Traditionally, pediatric patients who require coronary artery imaging have had to undergo an invasive cardiac catheterization procedure, which comes with several risks.
"Our goal is to minimize risk to patients always and the risks of a cardiac catheterization are multiple--there's the risk of invasive procedures, there's the risk of radiation, and the risk of anesthesia. When you look at any certain problem you've got to look at what is the least risk to the patient to get the information you need to make a clinical decision," B. Kelly Han, MD, a pediatric cardiologist at Minneapolis Heart Institute at Abbott Northwestern Hospital told InformationWeek Healthcare.
In order to find out just how effective these new CTA machines can be, Han and her colleagues reviewed 76 coronary CTAs performed on pediatric patients from three days old to 18 years of age that were performed on patients at the Minneapolis Heart Institute from June 2007 through February 2011.
The scans, performed on pediatric patients with coronary artery pathology such as anomaly, stenosis, and aneurysm, were conducted using a first-generation dual-source scanner (Somatom Definition), and a second-generation dual-source scanner (Somatom Definition Flash) from Siemens Healthcare.
These images can be linked to EMRs, or stored on a picture archiving and communication system (PACS), and according to Dr. Donald Rucker, vice president and chief medical officer at Siemens Healthcare, the increasing connectivity of hospital systems have made images like these quickly available to physicians.
Rucker, who also practices emergency medicine at the University of Pennsylvania Presbyterian Medical Center, told InformationWeek Healthcare that advances in CTA scans have transformed the way hospitals attend to their patients.
"For example, if a person comes in with chest pain, we would typically require admission to the hospital and then scheduling a tread mill test or a nuclear study, or maybe even a regular invasive cardiac catheterization, now in the emergency department we can order one of these Cardiac CT angiograms and basically know on the spot as soon as the interpretation is back whether the person has any narrowing of coronary arteries and should be admitted," Rucker added.
In the case of Han's study, researchers examined the heart rate control with beta blockade, and the radiation dose with varied scan modes, with the goal of comparing the image quality and the radiation dose. The researchers compared the age, heart rate, body surface area, radiation dose estimates, and image quality between three scan groups. Overall, 17 patients underwent subsequent surgical intervention and surgical findings correlated with coronary CTA in all cases.
The results of the study showed that the newer imaging modes decrease the radiation dose between four-fold and seven-fold, without loss in diagnostic accuracy or image quality.
"This technology is going to drastically change our profession. I just think there's going to be an even further shift toward non-invasive diagnostics and I think that overall the risk to a patient with serious congenital heart disease will be less," Han said.
She also noted that there is a preference for using the newer flash scan mode, because the radiation doses are exceedingly low. Doctors also benefit from the sharpness of the images, and a three dimensional view of the heart with a very high resolution, which is an important factor when viewing the heart of both adults and infants.
"You can look at a patient's heart from any angle in a three dimensional space and I think that for coronary arteries you can see things that we could not see in any other way--we can see calcium, we can see plaque and we can see coronary arteries in patients in a way that we did not see before," Han said.
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