Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Sep 9, 2023; 12(4): 230-236
Published online Sep 9, 2023. doi: 10.5409/wjcp.v12.i4.230
Radiation dose analysis of computed tomography coronary angiography in Children with Kawasaki disease
Mahesh Chandra Bhatt, Manphool Singhal, Rakesh Kumar Pilania, Subhash Chand Bansal, Niranjan Khandelwal, Pankaj Gupta, Surjit Singh
Mahesh Chandra Bhatt, Manphool Singhal, Subhash Chand Bansal, Niranjan Khandelwal, Pankaj Gupta, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Rakesh Kumar Pilania, Surjit Singh, Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Bhatt MC and Singhal M contributed to the data interpretation, writing of first draft, review of literature, editing of manuscript and critical revision of manuscript at all stages; Pilania RK contributed to the patient management, data interpretation, writing of first draft, review of literature, editing of manuscript and critical revision of manuscript at all stages; Bansal SC, Khandelwal N, and Gupta P contributed to the review of literature and editing of manuscript; Singh S contributed to the patient management, review of literature, editing of manuscript, critical revision of manuscript at all stages; Bhatt MC and Singhal M contributed equally; Singhal M finally approved the manuscript.
Institutional review board statement: The manuscript has been approved by Departmental Publication Review Board (RDG/EC/Pub/27 dated July 03, 2020), No. NK/1837/Res/2890.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The author(s) declare(s) that they had full access to all of the data in this study and the author(s) take(s) complete responsibility for the integrity of the data and the accuracy of the data analysis.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Manphool Singhal, MD, DNB, FICR, FSCCT, FSCMR, Professor, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh 160012, India. drmsinghal74@gmail.com
Received: May 17, 2023
Peer-review started: May 17, 2023
First decision: July 4, 2023
Revised: July 12, 2023
Accepted: August 9, 2023
Article in press: August 9, 2023
Published online: September 9, 2023
Processing time: 111 Days and 15.6 Hours
Abstract
BACKGROUND

There is evolving role of computed tomography coronary angiography (CTCA) in non-invasive evaluation of coronary artery abnormalities in children with Kawasaki disease (KD). Despite this, there is lack of data on radiation dose in this group of children undergoing CTCA.

AIM

To audit the radiation dose of CTCA in children with KD.

METHODS

Study (December 2013-February 2018) was performed on dual source CT scanner using adaptive prospective electrocardiography-triggering. The dose length product (DLP in milligray-centimeters-mGy.cm) was recorded. Effective radiation dose (millisieverts-mSv) was calculated by applying appropriate age adjusted conversion factors as per recommendations of International Commission on Radiological Protection. Radiation dose was compared across the groups (0-1, 1-5, 5-10, and > 10 years).

RESULTS

Eighty-five children (71 boys, 14 girls) with KD underwent CTCA. The median age was 5 years (range, 2 mo-11 years). Median DLP and effective dose was 21 mGy.cm, interquartile ranges (IQR) = 15 (13, 28) and 0.83 mSv, IQR = 0.33 (0.68, 1.01) respectively. Mean DLP increased significantly across the age groups. Mean effective dose in infants (0.63 mSv) was significantly lower than the other age groups (1-5 years 0.85 mSv, 5-10 years 1.04 mSv, and > 10 years 1.38 mSv) (P < 0.05). There was no significant difference in the effective dose between the other groups of children. All the CTCA studies were of diagnostic quality. No child required a repeat examination.

CONCLUSION

CTCA is feasible with submillisievert radiation dose in most children with KD. Thus, CTCA has the potential to be an important adjunctive imaging modality in children with KD.

Keywords: Computed tomography coronary angiography, Coronary artery abnormalities, Dual source computed tomography, Kawasaki disease, Radiation exposure

Core Tip: Dual source computed tomography (CT) scanners by virtue of high temporal resolution, faster gantry rotation, electrocardiography triggered tube current modulation, large area coverage, body adaptive automatic selection of tube current modulation and iterative reconstruction algorithm have largely addressed the issue of high radiation exposure when subjecting children with Kawasaki disease (KD) to CT coronary angiography. It is now possible to evaluate these patients using submilliseivert radiation exposure. This is a significant advance in management of KD.