Trends in the utilization of computed tomography and cardiac catheterization among children with congenital heart disease

Justin Cheng-Ta Yang; Ming-Tai Lin; Fu-Shan Jaw; Shyh-Jye Chen; Jou-Kou Wang; Tiffany Ting-Fang Shih; Mei-Hwan Wu; Yiu-Wah Li

doi:10.1016/j.jfma.2014.08.004

Trends in the utilization of computed tomography and cardiac catheterization among children with congenital heart disease

J Formos Med Assoc. 2015 Nov;114(11):1061-8. doi: 10.1016/j.jfma.2014.08.004. Epub 2014 Sep 18.

Authors

Justin Cheng-Ta Yang¹, Ming-Tai Lin², Fu-Shan Jaw³, Shyh-Jye Chen⁴, Jou-Kou Wang², Tiffany Ting-Fang Shih⁵, Mei-Hwan Wu², Yiu-Wah Li⁵

Affiliations

¹ Institute of Biomedical Engineering, College of Engineering and College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan; Department of Radiology, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan.
² College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
³ Institute of Biomedical Engineering, College of Engineering and College of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: james_5586@hotmail.com.
⁵ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

Background/purpose: Pediatric cardiac computed tomography (CT) is a noninvasive imaging modality used to clearly demonstrate the anatomical detail of congenital heart diseases. We investigated the impact of cardiac CT on the utilization of cardiac catheterization among children with congenital heart disease.

Methods: The study sample consisted of 2648 cardiac CT and 3814 cardiac catheterization from 1999 to 2009 for congenital heart diseases. Diagnoses were categorized into 11 disease groups. The numbers of examination, according to the different modalities, were compared using temporal trend analyses. The estimated effective radiation doses (mSv) of CT and catheterization were calculated and compared.

Results: The number of CT scans and interventional catheterizations had a slight annual increase of 1.2% and 2.7%, respectively, whereas that of diagnostic catheterization decreased by 6.2% per year. Disease groups fell into two categories according to utilization trend differences between CT and diagnostic catheterization. The increased use of CT reduces the need for diagnostic catheterization in patients with atrioventricular connection disorder, coronary arterial disorder, great vessel disorder, septal disorder, tetralogy of Fallot, and ventriculoarterial connection disorder. Clinicians choose either catheterization or CT, or both examinations, depending on clinical conditions, in patients with semilunar valvular disorder, heterotaxy, myocardial disorder, pericardial disorder, and pulmonary vein disorder. The radiation dose of CT was lower than that of diagnostic cardiac catheterization in all age groups.

Conclusion: The use of noninvasive CT in children with selected heart conditions might reduce the use of diagnostic cardiac catheterization. This may release time and facilities within the catheterization laboratory to meet the increasing demand for cardiac interventions.

Keywords: cardiac catheterization; children; congenital heart disease; multidetector computed tomography; utilization.

MeSH terms

Adolescent
Cardiac Catheterization / statistics & numerical data*
Cardiac Catheterization / trends*
Child
Child, Preschool
Coronary Vessels / diagnostic imaging
Female
Heart Defects, Congenital / classification
Heart Defects, Congenital / diagnostic imaging*
Humans
Infant
Infant, Newborn
Linear Models
Male
Multivariate Analysis
Retrospective Studies
Taiwan
Tertiary Care Centers
Tomography, X-Ray Computed / statistics & numerical data*
Tomography, X-Ray Computed / trends*