New Nomogram Helps Optimize 3-D Rotational Angiography for Congenital Cardiac Catheterization

New Nomogram Helps Optimize 3-D Rotational Angiography for Congenital Cardiac Catheterization 1024 775 Katie Brind'Amour, PhD, MS, CHES

Clinician-researchers studied a large number of 3-D rotational angiography (3DRA) cases to identify patient and practice factors that produce the highest quality images.

In an effort to aid in the successful application of 3-D rotational angiography (3DRA) in cardiac catheterization labs worldwide, a team of clinicians at Nationwide Children’s Hospital retrospectively reviewed 208 3DRAs to find which patient and process characteristics resulted in the best images. They then created an evidence-based contrast dose guide and nomogram to help their own team and others proactively optimize images captured with 3DRA.

“The goal was really to guide interventional cardiologists performing this technique in the catheterization lab,” says Arash Salavitabar, MD, director of The Heart Center XR Program at Nationwide Children’s and lead author on the Pediatric Cardiology publication. “Optimizing 3D rotational angiography using these tools can result in better imaging to inform many other procedures for these patients.”

The team also hoped to reduce wide variability in 3DRA practices across the country and internationally.

“Previously, we were basing our practice on a chart from a colleague who made a plot graph of patient weight vs volume of contrast,” says Aimee Armstrong, MD, director of Cardiac Catheterization and Interventional Therapies at Nationwide Children’s and senior author on the study. “It didn’t represent what resulted in high-quality imaging, it was just his experiences. Dr. Salavitabar suggested we find a way to determine the optimal characteristics of high quality 3DRA.”

The study included a broad range of patients from infancy to adulthood, which revealed that lower patient weight was associated with improved image quality. They also found that a higher volume of injection with more dilute contrast solution improved image quality. From these findings, the team designed a nomogram which clinicians can use to calculate a percent probability of achieving a high-quality 3DRA based on patient and injection characteristics. The team hopes the effort will help colleagues feel more confident in the use of 3DRA.

“3DRA can be used to help a surgeon prepare for an operation, help a cardiologist better understand the heart anatomy, guide an interventional cardiologist during procedures and even educate patients about their disease,” says Dr. Salavitabar. He believes the improved imaging will also assist The Heart Center Extended Reality Program’s augmented and virtual reality work by enhancing the accuracy of their projected 3-D holograms.

The team hopes to further improve the evidence base for the guide and nomogram through corroboration from institutions using equipment from other 3DRA vendors and by comparing the achievement of high-quality 3DRA before and after adoption of the nomogram.


Salavitabar A, Boe BA, Berman DP, Harrison A, Swinning J, Baptista K, Eisner M, Bai S, Armstrong AK. Optimizing 3D rotational angiography for congenital cardiac catheterization. Pediatric Cardiology. 2022 Aug 27. Epub ahead of print.

Image credit: Nationwide Children’s

About the author

Katherine (Katie) Brind’Amour is a freelance medical and health science writer based in Pennsylvania. She has written about nearly every therapeutic area for patients, doctors and the general public. Dr. Brind’Amour specializes in health literacy and patient education. She completed her BS and MS degrees in Biology at Arizona State University and her PhD in Health Services Management and Policy at The Ohio State University. She is a Certified Health Education Specialist and is interested in health promotion via health programs and the communication of medical information.