Clinical evaluation of dynamic intravenous coronary angiography using 2D monochromatic synchrotron radiation

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Purpose : We developed a dynamic intravenous coronary angiography (IVCAG) using two-dimensional monochromatic X-ray beam obtained form synchrotron radiation. In the present study, we applied it to patients and evaluated its clinical usefulness.Methods : Thirty-three patients underwent the IVCAG, who were suspected to have coronary artery disease or had already experienced PTCA or CABG.The IVCAG was carried out at the clinic in National Laboratory for High Energy Accelerator Research Organization. Synchrotron radiation was reflected asymmetrically with a silicon crystal to produce a wide (130mmx75mm) and monochromatic (37KeV) X-ray beam. Patients received an intravenous injection of 35-40ml of iodine contrast medium via the jugular vein, and then irradiation was performed for 5 msec periods at 100 msec intervals with a shutter. Images were acquired with an image intensifier and were recorded with a digital imaging system. IVCAG was repeated in 3 or 4 projections. The total irradiation d … More oses were limited to be less than 750 mSv.Results : The dynamic IVCAG permitted visualization of the right (#1 to #3) coronary artery in all patients. The left main trunk (#5) and the left anterior descending (LAD, #6 to #8) coronary arteries were also visualized in all patients. Whereas, although the proximal left circumflex (LCx, #11) coronary artery was visualized in 90% of the patients, the distal LCx artery were visualized in about 50% of the patients due to their overlapping with the left ventricle. As the result, because 16 patients were diagnosed to have no significant stenosis, they did not undergo conventional CAG.In the remainig 21 patients, the conventional CAG was performed and the findings of CAG were shown to be coincident with those of IVCAG.Conclusion : The dynamic IVCAG is suitable for evaluating coronary artery morphology and can be easily used for screening and follow-up of coronary artery disease. In future, the increase in intensity of synchrotron radition and improvement of X-ray detector are expected to improve the IVCAG image definition. Less