Author:

Abstract

Invasive cardiology began in the 1950s with the advent of cardiac catheterization for the precise diagnosis of cardiovascular disease. In the 1960s, invasive cardiology went into high gear with the application of coronary angiography to define the extent and location of obstructive disease within the coronary artery tree. Guidance of the catheters used in these diagnostic procedures relied solely on X-ray fluoroscopy and cine angiography. With the introduction of coronary angioplasty in the late 1970s, the era of interventional cardiology was born. Again, X-ray techniques provided guidance for the new catheters and devices developed not only for the diagnosis but also the treatment of cardiovascular disease. Thus, for five decades some of the greatest advancements in cardiovascular medicine relied on X-rays to provide visual guidance.

While an essential technology, X-ray guidance had numerous disadvantages. First, visualization of the heart required multiple two-dimensional projections to achieve a perception of three-dimensionality. Second, X-rays provided visualization and not true guidance, which relied on operator skills alone. Third, X-rays have the potential to injure both the patient and the laboratory personnel. The complexity of moderate interventional procedures requires increasing exposure to radiation.