Three-Dimensional Rotational Angiography in Congenital Heart Disease: Estimation of Radiation Exposure


Objectives: There is an increasing use of three-dimensional rotational angiography (3D-RA) during catheterization of congenital heart disease. Dose-area-product (DAP) measured by the angiography system and computed-tomography dose index (CTDI) do not appear practical for dose assessment. Hence, we performed real dose measurements in anthropomorphic phantoms. Methods: Three different anthropomorphic phantoms (10 kg, 19 kg and 73 kg bodyweight) equipped with thermoluminescent dosimeters (TLD) were used. We used a typical standard diagnostic program and a low-dose program. The effective dose (ED) was calculated according to the International Commission on Radiological Protection (ICRP) 103. The 3D distribution of radiation in the body was assessed. Results: ED for the male 10 kg phantom was 0.192 mSv in the diagnostic program and 0.050 mSv (male) in the low-dose program. The 19 kg phantom received an ED of 0.205 mSv (male) in the diagnostic program. In the low-dose program the ED reached 0.058 mSv (male). The male adult 73 kg phantom was exposed with an ED of 0.730 mSv in the diagnostic program and 0.282 mSv in the low-dose program. ED for the female phantoms was slightly higher for both acquisition-programs. Dose distribution was inhomogeneous with a dose maximum in the esophageal region behind the heart, whereas in the brain, intestine and gonads we found nearly no radiation. Conclusions: 3D-RA imaging in the interventional catheter laboratory is possible with an effective dose lower than 1 mSv. With its potential to reduce fluoroscopic time and the number of control angiographies in catheterization and intervention in complex anatomy, it can decrease the radiation dose.

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Reinke, G. , Halbfaß, J. , Dittrich, S. , Banckwitz, R. , Köhler, C. , Achenbach, S. , Rompel, O. and Glöckler, M. (2013) Three-Dimensional Rotational Angiography in Congenital Heart Disease: Estimation of Radiation Exposure. Open Journal of Radiology, 3, 124-129. doi: 10.4236/ojrad.2013.33020.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. C. Glatz, X. Zhu, M. J. Gillespie, B. D. Hanna and J. J. Rome, “Use of Angiographic CT Imaging in the Cardiac Catheterization Laboratory for Congenital Heart Di sease,” JACC: Cardiovascular Imaging, Vol. 3, No. 11, 2010, pp. 1149-1157. doi:10.1016/j.jcmg.2010.09.011
[2] M. Glockler, A. Koch, V. Greim, A. Shabaiek, A. Ruffer, R. Cesnjevar, et al., “The Value of Flat-Detector Com puted Tomography during Catheterisation of Congenital Heart Disease,” European Radiology, Vol. 21, No. 12, 2011, pp. 2511-2520. doi:10.1007/s00330-011-2214-3
[3] M. Glockler, J. Halbfass, A. Koch, S. Achenbach and S. Dittrich, “Multimodality 3D-Roadmap for Cardiovascular Interventions in Congenital Heart Disease—A Single -Center, Retrospective Analysis of 78 Cases,” Catheteri zation and Cardiovascular Interventions, 2012, in Press.
[4] M. Glockler, A. Koch, J. Halbfass, V. Greim, A. Ruffer, R. Cesnjevar, et al., “Assessment of Cavopulmonary Con nections by Advanced Imaging: Value of Flat-Detector Computed Tomography,” Cardiology in the Young, Vol. 23, No. 1, 2013, pp. 18-26.
[5] Y. Kyriakou, P. Deak, O. Langner and W. A. Kalender, “Concepts for Dose Determination in Flat-Detector CT,” Physics in Medicine and Biology, Vol. 53, No. 13, 2008, pp. 3551-3566.
[6] W. A. Kalender and Y. Kyriakou, “Flat-Detector Com puted Tomography (FD-CT),” European Radiology, Vol. 17, No. 11, 2007, pp. 2767-2779. doi:10.1007/s00330-007-0651-9
[7] T. Rivera, “Thermoluminescence in Medical Dosimetry,” Applied Radiation and Isotopes, Vol. 71, 2012, pp. 30-34,
[8] Annals of the ICRP, “Doses to Infants from Ingestion of Radionuclides in Mothers’ Milk,” Annals of the ICRP, Vol. 34, No. 3-4, 2004, pp. 15-267, 269-280. doi:10.1016/j.icrp.2005.02.001
[9] S. Mori, M. Endo, K. Nishizawa, T. Tsunoo, T. Aoyama, H. Fujiwara, et al., “Enlarged Longitudinal Dose Profiles in Cone-Beam CT and the Need for Modified Dosi metry,” Medical Physics, Vol. 32, No. 4, 2005, pp. 1061-1069. doi:10.1118/1.1877852
[10] J. Y. Wielandts, K. Smans, J. Ector, S. De Buck, H. Heidbuchel and H. Bosmans, “Effective Dose Analysis of Three-Dimensional Rotational Angiography During Ca theter Ablation Procedures,” Physics in Medicine and Bi ology, Vol. 55, No. 3, 2010, pp. 563-579. doi:10.1088/0031-9155/55/3/001
[11] J. Y. Wielandts, S. De Buck, J. Ector, A. Lagerche, R. Willems, H. Bosmans, et al., “Three-Dimensional Car diac Rotational Angiography: Effective Radiation Dose and Image Quality Implications,” Europace, Vol. 12, No. 2, 2010, pp. 194-201. doi:10.1093/europace/eup394
[12] J. Partridge, G. McGahan, S. Causton, M. Bowers, M. Mason, M. Dalby, et al., “Radiation Dose Reduction without Compromise of Image Quality in Cardiac An giography and Intervention with the Use of a Flat Panel Detector without an Antiscatter Grid,” Heart, Vol. 92, No. 4, 2006, pp. 507-510. doi:10.1136/hrt.2005.063909
[13] H. Justino, “The ALARA Concept in Pediatric Cardiac Catheterization: Techniques and Tactics for Managing Radiation Dose,” Pediatric Radiology, Vol. 36, Suppl. 2, 2006, pp. 146-153.
[14] J. Rassow, A. A. Schmaltz, F. Hentrich and C. Streffer, “Effective Doses to Patients from Paediatric Cardiac Ca theterization,” British Journal of Radiology, Vol. 73, No. 866, 2000, pp. 172-183.
[15] H. von Boetticher, “Geschlechtsspezifische Bestimmung der Effektiven Dosis am Beispiel von CT-Thoraxun tersuchungen,” Zeitschrift für Medizinische Physik, Vol. 13, No. 2, 2003, p. 123.
[16] A. D. Wrixon, “New Recommendations from the Interna tional Commission on Radiological Protection—A Re view,” Physics in Medicine and Biology, Vol. 53, No. 8, 2008, pp. R41-R60. doi:10.1088/0031-9155/53/8/R01
[17] M. A. Kuefner, S. Grudzenski, S. A. Schwab, M. Wied erseiner, M. Heckmann, W. Bautz, et al., “DNA Double Strand Breaks and Their Repair in Blood Lymphocytes of Patients Undergoing Angiographic Procedures,” Investi gative Radiology, Vol. 44, No. 8, 2009, pp. 440-446.
[18] M. A. Kuefner, F. M. Hinkmann, S. Alibek, S. Azoulay, K. Anders, W. A. Kalender, et al., “Reduction of X-Ray Induced DNA Double-Strand Breaks in Blood Lym phocytes During Coronary CT Angiography Using High Pitch Spiral Data Acquisition with Prospective ECG Triggering,” Investigative Radiology, Vol. 45, No. 4, 2010, pp. 182-187. doi:10.1097/RLI.0b013e3181d3eddf
[19] S. Achenbach, K. Anders and W. A. Kalender, “Dual Source Cardiac Computed Tomography: Image Quality and Dose Considerations,” European Radiology, Vol. 18, No. 6, 2008, pp. 1188-1198. doi:10.1007/s00330-008-0883-3
[20] M. A. Kuefner, S. Grudzenski, J. Hamann, S. Achenbach, M. Lell, K. Anders, et al., “Effect of CT Scan Protocols on X-Ray-Induced DNA Double-Strand Breaks in Blood lymphocytes of Patients Undergoing Coronary CT An giography,” European Radiology, Vol. 20, No. 12, 2010, pp. 2917-2924.

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