Cardiac CT Techniques in Neonates (and infants)

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1 Cardiac CT Techniques in Neonates (and infants) Siddharth P. Jadhav, MD Director, Body CT and MRI Edward B. Singleton Department of Pediatric Radiology Texas Children s Hospital

2 Disclosures None

3 Objectives To describe technical aspects of cardiac CT for optimal image quality at low radiation dose Review practical tips to avoid pitfalls

4 Background Echocardiography CT Angiography MRI

5 Background CT Angiography High spatial resolution Accessible No sedation! No breath hold!

6 Trends in Cardiovascular CT Monthly Imaging Trends at Texas Children's Hospital CT MRI Total Studies

7 Potential/Perceived Detractors of CTA Radiation Post-processing Need support team for a successful program

8 CTA Protocol Considerations Individualization Patient Indication

9 CTA Protocol Considerations ECG Gating Sedation Contrast Helical vs. Volumetric kv, ma Breath Hold IV Access

10 CTA Protocol: ECG Gating Prospective 40%

11 CTA Protocol: ECG Gating Prospective 75%

12 ECG Gating: Target mode 40 % 75 % Target mode prospective gating without padding Conventional prospective gating with padding

13 CTA Protocol: ECG Gating Retrospective - some coronary imaging

14 CTA Protocol: IV Access Peripheral IV Gauge Location Lower extremity Right>Left upper Power (pressure) injector Saline test bolus 24G 22G 20G

15 CTA Protocol: Contrast Non-ionic, Iodinated Saline flush Volume of contrast Weight-based Typically ml/kg Rate

16 CTA Protocol: Coverage 320 Detector allows 16cm Z-axis coverage Seconds / gantry rotation 10cm

17 CTA Protocol: Sedation Dependent on: Scan time Indication Anesthesia availability

18 CTA Protocol: Bolus Timing Automated Bolus Tracking Manual Visual

19 CTA Protocol: Radiation Dose Parameters ALARA, Image Gently kv, ma Indication based New generation scanners Iterative reconstruction Jadhav S, et al. CT Angiography of neonates and infants: comparison of radiation dose and image quality of target mode prospectively ECG-gated 320-MDCT and ungated helical 64-MDCT. AJR 2015 Feb; 204(2):W

20 CTA Protocol: Radiation Dose Parameters ALARA, Image Gently kv, ma Indication based New generation scanners Iterative reconstruction Jadhav S, et al. CT Angiography of neonates and infants: comparison of radiation dose and image quality of target mode prospectively ECG-gated 320-MDCT and ungated helical 64-MDCT. AJR 2015 Feb; 204(2):W

21 CTA Protocol: Radiation Dose Parameters ALARA, Image Gently kv, ma Indication based New generation scanners Iterative reconstruction Airways Vascular Ring General Anatomy Coronary Anatomy Jadhav S, et al. CT Angiography of neonates and infants: comparison of radiation dose and image quality of target mode prospectively ECG-gated 320-MDCT and ungated helical 64-MDCT. AJR 2015 Feb; 204(2):W

22 CTA Protocol: Radiation Dose Parameters ALARA, Image Gently kv, ma Indication based New generation scanners Iterative reconstruction Jadhav S, et al. CT Angiography of neonates and infants: comparison of radiation dose and image quality of target mode prospectively ECG-gated 320-MDCT and ungated helical 64-MDCT. AJR 2015 Feb; 204(2):W

23 CTA Protocol: Radiation Dose Parameters ALARA, Image Gently kv, ma Indication based New generation scanners Iterative reconstruction Images courtesy of Dr. Prakash Masand Jadhav S, et al. CT Angiography of neonates and infants: comparison of radiation dose and image quality of target mode prospectively ECG-gated 320-MDCT and ungated helical 64-MDCT. AJR 2015 Feb; 204(2):W

24 CT Denoising with AIDR

25 CTA Indications: Anatomy Pulmonary arteries Vascular ring/sling Pulmonary veins Aorta Stent / conduit / shunt / LVAD Systemic veins Coronary arteries 3D printing

26 CTA Indications: Function Dynamic: Airway Pulmonary vein stenosis

27 CTA Indications: Function Dynamic: Airway Pulmonary veins

28 CTA Indications: Other Contraindication to MRI Pacemaker Renal failure

29 Take home points Cardiac CTA in pediatric CHD: Volume is increasing Provides surgical roadmap Newer generation scanners allow dose reduction Individualized approach Support team is critical

30 Acknowledgements Dr. Prakash Masand Dr. Pamela Ketwaroo Texas Children s Department of Radiology

31 Thank you!

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