1
|
Anthony G, Liang Y, Zhao X. Performance evaluation of two interventional fluoroscope suites for cardiovascular imaging. J Appl Clin Med Phys 2022; 23:e13741. [PMID: 35950644 DOI: 10.1002/acm2.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 11/09/2022] Open
Abstract
Interventional cardiology involves catheter-based treatment of heart disease, generally through fluoroscopically guided interventional procedures. Patients can be subject to considerable radiation dose due to prolonged fluoroscopy time and radiographic exposure, and therefore efforts to minimize patient dose should always be undertaken. Developing standardized, effective quality control programs for these systems is a difficult task owing to cross-vendor differences and automated control of imaging protocols. Furthermore, analyses of radiation dose should be performed in the context of its associated effects on image quality. The aim of the study is to investigate radiation dose and image quality in two fluoroscopic systems used for interventional cardiology procedures. Image quality was assessed in terms of spatial resolution and modulation transfer function, signal-to-noise and contrast-to-noise ratios, and spatial-temporal resolution of fluoroscopy and cineradiography images with phantoms simulating various patient thicknesses under routine cardiology protocols. The entrance air kerma (or air kerma rate) was measured and used to estimate entrance surface dose (or dose rate) in the phantoms.
Collapse
Affiliation(s)
- Gregory Anthony
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, Indiana, USA
| | - Yun Liang
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Xuandong Zhao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
2
|
Stocker TJ, Abdel-Wahab M, Möllmann H, Deseive S, Massberg S, Hausleiter J. Trends and predictors of radiation exposure in percutaneous coronary intervention: the PROTECTION VIII study. EUROINTERVENTION 2022; 18:e324-e332. [PMID: 35076020 PMCID: PMC9912963 DOI: 10.4244/eij-d-21-00856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is indispensable in cardiology; however, exposure to potentially harmful ionising radiation remains a concern. AIMS This study was designed to assess the PCI-related radiation dose over the last decade and to identify predictors of increased dose exposure. METHODS The PROcedural radiaTion dose Exposure in percutaneous Coronary intervenTION (PROTECTION VIII) study included all PCIs reported to a German quality assurance programme between 2008 and 2018. Dose area product (DAP) and radiation time were analysed. Effective dose (ED) was estimated (ED=DAP*k; conversion coefficient k=0.0022 mSv/cGy*cm2). Multivariate linear regression analysis was used to identify predictors associated with a clinically relevant increase of radiation dose (ED ≥1 mSv). RESULTS We enrolled 3,704,986 patients undergoing PCI (median age 70 years, 30% female). Indications were chronic coronary syndrome (37.5%), unstable angina pectoris and non-ST-segment elevation myocardial infarction (non-STEMI; 33.2%) and STEMI (18.5%). Median DAP was 4,203 (interquartile range [IQR] 2,313-7,300) cGy*cm, ED was 9.2 mSv and median radiation time was 9.2 (IQR 5.8-15.0) min. Within the 10-year period, radiation exposure was reduced by 36% (p<0.001) and resulted in a median DAP of 3,070 cGy*cm (ED 6.8 mSv) in 2018. A significant 5.3-fold variability of median DAP was observed between catheterisation laboratories (p<0.001). We identified patient-related (gender, coronary artery bypass graft surgery, heart failure) and procedure-related (coronary occlusion PCI, ostial lesion PCI, left main PCI, multivessel PCI) predictors of increased radiation dose (all p<0.001). CONCLUSIONS This radiation dose survey demonstrates a considerable reduction of PCI radiation exposure during the last decade. However, large variability between catheterisation laboratories underlines the need for further radiation dose reduction.
Collapse
Affiliation(s)
- Thomas J. Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistraβe 15, 81377 Munich, Germany
| | | | - Helge Möllmann
- Department of Internal Medicine, Medizinische Klinik 1, St. Johannes-Hospital, Dortmund, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany,European Alliance for Medical Radiation Protection Research (EURAMED): The EURAMED rocc-n-roll project (www.euramed.eu)
| |
Collapse
|
3
|
Cheney AE, Vincent LL, McCabe JM, Kearney KE. Pregnancy in the Cardiac Catheterization Laboratory: A Safe and Feasible Endeavor. Circ Cardiovasc Interv 2021; 14:e009636. [PMID: 33877865 DOI: 10.1161/circinterventions.120.009636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Concerns over radiation exposure are ubiquitous to all interventional cardiologists; however, fear of exposure during childbearing years disproportionately deters women from entering the field. This review summarizes the available data on occupational radiation exposure during pregnancy with an emphasis on radiation quantification, the impact of exposure at various stages of fetal development, societal recommendations for safe levels of exposure during gestation, threshold levels necessary to induce fetal harm, and safe practices for the pregnant interventionalist. Reconciling the available information, we conclude that pregnancy in the cardiac catheterization laboratory is both safe and feasible. This review also highlights new technologies that may augment standard radiation safety techniques and are of particular interest to the pregnant interventional cardiologist. Finally, we propose steps to improve female representation in this field, underscoring the importance of a sex-balanced workforce.
Collapse
Affiliation(s)
- Amy E Cheney
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle
| | - Logan L Vincent
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle
| | - James M McCabe
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle
| | - Kathleen E Kearney
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle
| |
Collapse
|
4
|
Vemmou E, Alaswad K, Khatri JJ, Nikolakopoulos I, Karacsonyi J, Xenogiannis I, Karmpaliotis D, Garcia S, Burke MN, Brilakis ES. Patient Radiation Dose During Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2020; 13:e009412. [DOI: 10.1161/circinterventions.120.009412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Evangelia Vemmou
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
| | | | | | - Ilias Nikolakopoulos
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
| | - Judit Karacsonyi
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
| | - Iosif Xenogiannis
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
| | - Dimitri Karmpaliotis
- Center for Interventional Vascular Therapy, Columbia University, Medical Center, New York Presbyterian Hospital, New York City (D.K.)
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (S.G., M.N.B., E.S.B.)
| | - M. Nicholas Burke
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (S.G., M.N.B., E.S.B.)
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (S.G., M.N.B., E.S.B.)
| |
Collapse
|
5
|
Madder RD, Dixon SR, Seth M, Lee D, Earl T, Hill T, Shah I, Gurm HS. Institutional Variability in Patient Radiation Doses ≥5 Gy During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2020; 13:846-856. [DOI: 10.1016/j.jcin.2019.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022]
|
6
|
da Silva DA, Maia AF, Machado R, Freitas VLSDM, Pinheiro RDC, Franco NFA, Kremer DW, Navarro MV. Patient doses in cardiac catheterisation in Santa Catarina, Brazil. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Szarfer J, Albornoz F, Alonso A, Yurko V, Blanco F, Blanco R, Indavere A, Gigena G, Gagliardi J, Escudero AG. Is Dual-Axis Rotational Coronary Angiography Radiation Dose Reduction Achievable in a Population with 100% Suspected Coronary Artery Disease? A Randomized Trial. J Med Imaging Radiat Sci 2020; 51:241-246. [PMID: 31980416 DOI: 10.1016/j.jmir.2019.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have shown a reduction in radiation dose and contrast volume using dual-axis rotational coronary angiography (DARCA), but this has not been replicated in a population with 100% coronary artery disease (CAD). OBJECTIVE To find if DARCA dose reduction is achievable in this population, we sought to compare the radiation dose, contrast volume, and procedure time between DARCA and conventional coronary angiography (CCA) techniques in a setting characterized by a prevalence of 100% suspected coronary artery disease. METHODS An all-comer, prospective, randomized, open-label trial was conducted. Cine acquisition dose-area product (DAP), cumulative air kerma (AK), effective dose (E), fluoroscopic time, contrast volume, AK, cine acquisition DAP (CADAP), fluoroscopic DAP (F-DAP), and total DAP were compared between DARCA and CCA groups. RESULTS We included 503 consecutive patients with suspected CAD. 252 were assigned to DARCA and 251 to CCA. Stable coronary artery disease was reported in 465 cases and non-ST elevation acute coronary syndrome in 38. Mean age: 61.88 ± 11.2 years, male gender 70.2%. DARCA arm patients showed lower total E dose (6.85 [4.55-10.83] vs. 7.91 [5.58-11.94] Sv; P = .0023), and cine E (3.00 [2.00-4.00] vs. 4.00 [3.00-5.00] Sv; P < .0001). Total DAP was also lower (40.3 [26.8-63.7] vs. 46.5 [32.8-70.2] Gycm2; P = .0023), as a consequence of a lower CADAP (16.3 [10.5-22.9] vs. 23.4 [17.4-32.0] Gycm2; P < .0001), with lower AK (367 [248-1497] vs. 497 [381-1827] mGy; P < .0001), with less contrast medium used (90 [60.0-106.0] vs. 100 [75.0-120.0] mL; P = .014). CONCLUSION In a population with 100% suspected coronary artery disease, DARCA provides accurate information required in CAD, is safe, and results in a significant decrease in contrast material volume and radiation dose compared with CCA. The required extra projections did not neutralize the DARCA radiation dose and contrast volume reduction achievements.
Collapse
Affiliation(s)
- Jorge Szarfer
- Chief Coronary Care Unit, Cardiology Division, Hospital Argerich, Buenos Aires, Argentina.
| | - Federico Albornoz
- Cat. Lab, Cardiology Division, Hospital Argerich, Buenos Aires, Argentina
| | - Analía Alonso
- Cat. Lab, Cardiology Division, Hospital Argerich, Buenos Aires, Argentina
| | - Vielka Yurko
- Cat. Lab, Cardiology Division, Hospital Argerich, Buenos Aires, Argentina
| | - Federico Blanco
- Cat. Lab, Cardiology Division, Hospital Argerich, Buenos Aires, Argentina
| | - Rodrigo Blanco
- Cat. Lab, Cardiology Division, Hospital Argerich, Buenos Aires, Argentina
| | - Agustín Indavere
- Cat. Lab, Cardiology Division, Hospital Argerich, Buenos Aires, Argentina
| | - Gerardo Gigena
- Chief Cat. Lab, Cardiology Division, Hospital Argerich, Buenos Aires, Argentina
| | - Juan Gagliardi
- Chief Cardiology Division, Hospital Argerich, Buenos Aires, Argentina
| | | |
Collapse
|
8
|
Ison GR, Allahwala U, Weaver JC. Radiation Management in Coronary Angiography: Percutaneous Coronary Intervention for Chronic Total Occlusion at the Frontier. Heart Lung Circ 2019; 28:1501-1509. [DOI: 10.1016/j.hlc.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/10/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
|
9
|
Ahmad W, Hasselmann HC, Galas N, Majd P, Brunkwall S, Brunkwall JS. Image fusion using the two-dimensional-three-dimensional registration method helps reduce contrast medium volume, fluoroscopy time, and procedure time in hybrid thoracic endovascular aortic repairs. J Vasc Surg 2019; 69:1003-1010. [DOI: 10.1016/j.jvs.2018.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022]
|
10
|
Madder RD, VanOosterhout S, Mulder A, Ten Brock T, Clarey AT, Parker JL, Jacoby ME. Patient Body Mass Index and Physician Radiation Dose During Coronary Angiography. Circ Cardiovasc Interv 2019; 12:e006823. [DOI: 10.1161/circinterventions.118.006823] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ryan D. Madder
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | | | - Abbey Mulder
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | - Taylor Ten Brock
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | - Austin T. Clarey
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | - Jessica L. Parker
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | - Mark E. Jacoby
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| |
Collapse
|
11
|
|
12
|
Noise reduction technology reduces radiation dose in chronic total occlusions percutaneous coronary intervention: a propensity score-matched analysis. Int J Cardiovasc Imaging 2018; 34:1185-1192. [DOI: 10.1007/s10554-018-1343-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/21/2018] [Indexed: 10/24/2022]
|
13
|
McNeice AH, Brooks M, Hanratty CG, Stevenson M, Spratt JC, Walsh SJ. A retrospective study of radiation dose measurements comparing different cath lab X-ray systems in a sample population of patients undergoing percutaneous coronary intervention for chronic total occlusions. Catheter Cardiovasc Interv 2018; 92:E254-E261. [DOI: 10.1002/ccd.27541] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew H. McNeice
- Department of Cardiology; Belfast Health and Social Care Trust, c/o Level 9, Belfast City Hospital, Lisburn Road; Belfast BT9 7AB Northern Ireland
| | - Matthew Brooks
- Department of Cardiology; Edinburgh Royal Infirmary; Edinburgh, Scotland
| | - Colm G. Hanratty
- Department of Cardiology; Belfast Health and Social Care Trust, c/o Level 9, Belfast City Hospital, Lisburn Road; Belfast BT9 7AB Northern Ireland
| | - Michael Stevenson
- Department of Epidemiology & Public Health; Queen's University, University Road; Belfast Northern Ireland
| | - James C. Spratt
- Department of Cardiology; Edinburgh Royal Infirmary; Edinburgh, Scotland
- Forth Valley Hospital; Larbert Scotland
| | - Simon J. Walsh
- Department of Cardiology; Belfast Health and Social Care Trust, c/o Level 9, Belfast City Hospital, Lisburn Road; Belfast BT9 7AB Northern Ireland
| |
Collapse
|
14
|
Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Department of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
15
|
Sullivan PM, Harrison D, Badran S, Takao CM, Ing FF. Reduction in Radiation Dose in a Pediatric Cardiac Catheterization Lab Using the Philips AlluraClarity X-ray System. Pediatr Cardiol 2017; 38:1583-1591. [PMID: 28770307 DOI: 10.1007/s00246-017-1700-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/25/2017] [Indexed: 01/27/2023]
Abstract
The objective of this study was to compare radiation doses and imaging quality using Philips AlluraClarity (Philips Healthcare, Best, The Netherlands) X-ray system and an older generation reference system. AlluraClarity is a new generation fluoroscopy system designed to reduce radiation without compromising image quality, but reports of its use in pediatric patients are limited. Dose area products (DAP, mGy cm2) and DAP/kg were compared in patients catheterized using Allura Xper and AlluraClarity systems over a year of use for each. Randomly selected studies from each system were assessed for image quality. The 430 patients imaged with Clarity were larger than the 332 imaged with Xper (median BSA: 0.74 vs. 0.64 m2, p = 0.06), and median total fluoroscopic times (TFT) were similar (15.8 vs. 16.1 min, p = 0.37). Median DAPs were 8661 mGy cm2 (IQR: 18,300 mGy cm2) and 4523 mGy cm2 (IQR: 11,596 mGy cm2) with Xper and Clarity, respectively (p < 0.001). There was a reduction in median DAP in all procedure categories. After adjustment for BSA, TFT, and procedure type, using Clarity was associated with a 57.5% (95% CI 51.5-62.8%, p < 0.001) reduction in DAP for all procedures. Reductions did not significantly differ by weight (<10 kg, 10-40 kg, ≥ 40 kg). There was an adjusted percent reduction in DAP for each procedure category ranging from 39.0% (95% CI 25.6-50.1%, p < 0.001) for cardiac biopsies with or without coronary angiography to 67.6% (95% CI 61.2-72.8%, p < 0.001) for device occlusions. Mean overall imaging quality scores (4.3 ± 0.8 with Clarity vs. 4.4 ± 0.6 with Xper, p = 0.62) and scores based on specific quality parameters were similar in the two groups. Use of AlluraClarity substantially reduced radiation doses compared to the older generation reference system without compromising imaging quality in a pediatric cardiac catheterization lab.
Collapse
Affiliation(s)
- Patrick M Sullivan
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. .,Children's Hospital Los Angeles Heart Center, 4650 Sunset Blvd., #34, Los Angeles, CA, USA.
| | - David Harrison
- Division of General Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sarah Badran
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Cheryl M Takao
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Frank F Ing
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
16
|
Hoffmann R, Langenbrink L, Reimann D, Kastrati M, Becker M, Piatkowski M, Michaelsen J. Image noise reduction technology allows significant reduction of radiation dosage in cardiac device implantation procedures. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1374-1379. [PMID: 29052249 DOI: 10.1111/pace.13222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 09/24/2017] [Accepted: 10/08/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Novel x-ray systems with real-time image noise reduction technology (INRT) to reduce radiation dose during fluoroscopy and cine acquisition have become available. This study evaluated the reduction of radiation dose in device implantation with INRT. METHODS Radiation dose data from 132 consecutive new device implantation procedures (102 pacemaker [PM] or implantable cardioverter defibrillator [ICD] and 30 cardiac resynchronization therapy [CRT] devices) performed between January 2015 and December 2015 on an angiography system with INRT (Allura ClarityIQ) were collected. For comparison, radiation dose data from 147 consecutive device implantation procedures (121 PM/ICDs and 26 CRT devices) performed between June 2013 and September 2014 on a C-arm system with continuous and pulsed fluoroscopy option (4 frames/second) were evaluated. Total dose area product (DAP), fluoroscopy DAP, and cine DAP were evaluated. RESULTS Patient age, gender and body weight, procedure, and fluoroscopy times were similar between systems. In PM/ICD cases, DAP of INRT and C-arm system was similar (423 ± 381 cGycm2 vs 417 ± 517 cGycm) due to pulsed fluoroscopy with the C-arm system (78% of time) and sparse use of cine. In CRT procedures requiring higher image quality (82% use of continuous fluoroscopy with C-arm system), DAP of INRT was significantly lower (1,544 ± 834 cGycm vs 7,252 ± 6,431 cGycm, P < 0.001) due to less fluoroscopy DAP (1,414 ± 757 cGycm vs 5,854 ± 6,767 cGycm) and less cine DAP (130 ± 106 cGycm vs 1,399 ± 1,342 cGycm). Considering all procedures, total DAP was reduced by 60% using INRT. CONCLUSION Novel INRT results in a substantial lowering of radiation dose in device implantation, in particular, in complex CRT implantation procedures requiring high image quality.
Collapse
Affiliation(s)
- Rainer Hoffmann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Lukas Langenbrink
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Doris Reimann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Mirlind Kastrati
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Michael Becker
- Department of Cardiology, Medical Clinic I, University Clinic Aachen, Aachen, Germany
| | - Michal Piatkowski
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Jochen Michaelsen
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| |
Collapse
|
17
|
Minimizing exposure to radiation in invasive cardiology using modern dose-reduction technology: Evaluation of the real-life effects. Catheter Cardiovasc Interv 2017; 91:1194-1199. [DOI: 10.1002/ccd.27245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 01/28/2023]
|
18
|
van Dijk JD, Ottervanger JP, Delnoy PPHM, Lagerweij MCM, Knollema S, Slump CH, Jager PL. Impact of new X-ray technology on patient dose in pacemaker and implantable cardioverter defibrillator (ICD) implantations. J Interv Card Electrophysiol 2017; 48:105-110. [PMID: 27785663 PMCID: PMC5247544 DOI: 10.1007/s10840-016-0200-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 10/11/2016] [Indexed: 11/14/2022]
Abstract
PURPOSE New X-ray technology providing new image processing techniques may reduce radiation exposure. The aim of this study was to quantify this radiation exposure reduction for patients during pacemaker and implantable cardioverter defibrillator (ICD) implantation. METHODS In this retrospective study, 1185 consecutive patients who had undergone de novo pacemaker or ICD implantation during a 2-year period were included. All implantations in the first year were performed using the reference technology (Allura Xper), whereas in the second year, the new X-ray technology (AlluraClarity) was used. Radiation exposure, expressed as the dose area product (DAP), was compared between the two time periods to determine the radiation exposure reduction for pacemaker and ICD implantations without cardiac resynchronization therapy (CRT) and with CRT. Procedure duration and contrast volume were used as measures to compare complexity and image quality. RESULTS The study population consisted of 591 patients who had undergone an implantation using the reference technology, and 594 patients with the new X-ray technology. The two groups did not differ in age, gender, or body mass index. The DAP decreased with 69 % from 16.4 ± 18.5 to 5.2 ± 6.6 Gy cm2 for the non-CRT implantations (p < 0.001). The DAP decreased with 75 % from 72.1 ± 60.0 to 17.8 ± 17.4 Gy cm2 for the CRT implantations (p < 0.001). Nevertheless, procedure duration and contrast volume did not differ when using the new technology (p = 0.09 and p = 0.20, respectively). CONCLUSIONS Introduction of new X-ray technology resulted in a radiation exposure reduction of more than 69 % for patients during pacemaker and ICD implantation while image quality was unaffected.
Collapse
Affiliation(s)
- Joris D van Dijk
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | | | | | | | - Siert Knollema
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Cornelis H Slump
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Pieter L Jager
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| |
Collapse
|
19
|
Spink C, Avanesov M, Schmidt T, Grass M, Schoen G, Adam G, Bannas P, Koops A. Radiation dose reduction during transjugular intrahepatic portosystemic shunt implantation using a new imaging technology. Eur J Radiol 2016; 86:284-288. [PMID: 28027761 DOI: 10.1016/j.ejrad.2016.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/15/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare patient radiation dose in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation before and after an imaging-processing technology upgrade. METHODS In our retrospective single-center-study, cumulative air kerma (AK), cumulative dose area product (DAP), total fluoroscopy time and contrast agent were collected from an age- and BMI-matched collective of 108 patients undergoing TIPS implantation. 54 procedures were performed before and 54 after the technology upgrade. Mean values were calculated and compared using two-tailed t-tests. Two blinded, independent readers assessed DSA image quality using a four-rank likert scale and the Wilcoxcon test. RESULTS The new technology demonstrated a significant reduction of 57% of mean DAP (402.8 vs. 173.3Gycm2, p<0.001) and a significant reduction of 58% of mean AK (1.7 vs. 0.7Gy, p<0.001) compared to the precursor technology. Time of fluoroscopy (26.4 vs. 27.8min, p=0.45) and amount of contrast agent (109.4 vs. 114.9ml, p=0.62) did not differ significantly between the two groups. The DSA image quality of the new technology was not inferior (2.66 vs. 2.77, p=0.56). CONCLUSIONS In our study the new imaging technology halved radiation dose in patients undergoing TIPS maintaining sufficient image quality without a significant increase in radiation time or contrast consumption.
Collapse
Affiliation(s)
- C Spink
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - M Avanesov
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Schmidt
- Philips Healthcare, Hamburg, Germany
| | - M Grass
- Philips Research, Hamburg, Germany
| | - G Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Bannas
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Koops
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
20
|
Gunja A, Pandey Y, Xie H, Wolska BM, Shroff AR, Ardati AK, Vidovich MI. Image noise reduction technology reduces radiation in a radial-first cardiac catheterization laboratory. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:197-201. [PMID: 28089778 DOI: 10.1016/j.carrev.2016.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transradial coronary angiography (TRA) has been associated with increased radiation doses. We hypothesized that contemporary image noise reduction technology would reduce radiation doses in the cardiac catheterization laboratory in a typical clinical setting. METHODS AND RESULTS We performed a single-center, retrospective analysis of 400 consecutive patients who underwent diagnostic and interventional cardiac catheterizations in a predominantly TRA laboratory with traditional fluoroscopy (N=200) and a new image noise reduction fluoroscopy system (N=200). The primary endpoint was radiation dose (mGy cm2). Secondary endpoints were contrast dose, fluoroscopy times, number of cineangiograms, and radiation dose by operator between the two study periods. Radiation was reduced by 44.7% between the old and new cardiac catheterization laboratory (75.8mGycm2±74.0 vs. 41.9mGycm2±40.7, p<0.0001). Radiation was reduced for both diagnostic procedures (45.9%, p<0.0001) and interventional procedures (37.7%, p<0.0001). There was no statistically significant difference in radiation dose between individual operators (p=0.84). In multivariate analysis, radiation dose remained significantly decreased with the use of the new system (p<0.0001) and was associated with weight (p<0.0001), previous coronary artery bypass grafting (p<0.0007) and greater than 3 stents used (p<0.0004). TRA was used in 90% of all cases in both periods. Compared with a transfemoral approach (TFA), TRA was not associated with higher radiation doses (p=0.20). CONCLUSIONS Image noise reduction technology significantly reduces radiation dose in a contemporary radial-first cardiac catheterization clinical practice.
Collapse
Affiliation(s)
- Ateka Gunja
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Yagya Pandey
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Hui Xie
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL; Faculty of Health Sciences, Simon Fraser University
| | - Beata M Wolska
- Department of Physiology and Biophysics, Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, IL
| | - Adhir R Shroff
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Amer K Ardati
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mladen I Vidovich
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
| |
Collapse
|
21
|
Christakopoulos GE, Christopoulos G, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman MR, Lombardi WL, Tarar MNJ, Grantham JA, Kandzari DE, Lembo N, Moses JW, Kirtane AJ, Parikh M, Green P, Finn M, Garcia S, Doing AH, Hatem R, Thompson CA, Banerjee S, Brilakis ES. Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry. Can J Cardiol 2016; 33:478-484. [PMID: 28169091 DOI: 10.1016/j.cjca.2016.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) might lead to procedural failure and radiation skin injury. METHODS We examined the association between several clinical and angiographic variables on patient air kerma (AK) radiation dose among 748 consecutive CTO PCIs performed at 9 experienced US centres between May 2012 and May 2015. RESULTS The mean age was 65 ± 10 years, 87% of patients were men, and 35% had previous coronary artery bypass graft surgery (CABG). Technical and procedural success was 92% and 90%, respectively. The median patient AK dose was 3.40 (interquartile range, 2.00-5.40) Gy and 34% of the patients received > 4.8 Gy (high radiation exposure). In univariable analysis male sex (P = 0.016), high body mass index (P < 0.001), history of hyperlipidemia (P = 0.023), previous CABG (P < 0.001), moderate or severe calcification (P < 0.001), tortuosity (P < 0.001), proximal cap ambiguity (P = 0.001), distal cap at a bifurcation (P = 0.006), longer CTO occlusion length (P < 0.001), blunt/no blunt stump (P < 0.001), and centre (P < 0.001) were associated with higher patient AK dose. In multivariable analysis high body mass index (P < 0.001), previous CABG (P = 0.005), moderate or severe calcification (P = 0.005), longer CTO occlusion length (P < 0.001), and centre (P < 0.001) were independently associated with higher patient AK dose. CONCLUSIONS Approximately 1 in 3 patients who undergo CTO PCI receive high AK radiation dose (> 4.8 Gy). Several baseline clinical and angiographic characteristics can help predict the likelihood of high radiation dose and assist with intensifying efforts to reduce radiation exposure for the patient and the operator.
Collapse
Affiliation(s)
| | | | | | | | - Robert W Yeh
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Farouc A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Santiago Garcia
- Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Raja Hatem
- Columbia University, New York, New York, USA
| | | | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA; Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
| |
Collapse
|
22
|
Roguin A. Seeing is believing: finding new solutions to radiation exposure in our work routine. EUROINTERVENTION 2016; 12:e935-e937. [DOI: 10.4244/eijv12i8a155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
23
|
Chambers CE. Radiation dose variation in fluoroscopic imaging. Catheter Cardiovasc Interv 2015; 86:933-4. [DOI: 10.1002/ccd.26246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Charles E. Chambers
- Penn State Heart and Vascular Institute; MS Hershey Medical Center; Hershey Pennsylvania
| |
Collapse
|