Hashimoto Naoki, Kuraoka Ayako, Yamamura Kenichiro, Sagawa Koichi, Hashimoto Saki, Urabe Hiroaki, Hashimoto Joji, Mizumoto Takahiro, Hiroshima Masako, Hayashi Nobuyuki, Tateishi Yasunori
Department of Radiology, Fukuoka Children's Hospital, Fukuoka, Japan.
Department of Pediatric Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan.
Pediatr Radiol. 2025 May;55(6):1270-1280. doi: 10.1007/s00247-025-06222-5. Epub 2025 Apr 26.
Anti-scatter grids are commonly used for cardiac catheterization in children with heart disease. However, the effect of the grid on the radiation dose or image quality has not been sufficiently demonstrated.
To investigate the effect of the removal of an anti-scatter grid on radiation dose and image quality in phantom and clinical settings.
This research consists of a preliminary study using a manufactured phantom simulating a newborn's chest thickness and a clinical study of 30 infants with simple congenital heart disease. We evaluated the exposure dose by dose area product (DAP), air kerma (AK), and image quality using visual and physical assessments.
In the phantom study, removal of the anti-scatter grid decreased DAP and AK by 25.0% to 55.6%. In the clinical study, the DAP (sum) and AK (sum) without an anti-scatter grid were significantly lower than with the grid (1.22±0.58 Gy·cm vs. 1.83±0.64 Gy·cm, P=0.01; 16.22±6.98 mGy vs. 23.23±8.33 mGy, P=0.02, respectively). In fluoroscopy mode without an anti-scatter grid, longer source-image-distances improved the contrast-to-noise ratio for guidewires and angiographic catheters. The accuracy of the examination was not affected in the clinical setting.
The removal of the anti-scatter grid did not affect the accuracy of the examination and achieved a lower radiation dose in both phantom and clinical studies. Cardiac catheterization without an anti-scatter grid may be a beneficial option for small patients with simple congenital heart disease.
防散射格栅常用于患有心脏病儿童的心脏导管插入术中。然而，格栅对辐射剂量或图像质量的影响尚未得到充分证实。
研究在体模和临床环境中去除防散射格栅对辐射剂量和图像质量的影响。
本研究包括一项使用模拟新生儿胸部厚度的人造体模的初步研究以及一项对30例患有简单先天性心脏病婴儿的临床研究。我们通过剂量面积乘积（DAP）、空气比释动能（AK）评估暴露剂量，并使用视觉和物理评估来评估图像质量。
在体模研究中，去除防散射格栅使DAP和AK降低了25.0%至55.6%。在临床研究中，无防散射格栅时的DAP（总和）和AK（总和）显著低于有格栅时（分别为1.22±0.58 Gy·cm对1.83±0.64 Gy·cm，P = 0.01；16.22±6.98 mGy对23.23±8.33 mGy，P = 0.02）。在无防散射格栅的透视模式下，更长的源-图像距离提高了导丝和血管造影导管的对比噪声比。在临床环境中，检查的准确性未受影响。
在体模和临床研究中，去除防散射格栅均未影响检查的准确性，且实现了更低的辐射剂量。对于患有简单先天性心脏病的小患者，不使用防散射格栅的心脏导管插入术可能是一个有益的选择。
