how CCTA was used to characterize the composition and morphology of high-risk plaques prone to ACS and the current role of CCTA, including emerging CCTA technologies, advanced analysis, and characterization techniques in prognosticating the occurrence of ACS.
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Affiliation(s)
- Guanyu Lu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiehao Ou
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinyun Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zekun Tan
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tingyu Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
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23
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Abalo KD, Malekzadeh-Milani S, Hascoët S, Dreuil S, Feuillet T, Cohen S, Dauphin C, Filippo SD, Douchin S, Godart F, Guérin P, Helms P, Karsenty C, Lefort B, Mauran P, Ovaert C, Piéchaud JF, Thambo JB, Leuraud K, Bonnet D, Bernier MO, Rage E. Exposure to low-dose ionising radiation from cardiac catheterisation and risk of cancer: the COCCINELLE study cohort profile. BMJ Open 2021; 11:e048576. [PMID: 34344681 PMCID: PMC8336117 DOI: 10.1136/bmjopen-2020-048576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The COCCINELLE study is a nationwide retrospective French cohort set up to evaluate the risk of cancer in patients who undergone cardiac catheterisation (CC) procedures for diagnosis or treatment of congenital heart disease during childhood. PARTICIPANTS Children who undergone CC procedures from 1 January 2000 to 31 December 2013, before the age of 16 in one of the 15 paediatric cardiology departments which perform paediatric CC in mainland France were included. The follow-up started at the date of the first recorded CC procedure until the exit date, that is, the date of death, the date of first cancer diagnosis, the date of the 18th birthday or the 31 December 2015, whichever occurred first. The cohort was linked to the National Childhood Cancer Registry to identify patients diagnosed with cancer and with the French National Directory for the Identification of Natural Persons to retrieve the patients' vital status. FINDINGS TO DATE A total of 17 104 children were included in the cohort and followed for 110 335 person-years, with 22 227 CC procedures collected. Among the patients, 81.6% received only one procedure. Fifty-nine cancer cases were observed in the cohort. Standardised incidence ratios (SIRs) were increased for all-cancer (SIR=3.8, 95% CI: 2.9 to 4.9), leukaemia (SIR=3.3, 95% CI: 2.0 to 5.4), lymphoma (SIR=14.9, 95% CI: 9.9 to 22.5) and solid cancers excluding central nervous system (CNS) tumours (SIR=3.3, 95% CI: 2.0 to 5.5) compared with the general population. FUTURE PLANS Dose reconstruction is currently underway to estimate individual cumulative doses absorbed to relevant organs, including red bone marrow and brain for respectively haematologic disorders and CNS tumours risk estimation. A dose-response analysis will be conducted with consideration to confounding factors such as age at exposure, gender, predisposing factors to cancer and other sources of medical diagnostic low-dose ionising radiation.
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Affiliation(s)
- Kossi Dovene Abalo
- PSE-SANTE/SESANE/Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, Necker-Sick Children University Hospital, M3C-Necker, Université de Paris, Paris, France
| | - Sébastien Hascoët
- Paediatric and Congenital Cardiac Surgery Department, M3C Marie-Lannelongue Hospital, National Reference Centre, Groupe Hospitalier Saint-Joseph, Paris Saclay University, Plessis-Robinson, France
| | - Serge Dreuil
- PSE-SANTE/SER/UEM, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
| | | | - Sarah Cohen
- Paediatric and Congenital Cardiac Surgery Department, M3C Marie-Lannelongue Hospital, National Reference Centre, Groupe Hospitalier Saint-Joseph, Paris Saclay University, Plessis-Robinson, France
| | - Claire Dauphin
- Cardiology and Vascular Department, Hopital Gabriel Montpied, Clermont-Ferrand, France
| | - Sylvie Di Filippo
- Paediatric and Congential Cardiology Department, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Douchin
- Cardiopédiatrie, Hôpital couple enfant, CHU Grenoble Alpes, Grenoble cedex 9, France, Grenoble, France
| | - François Godart
- Service de Cardiologie Infantile et Congénitale, Institut Cœur Poumon, Lille Cedex, Lille, France
| | - Patrice Guérin
- Clinique Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax, Cardiopédiatrie, CHU Nantes, INSERM, Nantes Université, Nantes, France
| | - Pauline Helms
- Unit of Cardiopediatrics, University Hospital of Strasbourg, Strasbourg, France
| | - Clement Karsenty
- Pediatric and Congenital Cardiology, Children's Hospital and INSERM U1048, I2MC, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Toulouse, France
| | - Bruno Lefort
- Institut des Cardiopathies Congénitales, CHRU Tours, Tours, France
| | - Pierre Mauran
- Unité de cardiologie pédiatrique et congénitale, American Memorial Hospital, CHU de Reims, 47 rue Cognacq-Jay, Reims Cedex, Reims, France
| | - Caroline Ovaert
- Cardiologie pédiatrique et congénitale, Timone enfants, AP-HM et INSERM 1251, Aix-Marseille Université, Marseille, France
| | - Jean-François Piéchaud
- Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques-Cartier, Massy, France
| | - Jean-Benoît Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Klervi Leuraud
- PSE-SANTE/SESANE/Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
| | - Damien Bonnet
- Department of Congenital and Pediatric Cardiology, Necker-Sick Children University Hospital, M3C-Necker, Université de Paris, Paris, France
| | - Marie-Odile Bernier
- PSE-SANTE/SESANE/Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
| | - Estelle Rage
- PSE-SANTE/SESANE/Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
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24
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Van Hare GF. Radiofrequency ablation in the young. Heart Rhythm 2021; 18:1454-1455. [PMID: 34334158 DOI: 10.1016/j.hrthm.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- George F Van Hare
- Pediatric Cardiology Division, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
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25
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Nichols KJ, Gecelter R, Van Tosh A. Balancing risks and rewards in assessing pediatric heart disease. J Nucl Cardiol 2021; 28:1409-1412. [PMID: 31432466 DOI: 10.1007/s12350-019-01860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Kenneth J Nichols
- Department of Radiology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.
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26
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Partington SL, Valente AM, Bruyere J, Rosica D, Shafer KM, Landzberg MJ, Taqueti VR, Blankstein R, Skali H, Kwatra N, DiCarli MF, Grant FD, Dorbala S. Reducing radiation dose from myocardial perfusion imaging in subjects with complex congenital heart disease. J Nucl Cardiol 2021; 28:1395-1408. [PMID: 31407235 PMCID: PMC7104915 DOI: 10.1007/s12350-019-01811-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The prevalence of defects and effective radiation dose from various myocardial perfusion imaging (MPI) strategies in congenital heart disease (CHD) is unknown. METHODS We studied 75 subjects with complex CHD (ages 5 to 80 years) referred for MPI between 2002 and 2015. A rest and exercise or pharmacologic stress MPI was performed using 99mTechnetium sestamibi, 82rubidium or 13N-ammonia, and Sodium iodide SPECT (single-photon emission computed tomography), SPECT/CT or Cadmium zinc telluride (CZT) SPECT or PET (positron emission tomography)/CT scanners. Deidentified images were interpreted semi-quantitatively in three batches: stress only MPI, stress/rest MPI, and stress/rest MPI with taking into account a history of ventricular septal defect repair. Effective radiation dose was estimated for stress/rest MPI and predicted for 1-day stress-first (normal stress scans), and for 2-day stress/rest MPI (abnormal stress scans). RESULTS The median age was 18.6 years. The most common type of CHD was transposition of the great arteries (63%). Rest/stress MPI was abnormal in 43% of subjects and 25% of the abnormal scans demonstrated reversible defects. Of the subjects with abnormal MPI, 33% had significant underlying anatomic coronary artery obstruction. Estimated mean effective radiation dose ranged from 2.1 ± 0.6 mSv for 13N-ammonia PET/CT to 12.5 ± 0.9 mSv for SPECT/CT. Predicted effective radiation dose was significantly lower for stress-first MPI and for 2-day stress/rest protocols. CONCLUSIONS Due to the relatively high prevalence of abnormal stress MPI, tailored protocols with a stress-first MPI as well as the use of 2-day protocols and advanced imaging technologies including CZT SPECT, novel image reconstruction software, and PET MPI could substantially reduce radiation dose in complex CHD.
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Affiliation(s)
- Sara L Partington
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Boston, USA
- Division of Medicine, Department of Cardiology, Brigham and Women's Hospital, Boston, USA
| | - John Bruyere
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Dillenia Rosica
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Keri M Shafer
- Department of Cardiology, Boston Children's Hospital, Boston, USA
- Division of Medicine, Department of Cardiology, Brigham and Women's Hospital, Boston, USA
| | - Michael J Landzberg
- Department of Cardiology, Boston Children's Hospital, Boston, USA
- Division of Medicine, Department of Cardiology, Brigham and Women's Hospital, Boston, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Hicham Skali
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Neha Kwatra
- Division of Nuclear Medicine, Department of Radiology, Boston Children's Hospital, Boston, USA
| | - Marcelo F DiCarli
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Frederick D Grant
- Division of Nuclear Medicine, Department of Radiology, Boston Children's Hospital, Boston, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Harrison DJ, Shirley L, Michaud J, Rivera J, Quinn B, Bergersen L, Maschietto N. The Burden of Radiation Exposure During Transcatheter Closure of Atrial Septal Defect. Am J Cardiol 2021; 149:126-131. [PMID: 33757782 DOI: 10.1016/j.amjcard.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 12/01/2022]
Abstract
Radiation reduction in the pediatric cardiac catheterization laboratory is well-suited for targeted quality improvement (QI) interventions. Transcatheter atrial septal defect (ASD) closure was chosen for this QI project based on a homogenous procedural population and inter-operator variability in radiation usage, with the aim to reduce radiation exposure during ASD device closure by 50% over 1 year. The aim for this project was defined and a Key Driver Diagram (KDD) was created with three domains for change: modification of procedural practice, reporting and monitoring/feedback, and team engagement. All patients undergoing attempted transcatheter ASD closure were considered for inclusion. The primary outcome, % reduction in median radiation dose (DAP/Kg), was determined through comparison with a historical cohort. Additional radiation metrics, procedural characteristics, and adverse events (AE) were compared to the historical cohort. Radiation exposure (DAP/kg) was reduced by 55% with a median dose reduction from 26 (15, 61) in a historical cohort to 12 (6, 22) in the intervention population (p <0.001). Fluoroscopy time and cine acquisition utilization significantly decreased. Procedure time, procedural success (defined as successful delivery of the device) and AE did not increase in the QI cohort. Successful practice changes included standardized procedural strategies to limit fluoroscopy and cine acquisition, improved fluoroscopic practice, engagement of the multidisciplinary team, and feedback with data reporting by electronic and in-person reminders. In conclusion, application of QI methodologies such as KDD with engagement of a multidisciplinary team can effectively reduce radiation in the pediatric catheterization laboratory.
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Affiliation(s)
- David Joseph Harrison
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lauren Shirley
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Michaud
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jose Rivera
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Quinn
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicola Maschietto
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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28
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Salman R, More SR, Ferreira Botelho MP, Ketwaroo PM, Masand PM, Molossi S, Jadhav SP. Role of gated cardiac computed tomographic angiography in the evaluation of postsurgical complications after stage I Norwood procedure and its implications on management: a comparative study with two-dimensional echocardiography. Pediatr Radiol 2021; 51:1185-1191. [PMID: 33538849 DOI: 10.1007/s00247-021-04966-4] [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: 07/11/2020] [Revised: 11/17/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Norwood procedure is the first part of a three-stage surgical palliation for patients with functionally single ventricle anatomy. Complications after the stage I operation are not uncommon. Transthoracic echocardiography (TTE) is traditionally the mainstay for evaluation. OBJECTIVE The purpose of our study is to compare gated cardiac computed tomographic angiography (CCTA) with TTE when evaluating for postoperative complications after stage I Norwood procedure and to describe management implications. MATERIALS AND METHODS A retrospective chart review of all patients over a 4-year period who underwent nonelective urgent CCTA for suspected complications related to stage I Norwood procedure was performed. Elective CCTA studies before stage II palliation were excluded. Patient demographics, CCTA and TTE findings, as well as interventions performed, were recorded. RESULTS Thirty-four patients were included. The mean age at CCTA was 63 days (range: 4-210 days). All patients had a recent TTE with a mean time interval between TTE and CCTA of 2 days. CCTA detected 56 abnormalities in 30 patients, with 23 directly related to postsurgical complications, including shunt-related complications (10/23, 43%), Damus-Kaye-Stansel anastomotic narrowing (2/23, 9%) and neo-aortic arch/branch vessel abnormalities (11/23, 48%). These complications were managed as follows: surgery (9, 39%), catheter-based intervention (7, 30%), medical (4, 17%) and no change in management (3, 13%). TTE did not detect 8/23 (35%) findings found on CCTA, of which 75% were either managed with surgery (4/8, 50%) or catheter-based intervention (2/8, 25%). CONCLUSION CCTA plays an important role in detecting surgical complications after stage I Norwood procedure and demonstrates additional findings that have direct management implications.
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Affiliation(s)
- Rida Salman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Snehal R More
- Virtual Radiologic Corporation, Eden Prairie, MN, USA
| | - Marcos P Ferreira Botelho
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Pamela M Ketwaroo
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Prakash M Masand
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Silvana Molossi
- The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Siddharth P Jadhav
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
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29
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Ploussi A, Brountzos E, Rammos S, Apostolopoulou S, Efstathopoulos EP. Radiation Exposure in Pediatric Interventional Procedures. Cardiovasc Intervent Radiol 2021; 44:857-865. [PMID: 34009422 DOI: 10.1007/s00270-020-02752-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023]
Abstract
The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. The expanding applications of interventional procedures coupled with the potential harmful effects of ionizing radiation highlight the need to assess the delivered radiation dose and establish an effective radiation protection program, particularly in the radiosensitive pediatric population. Given the complexity and heterogeneity of interventional procedures as well as the unique characteristics of children, the management of radiation dose is proving to be quite challenging. The aim of the current article is to provide an overview of the radiation exposure in pediatric patients during interventional procedures focusing on the importance of radiation protection in the pediatric population, the reported radiation doses and the techniques of minimizing radiation dose.
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Affiliation(s)
- Agapi Ploussi
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Andrea Siggrou 356 Av., 17674, Kallithea, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Andrea Siggrou 356 Av., 17674, Kallithea, Greece
| | - Efstathios P Efstathopoulos
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece.
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Frush DP, Sorantin E. Radiation use in diagnostic imaging in children: approaching the value of the pediatric radiology community. Pediatr Radiol 2021; 51:532-543. [PMID: 33743037 DOI: 10.1007/s00247-020-04924-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 01/15/2023]
Abstract
Medical imaging is foundational in the care of children, and much of the medical imaging province depends on ionizing radiation: radiography, fluoroscopy, CT and nuclear imaging. Many considerations for this imaging in children are distinct in the domains of appropriate radiation use, other factors that determine examination quality, the opportunities to engage and educate through networking, and the translation of research efforts. Given these needs, it is worth approaching the contributions and their impact by the pediatric radiology community, especially to the enhancement of this value in the care of children.
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Affiliation(s)
- Donald P Frush
- Pediatric Radiology, Duke University Medical Center, Room #2568, 40 Duke Medicine Circle, Red Zone, Duke South Box 3808, Durham, NC, 27710, USA.
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Graz, Austria
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Response letter to the editor- ref ‘Radiographer knowledge and practice of paediatric radiation dose protocols in digital radiography in Gauteng’. Radiography (Lond) 2020; 26:e315-e316. [DOI: 10.1016/j.radi.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022]
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Sachdeva R, Valente AM, Armstrong AK, Cook SC, Han BK, Lopez L, Lui GK, Pickard SS, Powell AJ, Bhave NM, Sachdeva R, Valente AM, Pickard SS, Baffa JM, Banka P, Cohen SB, Glickstein JS, Kanter JP, Kanter RJ, Kim YY, Kipps AK, Latson LA, Lin JP, Parra DA, Rodriguez FH, Saarel EV, Srivastava S, Stephenson EA, Stout KK, Zaidi AN, Gluckman TJ, Aggarwal NR, Bhave NM, Dehmer GJ, Gilbert ON, Kumbhani DJ, Price AL, Winchester DE, Gulati M, Dehmer GJ, Doherty JU, Bhave NM, Daugherty SL, Dean LS, Desai MY, Gillam LD, Mehrotra P, Sachdeva R, Winchester DE. ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease: A Report of the American College of Cardiology Solution Set Oversight Committee and Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr 2020; 33:e1-e48. [PMID: 33010859 DOI: 10.1016/j.echo.2020.04.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The American College of Cardiology (ACC) collaborated with the American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Pediatric Echocardiography to develop Appropriate Use Criteria (AUC) for multimodality imaging during the follow-up care of patients with congenital heart disease (CHD). This is the first AUC to address cardiac imaging in adult and pediatric patients with established CHD. A number of common patient scenarios (also termed "indications") and associated assumptions and definitions were developed using guidelines, clinical trial data, and expert opinion in the field of CHD.1 The indications relate primarily to evaluation before and after cardiac surgery or catheter-based intervention, and they address routine surveillance as well as evaluation of new-onset signs or symptoms. The writing group developed 324 clinical indications, which they separated into 19 tables according to the type of cardiac lesion. Noninvasive cardiac imaging modalities that could potentially be used for these indications were incorporated into the tables, resulting in a total of 1,035 unique scenarios. These scenarios were presented to a separate, independent panel for rating, with each being scored on a scale of 1 to 9, with 1 to 3 categorized as "Rarely Appropriate," 4 to 6 as "May Be Appropriate," and 7 to 9 as "Appropriate." Forty-four percent of the scenarios were rated as Appropriate, 39% as May Be Appropriate, and 17% as Rarely Appropriate. This AUC document will provide guidance to clinicians in the care of patients with established CHD by identifying the reasonable imaging modality options available for evaluation and surveillance of such patients. It will also serve as an educational and quality improvement tool to identify patterns of care and reduce the number of Rarely Appropriate tests in clinical practice.
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Anderson S, Figueroa J, McCracken CE, Cochran C, Slesnick TC, Border WL, Sachdeva R. Factors Influencing Temporal Trends in Pediatric Inpatient Imaging Utilization. J Am Soc Echocardiogr 2020; 33:1517-1525. [PMID: 32919851 DOI: 10.1016/j.echo.2020.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Concern exists over exponential growth in cardiac imaging in adults, but there is paucity of such data for cardiac imaging trends in pediatric patients. The aims of this study were to determine temporal trends in the use of noninvasive cardiac imaging and compare these with trends in the use of noncardiac imaging and to identify factors influencing those trends using the Pediatric Health Information Service database. METHODS Pediatric inpatient encounter data from January 2004 to December 2017 at 35 pediatric hospitals were extracted from the Pediatric Health Information Service database. Temporal imaging utilization trends in cardiac and noncardiac ultrasound or echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) were assessed using linear mixed-effects models. Models were adjusted for case-mix index, complex chronic conditions, patient age, length of stay, payer source, and cardiac surgical volume. RESULTS A total of 5,869,335 encounters over 14 years were analyzed (median encounters per center per year, 11,411; median patient age, 4 years; median length of stay, 3 days). From 2004 to 2017, the rates of pediatric inpatient cardiac and noncardiac ultrasound and MRI increased, whereas the rate of noncardiac CT decreased. Cardiac CT use increased beginning in 2014 (+0.264 cardiac CT encounters per 1,000 encounters per year), surpassing the rate of rise of cardiac MRI. Case-mix index, cardiac surgical volume, and payer source affected the largest number of imaging trends. CONCLUSIONS Among pediatric inpatients, utilization of cardiac and noncardiac ultrasound and MRI has steadily increased. Noncardiac CT use declined and cardiac CT use increased after 2014. Factors influencing imaging trends include case-mix index, cardiac surgical volume, and payer source. This study lays a foundation for investigations of imaging-related resource utilization and outcomes among pediatric inpatients.
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Affiliation(s)
- Shae Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia.
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Charles Cochran
- Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia
| | - Timothy C Slesnick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia
| | - William L Border
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia
| | - Ritu Sachdeva
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia
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Kong P, Zhao G, Zhang Z, Zhang W, Fan T, Han Y, Pang K, Wang S, Zhang F, Wang W, Hu S, Pan X. Novel Panna Guide Wire Facilitates Percutaneous and Nonfluoroscopic Procedure for Atrial Septal Defect Closure: A Randomized Controlled Trial. Circ Cardiovasc Interv 2020; 13:e009281. [PMID: 32847382 DOI: 10.1161/circinterventions.120.009281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Echo-guided percutaneous procedures have been reported reliable and advantageous. However, the learning curve is difficult for junior doctors. We aimed to evaluate the safety and efficacy of a novel guidewire (Panna wire) in percutaneous atrial septal defect closure under transthoracic echocardiography guidance only. METHODS The Panna wire is designed for echo-guide procedure with a retractable spindle-shaped tip. A multicenter, randomized, controlled trial was conducted to evaluate the safety and efficacy of the Panna wire versus the conventional guidewire for junior doctors with <100 cases experience. The primary outcome was operative success rate. The secondary outcomes were incidence of major adverse events, operation time, time needed to enter the left atrium, number of arrhythmia episodes, number of misguidance to tricuspid valve, and incidence of peripheral vascular complications. RESULTS Between July 2018 and September 2019, 100 patients with atrial septal defect were randomized to either the Panna wire group (n=52) or the conventional wire group (n=48) at 3 centers. The baseline clinical characteristics were similarly distributed. The operative success rate (primary outcome) was 100% in the Panna wire group versus 68.75% in the conventional wire group (P<0.001). No major adverse events occurred in either group. Significant differences in favor of the Panna wire group were found in operation time (P=0.004), time needed to enter the left atrium (P<0.001), number of arrhythmia episodes (P<0.001), and number of misguidance to tricuspid valve (P=0.005). CONCLUSIONS The Panna wire is safe and effective and reduces the learning curve in percutaneous atrial septal defect closure under transthoracic echocardiography guidance only. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04096924.
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Affiliation(s)
- Pengxu Kong
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (P.K., G.Z., S.W., F.Z., S.H., X.P.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishilu, Xicheng District, Beijing, China
| | - Guangzhi Zhao
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (P.K., G.Z., S.W., F.Z., S.H., X.P.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishilu, Xicheng District, Beijing, China
| | - Zonggang Zhang
- Department of Cardiac Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China (Z.Z., W.Z.)
| | - Weimin Zhang
- Department of Cardiac Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China (Z.Z., W.Z.)
| | - Taibing Fan
- Department of Cardiovascular Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, China (T.F., Y.H.)
| | - Yu Han
- Department of Cardiovascular Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, China (T.F., Y.H.)
| | - Kunjing Pang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases (K.P.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishilu, Xicheng District, Beijing, China
| | - Shouzheng Wang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (P.K., G.Z., S.W., F.Z., S.H., X.P.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishilu, Xicheng District, Beijing, China
| | - Fengwen Zhang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (P.K., G.Z., S.W., F.Z., S.H., X.P.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishilu, Xicheng District, Beijing, China
| | - Weiwei Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, China (W.W.)
| | - Shengshou Hu
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (P.K., G.Z., S.W., F.Z., S.H., X.P.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishilu, Xicheng District, Beijing, China
| | - Xiangbin Pan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (P.K., G.Z., S.W., F.Z., S.H., X.P.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishilu, Xicheng District, Beijing, China
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De Monte F, Castaldi B, Branchini M, Bettinelli A, Milanesi O, Paiusco M, Roggio A. Typical values for pediatric interventional cardiology catheterizations: A standardized approach towards Diagnostic Reference Level establishment. Phys Med 2020; 76:134-141. [DOI: 10.1016/j.ejmp.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/21/2020] [Accepted: 07/01/2020] [Indexed: 12/31/2022] Open
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Individual Calculation of Effective Dose and Risk of Malignancy Based on Monte Carlo Simulations after Whole Body Computed Tomography. Sci Rep 2020; 10:9475. [PMID: 32528028 PMCID: PMC7289876 DOI: 10.1038/s41598-020-66366-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/14/2020] [Indexed: 01/30/2023] Open
Abstract
Detailed knowledge about radiation exposure is crucial for radiology professionals. The conventional calculation of effective dose (ED) for computed tomography (CT) is based on dose length product (DLP) and population-based conversion factors (k). This is often imprecise and unable to consider individual patient characteristics. We sought to provide more precise and individual radiation exposure calculation using image based Monte Carlo simulations (MC) in a heterogeneous patient collective and to compare it to phantom based MC provided from the National Cancer Institute (NCI) as academic reference. Dose distributions were simulated for 22 patients after whole-body CT during Positron Emission Tomography-CT. Based on MC we calculated individual Lifetime Attributable Risk (LAR) and Excess Relative Risk (ERR) of cancer mortality. EDMC was compared to EDDLP and EDNCI. EDDLP (13.2 ± 4.5 mSv) was higher compared to EDNCI (9.8 ± 2.1 mSv) and EDMC (11.6 ± 1.5 mSv). Relative individual differences were up to -48% for EDMC and -44% for EDNCI compared to EDDLP. Matching pair analysis illustrates that young age and gender are affecting LAR and ERR significantly. Because of these uncertainties in radiation dose assessment automated individual dose and risk estimation would be desirable for dose monitoring in the future.
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Recommendations for risk stratified use of cardiac computed tomography for congenital heart disease during the COVID-19 pandemic. J Cardiovasc Comput Tomogr 2020; 14:291-293. [PMID: 32565094 PMCID: PMC7282780 DOI: 10.1016/j.jcct.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022]
Abstract
The impact of the coronavirus disease (COVID-19) pandemic in the United States and around the world has required significant changes to medical practice. Amidst the rapidly evolving public health emergency, hospital centers have been required to postpone elective procedures, preserve personal protective equipment (PPE), practice social distancing and limit staff exposures. Patients with congenital heart disease (CHD) often need urgent evaluation, most commonly for preprocedural evaluation. We have stratified the most common indications for cardiac computed tomography (CCT) imaging in patients with CHD to help guide care for these patients during the COVID-19 pandemic including considerations for reopening.
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Quinn BP, Cevallos P, Armstrong A, Balzer D, El-said H, Foerster S, Glatz AC, Goodman A, Goldstein B, Hainstock M, Janssen D, Kreutzer J, Latson L, Leahy R, Petit C, Shahanavaz S, Trucco S, Whiteside W, Zampi JD, Bergersen L. Longitudinal Improvements in Radiation Exposure in Cardiac Catheterization for Congenital Heart Disease. Circ Cardiovasc Interv 2020; 13:e008172. [DOI: 10.1161/circinterventions.119.008172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The C3PO-QI (Congenital Cardiac Catheterization Project on Outcomes – Quality Improvement), a multicenter registry launched in 2015, instituted quality improvement (QI) initiatives to reduce patient radiation exposure. Through regular collaboration, this initiative would allow for harmony among active participants, maximizing efforts and efficiency at achieving radiation best practices. This study sought to report these efforts with a detailed methodology for which institutions can target initiatives, reducing radiation exposure, and increasing patient safety.
Methods:
Data were collected prospectively by 8 C3PO-QI institutions between January 1, 2015 and December 31, 2017. Radiation exposure was measured in dose area product per body weight (dose area product/kg; µGy*m
2
/kg) and reported by expected radiation exposure categories (REC) and institution for 40 published unique procedure types. Targeted interventions addressing selected strategic domains for radiation reduction were implemented in the pediatric catheterization labs of the C3PO-QI institutions.
Results:
The study consisted of 15 257 unique cases. Median exposure (dose area product/kg) was decreased by 30% for all procedures. Dose area product/kg was reduced in all 3 REC, with the greatest improvement observed in REC I (REC I, −37%; REC II, −23%; REC III, −27%). Although the baseline radiation exposures and exact percent decrease varied across all C3PO-QI sites, each institution demonstrated improvements in radiation dose over time. These improvements occurred with the implementation of institution-specific QI interventions accelerated by participation in the C3PO-QI multicenter collaborative.
Conclusions:
Substantial radiation dose reductions can be achieved using targeted QI methodology and interventions. Participation in a multicenter QI collaborative may accelerate improvement across all centers due to enhanced engagement and shared learning between sites.
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Affiliation(s)
- Brian P. Quinn
- Department of Cardiology, Boston Children’s Hospital, MA (B.P.Q., P.C., A.G., L.B.)
| | - Priscila Cevallos
- Department of Cardiology, Boston Children’s Hospital, MA (B.P.Q., P.C., A.G., L.B.)
| | - Aimee Armstrong
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH (A.A.)
| | - David Balzer
- Division of Pediatric Cardiology, St. Louis Children’s Hospital, St. Louis, MO (D.B., S.S.)
| | - Howaida El-said
- Division of Cardiology, Rady Children’s Hospital, San Diego, CA (H.E.-s)
| | - Susan Foerster
- Division of Cardiology, Children’s Hospital of Wisconsin, Milwaukee (S.F.)
| | - Andrew C. Glatz
- Division of Cardiology, Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (A.C.G.)
| | - Andrea Goodman
- Department of Cardiology, Boston Children’s Hospital, MA (B.P.Q., P.C., A.G., L.B.)
| | - Bryan Goldstein
- The Heart Institute, Cincinnati Children’s Hospital and Department of Pediatrics, University of Cincinnati College of Medicine, OH (B.G.)
| | - Michael Hainstock
- Division of Pediatric Cardiology, University of Virginia Children’s Hospital, University of Virginia, Charlottesville (M.H.)
| | - Dana Janssen
- Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center, Nashville, TN (D.J.)
| | - Jacqueline Kreutzer
- Division of Cardiology, Children’s Hospital of Pittsburgh of UPMC, PA (J.K., S.T.). The Heart Institute, Joe DiMaggio Children’s Hospital and Memorial Healthcare System, Hollywood, FL
| | | | - Ryan Leahy
- The Heart Institute, Children’s Hospital of Colorado, Denver (R.L.)
| | - Christopher Petit
- Division of Pediatric Cardiology, Children’s Healthcare of Atlanta Sibley Heart Center, Atlanta, GA (C.P.)
| | - Shabana Shahanavaz
- Division of Pediatric Cardiology, St. Louis Children’s Hospital, St. Louis, MO (D.B., S.S.)
| | - Sara Trucco
- Division of Cardiology, Children’s Hospital of Pittsburgh of UPMC, PA (J.K., S.T.). The Heart Institute, Joe DiMaggio Children’s Hospital and Memorial Healthcare System, Hollywood, FL
| | - Wendy Whiteside
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor (W.W., J.D.Z.)
| | - Jeffrey D. Zampi
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor (W.W., J.D.Z.)
| | - Lisa Bergersen
- Department of Cardiology, Boston Children’s Hospital, MA (B.P.Q., P.C., A.G., L.B.)
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Schindler P, Kehl HG, Wildgruber M, Heindel W, Schülke C. Cardiac CT in the Preoperative Diagnostics of Neonates with Congenital Heart Disease: Radiation Dose Optimization by Omitting Test Bolus or Bolus Tracking. Acad Radiol 2020; 27:e102-e108. [PMID: 31444109 DOI: 10.1016/j.acra.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Congenital heart diseases (CHD) belong to the leading causes of infant mortality worldwide. Prognostic improvements result from multimodal therapy strategies leading to an increased demand for noninvasive imaging. The aim of the study was to further optimize cardiac CT radiation dose by omitting the test bolus or bolus tracking scan, which can have a relevant share of radiation exposure, especially in neonates. MATERIALS AND METHODS This retrospective study included 25 neonates with CHD who received a CT angiography (CTA) from 2009 to 2018. The examinations were performed as a high-pitch CTA (pitch 3.4, 80 kV) with manual contrast administration (1.5 ml/kg body weight) and fixed scan delay depending on the respective heart defect. Diagnosis, adverse events, radiation dose parameters, objective (contrast-to-noise ratio) and subjective (4-point Likert scale) image quality as well as diagnostic accuracy compared to intraoperative findings was assessed. RESULTS All examinations were diagnostically evaluable without adverse events. The median CT dose index volume (CTDIvol) was 0.50 mGy (range, 0.15-0.94), the median dose-length product was 8 mGy × cm (range, 3-17). The estimation of the effective dose by Monte Carlo simulation revealed lower median dose levels 0.66 mSv (range, 0.25-1.40 mSv) than previously published in comparable groups. All examinations achieved a very good mean image quality score of 1.2 ± 0.4 with only minimal image noise and mean contrast-to-noise ratio of 16.1 ± 7.0. Diagnostic accuracy was 100 % as cardiac anatomy revealed no new diagnoses or significant differences in the subsequent cardiac surgery. CONCLUSION Cardiac high-pitch CTA of neonates with CHD can be performed safely and dose-reducing without additional test bolus or bolus tracking scan. With very good image quality, it provides a detailed insight into the cardiac anatomy and thus enables a differentiated, noninvasive therapy planning.
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Affiliation(s)
- Philipp Schindler
- Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149 Muenster, Germany.
| | - Hans-Gerd Kehl
- Department of Pediatric Cardiology, University Hospital Muenster, Muenster, Germany
| | - Moritz Wildgruber
- Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149 Muenster, Germany
| | - Walter Heindel
- Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149 Muenster, Germany
| | - Christoph Schülke
- Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149 Muenster, Germany
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P M, M AJ, L D. Assessment of Patient Dose with Special Look at Pediatrics during Cardiovascular Imaging. J Biomed Phys Eng 2020; 10:51-58. [PMID: 32158711 PMCID: PMC7036411 DOI: 10.31661/jbpe.v0i0.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/10/2018] [Indexed: 11/16/2022]
Abstract
Background During interventional cardiology processes, patients especially women and children receive high radiation doses due to their sensitivity. Objective In this study, we evaluated a pediatric patient dose separately in those undergone intervention cardiac procedure. Material and Methods In this cross sectional study, a public hospital with 252 patients, Entrance Skin Dose (ESD) and Dose-Area Product (DAP) were recorded. Prior to the beginning of fluoroscopic procedure, the chest thickness and Body Mass Index (BMI) of patients were measured. Furthermore, kV, mAs, angle of tube and time of angiography and angioplasty were recorded. Results Children ratio to all patients underwent the cardiovascular imaging was 1.8. The means of patients' ESD, DAP and fluoroscopy time were 178.3±17 mGy, 1123.6±11 μGycm2 and 281.4±181.2 s, respectively for coronary angiography. The females were 96.8 under 30 years and their dose mean was 276±37 mGy, 368±24 μGycm2 for ESD and DAP received, respectively with 376s fluoroscopy time. Mean mAs was 359±34 and kV was 71.23±2.7. Above all, a direct and significant correlation was found between the patients' chest thickness with kV (p=0.037, r = 0.11) and mAs (p<0.001, r = 0.28) variations. Conclusion The results demonstrated that the number of children referred to the cardiology department and also the dose rate received by them during this test was higher than the data provided for children in developing countries. Paying attention to the children's perception of high-fluorescence time is necessary in comparison with total angiography time in order to reduce the number of radiation injuries among pediatrics.
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Affiliation(s)
- Mehnati P
- PhD, Cardiovascular Research Center, Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asghari Jafarabadi M
- PhD, Department of Statistics and Epidemiology, Faculty of Health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Danaee L
- MSc, Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Orrù E, Mekabaty AE, Millan DS, Pearl MS, Gailloud P. Removal of Antiscatter Grids for Spinal Digital Subtraction Angiography: Dose Reduction without Loss of Diagnostic Value. Radiology 2020; 295:390-396. [PMID: 32125257 DOI: 10.1148/radiol.2020191786] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Spinal digital subtraction angiography (DSA) exposes patients and operators to substantial amounts of radiation. Antiscatter grid (ASG) removal is used to decrease radiation exposure but may reduce image quality. Purpose To determine whether ASG removal during spinal DSA in adults reduces radiation dose while maintaining diagnostic image quality and whether dose reduction is related to body mass index (BMI). Materials and Methods This Health Insurance Portability and Accountability Act-compliant prospective study included adults undergoing spinal DSA between January and December 2016. Each procedure included an additional angiographic acquisition performed twice, once with and once without ASG, either documenting the artery of Adamkiewicz (no pathology group) or the condition leading to the procedure (pathology group). Dose differences between study acquisitions and the influence of BMI were evaluated via paired t test. Two neurointerventionalists blinded to acquisition protocols were asked to independently evaluate a sample of 40 study acquisitions (20 with ASG, 20 without ASG) from 20 randomly selected participants to (a) rate image quality, (b) categorize findings, and (c) determine whether images had been obtained with or without ASG. Percentage agreement on image quality, findings categorization, and ability to correctly identify the acquisition protocol was calculated for both readers. Results Fifty-three participants (mean age ± standard deviation, 51 years ± 15.2; 32 men) were evaluated. ASG removal reduced the mean dose per acquisition by approximately 33% (mean dose-area product and air kerma decreased from 202 to 135.6 µGy/m2 and from 35.3 to 24 mGy, respectively; P < .001) independently of BMI (P = .3). Both readers evaluated all images (40 of 40) as being of diagnostic quality and correctly categorized findings in 19 of 20 (95%) cases. Overall percentage agreement for correct protocol identification was 60% (12 of 20) for grid-in and 45% (nine of 20) for grid-out images. Conclusion Antiscatter grid removal during spinal digital subtraction angiography decreased participants' radiation exposure while preserving diagnostic image quality. © RSNA, 2020.
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Affiliation(s)
- Emanuele Orrù
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
| | - Amgad El Mekabaty
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
| | - Diego San Millan
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
| | - Monica S Pearl
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
| | - Philippe Gailloud
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
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Sachdeva R, Valente AM, Armstrong AK, Cook SC, Han BK, Lopez L, Lui GK, Pickard SS, Powell AJ, Bhave NM, Sachdeva R, Valente AM, Pickard SS, Baffa JM, Banka P, Cohen SB, Glickstein JS, Kanter JP, Kanter RJ, Kim YY, Kipps AK, Latson LA, Lin JP, Parra DA, Rodriguez FH, Saarel EV, Srivastava S, Stephenson EA, Stout KK, Zaidi AN. ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease: A Report of the American College of Cardiology Solution Set Oversight Committee and Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Coll Cardiol 2020; 75:657-703. [PMID: 31918898 DOI: 10.1016/j.jacc.2019.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Goldstein BH, Bergersen L, Armstrong AK, Boe BA, El-Said H, Porras D, Shahanavaz S, Leahy RA, Kreutzer J, Zampi JD, Hainstock MR, Gudausky TM, Nicholson GT, Gauvreau K, Goodman A, Petit CJ. Adverse Events, Radiation Exposure, and Reinterventions Following Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2020; 75:363-376. [DOI: 10.1016/j.jacc.2019.11.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/26/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
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Stern H, Seidenbusch M, Hapfelmeier A, Meierhofer C, Naumann S, Schmid I, Spix C, Ewert P. Increased Cancer Incidence Following up to 15 Years after Cardiac Catheterization in Infants under One Year between 1980 and 1998-A Single Center Observational Study. J Clin Med 2020; 9:E315. [PMID: 31979109 PMCID: PMC7074298 DOI: 10.3390/jcm9020315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the incidence of cancer within the first 15 years of life in children who underwent cardiac catheterization under the age of one year. METHODS In this retrospective, single center study, 2770 infants (7.8% with trisomy 21) were studied. All infants underwent cardiac catheterization under one year of age between January 1980 and December 1998. Newly diagnosed cancer in the first 15 years of life was assessed through record linkage to the German Childhood Cancer Registry (GCCR). Cancer risk in study patients was compared to the GCCR population of children less than 15 years. Patients with trisomy 21 were compared to the Danish Cytogenic Register for trisomy 21. Effective radiation doses were calculated for each tumor patient and 60 randomly selected patients who did not develop cancer. RESULTS In total, 24,472.5 person-years were analyzed. Sixteen children developed cancer, while 3.64 were expected (standardized incidence ratio (SIR) = 4.4, 95% confidence interval (CI): 2.5-7.2, p < 0.001). There was no preferred cancer type. The observed incidence of leukemia and solid tumors in trisomy 21 was only slightly higher (1 in 476 py) than expected (1 in 609 py, p = 0.64). There was no direct relationship between the radiation dose and the incidence of cancer. CONCLUSION Cardiac catherization in the first year of life was associated with a significantly increased cancer risk in a population with congenital heart disease.
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Affiliation(s)
- Heiko Stern
- German Heart Center Munich, Clinic for Pediatric Cardiology and Congenital Heart Disease, Lazarettstrasse 36, D-80636 Muenchen, Germany; (C.M.); (S.N.); (P.E.)
| | - Michael Seidenbusch
- German Research Center for Environmental Health, Institute of Radiation Protection, Ingolstaedter Landstrasse 1, D-85764 Neuherberg, Munich, Germany;
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University Munich, Grillparzerstr. 18, Alexander Hapfelmeier, D-81675 Muenchen, Germany;
| | - Christian Meierhofer
- German Heart Center Munich, Clinic for Pediatric Cardiology and Congenital Heart Disease, Lazarettstrasse 36, D-80636 Muenchen, Germany; (C.M.); (S.N.); (P.E.)
| | - Susanne Naumann
- German Heart Center Munich, Clinic for Pediatric Cardiology and Congenital Heart Disease, Lazarettstrasse 36, D-80636 Muenchen, Germany; (C.M.); (S.N.); (P.E.)
| | - Irene Schmid
- Department of Pediatric Oncology and Hematology, Dr. von Hauner Childrens Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstrasse 4, 80337 Muenchen, Germany;
| | - Claudia Spix
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg-University, Obere Zahlbacher Strasse 69, 55131 Mainz, Germany;
| | - Peter Ewert
- German Heart Center Munich, Clinic for Pediatric Cardiology and Congenital Heart Disease, Lazarettstrasse 36, D-80636 Muenchen, Germany; (C.M.); (S.N.); (P.E.)
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Estimating radiation exposure during paediatric cardiac catheterisation: a potential for radiation reduction with air gap technique. Cardiol Young 2019; 29:1474-1480. [PMID: 31679554 PMCID: PMC6937389 DOI: 10.1017/s1047951119002506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The air gap technique (AGT) is an approach to radiation dose optimisation during fluoroscopy where an "air gap" is used in place of an anti-scatter grid to reduce scatter irradiation. The AGT is effective in adults but remains largely untested in children. Effects are expected to vary depending on patient size and the amount of scatter irradiation produced. METHODS Fluoroscopy and cineangiography were performed using a Phillips Allura Fluoroscope on tissue simulation anthropomorphic phantoms representing a neonate, 5-year-old, and teenager. Monte Carlo simulations were then used to estimate effective radiation dose first using a standard recommended imaging approach and then repeated using the AGT. Objective image quality assessments were performed using an image quality phantom. RESULTS Effective radiation doses for the neonate and 5-year-old phantom increased consistently (2-92%) when the AGT was used compared to the standard recommended imaging approaches in which the anti-scatter grid is removed at baseline. In the teenage phantom, the AGT reduced effective doses by 5-59%, with greater dose reductions for imaging across the greater thoracic dimension of lateral projection. The AGT increased geometric magnification but with no detectable change in image blur or contrast differentiation. CONCLUSIONS The AGT is an effective approach for dose reduction in larger patients, particularly for lateral imaging. Compared to the current dose optimisation guidelines, the technique may be harmful in smaller children where scatter irradiation is minimal.
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Multicenter Assessment of Radiation Exposure during Pediatric Cardiac Catheterizations Using a Novel Imaging System. J Interv Cardiol 2019; 2019:7639754. [PMID: 32089654 PMCID: PMC7012227 DOI: 10.1155/2019/7639754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/29/2019] [Accepted: 09/17/2019] [Indexed: 02/01/2023] Open
Abstract
Objectives To quantify radiation exposure during pediatric cardiac catheterizations performed by multiple operators on a new imaging platform, the Artis Q.zen (Siemens Healthcare, Forchheim, Germany), and to compare these data to contemporary benchmark values. Background The Artis Q.zen has been shown to achieve significant radiation reduction during select types of pediatric cardiac catheterizations in small single-center studies. No large multicenter study exists quantifying patient dose exposure for a broad spectrum of procedures. Methods Retrospective collection of Air Kerma (AK) and dose area product (DAP) for all pediatric cardiac catheterizations performed on this new imaging platform at four institutions over a two-year time period. Results A total of 1,127 pediatric cardiac catheterizations were analyzed. Compared to dose data from earlier generation Artis Zee imaging systems, this study demonstrates 70–80% dose reduction (AK and DAP) for similar patient and procedure types. Compared to contemporary benchmark data for common interventional procedures, this study demonstrates an average percent reduction in AK and DAP from the lowest dose saving per intervention of 39% for AK and 27% for DAP for transcatheter pulmonary valve implantation up to 77% reduction in AK and 70% reduction in DAP for atrial septal defect closure. Conclusion Use of next-generation imaging platforms for pediatric cardiac catheterizations can substantially decrease patient radiation exposure. This multicenter study defines new low-dose radiation measures achievable on a novel imaging system.
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Pros, cons and future perspectives - three questions on three dimensional guidance for cardiac catheterization in congenital heart disease. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:263-273. [PMID: 31592250 PMCID: PMC6777176 DOI: 10.5114/aic.2019.87688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/11/2019] [Indexed: 02/01/2023] Open
Abstract
Step changes in angiographic imaging are not commonplace. Since the move from analogue to digital and flat detector plates, two-dimensional imaging technology has certainly evolved but not jumped forward. Of all the routine imaging techniques used in cardiology, angiography has been the last modality to embrace the third dimension. Although the development of rotational angiography was initially for the benefit of neuroimaging and fusion of cross sectional datasets was aimed at the treatment of descending aortic pathology, interventional physicians in congenital and structural cardiology have immersed themselves in this technology over the last 10 years. Like many disruptive technologies, its introduction has divided opinion. We aimed to explore the mindset of those in the field of interventional cardiology who are driving imaging forward. These structured interviews recorded during the 21st Pediatric and Adult Interventional Cardiac Symposium illustrate the challenges and sticking points as well as giving an insight into the direction of travel for three-dimensional imaging and fusion techniques. Covering a wide range of career development, seniority and experience, the interviewees in this article are probably responsible for the majority of the published literature on invasive three-dimensional imaging in congenital heart disease.
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Cohen S, Gurvitz MZ, Beauséjour-Ladouceur V, Lawler PR, Therrien J, Marelli AJ. Cancer Risk in Congenital Heart Disease-What Is the Evidence? Can J Cardiol 2019; 35:1750-1761. [PMID: 31813507 DOI: 10.1016/j.cjca.2019.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 12/18/2022] Open
Abstract
As life expectancy in patients with congenital heart disease (CHD) has improved, the risk for developing noncardiac morbidities is increasing in adult patients with CHD (ACHD). Among these noncardiac complications, malignancies significantly contribute to the disease burden of ACHD patients. Epidemiologic studies of cancer risk in CHD patients are challenging because they require large numbers of patients, extended follow-up, detailed and validated clinical data, and appropriate reference populations. However, several observational studies suggest that cancer risks are significantly elevated in patients with CHD compared with the general population. CHD and cancer share genetic and environmental risk factors. An association with exposure to low-dose ionizing radiation secondary to medical therapeutic or diagnostic procedures has been reported. Patients with Down syndrome, as well as, to a lesser extent, deletion of 22q11.2 and renin-angiotensin system pathologies, may manifest both CHD and a predisposition to cancer. Such observations suggest that carcinogenesis and CHD may share a common basis in some cases. Finally, specific conditions, such as Fontan circulation and cyanotic CHD, may lead to multisystem consequences and subsequently to cancer. Nonetheless, there is currently no clear consensus regarding appropriate screening for cancer and surveillance modalities in CHD patients. Physicians caring for patients with CHD should be aware of this potential predisposition and meet screening recommendations for the general population fastidiously. An interdisciplinary and global approach is required to bridge the knowledge gap in this field.
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Affiliation(s)
- Sarah Cohen
- Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Hospital Marie Lannelongue, Paris-Sud University, Paris-Saclay University, Le Plessis-Robinson, France
| | - Michelle Z Gurvitz
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Patrick R Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada; Heart and Stroke/Richard Lewar Centre for Excellence, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Judith Therrien
- McGill Adult Unit for Congenital Heart Disease Excellence, Montréal, Québec, Canada
| | - Ariane J Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, Montréal, Québec, Canada.
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Clinical impact of cardiac computed tomography derived three-dimensional strain for adult congenital heart disease: a pilot study. Int J Cardiovasc Imaging 2019; 36:131-140. [PMID: 31471763 DOI: 10.1007/s10554-019-01691-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
Abstract
To assess ventricular function and dyssynchrony using three-dimensional (3D) computed tomography (CT) strain in adult congenital heart disease (ACHD). We prospectively analyzed a multiphase cardiac CT data set for 22 adult patients with CHD, including 8 patients with congenital systemic right ventricle (RV) and 14 patients with repaired Tetralogy of Fallot (TOF). Eight patients had a cardiac pacemaker. Volume of Interest was drawn on a multiplanar reconstruction of the ventricle with strain overlay using a 3D-strain algorithm. Ventricular strain, inter- and intraventricular dyssynchrony, and right ventricle outflow tract (RVOT)-apex dyssynchrony were calculated. RVOT-apex dyssynchrony by ventriculography was also compared in 15 patients. Pulmonary ventricular strain, systemic ventricular strain, and septal wall strain were lower in ACHD patients than in the controls, and lower in the ACHD with pacing group than without pacing group as well. Maximum interventricular time difference and intraventricular time difference were longer than in ACHD than in the controls, and longer in the ACHD with pacing group than without pacing group as well. RVOT-apex delay was significantly longer in patients with a pacemaker than in those without a pacemaker (118.1 ± 31.9 ms vs. 76.1 ± 36.2 ms, p = 0.03). RVOT delay determined by 3D CT strain significantly correlated with that determined by ventriculography (Pearson r = 0.55, p = 0.03). 3D CT strain can detect reduced biventricular contraction and inter- and intraventricular and RVOT-apex mechanical dyssynchrony can be assessed in patients with ACHD.
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