Ensuring the safety of pediatric cardiovascular and vascular patients who require computed tomographic angiography (CTA) for diagnostic purposes means that employing methods of low dose CTA is essential, according to Jeffrey C. Hellinger, M.D., a pediatric imaging specialist at Stony Brook University Medical Center. Dr. Hellinger expands on these methods in a review article in the early online edition of Radiologic Clinics of North America.
Dr. Hellinger has developed CTA protocols that he has lectured on nationally that balance lower doses of radiation and clear diagnostic images when using CTA on infants and children. As Principal Author of “Pediatric Computed Tomographic Angiography: Imaging the Cardiovascular System Gently,” Dr. Hellinger details the appropriate and safe use of non-invasive CTA, in the context of other potential cardiovascular imaging modalities, including radiography, echocardiography, vascular ultrasound, magnetic resonance imaging (MRI) and angiography (MRA), and invasive catheter angiography (CA).
“The use of any radiation in diagnostic methods carries a risk of causing cancer and of abnormal development, particularly in infants and children,” says Dr. Hellinger. “There is basically a medical necessity, if you are going to use radiation in your imaging, to use the lowest possible amount,” he emphasizes.
“I think it’s a controversial topic as to how much radiation will lead to increased cancer risk over the lifetime of a patient,” he adds. “As physicians and imagers, with CT angiography, it is our goal to use the lowest possible radiation without compromising imaging quality. There a balance between how low you can go with the technology and rendering a diagnosis. If the radiation dose is too low and the image is poor, you have wasted the radiation.”
Dr. Hellinger and co-authors present recommended low-dose pediatric CTA protocols and the necessary ancillary protocols to achieve high image quality, emphasizing that using complementary “gentle” cardiovascular CT “can enhance the diagnosis and management of the pediatric patient with cardiovascular disease. Given the intrinsic dependencies upon radiation, utilizing this modality in pediatric patients mandates a commitment to dose reduction strategies, striving for ALARA (As Lows As Reasonably Achievable) in each cardiovascular CT examination.”
For each patient, Dr. Hellinger writes, the risks, benefits and alternatives to cardiovascular CT should be reviewed. “The pediatric CTA protocols are uniquely designed to maximize the table speed, image at the lowest possible voltage, and use the lowest possible weight-based tube current.”
Dr. Hellinger, who joined SBUMC around the June 2010 launch of Stony Brook Long Island Children’s Hospital, the only dedicated children’s hospital east of the Nassau/Queens border, developed an expertise in creating low dose radiation pediatric imaging protocols over the past four years. He built a cardiovascular imaging program in the Department of Radiology at The Children’s Hospital of Philadelphia (CHOP).
At SBUMC, Dr. Hellinger joins Michael Poon, M.D, Director of the Advanced Cardiac Imaging Program and a world-renowned expert in cardiac CT and MRI. Central to their imaging diagnostic methods is SBUMC’s acquisition earlier this year of a state-of-the art 320-detector row CT scanner, which provides physicians with precise images of internal organs with a single rotation of the gantry, resulting in lower doses of radiation while providing the best imaging possible.
Co-authors of the journal article include: Dr. Poon of SBUMC; Andres Pena, M.D., Department of Radiology, The Children’s Hospital of Philadelphia (CHOP), University of Pennsylvania School of Medicine; Frandics P. Chan, M.D., Department of Radiology, Lucile Packard Children’s Hospital, Stanford University School of Medicine; and Monica Epelman, M.D., Department of Radiology, CHOP.