51
|
Radiation dose among different cardiac and vascular invasive procedures: The RODEO study. Int J Cardiol 2017; 240:92-96. [DOI: 10.1016/j.ijcard.2017.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 11/17/2022]
|
52
|
Radiation safety in the cardiac catheterization lab: A time series quality improvement initiative. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:S22-S26. [PMID: 28483588 DOI: 10.1016/j.carrev.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/10/2017] [Accepted: 04/19/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interventional cardiologists have one of the highest annual radiation exposures yet systems of care that promote radiation safety in cardiac catheterization labs are lacking. This study sought to reduce the frequency of radiation exposure, for PCI procedures, above 1.5Gy in labs utilizing a Phillips system at our local institution by 40%, over a 12-month period. METHODS We performed a time series study to assess the impact of different interventions on the frequency of radiation exposure above 1.5Gy. Process measures were percent of procedures where collimation and magnification were used and percent of completion of online educational modules. Balancing measures were the mean number of cases performed and mean fluoroscopy time. INTERVENTIONS Information sessions, online modules, policies and posters were implemented followed by the introduction of a new lab with a novel software (AlluraClarity©) to reduce radiation dose. RESULTS There was a significant reduction (91%, p<0.05) in the frequency of radiation exposure above 1.5Gy after utilizing a novel software (AlluraClarity©) in a new Phillips lab. Process measures of use of collimation (95.0% to 98.0%), use of magnification (20.0% to 14.0%) and completion of online modules (62%) helped track implementation. The mean number of cases performed and mean fluoroscopy time did not change significantly. CONCLUSION While educational strategies had limited impact on reducing radiation exposure, implementing a novel software system provided the most effective means of reducing radiation exposure.
Collapse
|
53
|
Gislason-Lee AJ, Keeble C, Egleston D, Bexon J, Kengyelics SM, Davies AG. Comprehensive assessment of patient image quality and radiation dose in latest generation cardiac x-ray equipment for percutaneous coronary interventions. J Med Imaging (Bellingham) 2017; 4:025501. [PMID: 28491907 PMCID: PMC5412945 DOI: 10.1117/1.jmi.4.2.025501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/14/2017] [Indexed: 11/14/2022] Open
Abstract
This study aimed to determine whether a reduction in radiation dose was found for percutaneous coronary interventional (PCI) patients using a cardiac interventional x-ray system with state-of-the-art image enhancement and x-ray optimization, compared to the current generation x-ray system, and to determine the corresponding impact on clinical image quality. Patient procedure dose area product (DAP) and fluoroscopy duration of 131 PCI patient cases from each x-ray system were compared using a Wilcoxon test on median values. Significant reductions in patient dose ([Formula: see text]) were found for the new system with no significant change in fluoroscopy duration ([Formula: see text]); procedure DAP reduced by 64%, fluoroscopy DAP by 51%, and "cine" acquisition DAP by 76%. The image quality of 15 patient angiograms from each x-ray system (30 total) was scored by 75 clinical professionals on a continuous scale for the ability to determine the presence and severity of stenotic lesions; image quality scores were analyzed using a two-sample [Formula: see text]-test. Image quality was reduced by 9% ([Formula: see text]) for the new x-ray system. This demonstrates a substantial reduction in patient dose, from acquisition more than fluoroscopy imaging, with slightly reduced image quality, for the new x-ray system compared to the current generation system.
Collapse
Affiliation(s)
| | - Claire Keeble
- University of Leeds, Division of Epidemiology and Biostatistics, Leeds, United Kingdom
| | - Daniel Egleston
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
| | - Josephine Bexon
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
| | | | - Andrew G. Davies
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
| |
Collapse
|
54
|
DEL GRECO MAURIZIO, MAINES MASSIMILIANO, MARINI MASSIMILIANO, COLELLA ANDREA, ZECCHIN MASSIMO, VITALI-SERDOZ LAURA, BLANDINO ALESSANDRO, BARBONAGLIA LORELLA, ALLOCCA GIUSEPPE, MUREDDU ROBERTO, MARENNA BIONDINO, ROSSI PAOLO, VACCARI DIEGO, CHIANCA ROBERTO, INDIANI STEFANO, DI MATTEO IRENE, ANGHEBEN CARLO, ZORZI ALESSANDRO. Three-Dimensional Electroanatomic Mapping System-Enhanced Cardiac Resynchronization Therapy Device Implantation: Results From a Multicenter Registry. J Cardiovasc Electrophysiol 2016; 28:85-93. [DOI: 10.1111/jce.13120] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/18/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - ALESSANDRO ZORZI
- Santa Maria del Carmine Hospital; Rovereto Italy
- Department of Cardiac, Thoracic and Vascular Sciences; University of Padova; Padova Italy
| |
Collapse
|
55
|
Aagaard P, Natale A, Briceno D, Nakagawa H, Mohanty S, Gianni C, Burkhardt JD, DI Biase L. Remote Magnetic Navigation: A Focus on Catheter Ablation of Ventricular Arrhythmias. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S38-44. [PMID: 26969222 DOI: 10.1111/jce.12938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
VT ablation is based on percutaneous catheter insertion under fluoroscopic guidance to selectively destroy (i.e., ablate) myocardial tissue regions responsible for the initiation or propagation of ventricular arrhythmias. Although the last decade has witnessed a rapid evolution of ablation equipment and techniques, the control over catheter movement during manual ablation has remained largely unchanged. Moreover, the procedures are long, and require ergonomically unfavorable positions, which can lead to operator fatigue. In an attempt to overcome these constraints, several technical advancements, including remote magnetic navigation (RMN), have been developed. RMN utilizes a magnetic field to remotely manipulate specially designed soft-tip ablation catheters anywhere in the x, y, or z plane inside the patient's chest. RMN also facilitates titration of the contact force between the catheter and the myocardial tissue, which may reduce the risk of complications while ensuring adequate lesion formation. There are several non-randomized studies showing that RMN has similar efficacy to manual ablation, while complication rates and total radiation exposure appears to be lower. Although these data are promising, larger randomized studies are needed to prove that RMN is superior to manual ablation of VT.
Collapse
Affiliation(s)
- Philip Aagaard
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy.,Division of Cardiology, Stanford University, Stanford, California, USA.,Case Western Reserve University, Cleveland, Ohio, USA.,EP Services, California Pacific Medical Center, San Francisco, California, USA.,Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA.,Dell Medical School, University of Texas, Austin, Texas, USA
| | - David Briceno
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - Luigi DI Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.,Department of Biomedical Engineering, University of Texas, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy
| |
Collapse
|
56
|
Som S, Patel AK, Sethi V, Faraz H, Admani I, Mathur A, Parrillo JE, Vaidya P. Barriers for transradial coronary angiography and interventions in 2016. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:221-225. [PMID: 27889310 DOI: 10.1016/j.carrev.2016.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Sumit Som
- Interventional Cardiology, Rutgers New Jersey Medical School, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey, 07601.
| | - Ankitkumar K Patel
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Virender Sethi
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Haroon Faraz
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Irfan Admani
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Atish Mathur
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Joseph E Parrillo
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Pranaychandra Vaidya
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| |
Collapse
|
57
|
Yang L, Sun G, Chen X, Chen G, Yang S, Guo P, Wang Y, Wang DW. Meta-Analysis of Zero or Near-Zero Fluoroscopy Use During Ablation of Cardiac Arrhythmias. Am J Cardiol 2016; 118:1511-1518. [PMID: 27639689 DOI: 10.1016/j.amjcard.2016.08.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
Data regarding the efficacy and safety of zero or near-zero fluoroscopic ablation of cardiac arrhythmias are limited. A literature search was conducted using PubMed and Embase for relevant studies through January 2016. Ten studies involving 2,261 patients were identified. Compared with conventional radiofrequency ablation method, zero or near-zero fluoroscopy ablation significantly showed reduced fluoroscopic time (standard mean difference [SMD] -1.62, 95% CI -2.20 to -1.05; p <0.00001), ablation time (SMD -0.16, 95% CI -0.29 to -0.04; p = 0.01), and radiation dose (SMD -1.94, 95% CI -3.37 to -0.51; p = 0.008). In contrast, procedure duration was not significantly different from that of conventional radiofrequency ablation (SMD -0.03, 95% CI -0.16 to 0.09; p = 0.58). There were no significant differences between both groups in immediate success rate (odds ratio [OR] 0.99, 95% CI 0.49 to 2.01; p = 0.99), long-term success rate (OR 1.13, 95% CI 0.42 to 3.02; p = 0.81), complication rates (OR 0.98, 95% CI 0.49 to 1.96; p = 0.95), and recurrence rates (OR 1.29, 95% CI 0.74 to 2.24; p = 0.37). In conclusion, radiation was significantly reduced in the zero or near-zero fluoroscopy ablation groups without compromising efficacy and safety.
Collapse
|
58
|
Gislason-Lee AJ, Keeble C, Malkin CJ, Egleston D, Bexon J, Kengyelics SM, Blackman D, Davies AG. Impact of latest generation cardiac interventional X-ray equipment on patient image quality and radiation dose for trans-catheter aortic valve implantations. Br J Radiol 2016; 89:20160269. [PMID: 27610932 PMCID: PMC5124836 DOI: 10.1259/bjr.20160269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/31/2016] [Accepted: 09/08/2016] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This study aimed to determine the impact on radiation dose and image quality of a new cardiac interventional X-ray system for trans-catheter aortic valve implantation (TAVI) patients compared to the previously-used cardiac X-ray system. METHODS Patient dose and image data were retrospectively collected from a Philips AlluraClarity (new) and Siemens Axion Artis (reference) X-ray system. Patient dose area product (DAP) and fluoroscopy duration of 41 patient cases from each X-ray system were compared using a Wilcoxon test. Ten patient aortograms from each X-ray system were scored by 32 observers on a continuous scale to assess the clinical image quality at the given phase of the TAVI procedure. Scores were dichotomised by acceptability and analysed using a Chi-squared test. RESULTS Significant reductions in patient dose (p << 0.001) were found for the new system with no significant change in fluoroscopy duration (p = 0.052); procedure DAP reduced by 55%, fluoroscopy DAP by 48% and "cine" acquisition DAP by 61%. There was no significant difference between image quality scores of the two X-ray systems (p = 0.06). CONCLUSIONS The new cardiac X-ray system demonstrated a very significant reduction in patient dose with no loss of clinical image quality. Advances in Knowledge: The huge growth of TAVI may impact on the radiation exposure of cardiac patients and particularly on operators including anaesthetists; cumulative exposure of interventional cardiologists performing high volume TAVI over 30-40 years may be harmful. The Phillips Clarity upgrade including improved image enhancement and optimised X-ray settings significantly reduced radiation without reducing clinically acceptable image quality.
Collapse
Affiliation(s)
| | - Claire Keeble
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | | | - Daniel Egleston
- Division of Biomedical Imaging, University of Leeds, Leeds, UK
| | - Josephine Bexon
- Division of Biomedical Imaging, University of Leeds, Leeds, UK
| | | | - Daniel Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Andrew G Davies
- Division of Biomedical Imaging, University of Leeds, Leeds, UK
| |
Collapse
|
59
|
Baselet B, Rombouts C, Benotmane AM, Baatout S, Aerts A. Cardiovascular diseases related to ionizing radiation: The risk of low-dose exposure (Review). Int J Mol Med 2016; 38:1623-1641. [PMID: 27748824 PMCID: PMC5117755 DOI: 10.3892/ijmm.2016.2777] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/07/2016] [Indexed: 12/27/2022] Open
Abstract
Traditionally, non-cancer diseases are not considered as health risks following exposure to low doses of ionizing radiation. Indeed, non-cancer diseases are classified as deterministic tissue reactions, which are characterized by a threshold dose. It is judged that below an absorbed dose of 100 mGy, no clinically relevant tissue damage occurs, forming the basis for the current radiation protection system concerning non-cancer effects. Recent epidemiological findings point, however, to an excess risk of non-cancer diseases following exposure to lower doses of ionizing radiation than was previously thought. The evidence is the most sound for cardiovascular disease (CVD) and cataract. Due to limited statistical power, the dose-risk relationship is undetermined below 0.5 Gy; however, if this relationship proves to be without a threshold, it may have considerable impact on current low-dose health risk estimates. In this review, we describe the CVD risk related to low doses of ionizing radiation, the clinical manifestation and the pathology of radiation-induced CVD, as well as the importance of the endothelium models in CVD research as a way forward to complement the epidemiological data with the underlying biological and molecular mechanisms.
Collapse
Affiliation(s)
- Bjorn Baselet
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK•CEN), Mol, Belgium
| | - Charlotte Rombouts
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK•CEN), Mol, Belgium
| | - Abderrafi Mohammed Benotmane
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK•CEN), Mol, Belgium
| | - Sarah Baatout
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK•CEN), Mol, Belgium
| | - An Aerts
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK•CEN), Mol, Belgium
| |
Collapse
|
60
|
Casella M, Dello Russo A, Pelargonio G, Del Greco M, Zingarini G, Piacenti M, Di Cori A, Casula V, Marini M, Pizzamiglio F, Zucchetti M, Riva S, Russo E, Narducci ML, Soldati E, Panchetti L, Startari U, Bencardino G, Perna F, Santangeli P, Di Biase L, Cichocki F, Fattore G, Bongiorni M, Picano E, Natale A, Tondo C. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial. Europace 2016; 18:1565-1572. [PMID: 26559916 PMCID: PMC5072134 DOI: 10.1093/europace/euv344] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/13/2015] [Indexed: 11/17/2022] Open
Abstract
AIMS Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients' lifetime attributable risks associated with such exposure. METHODS AND RESULTS We performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSiteTMNavXTM navigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients' radiation dose (0 mSv, iqr 0-0.08 vs. 8.87 mSv, iqr 3.67-22.01; P < 0.00001), total fluoroscopy time (0 s, iqr 0-12 vs. 859 s, iqr 545-1346; P < 0.00001), and operator radiation dose (1.55 vs. 25.33 µS per procedure; P < 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients' exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs. CONCLUSION This is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients' exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01132274.
Collapse
Affiliation(s)
- Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | | | | | - Gianluca Zingarini
- Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Marcello Piacenti
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Victor Casula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Radiology, University of Oulu, Oulu, Finland
| | | | - Francesca Pizzamiglio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | | | - Ezio Soldati
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Luca Panchetti
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | - Umberto Startari
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | | | | | - Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | | | - Giovanni Fattore
- Department of Policy Analysis and Public Management and CERGAS, Università Bocconi, Milan, Italy
| | - Mariagrazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| |
Collapse
|
61
|
Wilson SM, Prasan AM, Virdi A, Lassere M, Ison G, Ramsay DR, Weaver JC. Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography. EUROINTERVENTION 2016; 12:e939-e947. [DOI: 10.4244/eijv12i8a156] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
62
|
Barone E, Corrado A, Gemignani F, Landi S. Environmental risk factors for pancreatic cancer: an update. Arch Toxicol 2016; 90:2617-2642. [PMID: 27538405 DOI: 10.1007/s00204-016-1821-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/04/2016] [Indexed: 02/07/2023]
Abstract
Pancreatic cancer (PC) is one of the most aggressive diseases. Only 10 % of all PC cases are thought to be due to genetic factors. Here, we analyzed the most recently published case-control association studies, meta-analyses, and cohort studies with the aim to summarize the main environmental factors that could have a role in PC. Among the most dangerous agents involved in the initiation phase, there are the inhalation of cigarette smoke, and the exposure to mutagenic nitrosamines, organ-chlorinated compounds, heavy metals, and ionizing radiations. Moreover, pancreatitis, high doses of alcohol drinking, the body microbial infections, obesity, diabetes, gallstones and/or cholecystectomy, and the accumulation of asbestos fibers seem to play a crucial role in the progression of the disease. However, some of these agents act both as initiators and promoters in pancreatic acinar cells. Protective agents include dietary flavonoids, marine omega-3, vitamin D, fruit, vegetables, and the habit of regular physical activity. The identification of the factors involved in PC initiation and progression could be of help in establishing novel therapeutic approaches by targeting the molecular signaling pathways responsive to these stimuli. Moreover, the identification of these factors could facilitate the development of strategies for an early diagnosis or measures of risk reduction for high-risk people.
Collapse
Affiliation(s)
- Elisa Barone
- Genetic Unit, Department of Biology, University of Pisa, Via Derna, 1, 56121, Pisa, Italy
| | - Alda Corrado
- Genetic Unit, Department of Biology, University of Pisa, Via Derna, 1, 56121, Pisa, Italy
| | - Federica Gemignani
- Genetic Unit, Department of Biology, University of Pisa, Via Derna, 1, 56121, Pisa, Italy
| | - Stefano Landi
- Genetic Unit, Department of Biology, University of Pisa, Via Derna, 1, 56121, Pisa, Italy.
| |
Collapse
|
63
|
Abstract
OBJECTIVE The purposes of this article are to review available data regarding the range of protection devices and garments with a focus on eye protection and to summarize techniques for reducing scatter radiation exposure. CONCLUSION Fluoroscopy operators and staff can greatly reduce their radiation exposure by wearing properly fitted protective garments, positioning protective devices to block scatter radiation, and adhering to good radiation practices. By understanding the essentials of radiation physics, protective equipment, and the features of each imaging system, operators and staff can capitalize on opportunities for radiation protection while minimizing ergonomic strain. Practicing and promoting a culture of radiation safety can help fluoroscopy operators and staff enjoy long, productive careers helping patients.
Collapse
|
64
|
Reeves RR, Mahmud E. Reports of a Possible Causal Link between Brain, Head, and Neck Tumors and Radiation Exposure during Coronary Interventional Procedures: A Sobering Look at the Data. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2016.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
65
|
The Implementation of New Technologies Deserves Our Particular Attention Towards Radiation Safety. J Belg Soc Radiol 2016; 100:52. [PMID: 30038981 PMCID: PMC5854254 DOI: 10.5334/jbr-btr.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
66
|
Wei KC, Lin HY, Hung SK, Huang YT, Lee MS, Wang WH, Wu CS, Su YC, Shen BJ, Tsai SJ, Tsai WT, Chen LC, Li CY, Chiou WY. Leukemia Risk After Cardiac Fluoroscopic Interventions Stratified by Procedure Number, Exposure Latent Time, and Sex: A Nationwide Population-Based Case-Control Study. Medicine (Baltimore) 2016; 95:e2953. [PMID: 26962795 PMCID: PMC4998876 DOI: 10.1097/md.0000000000002953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A number of cardiac fluoroscopic interventions have increased rapidly worldwide over the past decade. Percutaneous transluminal coronary angioplasty (PTCA) and stent implantation have become increasingly popular, and these advancements have allowed patients to receive repetitive treatments for restenosis. However, these advancements also significantly increase radiation exposure that may lead to higher cumulative doses of radiation. In the present study, a nationwide population-based case-controlled study was used to explore the risk of leukemia after cardiac angiographic fluoroscopic intervention.A total of 5026 patients with leukemia and 100,520 control patients matched for age and sex (1:20) by a propensity score method without any cancer history were enrolled using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan between 2008 and 2010. All subjects were retrospectively surveyed (from year 2000) to determine receipt of cardiac fluoroscopic interventions. Data were analyzed using conditional logistic regression models, and estimated crude and adjusted odds ratios (95% confidence interval).After adjusting for age, gender, and comorbidities, PTCA was found to be associated with an increased risk of leukemia with an adjusted OR of 1.566 (95% CI, 1.282-1.912), whereas coronary angiography alone without PTCA and cardiac electrophysiologic study were not. Our results also showed that an increased frequency of PTCA and coronary angiography was associated with a higher risk of leukemia (adjusted OR: 1.326 to 1.530 [all P < 0.05]). Gender subgroup analyses demonstrated that men were associated with a higher risk of leukemia compared with women.These results provide additional data in the quantification of the long-term health effects of radiation exposure derived from the cardiac fluoroscopic diagnostic and therapeutic intervention. PTCA alone or PTCA with coronary angiography was associated with an elevated risk of leukemia. Continued follow-up of existing cohorts will be valuable to help assess lifetime risks of cancer.
Collapse
Affiliation(s)
- Kai-Che Wei
- From the Department of Dermatology (K-CW, C-SW), Kaohsiung Veterans General Hospital, Kaohsiung; Institute of Clinical Medicine (K-CW), College of Medicine, National Cheng Kung University, Tainan; Faculty of Yuhing Junior College of Health Care and Management (K-CW), Kaohsiung; Department of Radiation Oncology (H-YL, S-KH, M-SL, BJS, S-JT, W-TT, L-CC, W-YC), Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; School of Medicine (H-YL, S-KH, M-SL, B-JS, Y-CS, W-YC), Tzu Chi University, Hualien; Master Degree Program in Aging and Long-Term Care (Y-TH), College of Nursing, Kaohsiung Medical University; Department of Cardiology (W-HW), Kaohsiung Veterans General Hospital, Kaohsiung; Division of Hematology Oncology (Y-CS), Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; Department of Biomedical Imaging and Radiological Sciences (W-TT), National Yang-Ming University, Taipei; Department of Public Health (C-YL, W-YC), College of Medicine, National Cheng Kung University, Tainan; and Department of Public Health (C-YL), China Medical University, Taichung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
67
|
Li C, Athar M. Ionizing Radiation Exposure and Basal Cell Carcinoma Pathogenesis. Radiat Res 2016; 185:217-28. [PMID: 26930381 DOI: 10.1667/rr4284.s1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This commentary summarizes studies showing risk of basal cell carcinoma (BCC) development in relationship to environmental, occupational and therapeutic exposure to ionizing radiation (IR). BCC, the most common type of human cancer, is driven by the aberrant activation of hedgehog (Hh) signaling. Ptch, a tumor suppressor gene of Hh signaling pathway, and Smoothened play a key role in the development of radiation-induced BCCs in animal models. Epidemiological studies provide evidence that humans exposed to radiation as observed among the long-term, large scale cohorts of atomic bomb survivors, bone marrow transplant recipients, patients with tinea capitis and radiologic workers enhances risk of BCCs. Overall, this risk is higher in Caucasians than other races. People who were exposed early in life develop more BCCs. The enhanced IR correlation with BCC and not other common cutaneous malignancies is intriguing. The mechanism underlying these observations remains undefined. Understanding interactions between radiation-induced signaling pathways and those which drive BCC development may be important in unraveling the mechanism associated with this enhanced risk. Recent studies showed that Vismodegib, a Smoothened inhibitor, is effective in treating radiation-induced BCCs in humans, suggesting that common strategies are required for the intervention of BCCs development irrespective of their etiology.
Collapse
Affiliation(s)
- Changzhao Li
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohammad Athar
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
68
|
Ten Cate T, van Wely M, Gehlmann H, Mauti M, Camaro C, Reifart N, Suryapranata H, de Boer MJ. Novel X-ray image noise reduction technology reduces patient radiation dose while maintaining image quality in coronary angiography. Neth Heart J 2015; 23:525-30. [PMID: 26369914 PMCID: PMC4608924 DOI: 10.1007/s12471-015-0742-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AIMS The consequences of high radiation dose for patient and staff demand constant improvements in X-ray dose reduction technology. This study assessed non-inferiority of image quality and quantified patient dose reduction in interventional cardiology for an anatomy-specific optimised cine acquisition chain combined with advanced real-time image noise reduction algorithms referred to as 'study cine', compared with conventional angiography. METHODS Fifty patients underwent two coronary angiographic acquisitions: one with advanced image processing and optimised exposure system settings to enable dose reduction (study cine) and one with standard image processing and exposure settings (reference cine). The image sets of 39 patients (18 females, 21 males) were rated by six experienced independent reviewers, blinded to the patient and image characteristics. The image pairs were randomly presented. Overall 85 % of the study cine images were rated as better or equal quality compared with the reference cine (95 % CI 0.81-0.90). The median dose area product per frame decreased from 55 to 26 mGy.cm(2)/frame (53 % reduction, p < 0.001). CONCLUSION This study demonstrates that the novel X-ray imaging technology provides non-inferior image quality compared with conventional angiographic systems for interventional cardiology with a 53 % patient dose reduction.
Collapse
Affiliation(s)
- T Ten Cate
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands.
| | - M van Wely
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - H Gehlmann
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - M Mauti
- Philips Healthcare, Best, The Netherlands
| | - C Camaro
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - N Reifart
- Main-Taunus-Privatklinik, Bad Soden, Germany
| | - H Suryapranata
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - M J de Boer
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| |
Collapse
|
69
|
Bracken JA, Mauti M, Kim MS, Messenger JC, Carroll JD. A Radiation Dose Reduction Technology to Improve Patient Safety During Cardiac Catheterization Interventions. J Interv Cardiol 2015; 28:493-7. [DOI: 10.1111/joic.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- John A. Bracken
- University of Colorado Denver; Aurora Colorado
- Philips Healthcare; Markham, Ontario Canada
| | | | | | | | | |
Collapse
|
70
|
Giaccardi M, Del Rosso A, Guarnaccia V, Ballo P, Mascia G, Chiodi L, Colella A. Near-zero x-ray in arrhythmia ablation using a 3-dimensional electroanatomic mapping system: A multicenter experience. Heart Rhythm 2015; 13:150-6. [PMID: 26341606 DOI: 10.1016/j.hrthm.2015.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Radiation exposure related to conventional tachyarrhythmia radiofrequency catheter ablation (RFCA) carries small but not negligible stochastic and deterministic effects on health. These effects are cumulative and potentially more harmful in younger individuals. Nonfluoroscopic mapping systems can significantly reduce the radiological exposure and in some cases it can completely eliminate it. OBJECTIVE The aim of this study was to assess the safety, feasibility, and efficacy of a complete nonfluoroscopic approach for RFCA compared with ablation procedures performed under fluoroscopic guidance. METHODS RFCA was performed in 442 consecutive patients (mean age 58 ± 19 years). The first 145 patients (group 1) were treated only under fluoroscopic guidance, and the following 297 patients (group 2) were treated using a nonfluoroscopic electroanatomic mapping system (EnSite Velocity). RFCA was completely performed without fluoroscopy in 255 of 297 patients in group 2 (86%). RESULTS The acute success rate did not differ between group 1 and group 2 (97% vs 96%; P = .46), and there were no differences in either procedure time (87 ± 57 minutes vs 91 ± 52 minutes; P = .41) or complication rate. Fluoroscopic exposure in group 2 was significantly reduced in comparison with group 1 (14 ± 6 seconds vs 1159 ± 833 seconds; P < .0001). CONCLUSION Compared with the conventional fluoroscopic technique, the near-zero radiation (RX) approach provides similar outcomes and may significantly reduce or eliminate ionizing radiation exposure in RFCA. These reductions are achieved without altering the duration or compromising the safety and effectiveness of the procedure.
Collapse
Affiliation(s)
- Marzia Giaccardi
- Electrophysiology Unit, Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy.
| | - Attilio Del Rosso
- Electrophysiology Unit, Department of Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Vincenzo Guarnaccia
- Electrophysiology Unit, Department of Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Department of Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy
| | - Giuseppe Mascia
- Cardiology Unit, Department of Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy
| | - Leandro Chiodi
- Cardiology Unit, Department of Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy
| | - Andrea Colella
- Electrophysiology Unit, Department of Heart and Vessels, Careggi Hospital, Florence, Italy
| |
Collapse
|
71
|
Reeves RR, Ang L, Bahadorani J, Naghi J, Dominguez A, Palakodeti V, Tsimikas S, Patel MP, Mahmud E. Invasive Cardiologists Are Exposed to Greater Left Sided Cranial Radiation. JACC Cardiovasc Interv 2015; 8:1197-1206. [DOI: 10.1016/j.jcin.2015.03.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/24/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
|
72
|
Aagaard P, Natale A, Di Biase L. Robotic navigation for catheter ablation: benefits and challenges. Expert Rev Med Devices 2015; 12:457-69. [DOI: 10.1586/17434440.2015.1052406] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
73
|
Xie T, Lee C, Bolch WE, Zaidi H. Assessment of radiation dose in nuclear cardiovascular imaging using realistic computational models. Med Phys 2015; 42:2955-66. [PMID: 26127049 PMCID: PMC5148206 DOI: 10.1118/1.4921364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/24/2015] [Accepted: 05/08/2015] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Nuclear cardiology plays an important role in clinical assessment and has enormous impact on the management of a variety of cardiovascular diseases. Pediatric patients at different age groups are exposed to a spectrum of radiation dose levels and associated cancer risks different from those of adults in diagnostic nuclear medicine procedures. Therefore, comprehensive radiation dosimetry evaluations for commonly used myocardial perfusion imaging (MPI) and viability radiotracers in target population (children and adults) at different age groups are highly desired. METHODS Using Monte Carlo calculations and biological effects of ionizing radiation VII model, we calculate the S-values for a number of radionuclides (Tl-201, Tc-99m, I-123, C-11, N-13, O-15, F-18, and Rb-82) and estimate the absorbed dose and effective dose for 12 MPI radiotracers in computational models including the newborn, 1-, 5-, 10-, 15-yr-old, and adult male and female computational phantoms. RESULTS For most organs, (201)Tl produces the highest absorbed dose whereas (82)Rb and (15)O-water produce the lowest absorbed dose. For the newborn baby and adult patient, the effective dose of (82)Rb is 48% and 77% lower than that of (99m)Tc-tetrofosmin (rest), respectively. CONCLUSIONS (82)Rb results in lower effective dose in adults compared to (99m)Tc-labeled tracers. However, this advantage is less apparent in children. The produced dosimetric databases for various radiotracers used in cardiovascular imaging, using new generation of computational models, can be used for risk-benefit assessment of a spectrum of patient population in clinical nuclear cardiology practice.
Collapse
Affiliation(s)
- Tianwu Xie
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva 4 CH-1211, Switzerland
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, Maryland 20852
| | - Wesley E Bolch
- Departments of Nuclear & Radiological and Biomedical Engineering, University of Florida, Gainesville, Florida 32611
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva 4 CH-1211, Switzerland; Geneva Neuroscience Center, Geneva University, Geneva CH-1205, Switzerland; and Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, Netherlands
| |
Collapse
|
74
|
Harbron RW, Pearce MS, Salotti JA, McHugh K, McLaren C, Abernethy L, Reed S, O'Sullivan J, Chapple CL. Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study. Br J Radiol 2015; 88:20140852. [PMID: 25654205 DOI: 10.1259/bjr.20140852] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To gather data on radiation doses from fluoroscopically guided cardiac catheterization procedures in patients aged under 22 years at multiple centres and over a prolonged period in the UK. To evaluate and explain variation in doses. To estimate patient-specific organ doses and allow for possible future epidemiological analysis of associated cancer risks. METHODS Patient-specific data including kerma area product and screening times from 10,257 procedures carried out on 7726 patients at 3 UK hospitals from 1994 until 2013 were collected. Organ doses were estimated from these data using a dedicated dosimetry system based on Monte Carlo computer simulations. RESULTS Radiation doses from these procedures have fallen significantly over the past two decades. The organs receiving the highest doses per procedure were the lungs (median across whole cohort, 20.5 mSv), heart (19.7 mSv) and breasts (13.1 mSv). Median cumulative doses, taking into account multiple procedures, were 23.2, 22.2 and 16.7 mSv for these organs, respectively. Bone marrow doses were relatively low (median per procedure, 3.2 mSv; cumulative, 3.6 mSv). CONCLUSION Most modern cardiac catheterizations in children are moderately low-dose procedures. Technological advances appear to be the single most important factor in the fall in doses. Patients undergoing heart transplants undergo the most procedures. An epidemiological assessment of cancer risks following these procedures may be possible, especially using older data when doses were higher. ADVANCES IN KNOWLEDGE This is the first large-scale, patient-specific assessment of organ doses from these procedures in a young population.
Collapse
Affiliation(s)
- R W Harbron
- 1 The Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
75
|
|
76
|
Christopoulos G, Papayannis AC, Alomar M, Kotsia A, Michael TT, Rangan BV, Roesle M, Shorrock D, Makke L, Layne R, Grabarkewitz R, Haagen D, Maragkoudakis S, Mohammad A, Sarode K, Cipher DJ, Chambers CE, Banerjee S, Brilakis ES. Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization. Circ Cardiovasc Interv 2014; 7:744-50. [DOI: 10.1161/circinterventions.114.001974] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background—
The Radiation Reduction During Cardiac Catheterization Using Real-Time Monitoring study sought to examine the effect of a radiation detection device that provides real-time operator dose reporting through auditory feedback (Bleeper Sv; Vertec Scientific Ltd; Berkshire, UK) on patient dose and operator exposure during cardiac catheterization.
Methods and Results—
Between January 2012 and May 2014, 505 patients undergoing coronary angiography, percutaneous coronary intervention, or both were randomized to use (n=253) or no use (n=252) of the Bleeper Sv radiation monitor. Operator radiation exposure was measured in both groups using a second, silent radiation exposure monitoring device. Mean patient age was 65±8 years, most patients (99%) were men, and 30% had prior coronary artery bypass graft surgery. Baseline clinical characteristics were similar in the 2 study groups. Radial access was used in 18% and chronic total occlusion percutaneous coronary intervention constituted 7% of the total procedures. Median procedure time was 17 (12–27) minutes for diagnostic angiography, 42 (28–70) minutes for percutaneous coronary intervention, and 27 (14–51) minutes in the overall study population, with similar distribution between the study groups. First (9 [4–17] versus 14 [7–25] μSv;
P
<0.001) and second (5 [2–10] versus 7 [4–14] μSv;
P
<0.001) operator radiation exposure was significantly lower in the Bleeper Sv group. Use of the device did not result in a significant reduction in patient radiation dose. The effect of the Bleeper Sv device on operator radiation exposure was consistent among various study subgroups.
Conclusions—
Use of a real-time radiation monitoring device that provides auditory feedback can significantly reduce operator radiation exposure during cardiac catheterization.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01510353.
Collapse
Affiliation(s)
- Georgios Christopoulos
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Aristotelis C. Papayannis
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Mohammed Alomar
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Anna Kotsia
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Tesfaldet T. Michael
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Bavana V. Rangan
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Michele Roesle
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Deborah Shorrock
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Lorenza Makke
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Ronald Layne
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Rebecca Grabarkewitz
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Donald Haagen
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Spyros Maragkoudakis
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Atif Mohammad
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Karan Sarode
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Daisha J. Cipher
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Charles E. Chambers
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Subhash Banerjee
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| | - Emmanouil S. Brilakis
- From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.)
| |
Collapse
|
77
|
Kuon E, Felix SB, Weitmann K, Büchner I, Hummel A, Dörr M, Reffelmann T, Riad A, Busch MC, Empen K. ECG-gated coronary angiography enables submillisievert imaging in invasive cardiology. Herz 2014; 40 Suppl 3:247-53. [PMID: 25277222 DOI: 10.1007/s00059-014-4153-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The median dose area products (DAP) and effective doses (ED) of patients arising from coronary angiography (CA) are considerable: According the 2013 National German Registry, they amount to 19.8 Gy × cm(2) and 4.0 mSv, respectively. METHODS We investigated the feasibility of prospective electrocardiogram (ECG)-gated coronary angiography (CA)-a novel technique in invasive cardiology-with respect to possible reduction in irradiation effects. Instead of universally fix-rated radiographic acquisition within 7.5-15 frames/s, one single frame/heartbeat was triggered toward the diastolic moment immediately before atrial contraction (77 % of ECG-RR interval) most likely to provide motion-free and hence optimized resolution of the coronary tree. For 200 patients (body mass index 27.8 kg/m(2), age 67.5 years, male 55 %, 68 bpm) undergoing ECG-gated CA, we measured various median (interquartile range) parameters for radiation exposure. RESULTS The total DAP was 0.64 (0.46-1.00), radiographic fraction was 0.30 (0.19-0.43), and fluoroscopic fraction was 0.35 (0.21-0.57) Gy × cm(2). Radiographic imaging occurred within 21.7 s (17.1-26.3), with 25 frames (20-30) over the course of 7 runs (6-8). Fluoroscopy time was 119 s (94-141). Radiographic DAP was 12.6 mGy × cm(2)/frame and 13.8 mGy × cm(2)/s. Fluoroscopic DAP was 0.8 mGy × cm(2)/pulse and 3.1 mGy × cm(2)/s. Patient reference point air kerma was 17.0 mGy (11.1-28.1) and contrast volume was 70 ml (60-85). CONCLUSION In conclusion, invasive ECG-gated coronary imaging is feasible in clinical routine and enables patient EDs of approx. 3 % of typical values in invasive cardiology: 0.13 mSv (0.09-0.20).
Collapse
Affiliation(s)
- E Kuon
- Department of Cardiology, Klinik Fraenkische Schweiz, Feuersteinstr. 2, 91320, Ebermannstadt, Germany,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Zhang W, Jia N, Su J, Lin J, Peng F, Niu W. The comparison between robotic and manual ablations in the treatment of atrial fibrillation: a systematic review and meta-analysis. PLoS One 2014; 9:e96331. [PMID: 24800808 PMCID: PMC4011747 DOI: 10.1371/journal.pone.0096331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/06/2014] [Indexed: 12/30/2022] Open
Abstract
Objective To examine in what aspects and to what extent robotic ablation is superior over manual ablation, we sought to design a meta-analysis to compare clinical outcomes between the two ablations in the treatment of atrial fibrillation. Methods and Results A literature search was conducted of PubMed and EMBASE databases before December 1, 2013. Data were extracted independently and in duplicate from 8 clinical articles and 792 patients. Effect estimates were expressed as weighted mean difference (WMD) or odds ratio (OR) and the accompanied 95% confidence interval (95% CI). Pooling the results of all qualified trials found significant reductions in fluoroscopic time (minutes) (WMD; 95% CI; P: -8.9; -12.54 to -5.26; <0.0005) and dose-area product (Gy×cm2) (WMD; 95% CI; P: -1065.66; -1714.36 to -416.96; 0.001) for robotic ablation relative to manual ablation, with evident heterogeneity (P<0.0005) and a low probability of publication bias. In subgroup analysis, great improvement of fluoroscopic time in patients with robotic ablation was consistently presented in both randomized and nonrandomized clinical trials, particularly in the former (WMD; 95% CI; P: -12.61; -15.13 to -10.09; <0.0005). Success rate of catheter ablation was relatively higher in patients with robotic ablation than with manual ablation (OR; 95% CI; P: 3.45; 0.24 to 49.0; 0.36), the difference yet exhibiting no statistical significance. Conclusions This study confirmed and extended previous observations by quantifying great reductions of fluoroscopic time and dose-area product in patients referred for robotic ablation than for manual ablation in the treatment of atrial fibrillation, especially in randomized clinical trials.
Collapse
Affiliation(s)
- Wenli Zhang
- Department of Cardiology, Fuzhou General Hospital of Nanjing Command, PLA, Fujian Medical University, Fuzhou, Fujian, China
| | - Nan Jia
- Department of Cardiology, The Fourth People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Jinzi Su
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jinxiu Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- * E-mail: (FP); (WN)
| | - Wenquan Niu
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail: (FP); (WN)
| |
Collapse
|
79
|
Heidbuchel H, Wittkampf FHM, Vano E, Ernst S, Schilling R, Picano E, Mont L, Jais P, de Bono J, Piorkowski C, Saad E, Femenia F. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace 2014; 16:946-64. [PMID: 24792380 DOI: 10.1093/europace/eut409] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more complex procedures have the risk to increase the radiation exposure, both for the patients and the operators. The professional lifetime attributable excess cancer risk may be around 1 in 100 for the operators, the same as for a patient undergoing repetitive complex procedures. Moreover, recent reports have also hinted at an excess risk of brain tumours among interventional cardiologists. Apart from evaluating the need for and justifying the use of radiation to assist their procedures, physicians have to continuously explore ways to reduce the radiation exposure. After an introduction on how to quantify the radiation exposure and defining its current magnitude in electrophysiology compared with the other sources of radiation, this position paper wants to offer some very practical advice on how to reduce exposure to patients and staff. The text describes how customization of the X-ray system, workflow adaptations, and shielding measures can be implemented in the cath lab. The potential and the pitfalls of different non-fluoroscopic guiding technologies are discussed. Finally, we suggest further improvements that can be implemented by both the physicians and the industry in the future. We are confident that these suggestions are able to reduce patient and operator exposure by more than an order of magnitude, and therefore think that these recommendations are worth reading and implementing by any electrophysiological operator in the field.
Collapse
Affiliation(s)
- Hein Heidbuchel
- Department of Cardiovascular Medicine, University Hospital Gasthuisberg, University of Leuven, 3000 Leuven, Belgium
| | - Fred H M Wittkampf
- Heart Lung Center, Department of Cardiology, University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Eliseo Vano
- Radiology Department, Medicine School, Complutense University and San Carlos Hospital, IdISSC, Madrid 28040, Spain
| | - Sabine Ernst
- NIHR Biomedical Research Unit and Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, SW3 6NP, London, UK
| | - Richard Schilling
- Biomedical Research Unit, Bart's Health NHS Trust and the William Harvey Research Institute, London EC1A 7BE, UK
| | - Eugenio Picano
- CNR Biomedical Sciences Department, Institute of Clinical Physiology, 56124, Pisa, Italy
| | - Lluis Mont
- Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia 08036, Spain
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Joseph de Bono
- Queen Elizabeth Medical Centre, Department of Cardiology, Birmingham, United Kingdom
| | | | - Eduardo Saad
- Hospital Pró-Cardíaco, Setor de Arritmia Invasiva, Rio de Janeiro, Brazil
| | - Francisco Femenia
- Biomedical Research Unit, Bart's Health NHS Trust and the William Harvey Research Institute, London EC1A 7BE, UK
| |
Collapse
|
80
|
Effectiveness of low rate fluoroscopy at reducing operator and patient radiation dose during transradial coronary angiography and interventions. JACC Cardiovasc Interv 2014; 7:567-74. [PMID: 24746649 DOI: 10.1016/j.jcin.2014.02.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/13/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study sought to determine the efficacy of low rate fluoroscopy at 7.5 frames/s (FPS) versus conventional 15 FPS for reduction of operator and patient radiation dose during diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) via the transradial approach (TRA). BACKGROUND TRA for cardiac catheterization is potentially associated with increased radiation exposure. Low rate fluoroscopy has the potential to reduce radiation exposure. METHODS Patients undergoing TRA diagnostic angiography ± ad-hoc PCI were randomized to fluoroscopy at 7.5 FPS versus 15 FPS prior to the procedure. Both 7.5 and 15 FPS fluoroscopy protocols were configured with a fixed dose per pulse of 40 nGy. Primary endpoints were operator radiation dose (measured with dosimeter attached to the left side of the thyroid shield in μSievert [μSv]), patient radiation dose (expressed as dose-area product in Gy·cm(2)), and fluoroscopy time. RESULTS From October 1, 2012 to August 30, 2013, from a total of 363 patients, 184 underwent DCA and 179 underwent PCI. Overall, fluoroscopy at 7.5 FPS compared with 15 FPS was associated with a significant reduction in operator dose (30% relative reduction [RR], p < 0.0001); and in patient's dose-area product (19% RR; p = 0.022). When stratified by procedure type, 7.5 FPS compared with 15 FPS was associated with significant reduction in operator dose during both DCA (40% RR; p < 0.0001) and PCI (28% RR; p = 0.0011). Fluoroscopy at 7.5 FPS, compared with 15 FPS, was also associated with substantial reduction in patients' dose-area product during DCA (26% RR; p = 0.0018) and during PCI (19% RR; p = 0.13). Fluoroscopy time was similar in 7.5 FPS and 15 FPS groups for DCA (3.4 ± 2.0 min vs. 4.0 ± 4.7 min; p = 0.42) and PCI (11.9 ± 8.4 min vs. 13.3 ± 9.7 min; p = 0.57), respectively. CONCLUSIONS Fluoroscopy at 7.5 FPS, compared with 15 FPS, is a simple and effective method in reducing operator and patient radiation dose during TRA DCA and PCI.
Collapse
|
81
|
Morvan G. L’imagerie médicale diagnostique est-elle iatrogène ? BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2014. [DOI: 10.1016/s0001-4079(19)31283-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
82
|
Drews T, Pasic M, Juran R, Unbehaun A, Dreysse S, Kukucka M, Mladenow A, Hetzer R, Buz S. Safety considerations during transapical aortic valve implantation. Interact Cardiovasc Thorac Surg 2014; 18:574-9. [DOI: 10.1093/icvts/ivt560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
83
|
Picano E, Vano E, Rehani MM, Cuocolo A, Mont L, Bodi V, Bar O, Maccia C, Pierard L, Sicari R, Plein S, Mahrholdt H, Lancellotti P, Knuuti J, Heidbuchel H, Di Mario C, Badano LP. The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. Eur Heart J 2014; 35:665-72. [DOI: 10.1093/eurheartj/eht394] [Citation(s) in RCA: 251] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
84
|
Latest-generation catheterization systems enable invasive submillisievert coronary angiography. Herz 2013; 40 Suppl 3:233-9. [PMID: 24317020 DOI: 10.1007/s00059-013-4015-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/05/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The radiation risk of patients undergoing invasive cardiology remains considerable and includes skin injuries and cancer. To date, submillisievert coronary angiography has not been considered feasible. PATIENTS AND METHODS In 2011, we compared results from 100 consecutive patients undergoing elective coronary angiography using the latest-generation flat-panel angiography system (FPS) with results from examinations by the same operator using 106 historic controls with a conventional image-intensifier system (IIS) that was new in 2002. RESULTS The median patient exposure parameters were measured as follows: dose-area product (DAP) associated with radiographic cine acquisitions (DAP(R)) and fluoroscopy (DAP(F)) scenes, radiographic frames and runs, and cumulative exposure times for radiography and fluoroscopy. On the FPS as compared to the traditional IIS, radiographic detector entrance dose levels were reduced from 164 to 80 nGy/frame and pulse rates were lowered from 12.5/s to 7.5/s during radiography and from 25/s to 4/s during fluoroscopy. The cardiologist's performance patterns remained comparable over the years: fluoroscopy time was constant and radiography time even slightly increased. Overall patient DAP decreased from 7.0 to 2.4 Gy × cm(2); DAP(R), from 4.2 to 1.7 Gy × cm(2); and DAP(F), from 2.8 to 0.6 Gy × cm(2). Time-adjusted DAP(R)/s decreased from 436 to 130 mGy × cm(2) and DAP(F)/s, from 21.6 to 4.4 mGy × cm(2). Cumulative patient skin dose with the FPS amounted to 67 mGy, and the median (interquartile range) of effective dose was 0.5 (0.3 … 0.7) mSv. CONCLUSION Consistent application of radiation-reducing techniques with the latest-generation flat-panel systems enables submillisievert coronary angiography in invasive cardiology.
Collapse
|
85
|
Bakht MK, Hosseini V, Honarpisheh H. Radiolabeled nanoceria probes may reduce oxidative damages and risk of cancer: A hypothesis for radioisotope-based imaging procedures. Med Hypotheses 2013; 81:1164-8. [DOI: 10.1016/j.mehy.2013.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/27/2013] [Accepted: 10/08/2013] [Indexed: 11/27/2022]
|
86
|
Miglioranza MH, Gargani L, Sant'Anna RT, Rover MM, Martins VM, Mantovani A, Weber C, Moraes MA, Feldman CJ, Kalil RAK, Sicari R, Picano E, Leiria TLL. Lung ultrasound for the evaluation of pulmonary congestion in outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography. JACC Cardiovasc Imaging 2013; 6:1141-51. [PMID: 24094830 DOI: 10.1016/j.jcmg.2013.08.004] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/19/2013] [Accepted: 08/19/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this study was to define the performance of lung ultrasound (LUS) compared with clinical assessment, natriuretic peptides, and echocardiography, to evaluate decompensation in patients with systolic heart failure (HF) in an outpatient clinic. BACKGROUND Evaluation of pulmonary congestion in chronic HF is challenging. LUS has been recently proposed as a reliable tool for the semiquantification of extravascular lung water through assessment of B-lines. METHODS This was a cohort study of patients with moderate to severe systolic HF. Receiver-operating characteristic (ROC) analyses were performed to compare LUS with a previously validated clinical congestion score (CCS), amino-terminal portion of B-type natriuretic peptide (NT-proBNP), E/e' ratio, chest x-ray, and 6-min walk test. RESULTS Ninety-seven patients were enrolled. Decompensation was present in 57.7% of patients when estimated by CCS, 68% by LUS, 53.6% by NT-proBNP, and 65.3% by E/e' ≥15. The number of B-lines was correlated to NT-proBNP (r = 0.72; p < 0.0001), E/e' (r = 0.68; p < 0.0001), and CCS (r = 0.43; p < 0.0001). In ROC analyses, considering as reference for decompensation a combined method (E/e' ≥ 15 and/or NT-proBNP >1,000 pg/ml), LUS yielded a C-statistic of 0.89 (95% confidence interval: 0.82 to 0.96), providing the best accuracy with a cutoff ≥ 15 B-lines (sensitivity 85%, specificity 83%). A systematic approach using CCS, E/e', NT-proBNP, chest x-ray, and 6-min walk test in different combinations as reference for decompensation also corroborated this cutoff and found a similar accuracy for LUS. CONCLUSIONS In an HF outpatient clinic, B-lines were significantly correlated with more established parameters of decompensation. A B-line ≥15 cutoff could be considered for a quick and reliable assessment of decompensation in outpatients with HF.
Collapse
|
87
|
Physicians' Radiation Exposure in the Catheterization Lab. JACC Cardiovasc Interv 2013; 6:1095-102. [DOI: 10.1016/j.jcin.2013.05.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/26/2013] [Accepted: 05/09/2013] [Indexed: 11/17/2022]
|
88
|
Borghini A, Luca Gianicolo EA, Picano E, Andreassi MG. Ionizing radiation and atherosclerosis: Current knowledge and future challenges. Atherosclerosis 2013; 230:40-7. [DOI: 10.1016/j.atherosclerosis.2013.06.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/13/2013] [Accepted: 06/12/2013] [Indexed: 11/16/2022]
|
89
|
Cumulative radiation exposure and cancer risk of patients with ischemic heart diseases from diagnostic and therapeutic imaging procedures. Eur J Radiol 2013; 82:1926-32. [PMID: 23954016 DOI: 10.1016/j.ejrad.2013.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/27/2013] [Accepted: 07/17/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To present a detailed analysis of the cumulative radiation exposure and cancer risk of patients with ischemic heart diseases (IHD) from diagnostic and therapeutic imaging. METHODS For 1219 IHD patients, personal and examination data were retrieved from the information systems of a university hospital. For each patient, cumulative organ doses and the corresponding effective dose (E) resulting from all imaging procedures performed within 3 months before and 12 months after the date of the diagnosis were calculated. The cumulative lifetime attributable risk (LAR) of the patients to be diseased by radiation-related cancer was estimated using sex-, age-, and organ-specific risk models. RESULTS Among the 3870 procedures performed in the IHD patients, the most frequent were radiographic examinations (52.4%) followed by coronary catheter angiographies and percutaneous cardiac interventions (41.3%), CT scans (3.9%), and perfusion SPECT (2.3%). 87% of patient exposure resulted from heart catheter procedures. E and LAR were significantly higher in males than females (average, 13.3 vs. 10.3 mSv and 0.09 vs. 0.07%, respectively). Contrary to the effective dose, the cancer risk decreased markedly for both sexes with increasing age. CONCLUSIONS Although IHD patients were partially exposed to considerable amounts of radiation, estimated LARs were small as compared to their baseline risk to develop cancer in the remaining life.
Collapse
|
90
|
Ascione L, Carlomagno G, Sordelli C, Iengo R, Monda V, Severino S, Merenda R, D'Andrea A, Caso P. Dipyridamole coronary flow reserve stratifies prognosis in acute coronary syndrome patients without left anterior descending disease. Eur Heart J Cardiovasc Imaging 2013; 14:858-64. [DOI: 10.1093/ehjci/jes305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
91
|
Reduction of Exposure of Patients and Staff to Radiation During Fluoroscopically Guided Interventional Procedures. CURRENT RADIOLOGY REPORTS 2012. [DOI: 10.1007/s40134-012-0001-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
92
|
Abstract
PURPOSE OF REVIEW To evaluate the relationship between cardiac fat accumulation and insulin resistance. We discuss the current knowledge regarding the different techniques for measuring, in vivo in humans, cardiac fat deposition, the effects of systemic and myocardial insulin resistance and the clinical relevance of the relation between atherosclerosis and cardiac fat in conditions of insulin resistance. RECENT FINDINGS In humans, fat accumulates mainly around the heart, as epicardial, perivascular and intrathoracic fat, but also inside the cardiomyocytes. All these cardiac fat depots have been shown to be markers of cardiac lipotoxicity, mitochondrial dysfunction, inflammation and local and systemic insulin resistance as well as of atherosclerosis and cardiac dysfunction. SUMMARY Although cardiac fat is associated with impairment in heart metabolism and cardiac dysfunction, the interplay among cardiac fat accumulation, insulin resistance and cardiac dysfunction remains to be fully established.
Collapse
Affiliation(s)
- Amalia Gastaldelli
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | | | | |
Collapse
|
93
|
Coronary Flow Reserve During Dipyridamole Stress Echocardiography Predicts Mortality. JACC Cardiovasc Imaging 2012; 5:1079-85. [DOI: 10.1016/j.jcmg.2012.08.007] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/27/2012] [Accepted: 08/20/2012] [Indexed: 11/22/2022]
|
94
|
|
95
|
|
96
|
Bibliography. Cardiovascular medicine (CM). Current world literature. Curr Opin Pediatr 2012; 24:656-60. [PMID: 22954957 DOI: 10.1097/mop.0b013e328358bc78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
97
|
Current world literature. Curr Opin Cardiol 2012; 27:556-64. [PMID: 22874129 DOI: 10.1097/hco.0b013e32835793f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
98
|
Sabatino L, Picano E, Andreassi MG. Telomere shortening and ionizing radiation: A possible role in vascular dysfunction? Int J Radiat Biol 2012; 88:830-9. [DOI: 10.3109/09553002.2012.709307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
99
|
Casartelli M, Bombardini T, Simion D, Gaspari MG, Procaccio F. Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart. Cardiovasc Ultrasound 2012; 10:25. [PMID: 22721412 PMCID: PMC3439356 DOI: 10.1186/1476-7120-10-25] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 06/12/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heart transplantation is limited by a severe donor organ shortage. Potential donors with brain death (BD) and left ventricular dysfunction due to neurogenic stunning are currently excluded from donation--although such abnormalities can be reversible with aggressive treatment including Hormonal Treatment (HT) and deferred organ retrieval. AIM To assess the recovery of left ventricular dysfunction in potential brain-dead donors with hemodynamic instability treated by aggressive treatment and HT. METHODS In a single-center, observational study design, we evaluated 15 consecutive brain-dead potential donors (DBD) (8 males, age = 48 ± 15 years) with hemodynamic instability. All underwent standard hemodynamic monitoring and transthoracic 2-dimensional echo (2-DE) with assessment of Ejection Fraction (EF). Measurements were obtained before BD and after BD within 6 h, at 24 h and within 48 h. HT (with insulin, methylprednisolone, vasopressin and T3) was started as soon as possible to treat hemodynamic instability and avoid administration of norepinephrine (NE). Eligible potential heart donors underwent coronary angiography. RESULTS After HT, we observed a normalization of hemodynamic conditions with improvement of mean arterial pressure (pre = 68 ± 8 mmHg vs post = 83 ± 13 mmHg, p < .01), cardiac index (pre = 2.4 ± 0.6 L/min/m2 vs post 3.7 ± 1.2 L/min/m2, p < .05), EF (pre = 48 ± 15 vs post = 59 ± 3%, p < .01) without administration of norepinephrine (NE) in 67% of cases. Five potential donors were excluded from donation (opposition, n = 3, tubercolosis n = 1, malignancy n = 1). At pre-harvesting angiography, coronary artery stenosis was present in 2 of the 10 consented donors. Eight hearts were uneventfully transplanted. No early graft failure occurred and all eight recipients were alive at 6-month follow-up. CONCLUSION In BD donors, intensive treatment including HT is associated with improvement of regional and global LV function and reverse remodeling detectable by transthoracic 2DE. Donor hearts with recovered LV function may be eligible for uneventful heart transplant. The wait (in brain death), treat (with HT) and see (with 2D echo) strategy can help rescue organs suitable for heart donation.
Collapse
|
100
|
Low Quality and Lack of Clarity of Current Informed Consent Forms in Cardiology. JACC Cardiovasc Imaging 2012; 5:649-55. [DOI: 10.1016/j.jcmg.2012.03.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 02/22/2012] [Accepted: 03/22/2012] [Indexed: 11/20/2022]
|