1
|
Besson FL, Treglia G, Bucerius J, Anagnostopoulos C, Buechel RR, Dweck MR, Erba PA, Gaemperli O, Gimelli A, Gheysens O, Glaudemans AWJM, Habib G, Hyafil F, Lubberink M, Rischpler C, Saraste A, Slart RHJA. A systematic review for the evidence of recommendations and guidelines in hybrid nuclear cardiovascular imaging. Eur J Nucl Med Mol Imaging 2024; 51:2247-2259. [PMID: 38221570 PMCID: PMC11178580 DOI: 10.1007/s00259-024-06597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVES This study aimed to evaluate the level of evidence of expert recommendations and guidelines for clinical indications and procedurals in hybrid nuclear cardiovascular imaging. METHODS From inception to August 2023, a PubMed literature analysis of the latest version of guidelines for clinical hybrid cardiovascular imaging techniques including SPECT(/CT), PET(/CT), and PET(/MRI) was performed in two categories: (1) for clinical indications for all-in primary diagnosis; subgroup in prognosis and therapy evaluation; and for (2) imaging procedurals. We surveyed to what degree these followed a standard methodology to collect the data and provide levels of evidence, and for which topic systematic review evidence was executed. RESULTS A total of 76 guidelines, published between 2013 and 2023, were included. The evidence of guidelines was based on systematic reviews in 7.9% of cases, non-systematic reviews in 47.4% of cases, a mix of systematic and non-systematic reviews in 19.7%, and 25% of guidelines did not report any evidence. Search strategy was reported in 36.8% of cases. Strengths of recommendation were clearly reported in 25% of guidelines. The notion of external review was explicitly reported in 23.7% of cases. Finally, the support of a methodologist was reported in 11.8% of the included guidelines. CONCLUSION The use of evidence procedures for developing for evidence-based cardiovascular hybrid imaging recommendations and guidelines is currently suboptimal, highlighting the need for more standardized methodological procedures.
Collapse
Affiliation(s)
- Florent L Besson
- Department of Nuclear Medicine-Molecular Imaging, DMU SMART IMAGING, Hôpitaux Universitaires Paris-Saclay, AP-HP, CHU Bicêtre, Le Kremlin Bicetre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicetre, France
- Commissariat À L'énergie Atomique Et Aux Énergies Alternatives (CEA), Centre National de La Recherche Scientifique (CNRS), Inserm, BioMaps, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Jan Bucerius
- Department of Nuclear Medicine, Georg-August University Göttingen, Universitätsmedizin Göttingen, Gottingen, Germany
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Paula A Erba
- Department of Medicine and Surgery, University of Milan Bicocca, and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
| | - Fabian Hyafil
- Department of Nuclear Medicine, DMU IMAGINA, Georges-Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, F75015, Paris, France
| | - Mark Lubberink
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Antti Saraste
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
| |
Collapse
|
2
|
Massera RT, Dehairs M, Verhoeven H, Bosmans H, Marshall N. A comprehensive assessment of a prototype high ratio antiscatter grid in interventional cardiology using experimental measurements and Monte Carlo simulations. Phys Med Biol 2024; 69:135015. [PMID: 38862002 DOI: 10.1088/1361-6560/ad56f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/11/2024] [Indexed: 06/13/2024]
Abstract
Objective. To assess the performance of a new antiscatter grid design in interventional cardiology for image quality improvement and dose reduction using experimental measurements and Monte Carlo (MC) simulation.Approach.Experimental measurements were performed on an angiography system, using a multi-layered tissue simulating composite phantom made from of poly(methyl methacrylate), aluminium and expanded polystyrene (2/0.2/0.7 cm). The total phantom thickness ranged from 20.3 cm to 40.6 cm. Four conditions were compared; (A) 105 cm source-image receptor distance (SID) without grid, (Bi) 105 cm SID with grid ratio (r) and strip density (N) (r15N80), (Bii) 120 cm SID without grid, and (Biii) 120 cm SID with high ratio grid (r29N80). The system efficiency (η), defined by the signal-to-noise ratio, was compared from theBconditions against caseA. These conditions were also simulated with MC techniques, allowing additional phantom compositions to be explored. Weighted image quality improvement factor (ηw(u)) was studied experimentally at a specific spatial frequency due to the SID change. Images were simulated with an anthropomorphic chest phantom for the different conditions, and the system efficiency was compared for the different anatomical regions.Main results.Good agreement was found between theηandηw(u) methods using both measured and simulated data, with average relative differences between 2%-11%. CaseBiiiprovided higherηvalues compared toA, andBifor thicknesses larger than 20.3 cm. In addition, caseBiiialso provided higherηvalues for high attenuating areas in the anthropomorphic phantom, such as behind the spine.Significance.The new antiscatter grid design provided higher system efficiency compared to the standard grid for the parameters explored in this work.
Collapse
Affiliation(s)
- Rodrigo T Massera
- Medical Imaging Research Centre, Medical Physics and Quality Assessment, KU Leuven, 3000 Leuven, Belgium
| | - Michiel Dehairs
- Medical Imaging Research Centre, Medical Physics and Quality Assessment, KU Leuven, 3000 Leuven, Belgium
- Department of Medical Physics, Institute Jules Bordet Instituut, Rue Meylemeersch 90, Bruxelles 1070, Belgium
| | - Hannelore Verhoeven
- Competentiecentrum medische stralingsfysica, UZ Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Hilde Bosmans
- Medical Imaging Research Centre, Medical Physics and Quality Assessment, KU Leuven, 3000 Leuven, Belgium
- Competentiecentrum medische stralingsfysica, UZ Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Nicholas Marshall
- Medical Imaging Research Centre, Medical Physics and Quality Assessment, KU Leuven, 3000 Leuven, Belgium
- Competentiecentrum medische stralingsfysica, UZ Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
3
|
Mugnai G, Velagic V, Malagù M, de Asmundis C, Tomasi L, Bolzan B, Chierchia GB, Ribichini FL, Ströker E, Bertini M. Zero fluoroscopy catheter ablation of premature ventricular contractions: a multicenter experience. J Interv Card Electrophysiol 2024; 67:827-836. [PMID: 38102499 DOI: 10.1007/s10840-023-01723-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Catheter ablation has become an established treatment option for premature ventricular complexes (PVCs). The use of fluoroscopy exposes patients and medical staff to potentially harmful stochastic and deterministic effects of ionizing radiations. We sought to analyze procedural outcomes in terms of safety and efficacy using a "zero fluoroscopy" approach for catheter ablation of PVCs. METHODS The present retrospective, multicenter, observational study included 131 patients having undergone catheter ablation of PVCs using "zero fluoroscopy" between 2019 and 2020 in four centers compared with another group who underwent the procedure with fluoroscopy. RESULTS Median age was 51.0 ± 15.9 years old; males were 77 (58.8%). Among the study population, 26 (19.8%) had a cardiomyopathy. The most frequent PVC origin was right ventricular outflow tract (55%) followed by the left ventricle (16%), LVOT and cusps (13.7%), and aortomitral continuity (5.3%). Acute suppression of PVC was achieved in 127 patients (96.9%). At 12 months, a complete success was documented in 109 patients (83.2%), a reduction in PVC burden in 18 patients (13.7%), and a failure was recorded in four patients (3.1%). Only two minor complications occurred (femoral hematoma and arteriovenous fistula conservatively treated). CONCLUSIONS The PVC ablation with a "zero" fluoroscopy approach appears to be a safe procedure with no major complications and good rates of success and recurrence in our multicenter experience.
Collapse
Affiliation(s)
- Giacomo Mugnai
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
| | - Vedran Velagic
- Department of Cardiovascular Diseases, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Michele Malagù
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Luca Tomasi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Bruna Bolzan
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Flavio Luciano Ribichini
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Matteo Bertini
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy
| |
Collapse
|
4
|
Sperry BW, Vamenta MS, Gunta SP, Thompson RC, Einstein AJ, Castillo M, Chaudhary PD, Bremner LI, Cohen YA, Bateman TM, McGhie AI. Influence of Body Mass Index on Radiation Exposure Across Imaging Modalities in the Evaluation of Chest Pain. J Am Heart Assoc 2024; 13:e033566. [PMID: 38591342 DOI: 10.1161/jaha.123.033566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Essential to a patient-centered approach to imaging individuals with chest pain is knowledge of differences in radiation effective dose across imaging modalities. Body mass index (BMI) is an important and underappreciated predictor of effective dose. This study evaluated the impact of BMI on estimated radiation exposure across imaging modalities. METHODS AND RESULTS This was a retrospective analysis of patients with concern for cardiac ischemia undergoing positron emission tomography (PET)/computed tomography (CT), cadmium zinc telluride single-photon emission CT (SPECT) myocardial perfusion imaging, or coronary CT angiography (CCTA) using state-of-the-art imaging modalities and optimal radiation-sparing protocols. Radiation exposure was calculated across BMI categories based on established cardiac imaging-specific conversion factors. Among 9046 patients (mean±SD age, 64.3±13.1 years; 55% men; mean±SD BMI, 30.6±6.9 kg/m2), 4787 were imaged with PET/CT, 3092 were imaged with SPECT/CT, and 1167 were imaged with CCTA. Median (interquartile range) radiation effective doses were 4.4 (3.9-4.9) mSv for PET/CT, 4.9 (4.0-6.3) mSv for SPECT/CT, and 6.9 (4.0-11.2) mSv for CCTA. Patients at a BMI <20 kg/m2 had similar radiation effective dose with all 3 imaging modalities, whereas those with BMI ≥20 kg/m2 had the lowest effective dose with PET/CT. Radiation effective dose and variability increased dramatically with CCTA as BMI increased, and was 10 times higher in patients with BMI >45 kg/m2 compared with <20 kg/m2 (median, 26.9 versus 2.6 mSv). After multivariable adjustment, PET/CT offered the lowest effective dose, followed by SPECT/CT, and then CCTA (P<0.001). CONCLUSIONS Although median radiation exposure is modest across state-of-the-art PET/CT, SPECT/CT, and CCTA systems using optimal radiation-sparing protocols, there are significant variations across modalities based on BMI. These data are important for making patient-centered decisions for ischemic testing.
Collapse
Affiliation(s)
- Brett W Sperry
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| | - Mary Stefanie Vamenta
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| | | | - Randall C Thompson
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology New York NY
- Department of Medicine Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
- Department of Radiology Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Michelle Castillo
- Seymour, Paul and Gloria Milstein Division of Cardiology New York NY
- Department of Medicine Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Priyanka D Chaudhary
- Department of Radiology Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Luca I Bremner
- Seymour, Paul and Gloria Milstein Division of Cardiology New York NY
- Vagelos College of Physicians and Surgeons Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Yosef A Cohen
- Seymour, Paul and Gloria Milstein Division of Cardiology New York NY
- Department of Medicine Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
- Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian Hospital New York NY
| | - Timothy M Bateman
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| | - A Iain McGhie
- Saint Luke's Mid America Heart Institute Kansas City MO
- University of Missouri-Kansas City Kansas City MO
| |
Collapse
|
5
|
Picano E, Pierard L, Peteiro J, Djordjevic-Dikic A, Sade LE, Cortigiani L, Van De Heyning CM, Celutkiene J, Gaibazzi N, Ciampi Q, Senior R, Neskovic AN, Henein M. The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC. Eur Heart J Cardiovasc Imaging 2024; 25:e65-e90. [PMID: 37798126 DOI: 10.1093/ehjci/jead250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
Since the 2009 publication of the stress echocardiography expert consensus of the European Association of Echocardiography, and after the 2016 advice of the American Society of Echocardiography-European Association of Cardiovascular Imaging for applications beyond coronary artery disease, new information has become available regarding stress echo. Until recently, the assessment of regional wall motion abnormality was the only universally practiced step of stress echo. In the state-of-the-art ABCDE protocol, regional wall motion abnormality remains the main step A, but at the same time, regional perfusion using ultrasound-contrast agents may be assessed. Diastolic function and pulmonary B-lines are assessed in step B; left ventricular contractile and preload reserve with volumetric echocardiography in step C; Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery in step D; and ECG-based heart rate reserve in non-imaging step E. These five biomarkers converge, conceptually and methodologically, in the ABCDE protocol allowing comprehensive risk stratification of the vulnerable patient with chronic coronary syndromes. The present document summarizes current practice guidelines recommendations and training requirements and harmonizes the clinical guidelines of the European Society of Cardiology in many diverse cardiac conditions, from chronic coronary syndromes to valvular heart disease. The continuous refinement of imaging technology and the diffusion of ultrasound-contrast agents improve image quality, feasibility, and reader accuracy in assessing wall motion and perfusion, left ventricular volumes, and coronary flow velocity. Carotid imaging detects pre-obstructive atherosclerosis and improves risk prediction similarly to coronary atherosclerosis. The revolutionary impact of artificial intelligence on echocardiographic image acquisition and analysis makes stress echo more operator-independent and objective. Stress echo has unique features of low cost, versatility, and universal availability. It does not need ionizing radiation exposure and has near-zero carbon dioxide emissions. Stress echo is a convenient and sustainable choice for functional testing within and beyond coronary artery disease.
Collapse
Affiliation(s)
- Eugenio Picano
- Institute of Clinical Physiology of the National Research Council, CNR, Via Moruzzi 1, 56124 Pisa, Italy
| | - Luc Pierard
- University of Liège, Walloon Region, Belgium
| | - Jesus Peteiro
- CHUAC-Complexo Hospitalario Universitario A Coruna, CIBER-CV, University of A Coruna, 15070 La Coruna, Spain
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Clinical Centre of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center UPMC Heart & Vascular Institute, Pittsburgh, PA, USA
| | | | | | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy
| | - Roxy Senior
- Imperial College, UK
- Royal Brompton Hospital Imperial College London, UK
- Northwick Park Hospital, London, UK
| | - Aleksandar N Neskovic
- Department of Cardiology, University Clinical Hospital Center Zemun-Belgrade Faculty of Medicine, University of Belgrade, Serbia
| | - Michael Henein
- Department of Public Health and Clinical Medicine Units: Section of Medicine, Umea University, Umea, Sweden
| |
Collapse
|
6
|
Clerc OF, Frey SM, Honegger U, Amrein MLF, Caobelli F, Haaf P, Zellweger MJ. Coronary artery calcium score and pre-test probabilities as gatekeepers to predict and rule out perfusion defects in positron emission tomography. J Nucl Cardiol 2023; 30:2559-2573. [PMID: 37415007 PMCID: PMC10682222 DOI: 10.1007/s12350-023-03322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Little is known about the gatekeeper performance of coronary artery calcium score (CACS) before myocardial perfusion positron emission tomography (PET), compared with updated pre-test probabilities from American and European guidelines (pre-test-AHA/ACC, pre-test-ESC). METHODS We enrolled participants without known coronary artery disease undergoing CACS and Rubidium-82 PET. Abnormal perfusion was defined as summed stress score ≥ 4. Using Bayes' formula, pre-test probabilities and CACS were combined into post-test probabilities. RESULTS We included 2050 participants (54% male, mean age 64.6 years) with median CACS 62 (IQR 0-380), pre-test-ESC 17% (11-26), pre-test-AHA/ACC 27% (16-44), and abnormal perfusion in 437 participants (21%). To predict abnormal perfusion, area under the curve of CACS was 0.81, pre-test-AHA/ACC 0.68, pre-test-ESC 0.69, post-test-AHA/ACC 0.80, and post-test-ESC 0.81 (P < 0.001 for CACS vs. each pre-test, and each post-test vs. pre-test). CACS = 0 had 97% negative predictive value (NPV), pre-test-AHA/ACC ≤ 5% 100%, pre-test-ESC ≤ 5% 98%, post-test-AHA/ACC ≤ 5% 98%, and post-test-ESC ≤ 5% 96%. Among participants, 26% had CACS = 0, 2% pre-test-AHA/ACC ≤ 5%, 7% pre-test-ESC ≤ 5%, 23% post-test-AHA/ACC ≤ 5%, and 33% post-test-ESC ≤ 5% (all P < 0.001). CONCLUSIONS CACS and post-test probabilities are excellent predictors of abnormal perfusion and can rule it out with very high NPV in a substantial proportion of participants. CACS and post-test probabilities may be used as gatekeepers before advanced imaging. Coronary artery calcium score (CACS) predicted abnormal perfusion (SSS ≥ 4) in myocardial positron emission tomography (PET) better than pre-test probabilities of coronary artery disease (CAD), while pre-test-AHA/ACC and pre-test-ESC performed similarly (left). Using Bayes' formula, pre-test-AHA/ACC or pre-test-ESC were combined with CACS into post-test probabilities (middle). This calculation reclassified a substantial proportion of participants to low probability of CAD (0-5%), not needing further imaging, as shown for AHA/ACC probabilities (2% with pre-test-AHA/ACC to 23% with post-test-AHA/ACC, P < 0.001, right). Very few participants with abnormal perfusion were classified under pre-test or post-test probabilities 0-5%, or under CACS 0. AUC: area under the curve. Pre-test-AHA/ACC: Pre-test probability of the American Heart Association/American College of Cardiology. Post-test-AHA/ACC: Post-test probability combining pre-test-AHA/ACC and CACS. Pre-test-ESC: Pre-test probability of the European Society of Cardiology. SSS: Summed stress score.
Collapse
Affiliation(s)
- Olivier F Clerc
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Simon M Frey
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ursina Honegger
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Melissa L F Amrein
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Federico Caobelli
- Department of Nuclear Medicine, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
| |
Collapse
|
7
|
Picano E. Economic, ethical, and environmental sustainability of cardiac imaging. Eur Heart J 2023; 44:4748-4751. [PMID: 36477859 DOI: 10.1093/eurheartj/ehac716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/20/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2023] Open
Abstract
Current cardiology guidelines assign a class of recommendation 1 for the diagnosis of chest pain to five imaging techniques based on either anatomic (coronary computed tomography angiography) or functional approaches, such as stress single-photon emission tomography, stress positron emission tomography, stress cardiovascular magnetic resonance, and stress echocardiography. The choice is left to the prescribing physician, based on local availability and expertise. However, the five techniques differ substantially in their cost, applicability based on patient characteristics, long-term risk, and environmental impact. The average European immediate cost ranges from 50 to 1000 euros. The radiation exposure ranges from 0 to 500 chest x-rays. The environmental footprint ranges from 3 to 300 kg of carbon dioxide emissions equivalent. The ethical code of the World Medical Association 2021 recommends the responsible use of healthcare money by doctors, with the minimization of potential damage to patients and the environment. The Euratom law 2013/directive 59 reinforces the justification principle and the optimization principle for medical radiation exposures, with the legal responsibility of both the referrer and the practitioner. A small cost, a minimal long-term risk, and a modest carbon emission per examination multiplied by billions of tests per year become an unaffordable economic burden in the short-term, significant population damage to public health over the years, and impacts on climate change in decades. The cardiology community may wish to adopt a more sustainable practice with affordable, radiation-optimized, and carbon-neutral practices for the benefit of patients, physicians, payers, and the planet.
Collapse
Affiliation(s)
- Eugenio Picano
- Research Director, Institute of Clinical Physiology of the National Research Council, CNR Research Campus, Via Moruzzi, 1, Building C- First floor- Room 130, 56124 Pisa, Italy
| |
Collapse
|
8
|
Cimci M, Batar B, Bostanci M, Durmaz E, Karayel B, Raimoglou D, Guven M, Karadag B. The Long-Term Impact of Ionizing Radiation on DNA Damage in Patients Undergoing Multiple Cardiac Catheterizations. Cardiovasc Toxicol 2023; 23:278-283. [PMID: 37458898 DOI: 10.1007/s12012-023-09801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/08/2023] [Indexed: 08/18/2023]
Abstract
Ionizing radiation (IR) exposures have increased exponentially in recent years due to the rise in diagnostic and therapeutic interventions. A number of small-scale studies investigated the long-term effect of IR on health workers or immediate effects of IR on patients undergoing catheterization procedures; however, the long-term impact of multiple cardiac catheterizations on DNA damage on a patient population is not known. In this study, the effects of IR on DNA damage, based on micronuclei (MN) frequency and 8-hydroxy-2'-deoxyguanosine (8-OHdG) as markers in peripheral lymphocytes, were evaluated in patients who previously underwent multiple cardiac catheterization procedures. Moreover, genetic polymorphisms in genes PARP1 Val762Ala, OGG1 Ser326Cys, and APE1 Asn148Glu as a measure of sensitivity to radiation exposure were also investigated in the same patient population. The patients who underwent ≥ 3 cardiac catheterization procedures revealed higher DNA injury in comparison to the patients who underwent ≤ 2 procedures, documented with the presence of higher level of MN frequency (6.4 ± 4.8 vs. 9.1 ± 4.3, p = 0.002) and elevated serum 8-OHdG levels (33.7 ± 3.8 ng/mL vs. 17.4 ± 1.9 ng/mL, p = 0.001). Besides, OGG1 Ser326Cys and APE1 Asn148Glu heterozygous and homozygous polymorphic types, which are related with DNA repair mechanisms, were significantly associated with MN frequency levels (p = 0.006 for heterozygous and p = 0.001 for homozygous with respect to OGG1 Ser326Cys, p = 0.007 for heterozygous and p = 0.001 for homozygous with respect to APE1 Asn148Glu). There was no significant difference in terms of PARP1 Val762Ala gene polymorphism between two groups.
Collapse
Affiliation(s)
- Murat Cimci
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Bahadir Batar
- Department of Medical Biology, Tekirdag Namik Kemal University School of Medicine, Tekirdaǧ, Turkey
| | - Merve Bostanci
- Department of Medical Biology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eser Durmaz
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bahadir Karayel
- Department of Internal Medicine, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Damla Raimoglou
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Guven
- Department of Medical Biology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bilgehan Karadag
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
9
|
Sant`Anna RT, de Lima GG, Saffi MAL, Kruse ML, Leiria TLL. Atrial Fibrillation Ablation: Impact of Intracardiac Echocardiography in Reducing Procedure Time and Hospitalization. Arq Bras Cardiol 2023; 120:e20220306. [PMID: 37194828 PMCID: PMC10263395 DOI: 10.36660/abc.20220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Intracardiac echocardiography (ICE) allows visualization of cardiac structures and recognition of complications during atrial fibrillation ablation (AFA). Compared to transesophageal echocardiography (TEE), ICE is less sensitive to detecting thrombus in the atrial appendage but requires minimal sedation and fewer operators, making it attractive in a resource-constrained setting. OBJECTIVE To compare 13 cases of AFA using ICE (AFA-ICE group) with 36 cases of AFA using TEE (AFA-TEE group). METHODS This is a single-center prospective cohort study. The main outcome was procedure time. Secondary outcomes: fluoroscopy time, radiation dose (mGy/cm2), major complications, and length of hospital stay in hours. The clinical profile was compared using the CHA2DS2-VASc score. A p-value <0.05 was considered a statistically significant difference between groups. RESULTS The median CHA2DS2-VASc score was 1 (0-3) in the AFA-ICE group and 1 (0-4) in the AFA-TEE group. The total procedure time was 129 ± 27 min in the AFA-ICE group and 189 ± 41 min in the AFA-TEE group (p<0.001); the AFA-ICE group received a lower dose of radiation (mGy/cm2, 51296 ± 24790 vs. 75874 ± 24293; p=0.002), despite the similar fluoroscopy time (27.48 ± 9. 79 vs. 26.4 ± 9.32; p=0.671). The median length of hospital stay did not differ; 48 (36-72) hours (AFA-ICE) and 48 (48-66) hours (AFA-TEE) (p=0.27). CONCLUSIONS In this cohort, AFA-ICE was related to shorter procedure times and less exposure to radiation without increasing the risk of complications or the length of hospital stay.
Collapse
Affiliation(s)
- Roberto Tofani Sant`Anna
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
| | - Gustavo Glotz de Lima
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrasil Universidade Federal de Ciências da Saúde de Porto Alegre , Porto Alegre , RS – Brasil
| | - Marco Aurélio Lumertz Saffi
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clínicas de Porto Alegre , Porto Alegre , RS – Brasil
| | - Marcelo Lapa Kruse
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
| | - Tiago Luiz Luz Leiria
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS – Brasil
| |
Collapse
|
10
|
Paalimäki-Paakki K, Virtanen M, Henner A, Vähänikkilä H, Nieminen MT, Schroderus-Salo T, Kääriäinen M. Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time: A randomised controlled trial. Radiography (Lond) 2023; 29 Suppl 1:S13-S23. [PMID: 36280541 DOI: 10.1016/j.radi.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups. METHODS A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination. RESULTS Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time. CONCLUSION Access to 360°VCE can reduce patients' pre-CCTA anxiety levels. IMPLICATIONS FOR PRACTICE The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.
Collapse
Affiliation(s)
- Karoliina Paalimäki-Paakki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland.
| | - Mari Virtanen
- School of Rehabilitation and Examination, Helsinki Metropolia University of Applied Sciences, Helsinki, Finland
| | - Anja Henner
- Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Miika T Nieminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Tanja Schroderus-Salo
- Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland
| |
Collapse
|
11
|
Calo P, Dischinger J, Görtz H. Strahlenschutz in der Gefäßchirurgie. GEFÄSSCHIRURGIE 2023. [DOI: 10.1007/s00772-023-00980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
|
12
|
Latsios G, Leopoulou M, Synetos A, Karanasos A, Papanikolaou A, Bounas P, Stamatopoulou E, Toutouzas K, Tsioufis K. Cardiac arrest and cardiopulmonary resuscitation in “hostile” environments: Using automated compression devices to minimize the rescuers’ danger. World J Cardiol 2023; 15:45-55. [PMID: 36911750 PMCID: PMC9993930 DOI: 10.4330/wjc.v15.i2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023] Open
Abstract
Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual, “hands-on”, rescuer-delivered chest compressions. The -theoretical- advantages include high-quality non-stop compressions, thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially “hazardous” victim, or from hazardous and/or difficult resuscitation conditions. Such circumstances involve cardiopulmonary resuscitation (CPR) in the Cardiac Catheterization Laboratory, especially directly under the fluoroscopy panel, where radiation is well known to cause detrimental effects to the rescuer, and CPR during/after land or air transportation of cardiac arrest victims. Lastly, CPR in a coronavirus disease 2019 patient/ward, where the danger of contamination and further serious illness of the health provider is very existent. The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these “hostile” and dangerous settings, while comparing them to manual compressions.
Collapse
Affiliation(s)
- George Latsios
- 1st University Department of Cardiology, "Hippokration" University Hospital, Athens Medical School, Athens 11527, Greece
| | - Marianna Leopoulou
- 1st Cardiology Clinic, 'Hippokration' University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
- Department of Cardiology, "Elpis" Athens General Hospital, Athens 11522, Greece
| | - Andreas Synetos
- 1st Department of Cardiology, Athens Medical School, University Athens, Hippokrat Hospital, Athens 11527, Greece
| | - Antonios Karanasos
- 1st University Department of Cardiology, "Hippokration" University Hospital, Athens Medical School, Athens 11527, Greece
| | - Angelos Papanikolaou
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital, Athens 11527, Greece
| | - Pavlos Bounas
- Department of Cardiology, “Thriasio” General Hospital, Thriasio General Hospital, Elefsina 19600, Greece
| | - Evangelia Stamatopoulou
- CathLab, 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Attikon University Hospital, Athens 12462, Greece
| | | | - Kostas Tsioufis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, “Hippokration” General Hospital, "Hippokration" University Hospital, Athens 11527, Greece
| |
Collapse
|
13
|
Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
|
14
|
Linet MS, Applegate KE, McCollough CH, Bailey JE, Bright C, Bushberg JT, Chanock SJ, Coleman J, Dalal NH, Dauer LT, Davis PB, Eagar RY, Frija G, Held KD, Kachnic LA, Kiess AP, Klein LW, Kosti O, Miller CW, Miller-Thomas MM, Straus C, Vapiwala N, Wieder JS, Yoo DC, Brink JA, Dalrymple JL. A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools. J Am Coll Radiol 2023; 20:251-264. [PMID: 36130692 PMCID: PMC10578400 DOI: 10.1016/j.jacr.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 12/27/2022]
Abstract
US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.
Collapse
Affiliation(s)
- Martha S Linet
- Chief and Senior Investigator, Radiation Epidemiology Branch (retired) and currently NIH Scientist Emerita, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Kimberly E Applegate
- Division Chief and Professor of Pediatric Radiology (retired), University of Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky, and currently Chair of Committee 3 of the International Commission on Radiological Protection, Ottawa, Canada
| | - Cynthia H McCollough
- Brooks-Hollern Professor of Medical Physics and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Janet E Bailey
- Professor of Radiology and Associate Chair for Education in Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Cedric Bright
- Associate Dean for Admissions and Clinical Professor, Department of Internal Medicine, East Carolina's Brody School of Medicine, Greenville, North Carolina
| | - Jerrold T Bushberg
- Clinical Professor of Radiology and Radiation Oncology, University of California Davis School of Medicine, Sacramento, California, and Vice President, National Council of Radiation Protection and Measurements, Bethesda, Maryland
| | - Stephen J Chanock
- Director and Chief of the Cancer Genomics Research Laboratory, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jenna Coleman
- Executive Director of the Medical Educational Council of Pensacola, Pensacola, Florida
| | - Nicole H Dalal
- Resident, Department of Internal Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Lawrence T Dauer
- Attending Physicist, Departments of Medical Physics and Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pamela B Davis
- Dean School of Medicine (emerita) and Arline H. and Curtis F. Garvin Research Professor, Center for Community Health Integration, and Professor of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert Y Eagar
- Diagnostic Radiology Resident, Department of Radiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Guy Frija
- Professor of Radiology (Emeritus), Université de Paris, Paris, France
| | - Kathryn D Held
- President of the National Council on Radiation Protection and Measurements, Bethesda, Maryland, and Associate Radiation Biologist, Department of Radiation Oncology, Massachusetts General Hospital and Associate Professor of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Lisa A Kachnic
- Chair, Department of Radiation Oncology, Columbia University Medical Center and the Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Ana P Kiess
- Assistant Professor of Radiation Oncology and Molecular Radiation Sciences and Director of the Residency Program, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lloyd W Klein
- Clinical Professor of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Ourania Kosti
- Senior Program Officer at the Nuclear and Radiation Studies Board of the National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Charles W Miller
- Chief (retired) Radiation Studies Branch, Division of Environmental Hazards and Health Effects, Centers for Disease Control and Prevention, Atlanta, Georgia, and currently a Consultant in Nuclear and Radiological Environmental Health, Atlanta, Georgia
| | - Michelle M Miller-Thomas
- Associate Professor of Radiology and Director of Medical Student Education at Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Christopher Straus
- Associate Professor of Radiology and Director of Medical Student Education, University of Chicago School of Medicine, Chicago, Illinois
| | - Neha Vapiwala
- Professor and Vice Chair of Education, Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica S Wieder
- Director of the Center for Radiation Information and Outreach, US Environmental Protection Agency, Washington, DC
| | - Don C Yoo
- Director of Nuclear Medicine, Miriam Hospital and Professor of Diagnostic Imaging and Clinical Educator, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - James A Brink
- Chair, Department of Radiology, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John L Dalrymple
- Professor of Obstetrics, Gynecology and Reproductive Biology and Associate Dean for Medical Education Quality Improvement, Harvard Medical School, Boston, Massachusetts, and Associate Chair and Vice Chair for Faculty Development and Faculty Affairs and Gynecologic Oncology Fellowship Program Director, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
15
|
[Intraoperative imaging of children and adolescents, for selected fractures and in follow-up after conservative and operative treatment : Part 2 of the results of a nationwide online survey of the Pediatric Traumatology Section of the German Trauma Society]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:42-54. [PMID: 34918188 PMCID: PMC9842560 DOI: 10.1007/s00113-021-01114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/27/2023]
Abstract
The indication for radiographic examinations in pediatric and adolescent trauma patients should follow ALARA (as low as reasonably achievable). Because of the effect of radiation on the growing sensitive tissues of these young patients, a strict indication should always be given for radiation use and during controls after fracture repair. METHODS An online survey by the Pediatric Traumatology Section (SKT) of the German Trauma Society (DGU) from Nov. 15, 2019, to Feb. 29, 2020, targeting trauma, pediatric, and general surgeons and orthopedic surgeons. RESULTS Participants: 788. Intraoperative applications: Collimation 50% always, postprocessing for magnification 40%, pulsed x-ray 47%, and 89% no continuous fluoroscopy; 63% osteosynthesis never directly on image intensifier. Radiographic controls after implant removal never used by 24%. After operated supracondylar humerus fracture, controls are performed up to 6 times. After distal radius greenstick fracture, 40% refrain from further X-ray controls, after conservatively treated clavicular shaft fracture, 55% refrain from further controls, others X-ray several times. After nondisplaced conservatively treated tibial shaft fracture, 63% recommend radiographic control after 1 week in two planes, 24% after 2 weeks, 37% after 4 weeks, and 32% after 6 weeks. DISCUSSION The analysis shows that there is no uniform radiological management of children and adolescents with fractures among the respondents. For some indications for the use of radiography, the benefit does not seem evident. The ALARA principle does not seem to be consistently followed. CONCLUSION Comparing the documented results of the survey with the consensus results of the SKT, differences are apparent.
Collapse
|
16
|
Climate Change, Carbon Dioxide Emissions, and Medical Imaging Contribution. J Clin Med 2022; 12:jcm12010215. [PMID: 36615016 PMCID: PMC9820937 DOI: 10.3390/jcm12010215] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Human activities have raised the atmosphere's carbon dioxide (CO2) content by 50% in less than 200 years and by 10% in the last 15 years. Climate change is a great threat and presents a unique opportunity to protect cardiovascular health in the next decades. CO2 equivalent emission is the most convenient unit for measuring the greenhouse gas footprint corresponding to ecological cost. Medical imaging contributes significantly to the CO2 emissions responsible for climate change, yet current medical guidelines ignore the carbon cost. Among the common cardiac imaging techniques, CO2 emissions are lowest for transthoracic echocardiography (0.5-2 kg per exam), increase 10-fold for cardiac computed tomography angiography, and 100-fold for cardiac magnetic resonance. A conservative estimate of 10 billion medical examinations per year worldwide implies that medical imaging accounts for approximately 1% of the overall carbon footprint. In 2016, CO2 emissions from magnetic resonance imaging and computed tomography, calculated in 120 countries, accounted for 0.77% of global emissions. A significant portion of global greenhouse gas emissions is attributed to health care, which ranges from 4% in the United Kingdom to 10% in the United States. Assessment of carbon cost should be a part of the cost-benefit balance in medical imaging.
Collapse
|
17
|
Clerkin KJ, Topkara VK, Farr MA, Jain R, Colombo PC, Restaino S, Sayer G, Castillo M, Lam EY, Chernovolenko M, Yuzefpolskaya M, DeFilippis E, Latif F, Zorn E, Takeda K, Johnson LL, Uriel N, Einstein AJ. Noninvasive Physiologic Assessment of Cardiac Allograft Vasculopathy Is Prognostic for Post-Transplant Events. J Am Coll Cardiol 2022; 80:1617-1628. [PMID: 36265957 PMCID: PMC9758655 DOI: 10.1016/j.jacc.2022.08.751] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial coronary arteries and the microvasculature. A leading cause of post-transplant mortality, CAV affects 50% of heart transplant recipients within 10 years of heart transplant. OBJECTIVES This analysis examined the outcomes of heart transplant recipients with reduced myocardial blood flow reserve (MBFR) and microvascular CAV detected by 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging. METHODS A total of 181 heart transplant recipients who underwent PET to assess for CAV were included with a median follow-up of 4.7 years. Patients were classified into 2 groups according to the total MBFR: >2.0 and ≤2.0. Microvascular CAV was defined as no epicardial CAV detected by PET and/or coronary angiography, but with an MBFR ≤2.0 by PET. RESULTS In total, 71 (39%) patients had an MBFR ≤2.0. Patients with an MBFR ≤2.0 experienced an increased risk for all outcomes: 7-fold increase in death or retransplantation (HR: 7.05; 95% CI: 3.2-15.6; P < 0.0001), 12-fold increase in cardiovascular death (HR: 12.0; 95% CI: 2.64-54.12; P = 0.001), and 10-fold increase in cardiovascular hospitalization (HR: 10.1; 95% CI: 3.43-29.9; P < 0.0001). The 5-year mean survival was 302 days less than those with an MBFR >2.0 (95% CI: 260.2-345.4 days; P < 0.0001). Microvascular CAV (adjusted HR: 3.86; 95% CI: 1.58-9.40; P = 0.003) was independently associated with an increased risk of death or retransplantation. CONCLUSIONS Abnormal myocardial blood flow reserve, even in the absence of epicardial CAV, identifies patients at a high risk of death or retransplantation. Measures of myocardial blood flow provide prognostic information in addition to traditional CAV assessment.
Collapse
Affiliation(s)
- Kevin J Clerkin
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Veli K Topkara
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/VeliKTopkaraMD
| | - Maryjane A Farr
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/MaryjaneFarrMD
| | - Rashmi Jain
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Paolo C Colombo
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Restaino
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Gabriel Sayer
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Michelle Castillo
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elaine Y Lam
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Margarita Chernovolenko
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Melana Yuzefpolskaya
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ersilia DeFilippis
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/ersied727
| | - Farhana Latif
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Emmanuel Zorn
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Lynne L Johnson
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/NirUrielMD
| | - Andrew J Einstein
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/AndrewEinstein7
| |
Collapse
|
18
|
Jovanovic I, Tesic M, Djordjevic-Dikic A, Giga V, Beleslin B, Aleksandric S, Boskovic N, Petrovic O, Marjanovic M, Vratonjic J, Paunovic I, Ivanovic B, Trifunovic-Zamaklar D. Role of different echocardiographic modalities in the assessment of microvascular function in women with ischemia and no obstructive coronary arteries. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1134-1142. [PMID: 36218210 DOI: 10.1002/jcu.23313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
This review summarizes current knowledge about echocardiographic modalities used to assess microvascular function and left ventricular (LV) systolic function in women with ischemia and no obstructive coronary arteries (INOCA). Although the entire pathophysiological background of this clinical entity still remains elusive, it is primarily linked to microvascular dysfunction which can be assessed by coronary flow velocity reserve. Subtle impairments of LV systolic function in women with INOCA are difficult to assess by interpretation of wall motion abnormalities. LV longitudinal function impairment is considered to be an early marker of subclinical systolic dysfunction and can be assessed by global longitudinal strain quantification.
Collapse
Affiliation(s)
- Ivana Jovanovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Milorad Tesic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislav Giga
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Srdjan Aleksandric
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Olga Petrovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Marjanovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Jelena Vratonjic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Ivana Paunovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
| | - Branislava Ivanovic
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Trifunovic-Zamaklar
- Clinic for Cardiology, University clinical center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
19
|
Uthirapathy I, Dorairaj P, Ravi S, Somasundaram S. Knowledge and practice of radiation safety in the Catherization laboratory among Interventional Cardiologists - An online survey. Indian Heart J 2022; 74:420-423. [PMID: 35970381 DOI: 10.1016/j.ihj.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/27/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
An Online Survey among Interventional Cardiologists (IC) assessed the knowledge (five questions) and practice of radiation safety (eleven questions). Out of 185 respondents, knowledge of annual radiation dose (2% knew), LAO cranial view giving maximum radiation (48%) and benefit of assessment of radiation exposure with dose area product (31%) was limited. Radiation safety was practiced "whenever I remember" in 37-59%. Radiation safety practices were optimal frame rate selection (32%), distancing from x-ray unit (17%), collimation use (30%), positioning the image detector close to chest (91%) and personal dosimeters use (40%). A major gap exists between knowledge and practice of radiation safety.
Collapse
|
20
|
Ismail H, Bradley AJ, Lewis JF. Cardiovascular Imaging in Pregnancy: Valvulopathy, Hypertrophic Cardiomyopathy, and Aortopathy. Front Cardiovasc Med 2022; 9:834738. [PMID: 35990938 PMCID: PMC9381830 DOI: 10.3389/fcvm.2022.834738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Pregnancy is associated with profound hemodynamic changes that are particularly impactful in patients with underlying cardiovascular disease. Management of pregnant women with cardiovascular disease requires careful evaluation that considers the well-being of both the woman and the developing fetus. Clinical assessment begins before pregnancy and continues throughout gestation into the post-partum period and is supplemented by cardiac imaging. This review discusses the role of imaging, specifically echocardiography, cardiac MRI, and cardiac CT, in pregnant women with valvular diseases, hypertrophic cardiomyopathy, and aortic pathology.
Collapse
|
21
|
Hachiya S, Kosuge H, Fujita Y, Hida S, Chikamori T. Performance of Hybrid Imaging in the Diagnosis of Coronary Artery Disease. Am J Cardiol 2022; 174:34-39. [PMID: 35379453 DOI: 10.1016/j.amjcard.2022.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
Single-photon emission computed tomography (SPECT) and computed tomography coronary angiography (CTCA) are usually performed independently in patients with suspected coronary artery disease. We assessed the hypothesis that hybrid SPECT/CTCA imaging results in higher diagnostic accuracy than either method alone, particularly in cases presenting with high levels of coronary calcification. A total of 243 major coronary vessels in 81 patients with known or suspected coronary artery disease were screened using SPECT with semiconductor detectors and CTCA with 256-detector row computed tomography. Patients who were diagnosed with myocardial ischemia underwent coronary angiography. Coronary angiography results were defined as positive for stenosis when the stenosis diameter was >70% or fractional flow reserve was <0.8. These data were then compared with a fused image of the SPECT and CTCA datasets generated using a dedicated workstation. To detect significant coronary artery stenosis, the respective sensitivity, specificity, and accuracy were 73%, 61%, and 67% with SPECT alone, 96%, 44%, and 67% with CTCA alone, and 95%, 75%, and 84% with hybrid imaging. Moreover, hybrid imaging allowed the accurate diagnosis of 47 vessels with severe calcification that CTCA alone could not evaluate correctly. Hybrid imaging shows greater diagnostic accuracy than single-modality evaluation through more comprehensive information on potential coronary stenosis and its hemodynamic significance.
Collapse
Affiliation(s)
- Shoko Hachiya
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hisanori Kosuge
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
| | - Yasuhiro Fujita
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Satoshi Hida
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | | |
Collapse
|
22
|
Local diagnostic reference levels and effective doses: single institution levels for interventional cardiology procedures for adult patients. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2022. [DOI: 10.2478/pjmpe-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Introduction: The current regulations in Poland in the field of interventional radiology only include diagnostic reference levels (DRL) for five procedures, containing only two for cardiological (hemodynamic) procedures, and only for adults. Given the insufficient number of DRLs, the need to introduce local levels based on the intervention procedures performed was identified. The purpose of this research was the evaluation of radiation doses (DRL, effective dose) received by patients in cardiological interventional procedures.
Material and methods: The DRL level was defined as the 75th percentile of the distribution of dosimetric parameters KAP and Kair,ref for each type of cardiological procedure. Data include three different X-ray units and 27 interventional cardiologists, derived from February 2019 to June 2019 and from August 2021 to December 2021. In order to estimate the effective dose, the appropriate conversion factors for cardiological procedures were used. The total number of analyzed procedures was 3818.
Results: The proposed local DRL levels were found to be mostly lower than data found in literature and in the current Polish national requirements (60%-70% lower for coronary angiography (CA) and percutaneous coronary angioplasty (PCI) procedures). Median equivalent doses for cardiological procedures were estimated at 2.66 mSv, 6.11 mSv and 7.22 mSv for CA, PCI and combined PCI with CA procedure, respectively.
Conclusions: The proposed local/institutional DRLs seem to be suitable for use and could be utilized by other centers for comparison purposes.
Collapse
|
23
|
Xu J, Gao Y, Liu C, Wang Y. Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography vs without intracardiac echocardiography: A meta-analysis of observational and randomized studies. J Cardiovasc Electrophysiol 2022; 33:897-907. [PMID: 35212079 DOI: 10.1111/jce.15423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIMS Intracardiac echocardiography (ICE) provides superior quality images and can monitor catheter location within the heart continuously. Given the limited evidence, we conducted the meta-analysis to evaluate outcomes with ICE in radiofrequency (RF) ablation of atrial fibrillation (AF). METHODS AND RESULTS PubMed/MEDLINE, Embase and Cochrane were searched for studies reporting RF ablation for treatment of AF with the use of ICE vs without ICE and 12 studies were included. Sensitivity analyses limiting studies to ablation with the use of contact force (CF) catheters were conducted and subgroup analyses were performed according to the published year. In main analyses, RF ablation with ICE for treatment of AF was associated with significant reduction in total X-ray time (MD, -9.80; 95% CI, -15.57 to -4.04; I2 =99%; p <0.01), total procedure time (MD, -17.65; 95% CI, -30.22 to -5.09; I2 =89%; p <0.01), and complications (RR, 0.90; 95% CI, 0.87 to 0.92; I2 =20%; p<0.01) vs without ICE. The ICE-guided group tended to decrease total absorbed X-ray dose (SMD, -0.91; 95% CI, -1.86 to 0.04; I2 =96%; p =0.06). Freedom from arrhythmia (RR, 1.06; 95% CI, 0.98 to 1.14; I2 =0%; p =0.13) was comparable between the two groups. CONCLUSION In patients with AF, ICE-guided RF ablation is correlated with significant reductions in total X-ray time, total procedure time, and complications vs ablation without ICE. Total absorbed X-ray dose tends to reduce in the ICE group and freedom from arrhythmia is comparable between the two groups. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Jingmiao Xu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Ying Gao
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Chunhui Liu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Yaping Wang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| |
Collapse
|
24
|
Fong KM, Au SY, Lee MKY. Artificial intelligence-assisted frame rate augmentation in fluoroscopy. J Cardiovasc Med (Hagerstown) 2022; 23:e8-e10. [PMID: 34346905 DOI: 10.2459/jcm.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ka Man Fong
- Department of Intensive Care, Queen Elizabeth Hospital
| | - Shek Yin Au
- Department of Intensive Care, Queen Elizabeth Hospital
| | | |
Collapse
|
25
|
Abstract
Environmental impact of medical imaging is ill-defined and poorly recognised but can vary by a factor of 100 or 1 000 between one test or the other. One echocardiogram produces 2 Kg and a 3 Tesla magnetic resonance imaging produces 200 to 300 kg of carbon dioxide (CO2) equivalent. For 2016, CO2 emissions for magnetic resonance imaging and computed tomography calculated in 120 countries accounted for 0.77% of global emissions. In imaging justification, we usually consider benefit, cost, and risk including long-term cancer risk. Environmental footprint should be included, since there is a fourth partner in the imaging deal: not only the patient, the physician, the payer, but also the planet. Medical imaging is an important source of carbon footprint in the global scale. Environmental impact of each imaging examination might be spelled-out and missing data provided to bridge the knowledge gap. Research may develop a catalogue of carbon footprints associated with specific test modalities, and provide an updated estimation of medical imaging impact on global carbon footprint, promoting new approaches towards a progressive de-carbonization of testing with climate-neutral choices.
Collapse
|
26
|
Sharkey AR, Gambhir P, Saraskani S, Walker R, Hajilou A, Bassett P, Sandhu N, Croasdale P, Honey I, Diamantopoulos A, Goh V. Occupational radiation exposure in doctors: an analysis of exposure rates over 25 years. Br J Radiol 2021; 94:20210602. [PMID: 34538079 PMCID: PMC8553192 DOI: 10.1259/bjr.20210602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Healthcare professionals' occupational exposure to ionising radiation may be increasing due to increasing use of imaging and image-guided intervention. This study aims to assess the occupational exposure of doctors over a 25-year period at an NHS teaching hospital. METHODS Dosemeter measurements were collected prospectively from 1995 to 2019. Two retrospective analyses were performed over time (first including all measurements, second excluding "zero-dose" measurements), and by speciality. Group comparisons were undertaken using multilevel linear regression; a p-value <0.05 was deemed significant. RESULTS 8,892 measurements (3,983 body, 1,514 collar, 649 eye, 2,846 hand), of which 3,350 were non-zero measurements (1,541 body, 883 collar, 155 eye, 771 hand), were included. Whole dataset analysis found a significant decrease in exposure for radiologists and cardiologists, as measured by body, hand and collar dosemeters over the last 25 years (p < 0.01 for all). The non-zero readings reflect the whole cohort analysis except in the case of eye dosemeters, which showed a significant decrease in exposure for cardiologists (p < 0.01), but a significant increase for radiologists and surgeons/anaesthetists (p < 0.01 for both). CONCLUSIONS Whilst ionising radiation remains an occupational risk for doctors, the overall decreasing trend in occupational exposure is reassuring. However, a significant rise in eye dose for radiologists, surgeons and anaesthetists is concerning, and close monitoring is required to prevent future issues. ADVANCES IN KNOWLEDGE This paper is one of few evaluating the occupational radiation exposure to doctors over a 25-year period, showing that although most dosemeter measurements reflect decreasing exposure, the increase in eye exposure warrants caution.
Collapse
Affiliation(s)
- Amy R Sharkey
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | | | - Ross Walker
- King's College London, London, United Kingdom
| | | | - Paul Bassett
- Statsconsultancy Ltd, Buckinghamshire, United Kingdom
| | - Navneet Sandhu
- Department of Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Peter Croasdale
- Department of Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ian Honey
- Department of Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Vicky Goh
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| |
Collapse
|
27
|
Osman E, Sulieman A, Alzimami K, Tamam N, Jambi LK, Babikir E, Abd-Elghany AA, Abuzaid M, Omer H, Bradley D. Radiation exposure during therapeutic cardiac interventional procedures. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
28
|
Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Comparison of patient and staff temple dose during fluoroscopically guided coronary angiography, implantable cardiac devices, and electrophysiology procedures. Phys Med 2021; 90:142-149. [PMID: 34649045 DOI: 10.1016/j.ejmp.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/03/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022] Open
Abstract
There is a paucity of literature comparing patient and staff dose during coronary angiography (CA), implantable cardiac devices, permanent pacemakers (PPM) and electrophysiology (EP) procedures and little noting dose to staff other than cardiologists. This study sought to compare patient and occupational dose during a range of fluoroscopically guided cardiac procedures. Radiation dose levels for the patients (n = 1651), cardiologists (n = 24), scrub (n = 32) and scout nurses (n = 35) were measured in a prospective single-centre study between February 2017 and August 2019. A comparison of dose during CA, device implantation, PPM insertion and EP studies was performed. Three angiographic units were used, with dosimeters worn on the temple of staff. Results indicated that occupational dose during PPM was significantly higher than other procedures. The cardiologist had the highest mean dose during biventricular implantable cardioverter-defibrillators; levels were approximately five times that of 'normal' pacemaker insertions. Transcatheter aortic valve implantations (TAVI) were associated with relatively high mean doses for both staff and patients and had a statistically significant higher (>2 times) mean patient dose area product than all other categories. TAVI workups were also related to higher mean cardiologist and scrub nurse dose. It was observed that the mean scrub nurse dose can exceed that of the cardiologist. The highest mean dose for Scout nurses were recorded during EP studies. Given the significantly higher temple dose associated with PPM insertion, cardiologists should consider utilizing ceiling mounted lead shields, lead glasses and/or skull caps where possible. Efforts should also be made to minimize the use of DSA during TAVI and TAVI workups to reduce cardiologist, nurse and patient dose.
Collapse
Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faulty of Science, Queensland Univeristy of Technology, 2 George Street, Brisbane, QLD 4000, Australia; Greenslopes Private Hospital, Ramsay Health Care, Newdegate Street, Greenslopes, Brisbane, QLD 4120, Australia.
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies (CBT), Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia; QMIR Berghofer Medical Research Institute, 200 Herston Road, Herston, QLD 4006, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faulty of Science, Queensland Univeristy of Technology, 2 George Street, Brisbane, QLD 4000, Australia
| |
Collapse
|
29
|
Kidoń J, Polaczek-Grelik K, Żurek P, Wojakowski W, Ochala A. Exposure of the eye lens and brain for interventional cardiology staff. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:298-304. [PMID: 34819966 PMCID: PMC8596714 DOI: 10.5114/aic.2021.109576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Occupational exposure to ionizing radiation for people working with an X-ray treatment unit is one of the highest in medicine. The epidemiological data analyzed by the International Commission on Radiological Protection (ICRP) indicate that the dose threshold for tissues located in the eye lens is or may be lower than previously thought. The new ICRP recommendations reduce the currently used threshold 7.5 times to the limit of 20 mSv per year. AIM To carry out measurements of equivalent doses for the lenses and scalps of cardiology interventional staff to determine the actual exposure. MATERIAL AND METHODS Personnel performing interventional cardiology procedures participated in the measurements. The measurements were performed using thermoluminescence dosimetry in two measurement periods. The operational quantities used in individual dosimetry were determined (dose equivalent for the scalp, dose equivalent for the eye lens). In both measurement periods, 69 operators and 12 nurses took part. RESULTS The maximum value of eye doses for cardiologists was 18.80 mSv per year, with a mean of 9.83 ±6.47 mSv/year (for all cases), 5.70 ±4.26 mSv/year (with safety glasses/headgear), 13.14 ±6.28 mSv/year (without safety glasses/headgear), and 6.28 ±1.76 mSv per year for the nurses. The values of brain doses fluctuate around 1 mSv per quarter. CONCLUSIONS Dose equivalents for the lenses of the eyes obtained by cardiologists may be close to or exceed the current dose limits.
Collapse
Affiliation(s)
- Joanna Kidoń
- Invasive Cardiology and Electrocardiology Department, Medical University of Silesia, Katowice, Poland
| | - Kinga Polaczek-Grelik
- Prof. K. Gibiński Memorial University Clinical Centre, Medical University of Silesia, Katowice, Poland
| | - Przemysław Żurek
- 2 Department of Cardiology, Upper Silesian Medical Center, Katowice, Poland
| | - Wojciech Wojakowski
- 3 Department of Cardiology, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Andrzej Ochala
- Invasive Cardiology and Electrocardiology Department, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
30
|
Abdulsalam N, Gillis AM, Rzeszut AK, Yong CM, Duvernoy CS, Langan MN, West K, Velagapudi P, Killic S, O'Leary EL. Gender Differences in the Pursuit of Cardiac Electrophysiology Training in North America. J Am Coll Cardiol 2021; 78:898-909. [PMID: 34446162 DOI: 10.1016/j.jacc.2021.06.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the increase in the number of female physicians across most specialties within cardiology, <10% of clinical cardiac electrophysiology (EP) fellows are women. OBJECTIVES This study sought to determine the factors that influence fellows-in-training (FITs) to pursue EP as a career choice and whether this differs by gender. METHODS The authors conducted an online multiple-choice survey through the American College of Cardiology to assess the decision factors that influence FITs in the United States and Canada to pursue cardiovascular subspecialties. RESULTS A total of 933 (30.5%) FITs completed the survey; 129 anticipated specializing in EP, 259 in interventional cardiology (IC), and 545 in a different field or were unsure. A total of 1 in 7 (14%) FITs indicated an interest in EP. Of this group, more men chose EP than women (84% vs 16%; P < 0.001). The most important factor that influenced FITs to pursue EP was a strong interest in the field. Women were more likely to be influenced by having a female role model (P = 0.001) compared with men. After excluding FITs interested in IC, women who deselected EP were more likely than men to be influenced by greater interest in another field (P = 0.004), radiation concerns (P = 0.001), lack of female role models (P = 0.001), a perceived "old boys' club" culture (P = 0.001) and discrimination/harassment concerns (P = 0.001). CONCLUSIONS Women are more likely than men to be negatively influenced by many factors when it comes to pursuing EP as a career choice. Addressing those factors will help decrease the gender disparity in the field.
Collapse
Affiliation(s)
- Nashwa Abdulsalam
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA; Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Anne M Gillis
- Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Anne K Rzeszut
- Market Intelligence, American College of Cardiology, Washington, DC, USA
| | - Celina M Yong
- VA Palo Alto Medical Center, Palo Alto, California, USA; Department of Medicine, Stanford University and Stanford Cardiovascular Institute, Stanford, California, USA
| | - Claire S Duvernoy
- VA Ann Arbor Healthcare System/University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan, USA
| | - Marie-Noelle Langan
- Division of Cardiology, Mt. Sinai School of Medicine, New York, New York, USA
| | - Kristin West
- Member Strategy, American College of Cardiology, Washington, DC, USA
| | - Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sena Killic
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Edward L O'Leary
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
| |
Collapse
|
31
|
Stress Echo 2030: The Novel ABCDE-(FGLPR) Protocol to Define the Future of Imaging. J Clin Med 2021; 10:jcm10163641. [PMID: 34441937 PMCID: PMC8397117 DOI: 10.3390/jcm10163641] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF); 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021–2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient.
Collapse
|
32
|
Sieren MM, Maintz D, Gutberlet M, Krombach GA, Bamberg F, Hunold P, Lehmkuhl L, Fischbach K, Reinartz S, Antoch G, Barkhausen J, Sandstede J, Völker M, Naehle C. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. ROFO-FORTSCHR RONTG 2021; 194:181-191. [PMID: 34384112 DOI: 10.1055/a-1554-9236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In the light of the increasing importance of cardiovascular cross-sectional imaging in current guidelines, the goal of this study is to provide a comprehensive overview of cardiovascular imaging (CVI) offered by radiological institutions across Germany. MATERIALS AND METHODS Data were extracted from the national certification program database of the German Roentgen Society (DRG) from 2015-2021. A nationwide online survey among radiology institutes (university hospitals, non-university hospitals, and private practices) was conducted for 2019, and data was extracted from the European Society of Cardiovascular Radiology (ESCR) registry. The data collection's key points included the number of centers and individuals certified for CVI, the number of cardiac CT and MRI examinations performed, the reporting habits, and the participation in the ESCR registry. RESULTS 71 centers and 1278 persons, both with a substantial increase since 2015, were registered and certified by the DRG to perform CVI. According to the survey, a total of 69,286 CT and 64,281 MRI examinations were performed annually. Data from the survey and the ESCR registry indicated that reporting was mostly done solely by radiologists or, to a lesser degree, in joint consensus meetings with non-radiologists. The overall participation rate in the ESCR registry was 48 % among the survey's participants. CONCLUSION This comprehensive analysis demonstrates that high-quality CVI by radiologists is available nationwide. The current challenges are to provide the best medical and technical quality of CVI by radiology for patient care and to ensure economic sustainability in the German health care system to accommodate the predicted substantial need for CVI in the future. KEY POINTS · High-quality advanced CVI service by radiologists is available nationwide.. · Highly qualified specialist knowledge is widely represented from university to private practices.. · Certification programs successfully contribute to the dissemination & deepening of CVI expertise.. · The ESCR registry is an established international tool for the documentation of CVI.. CITATION FORMAT · Sieren M, Maintz D, Gutberlet M et al. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1554-9236.
Collapse
Affiliation(s)
- Malte Maria Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - David Maintz
- Department for Interventional and Diagnostic Radiology, University Hospital Cologne, Germany
| | - Matthias Gutberlet
- Department for Diagnostic and Interventional Radiology, Heart Center Leipzig - University Leipzig, Germany.,Steering Committee Chair MRCT-Registry of the ESCR, ESCR, Vienna, Austria
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, University-Hospital Gießen, Germany
| | - Fabian Bamberg
- Department for Diagnostic and Interventional Radiology, University Hospital Freiburg, Germany
| | - Peter Hunold
- n/a, FOKUS Radiologie & Nuklearmedizin, Göttingen, Germany
| | - Lukas Lehmkuhl
- Department for Diagnostic and Interventional Radiology, RHÖN Clinic, Campus Bad Neustadt, Germany
| | - Katharina Fischbach
- Diagnostische Radiologie, Otto-von-Guericke-Universität, Magdeburg, Germany.,Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Sebastian Reinartz
- Department for Diagnostic and Interventional Radiology, University Hospital Aachen, Germany
| | - Gerald Antoch
- Department for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, University Hospital Düsseldorf, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Jörn Sandstede
- Hamburg Wördemanns Weg, Radiologische Allianz, Hamburg, Germany.,Berufsverband der deutschen Radiologen e.V. (BDR), Munich, Germany
| | - Martin Völker
- Bereich Wissenschaft, Nachwuchsförderung, Zertifizierung, German Roentgen Society "Deutsche Röntgengesellschaft", Berlin, Germany
| | - Claas Naehle
- Department for Interventional and Diagnostic Radiology, University Hospital Cologne, Germany
| |
Collapse
|
33
|
Linet MS, Davis PB, Brink JA. The Need for a Broad-based Introduction to Radiation Science within U.S. Medical Schools' Educational Curriculum. Radiology 2021; 301:35-40. [PMID: 34282969 DOI: 10.1148/radiol.2021210665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martha S Linet
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, NCI Shady Grove Room 7E536, Bethesda, MD 20892-9778 (M.S.L.); Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio (P.B.D.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.B.)
| | - Pamela B Davis
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, NCI Shady Grove Room 7E536, Bethesda, MD 20892-9778 (M.S.L.); Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio (P.B.D.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.B.)
| | - James A Brink
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, NCI Shady Grove Room 7E536, Bethesda, MD 20892-9778 (M.S.L.); Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio (P.B.D.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.B.)
| |
Collapse
|
34
|
Latsios G, Leopoulou M, Synetos A, Karanasos A, Melidi E, Toutouzas K, Tsioufis K. The role of automated compression devices in out-of- and in- hospital cardiac arrest. Can we spare rescuers’ hands? EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Research regarding the use of mechanical compressions in the setting of a cardiac arrest, either outside of or inside the hospital environment has produced mixed results. The debate whether they can replace manual compressions still remains. The aim of this review is to present current literature contemplating the application of mechanical compressions in both settings, data comparing them to manual compressions as well as current guidelines regarding their implementation in everyday clinical use. Currently, their implementation in the resuscitation protocol seems to benefit the victims of an in-hospital cardiac arrest rather than the victims that sustain a cardiac arrest outside of the hospital.
Collapse
|
35
|
Affiliation(s)
- Eugenio Picano
- Research Director, Institute of Clinical Physiology, Italian National Research Council, 56124 Pisa, Italy, Tel: +39 050 315 2246; Fax: +39 050 315 2374
| |
Collapse
|
36
|
Naidu SS, Abbott JD, Bagai J, Blankenship J, Garcia S, Iqbal SN, Kaul P, Khuddus MA, Kirkwood L, Manoukian SV, Patel MR, Skelding K, Slotwiner D, Swaminathan RV, Welt FG, Kolansky DM. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv 2021; 98:255-276. [PMID: 33909349 DOI: 10.1002/ccd.29744] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.
Collapse
Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - J Dawn Abbott
- Cardiovascular Institute of Lifespan, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jayant Bagai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Blankenship
- Cardiology Division, The University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Sohah N Iqbal
- Mass General Brigham Salem Hospital, Salem, Massachusetts, USA
| | | | - Matheen A Khuddus
- The Cardiac and Vascular Institute and North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Lorrena Kirkwood
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Manesh R Patel
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - David Slotwiner
- Division of Cardiology, New York Presbyterian, Weill Cornell Medicine Population Health Sciences, Queens, New York, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
37
|
Indik JH. Radiation Safety Is Not a No-Brainer. JACC Clin Electrophysiol 2021; 7:171-173. [PMID: 33602397 DOI: 10.1016/j.jacep.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Julia H Indik
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA.
| |
Collapse
|
38
|
Hirschfeld CB, Mercuri M, Pascual TNB, Karthikeyan G, Vitola JV, Mahmarian JJ, Better N, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Dorbala S, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Shaw LJ, Underwood SR, Rehani MM, Paez D, Dondi M, Einstein AJ. Worldwide Variation in the Use of Nuclear Cardiology Camera Technology, Reconstruction Software, and Imaging Protocols. JACC Cardiovasc Imaging 2021; 14:1819-1828. [PMID: 33454257 DOI: 10.1016/j.jcmg.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED). BACKGROUND Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols. METHODS Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study) registry, a multinational, cross-sectional study comprising 7,911 imaging studies from 308 labs in 65 countries. The study compared regional use of camera technologies, advanced post-processing software, and protocol characteristics and analyzed the influence of each factor on ED. RESULTS Cadmium-zinc-telluride and positron emission tomography (PET) cameras were used in 10% (regional range 0% to 26%) and 6% (regional range 0% to 17%) of studies worldwide. Attenuation correction was used in 26% of cases (range 10% to 57%), and advanced post-processing software was used in 38% of cases (range 26% to 64%). Stress-first single-photon emission computed tomography (SPECT) imaging comprised nearly 20% of cases from all world regions, except North America, where it was used in just 7% of cases. Factors associated with lower ED and odds ratio for achieving radiation dose ≤9 mSv included use of cadmium-zinc-telluride, PET, advanced post-processing software, and stress- or rest-only imaging. Overall, 39% of all studies (97% PET and 35% SPECT) were ≤9 mSv, while just 6% of all studies (32% PET and 4% SPECT) achieved a dose ≤3 mSv. CONCLUSIONS Newer-technology cameras, advanced software, and stress-only protocols were associated with reduced ED, but worldwide adoption of these practices was generally low and varied significantly between regions. The implementation of dose-optimizing technologies and protocols offers an opportunity to reduce patient radiation exposure across all world regions.
Collapse
Affiliation(s)
- Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Mathew Mercuri
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas N B Pascual
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Nathan Better
- Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | | | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Vikram Lele
- Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Mumbai, India
| | - V Peter C Magboo
- Department of Physical Sciences and Mathematics, University of the Philippines, Manila, the Philippines; Department of Nuclear Medicine, University of Santo Tomas Hospital, Manila, the Philippines
| | - Erick Alexánderson
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, Mexico
| | - Adel H Allam
- Cardiology Department, Al Azhar University, Cairo, Egypt
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Scott Jerome
- Intersocietal Accreditation Commission, Ellicott City, Maryland; Division of Cardiology, University of Maryland, Baltimore, Maryland, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Israel; Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Leslee J Shaw
- New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Paez
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA.
| | | |
Collapse
|
39
|
Mowers KL, Fullerton JB, Hicks D, Singh GK, Johnson MC, Anwar S. 3D Echocardiography Provides Highly Accurate 3D Printed Models in Congenital Heart Disease. Pediatr Cardiol 2021; 42:131-141. [PMID: 33083888 DOI: 10.1007/s00246-020-02462-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/16/2020] [Indexed: 01/22/2023]
Abstract
Cardiac 3D printing is mainly performed from magnetic resonance imaging (MRI) and computed tomography (CT) 3D datasets, though anatomic detail of atrioventricular (AV) valves may be limited. 3D echo provides excellent visualization of AV valves. Thus, we tested the feasibility and accuracy of 3D printing from 3D echo in this pilot series of subjects with congenital heart disease (CHD), with a focus on valve anatomy. Five subjects with CHD were identified. 3D echo data were converted to 3D printable files and printed in collaboration with 3D Systems Healthcare (Golden, Colorado). A novel technique for valve modeling was utilized using commercially available software. Two readers (KM, SA) independently measured valve structures from 3D models and compared to source echo images. 3D printing was feasible for all cases. Table 1 shows measurements comparing 2D echo to 3D models. Bland Altman analysis showed close agreement and no significant bias between 2D and digital 3D models (mean difference 0.0, 95% CI 1.1 to - 1.1) or 2D vs printed 3D models, though with wider limits of agreement (mean difference - 0.3, 95% CI 1.9 to - 2.6). Accuracy of 3D models compared to 2D was within < 0.5 mm. This pilot study shows 3D echo datasets can be used to reliably print AV and semilunar valve structures in CHD. The 3D models are highly accurate compared to the source echo images. This is a novel and value-added technique that adds incremental information on cardiac anatomy over current methods.
Collapse
Affiliation(s)
- K L Mowers
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - D Hicks
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - G K Singh
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - M C Johnson
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - S Anwar
- School of Medicine, University of California, 1975 4th Street Second Floor, Room# A2421, UCSF Box 4029, San Francisco, CA, 94143, USA.
| |
Collapse
|
40
|
Byrne RA, Hanratty CG, Gilligan P. Occupational radiation exposure in interventional cardiology - time for further action. EUROINTERVENTION 2020; 16:613-616. [PMID: 33095162 DOI: 10.4244/eijv16i8a113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Robert A Byrne
- Cardiovascular Research Institute Dublin, Mater Private Hospital, Dublin, Ireland
| | | | | |
Collapse
|
41
|
Affiliation(s)
- Ariel Roguin
- 2 Hillel Yaffe Medical Centre, Technion - Israel Institute of Technology, Hadera, Israel
| | - James Nolan
- Department of Cardiology, Royal Stoke University Hospital and Keele University, Stoke-on-Trent, Staffordshire, UK
| |
Collapse
|
42
|
Wilson-Stewart KS, Fontanarosa D, Li D, Drovandi CC, Anderson RK, Trapp JV. Taller staff occupationally exposed to less radiation to the temple in cardiac procedures, but risk higher doses during vascular cases. Sci Rep 2020; 10:16103. [PMID: 32999372 PMCID: PMC7528059 DOI: 10.1038/s41598-020-73101-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/11/2020] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the effect of nurse and doctor height on occupational dose to the temple during fluoroscopically guided cardiovascular procedures. Additionally, an evaluation of the relationship between doctor height and table height was performed. Staff exposed during fluoroscopic procedures may be at elevated risk of cardiovascular damage or oncogenesis and have demonstrated a higher incidence of subscapular cataracts. The heads of taller staff may be exposed to reduced levels of radiation due to the increased distance from the area of highest intensity X-ray scatter. Limited research has been performed investigating height as a predictor of head dose to nursing staff. The level of radiation dose at the level of the temple to the doctor (n = 25), scrub (n = 28), and scout nurse (n = 29) was measured in a prospective single-center, observational study using Philips DoseAware badges. Procedural characteristics were recorded for vascular and cardiac cases performed in three dedicated angiography suites. Data were also collected to investigate relationships between doctor height and table height. Data were collected for 1585 cardiac and 294 vascular procedures. Staff height was a statistically significant predictor of temple dose for doctors, scrub, and scout nurses when considering the full data sample. The log temple dose demonstrated an inverse relationship to staff height during cardiac procedures, but a positive relationship for scrub and scout nurses during vascular studies. This observational study has demonstrated that taller staff are exposed to less cranial exposure dose during fluoroscopically guided cardiac examinations but has revealed a positive correlation between height and temple dose during vascular procedures. It was also determined that doctor height was correlated with average procedural table height and that vascular access point influences the choice of table elevation.
Collapse
Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia. .,Cardiovascular Suites, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, Australia.
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Q Block, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia
| | - Dan Li
- School of Mathematical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Centre for Data Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Chris C Drovandi
- School of Mathematical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Centre for Data Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Rebecca K Anderson
- Cardiovascular Suites, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
| |
Collapse
|
43
|
Bundy JJ, McCracken IW, Shin DS, Monroe EJ, Johnson GE, Ingraham CR, Kanal KM, Bundy RA, Jones ST, Valji K, Chick JFB. Fluoroscopically-guided interventions with radiation doses exceeding 5000 mGy reference point air kerma: a dosimetric analysis of 89,549 interventional radiology, neurointerventional radiology, vascular surgery, and neurosurgery encounters. CVIR Endovasc 2020; 3:69. [PMID: 32960372 PMCID: PMC7509020 DOI: 10.1186/s42155-020-00159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose To quantify and categorize fluoroscopically-guided procedures with radiation doses exceeding 5000 mGy reference point air kerma (Ka,r). Ka,r > 5000 mGy has been defined as a “significant radiation dose” by the Society of Interventional Radiology. Identification and analysis of interventions with high radiation doses has the potential to reduce radiation-induced injuries. Materials and methods Radiation dose data from a dose monitoring system for 19 interventional suites and 89,549 consecutive patient encounters from January 1, 2013 to August 1, 2019 at a single academic institution were reviewed. All patient encounters with Ka,r > 5000 mGy were included. All other encounters were excluded (n = 89,289). Patient demographics, medical specialty, intervention type, fluoroscopy time (minutes), dose area product (mGy·cm2), and Ka,r (mGy) were evaluated. Results There were 260 (0.3%) fluoroscopically-guided procedures with Ka,r > 5000 mGy. Of the 260 procedures which exceeded 5000 mGy, neurosurgery performed 81 (30.5%) procedures, followed by interventional radiology (n = 75; 28.2%), neurointerventional radiology (n = 55; 20.7%), and vascular surgery (n = 49; 18.4%). The procedures associated with the highest Ka,r were venous stent reconstruction performed by interventional radiology, arteriovenous malformation embolization performed by neurointerventional radiology, spinal hardware fixation by neurosurgery, and arterial interventions performed by vascular surgery. Neurointerventional radiology had the highest mean Ka,r (7,799 mGy), followed by neurosurgery (7452 mGy), vascular surgery (6849 mGy), and interventional radiology (6109 mGy). The mean Ka,r for interventional radiology performed procedures exceeding 5000 mGy was significantly lower than that for neurointerventional radiology, neurosurgery, and vascular surgery. Conclusions Fluoroscopically-guided procedures with radiation dose exceeding 5000 mGy reference point air kerma are uncommon. The results of this study demonstrate that a large proportion of cases exceeding 5000 mGy were performed by non-radiologists, who likely do not receive the same training in radiation physics, radiation biology, and dose reduction techniques as radiologists.
Collapse
Affiliation(s)
- Jacob J Bundy
- Wake Forest Baptist Health, One Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ian W McCracken
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - David S Shin
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Eric J Monroe
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Guy E Johnson
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | | | - Kalpana M Kanal
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Richa A Bundy
- Wake Forest Baptist Health, One Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Sean T Jones
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Karim Valji
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | | |
Collapse
|
44
|
Faroux L, Villecourt A, Guimaraes L, Wintzer-Wehekind J, Junquera L, Arsenault J, Blanpain T, Tassan-Mangina S, Heroguelle V, Ruggieri VG, Metz D, Kalavrouziotis D, Dumont E, Paradis JM, Delarochellière R, Del Val D, Muntané-Carol G, Mohammadi S, Rodés-Cabau J. Radiation Exposure During Transcatheter Aortic Valve Replacement: Impact of Arterial Approach and Prosthesis Type. Ann Thorac Surg 2020; 111:1601-1606. [PMID: 32950489 DOI: 10.1016/j.athoracsur.2020.06.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/03/2020] [Accepted: 06/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of novel alternative access and valve type on radiation exposure during transcatheter aortic valve replacement (TAVR) has not yet been evaluated. This study sought to determine the impact of a transarterial approach and prosthesis type on physician and patient exposure to radiation during TAVR. METHODS This was a prospective study including 140 consecutive patients undergoing TAVR by transfemoral (n = 102) or transcarotid (TC) (n = 38) access at 2 centers. Implanted valves were the self-expanding Evolut R/PRO system (Medtronic, Minneapolis, MN; n = 38) and the balloon-expandable SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA; n = 102). The primary endpoint was first operator radiation exposure. The secondary endpoint was patient radiation exposure. RESULTS First operator radiation exposure was 4-fold greater during TC TAVR (P < .001). The use of a self-expanding valve was associated with a longer x-ray time (P = .015) and a 2-fold greater first operator radiation dose (P = .018). Patient radiation dose was not significantly affected by arterial approach (P = .055) or valve type (P = .095). After adjustment for potential confounders, the TC approach remained associated with a 174.8% (95% confidence interval, 80.6-318.3, P < .001) increase in first operator radiation dose, whereas the use of a self-expanding valve no longer influenced the first operator dose (P = .630). CONCLUSIONS TC access and the use of a self-expanding valve were associated with a 4- and 2-fold greater first operator radiation exposure during TAVR procedures, respectively. Unlike the arterial approach, the effect of bioprosthesis type on radiation exposure was mainly related to x-ray time and was no longer significant after adjustment.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology, Reims University Hospital, Reims, France; EA3797 VieFra, University of Reims Champagne-Ardenne, Reims, France
| | | | - Leonardo Guimaraes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean Arsenault
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thierry Blanpain
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | | | | | - Damien Metz
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
| |
Collapse
|
45
|
Hirschfeld CB, Dondi M, Pascual TNB, Mercuri M, Vitola J, Karthikeyan G, Better N, Mahmarian JJ, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Underwood SR, Rehani MM, Vassileva J, Paez D, Einstein AJ. Worldwide Diagnostic Reference Levels for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging: Findings From INCAPS. JACC Cardiovasc Imaging 2020; 14:657-665. [PMID: 32828783 DOI: 10.1016/j.jcmg.2020.06.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). BACKGROUND Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. METHODS Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. RESULTS The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m-labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. CONCLUSIONS This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.
Collapse
Affiliation(s)
- Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Maurizio Dondi
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Thomas N B Pascual
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Mathew Mercuri
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joao Vitola
- Quanta Diagnóstico e Terapia, Curitiba, Brazil
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nathan Better
- Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Salah E Bouyoucef
- Department of Nuclear Medicine, Centre Hospitalo-Universitaire de Bab El Ouéd, Alger, Algeria
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Vikram Lele
- Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Mumbai, India
| | - Vincent Peter C Magboo
- Department of Physical Sciences and Mathematics, University of the Philippines, Quezon City, Philippines; Department of Nuclear Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | - Erick Alexánderson
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico; Department of Physiology, School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Adel H Allam
- Cardiology Department, Al Azhar University, Cairo, Egypt
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Scott Jerome
- Intersocietal Accreditation Commission, Ellicott City, Maryland, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel; Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
| | | |
Collapse
|
46
|
Hong JH, Park EA, Lee W, Ahn C, Kim JH. Incremental Image Noise Reduction in Coronary CT Angiography Using a Deep Learning-Based Technique with Iterative Reconstruction. Korean J Radiol 2020; 21:1165-1177. [PMID: 32729262 PMCID: PMC7458859 DOI: 10.3348/kjr.2020.0020] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the feasibility of applying a deep learning-based denoising technique to coronary CT angiography (CCTA) along with iterative reconstruction for additional noise reduction. Materials and Methods We retrospectively enrolled 82 consecutive patients (male:female = 60:22; mean age, 67.0 ± 10.8 years) who had undergone both CCTA and invasive coronary artery angiography from March 2017 to June 2018. All included patients underwent CCTA with iterative reconstruction (ADMIRE level 3, Siemens Healthineers). We developed a deep learning based denoising technique (ClariCT.AI, ClariPI), which was based on a modified U-net type convolutional neural net model designed to predict the possible occurrence of low-dose noise in the originals. Denoised images were obtained by subtracting the predicted noise from the originals. Image noise, CT attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were objectively calculated. The edge rise distance (ERD) was measured as an indicator of image sharpness. Two blinded readers subjectively graded the image quality using a 5-point scale. Diagnostic performance of the CCTA was evaluated based on the presence or absence of significant stenosis (≥ 50% lumen reduction). Results Objective image qualities (original vs. denoised: image noise, 67.22 ± 25.74 vs. 52.64 ± 27.40; SNR [left main], 21.91 ± 6.38 vs. 30.35 ± 10.46; CNR [left main], 23.24 ± 6.52 vs. 31.93 ± 10.72; all p < 0.001) and subjective image quality (2.45 ± 0.62 vs. 3.65 ± 0.60, p < 0.001) improved significantly in the denoised images. The average ERDs of the denoised images were significantly smaller than those of originals (0.98 ± 0.08 vs. 0.09 ± 0.08, p < 0.001). With regard to diagnostic accuracy, no significant differences were observed among paired comparisons. Conclusion Application of the deep learning technique along with iterative reconstruction can enhance the noise reduction performance with a significant improvement in objective and subjective image qualities of CCTA images.
Collapse
Affiliation(s)
- Jung Hee Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Whal Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chulkyun Ahn
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jong Hyo Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| |
Collapse
|
47
|
Angelidis G, Tsougos I, Valotassiou V, Georgoulias P. Low-dose radiation cancer risk hypothesis may lead to 'radiophobia'-driven imaging avoidance? J Nucl Cardiol 2020; 27:1050. [PMID: 29956201 DOI: 10.1007/s12350-018-1354-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 06/18/2018] [Indexed: 12/24/2022]
Affiliation(s)
- G Angelidis
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - I Tsougos
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - V Valotassiou
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - P Georgoulias
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece.
| |
Collapse
|
48
|
Kocyigit D, Gurses KM, Taydas O, Poker A, Ozer N, Hazirolan T, Tokgozoglu L. Role of femoral artery ultrasound imaging in cardiovascular event risk prediction in a primary prevention cohort at a medium-term follow-up. J Cardiol 2020; 75:537-543. [DOI: 10.1016/j.jjcc.2019.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/04/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
|
49
|
Kim JS, Lee BK, Ryu DR, Chun K, Kwon HS, Nam SR, Kim DI, Lee SY, Jeong JO, Bae JW, Park JS, Ahn Y, Chae JK, Yoon MH, Lee SH, Yoon J, Gwon HC, Choi D, Kwon SM, Roh YH, Cho BR. Occupational radiation exposure in femoral artery approach is higher than radial artery approach during coronary angiography or percutaneous coronary intervention. Sci Rep 2020; 10:7104. [PMID: 32346022 PMCID: PMC7188817 DOI: 10.1038/s41598-020-62794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
Medical radiation exposure is a significant concern for interventional cardiologists (IC). This study was aimed at estimating the radiation exposure of IC operators and assistants in real clinical practice. The radiation exposure of the operator and assistant was evaluated by conducting two types of procedures via coronary angiography (CAG) and percutaneous coronary intervention (PCI) on 1090 patients in 11-cardiovascular centers in Korea. Radiation exposure was measured using an electronic personal dosimeter (EPD). EPD were attached at 3 points on each participant: on the apron on the left anterior chest (A1), under the apron on the sternum (A2), and on the thyroid shield (T). Average radiation exposure (ARE) of operators at A1, A2, and T was 19.219 uSv, 4.398 uSv, and 16.949 uSv during CAG and 68.618 uSv, 15.213 uSv, and 51.197 uSv during PCI, respectively. ARE of assistants at A1, A2, and T was 4.941 uSv, 0.860 uSv, and 5.232 uSv during CAG and 20.517 uSv, 4.455 uSv, and 16.109 uSv during PCI, respectively. AED of operator was 3.4 times greater during PCI than during CAG.
Collapse
Affiliation(s)
- Jung-Su Kim
- Department of Radiologic technology, Daegu Health College, Daegu, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Dong-Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Kwangjin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Ho-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - So-Ra Nam
- Department of Health and Safety Convergence Science, College of Health Science, Korea University, Seoul, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Korea
| | - Sung-Yun Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Inje University, College of Medicine, Goyang, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University, School of Medicine, Daegu, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University, School of Medicine, Chonnam, Korea
| | - Je-Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospita, Chonbuk National University, School of Medicine, Chonbuk, Korea
| | - Myeong-Ho Yoon
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Ajou University, School of Medicine, Kyeonggi, Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju, College of Medicine, Wonju, Korea
| | - Jeonghan Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju, College of Medicine, Wonju, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon-Mu Kwon
- Department of Radiologic technology, Daegu Health College, Daegu, Korea
| | - Young-Hoon Roh
- Department of Health and Safety Convergence Science, College of Health Science, Korea University, Seoul, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea.
| |
Collapse
|
50
|
Klein LW, Goldstein JA, Haines D, Chambers C, Mehran R, Kort S, Valentine CM, Cox D. SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory: Shifting the Paradigm for Healthcare Workers' Protection. J Am Coll Cardiol 2020; 75:1718-1724. [PMID: 32273037 DOI: 10.1016/j.jacc.2020.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|