EDITORIAL: Three dimensional imaging using 64 detector row multi-slice CT should be used more widely for the diagnosis and management of congenital heart disease

Although 64 detector row multi-slice CT (MSCT) is the latest advance in multi-slice technology, it remains less frequently utilized for the diagnosis and management of congenital heart disease (CHD) compared to diagnostic cardiac catheterization (DCC) with biplane angiography, two dimensional echocardiography (2DE), and magnetic resonance imaging (MRI). When used, the interpreting physician is usually a radiologist who visualizes 2D slices in the axial plane and rarely in three dimensions (3D). Many pediatric cardiologists complain that th e radiation exposure (RE) from MSCT is too high to ethically justify its use in children, but ignore the effective dose to which their patients are exposed during DCC and interventional CC (ICC) using biplane fluoroscopy and cineangiography. Gating image acquisition to the ECG signal is rarely done because it is thought to dramatically increase RE. And the literature is not very helpful. Methods to calculate RE are complex especially in infants and children, arcane, and very poorly explained. Radiation units of measure and their meaning vary from report to report, and explanatory language is abstruse and often incomprehensible to those who would order such tests.