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Subban V. Radiation doses during cardiac catheterisation procedures in India: a multicentre study: Radiation dose study. ASIAINTERVENTION 2020; 6:25-33. [PMID: 34912981 PMCID: PMC8525728 DOI: 10.4244/aij-d-18-00044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/04/2020] [Indexed: 10/25/2023]
Abstract
AIMS Established, evidence-based measures of radiation are required to minimise its hazards, while maintaining adequate image quality. The aim of this study is to evaluate radiation data and generate reference radiation levels for commonly performed coronary catheterisation procedures in India. METHODS AND RESULTS In this prospective, observational study, all procedures were performed in accordance with the established standards using Innova IGS 520/2100-IQ catheterisation laboratories. Demographic, procedural and radiation data were collected. Dose reference limits (DRL) were established as the 75th percentile of the total distribution. There were 2,906 coronary angiograms (CAG), 750 percutaneous coronary interventions (PCI) and 715 CAG+PCI. DRLs for dose area product were: 19.6 Gy·cm2 for CAG, 49.8 Gy·cm2 for PCI and 72.0 Gy·cm2 for CAG+PCI, respectively. Median cumulative air kerma levels were: 185 mGy for CAG, 533mGy for PCI, and 891 mGy for CAG+PCI. Male gender, higher BMI, combining CAG+PCI, fluoroscopy time, number of cine frames, and image acquisition settings were significant contributors to increased radiation dose. CONCLUSIONS This study established reference radiation dose levels for diagnostic and interventional coronary procedures in India, which were comparable to and in the lower range of international standards.
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Affiliation(s)
- Vijayakumar Subban
- Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
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2
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Ngaile J, Msaki P, Nyanda P, Muhulo A, Muhogora W, Mvungi R. Estimation of equivalent organ and effective doses to patients undergoing coronary angiography and percutaneous coronary intervention procedures using Monte Carlo simulation. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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3
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Khaleghi Fard A, Alian AHM, Pourafkari L, Ghojazadeh M, Tarighatnia A, Farajollahi A. IMPACT OF PELVIC AND RAD-BOARD LEAD SHIELDS ON OPERATOR AND PATIENT RADIATION DOSE IN TRANS-RADIAL CORONARY PROCEDURES. RADIATION PROTECTION DOSIMETRY 2019; 187:108-114. [PMID: 31135929 DOI: 10.1093/rpd/ncz147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 04/19/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Trans-radial approach for cardiac catheterisation procedures has long been associated with high operator and patient radiation dose. The aim of the present study was to determine the effect of pelvic and radial shields on decreasing coronary procedure radiation doses. METHODS A total of 418 patients randomly underwent diagnostic and therapeutic cardiac procedures with and without the pelvic and rad-board lead shields during the procedures. The operator and patient doses were then determined by means of a personal dosimeter and dose area product (DAP), respectively. RESULTS The shields decreased the operator radiation dose by 40% in coronary angiography (CA) and by 45% during angioplasty (PCI). These results were achieved at the cost of increased patient radiation dose. CONCLUSION Pelvic lead shields combined with rad-board shields are highly effective in reducing operator radiation dose in trans-radial approach, but it is only achieved at the cost of increased patient DAP.
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Affiliation(s)
- Aida Khaleghi Fard
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Faculty of Medicine, Department of Medical Physics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Anesthesiology Department, University of Buffalo, Buffalo, USA
| | - Morteza Ghojazadeh
- Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Tarighatnia
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Faculty of Medicine, Department of Medical Physics, Tabriz University of Medical Sciences, Tabriz, Iran
- Interventional Cardiology Unit, Aalinasab Hospital, Tabriz, Iran
| | - Alireza Farajollahi
- Faculty of Medicine, Department of Medical Physics, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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4
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Matei TI, Paziuc A, Mester P, Ispas A, Puie P, Blaga L, de Quatrebarbe J, Maniora F, Vanwalleghem S, Madiot H, Ricard C, Mangin L, Belle L. [Evaluation of the incidence of radiodermatitis lesions in interventional cardiology]. Ann Cardiol Angeiol (Paris) 2019; 68:293-299. [PMID: 31542198 DOI: 10.1016/j.ancard.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The percutaneous coronary interventions use large doses of ionizing radiation, particularly when treating complex lesions. The incidence of radio-induced skin lesions is poorly known. Our goal was to evaluate the frequency of occurrence of such lesions, as well as the factors that may contribute to a high radiation dose. The recommended DAP (dose-area product) cutoff for skin monitoring after percutaneous coronary interventions is 500Gy cm2. PATIENTS AND METHOD We prospectively studied the incidence of acute (after 5-7 days) and subacute (after 7 days to 6 months) skin lesions following angioplasty with a dose-area product (DAP) ≥200Gy cm2 in patients who underwent coronary angioplasty in our center in 2013. RESULTS Nine hundred and thirty three consecutive procedures were analyzed, of which 102 with a DAP ≥200Gy cm2. Three patients presented an acute lesion. Two of these three patients also had subacute lesions. Another patient presented only a subacute lesion. 4.82% (95% CI: [0-10]) of the patients with a DAP ≥200Gy cm2 developed radiodermitis lesions, or 0.47% (95% CI: [0-0.9]) of all the patients who underwent angioplasty. The Body Mass Index and the elective (as opposed to energy) procedures were independently associated with a procedure with a DAP ≥200Gy cm2. CONCLUSION Radiodermatitis lesions occur for 4.82% of patients benefiting from procedures with a DAP ≥200Gy cm2. We suggest the establishment of a DAP threshold for dermal monitoring of patients of 200Gy cm2 per procedure instead of 500Gy cm2.
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Affiliation(s)
- T I Matei
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
| | - A Paziuc
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - P Mester
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - A Ispas
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - P Puie
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - L Blaga
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - J de Quatrebarbe
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - F Maniora
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - S Vanwalleghem
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - H Madiot
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - C Ricard
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - L Mangin
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - L Belle
- Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
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Rizk C, Fares G, Vanhavere F, Farah J. MEASUREMENT OF PATIENT SKIN DOSE DISTRIBUTIONS IN THREE LEBANESE INTERVENTIONAL CARDIOLOGY SUITES. RADIATION PROTECTION DOSIMETRY 2019; 183:375-385. [PMID: 30165531 DOI: 10.1093/rpd/ncy152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/28/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Using a mesh of 30 thermoluminescent dosemeters, adults' patient skin doses were measured for 99 coronary angiography (CA) and 89 percutaneous coronary interventions (PCI) performed in three Lebanese hospitals. Average peak skin dose (Dskin,max) were 152 mGy (range: 16-1144) for CAs and 576 mGy (range: 7-3361) for PCIs. While only four patients had a Dskin,max value exceeding the 2 Gy threshold for skin injuries, several patients had skin dose values above 1 Gy at several distinct locations proving that Dskin,max alone is not sufficient for repetitive procedures; 2D dose maps are required instead. Dskin,max correlated well with total air kerma-area product (PKA,T) for PCI in Hospitals 1 and 2 (R = 0.91 and 0.76, respectively) enabling the setup of an alert level at PKA,T = 240 and 210 Gy cm2, respectively, corresponding to a Dskin,max of 2 Gy. This was not possible for Hospital 3 due to weak correlations between Dskin,max and PKA,T.
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Affiliation(s)
- C Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research, PO Box 11-8281, Riad El Solh, Beirut, Lebanon
- Faculty of Sciences, Saint Joseph University, PO Box 11-514, Riad El Solh, Beirut, Lebanon
| | - G Fares
- Faculty of Sciences, Saint Joseph University, PO Box 11-514, Riad El Solh, Beirut, Lebanon
| | - F Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang 200, Mol, Belgium
| | - J Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France
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Determinants of Greater Peak Radiation Skin Dose in Contemporary Percutaneous Coronary Interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:6-11. [PMID: 30948291 DOI: 10.1016/j.carrev.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Skin radiation injuries, especially radiation ulcers, are serious side effects caused by ionizing radiation during percutaneous coronary interventions (PCI). Because skin radiation injuries are closely associated with the peak skin dose, it is important to minimize the peak skin dose. The aim of the present study was to investigate the determinants of greater peak skin dose in current PCI. METHODS We included 707 consecutive coronary artery lesions, and divided them into an excess radiation group (n = 26; defined as peak skin dose ≥2 Gy) and a standard radiation group (n = 681; defined as peak skin dose <2 Gy). Clinical, lesion, and procedural characteristics were compared between the 2 groups. Univariate and multivariate logistic regression analyses were performed to identify determinants of the excess radiation group. RESULTS A multivariate logistic regression analysis revealed that body surface area (BSA) [0.1 m2 increase: odds ratio (OR) 1.39, 95% confidence interval (CI) 1.13-1.71, P < 0.01], PCI to a right coronary artery (RCA) (OR 3.11, 95% CI 1.35-7.17, P < 0.01), and PCI to a chronic total occlusion (CTO) (OR 6.69, 95% CI 2.65-16.87, P < 0.01) were significantly associated with the excess radiation group. CONCLUSIONS Greater BSA, PCI to RCA lesions, and PCI to CTO lesions were significantly associated with excess radiation dose. The first step in the prevention of radiation injuries in current PCI will be to recognize these risk factors.
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7
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Ngaile JE, Msaki PK, Mvungi R, Schreiner LJ. PRELIMINARY INVESTIGATION OF RADIATION DOSE TO PATIENTS FROM CARDIOVASCULAR INTERVENTIONAL PROCEDURES IN TANZANIA. RADIATION PROTECTION DOSIMETRY 2018; 181:317-332. [PMID: 29474654 DOI: 10.1093/rpd/ncy030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Although contemporary cardiac X-ray exams are typically set so benefits outweighs the risk, the growing use and increasing complexity of the cardiovascular interventional radiological (CVIR) procedures does increase the risk of radiation-related tissue effects and stochastic effects to the individual patients and the population. In view of these radiological concerns there is a need to investigate factors that influence the doses received by the patients and enable optimisation needed. The air kerma area product (KAP), cumulative air kerma (CAK) and fluoroscopy time (FT) to patients from two major CVIR procedures: coronary angiography (CA) and percutaneous coronary interventions (PCI), were obtained from two major hospitals in Tanzania. The CAK and KAP were determined using ionisation chambers equipped in each angiographic unit. The median values of the KAP, CAK and FT for the CA procedures were 37.8 Gy cm2, 425.5 mGy and 7.6 min, respectively, while for the PCI were 86.5 Gy cm2, 1180.3 mGy and 19.0 min, respectively. The overall differences among individual KAP, CAK and FT values across the two hospitals investigated differed by factors of up to 33.5, 58.7 and 26.3 for the CA, while for the PCI procedures differed by factors of up to 10.9, 25.3 and 13.8, respectively. The mean values of KAP and FT for both CA and PCI were mostly higher than those reported values for Ireland, Belgium, Greece, France, China and Australia. The third quartiles of the KAP, CAK and FT for both CA and PCI were relatively above the preliminary diagnostic reference levels proposed by the IAEA, DIMOND III and SENTINEL. The observed substantial variations of mean values of technical parameters and patient doses (KAP, CAK and FT values) observed for the CA and PCI procedures inter and intra-hospitals were mainly explained by the complexity of the CVIR procedures, the nature of pathology, patient-specific characteristics, the variation in levels of skills and experiences among IC personnel, and the different procedural protocols employed among interventional cardiologists and hospitals. The observed great variations of procedural protocols and patient doses within and across the hospitals and relative higher dose than reported values from the literature call for the need to optimise radiation dose to patient from IC procedures.
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Affiliation(s)
- J E Ngaile
- Department of Physics, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - P K Msaki
- Department of Physics, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - R Mvungi
- Jakaya Kikwete Cardiac Institute, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - L J Schreiner
- Departments of Oncology and Physics, Queens University, Kingston, Onatrio, Canada
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Dabin J, Maeremans J, Berus D, Schoonjans W, Tamborino G, Dens J, Kayaert P. DOSIMETRY DURING PERCUTANEOUS CORONARY INTERVENTIONS OF CHRONIC TOTAL OCCLUSIONS. RADIATION PROTECTION DOSIMETRY 2018; 181:120-128. [PMID: 29351645 DOI: 10.1093/rpd/ncx303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/24/2017] [Indexed: 06/07/2023]
Abstract
Percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) increase the risk of high radiation exposure for both the patient and the cardiologist. This study evaluated the maximum dose to the patients' skin (MSD) and the exposure of the cardiologists during CTO-PCI. Moreover, the efficiency of radioprotective drapes to reduce cardiologist exposure was assessed. Patient dose was measured during 31 procedures; dose to the cardiologist's extremities were measured during 65 procedures, among which 31 were performed with radioprotective drapes. The MSD was high (median: 1254 mGy; max: 6528 mGy), and higher than 2 Gy for 33% of the patients. The dose to the cardiologists' extremities per procedure was also of concern (median: 25-465 μSv), particularly to the left eye (median: 68 μSv; max: 187 μSv). Radioprotective drapes reduced the exposure to physician's upper limbs and eyes; especially to the left side (from -28 to -49%).
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Affiliation(s)
- Jérémie Dabin
- Research in Dosimetric Application, Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, Mol, Belgium
| | - Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Martelarenlaan 42, Hasselt, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk, Belgium
| | - Danielle Berus
- Radiation Protection Department, Vrije Universiteit Brussel and UZ Brussel, Laarbeeklaan 103, Brussels, Belgium
| | - Werner Schoonjans
- Research in Dosimetric Application, Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, Mol, Belgium
| | - Giulia Tamborino
- Research in Dosimetric Application, Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, Mol, Belgium
| | - Jo Dens
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Martelarenlaan 42, Hasselt, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk, Belgium
| | - Peter Kayaert
- Department of Cardiology, UZ Brussel, Laarbeeklaan 103, Brussels, Belgium
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Varghese A, Livingstone RS, Varghese L, Dey S, Jose J, Thomson VS, George OK, George PV. Radiation dose from percutaneous transluminal coronary angioplasty procedure performed using a flat detector for different clinical angiographic projections. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:511-524. [PMID: 29380743 DOI: 10.1088/1361-6498/aaab71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The radiation dose from complex cardiac procedures is of concern due to the lengthy fluoroscopic screening time and vessel complexities. This study intends to assess radiation dose based on angiographic projection and vessel complexities for clinical protocols used in the performance of percutaneous transluminal coronary angioplasty (PTCA). Dose-area product (DAP), reference air kerma (K a,r) and real-time monitoring of tube potentials and tube current for each angiographic projection and dose setting were evaluated for 66 patients who underwent PTCA using a flat detector system. The mean DAP and cumulative K a,r were 32.71 Gy cm2 (0.57 Gy), 51.24 Gy cm2 (0.9 Gy) and 102.03 Gy cm2 (1.77 Gy) for single-, double- and triple-vessel PTCA, respectively. Among commonly used angiographic projections, left anterior oblique 45°-caudal 35° reached 2 Gy in 55 min using a low-dose fluoroscopy setting and 21 min for a medium-dose setting. Use of a low-dose setting for fluoroscopic screening showed a radiation dose reduction of 39% compared with a medium-dose setting.
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Affiliation(s)
- Anna Varghese
- Department of Radiology, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, South India
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Greffier J, Goupil J, Larbi A, Stefanovic X, Pereira F, Moliner G, Ovtchinnikoff S, Beregi J, Frandon J. Assessment of patient's peak skin dose during abdominopelvic embolization using radiochromic (Gafchromic) films. Diagn Interv Imaging 2018; 99:321-329. [DOI: 10.1016/j.diii.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
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Magnier F, Poulin M, Van Ngoc Ty C, Osmond E, Bonniaud G, Coulot J, Pereira B, Boyer L, Guersen J, Cassagnes L. Comparison of Patient Skin Dose Evaluated Using Radiochromic Film and Dose Calculation Software. Cardiovasc Intervent Radiol 2018; 41:762-771. [PMID: 29417266 DOI: 10.1007/s00270-018-1888-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare, in an interventional radiology setting, peak skin doses (PSDs) delivered as calculated using a dedicated software tool and as measured using radiochromic film. To assess the utility of this dose calculation software tool in routine clinical practice. MATERIALS AND METHODS First, radiochromic films were positioned on the examination table in the back of an adult anthropomorphic phantom to measure PSD, and X-ray examinations were simulated. Then, films were again positioned in the patient's back for 59 thoracic or abdominopelvic endovascular interventions. The results obtained with the radiochromic films were taken as a reference and were statistically compared with those of the software. RESULTS With measured PSDs ranging from 100 to 7000 mGy, the median software-film difference was 8.5%. Lin's concordance coefficient was 0.98 [0.97; 0.99] (p < 0.001), meaning that concordance was excellent between the two methods. For the films where PSD exceeded 1000 mGy, the median difference in the measured value was 8.7% [- 1.3; 21.1], with a maximum discrepancy of 34%. Lin's concordance coefficient was 0.98 [0.96; 1] (p < 0.001), meaning that concordance was excellent between the two methods. CONCLUSION Comparison between radiochromic films and the software tool showed that the software is a suitable tool for a simple and reliable estimation of PSD. The software seems to be a good alternative to films, whose use remains complex.
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Affiliation(s)
- Florian Magnier
- Pôle d'Imagerie Diagnostique et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France. .,Plateforme régionale de physique médicale, Centre Jean Perrin, 63011, Clermont-Ferrand, France.
| | - Maxime Poulin
- Pôle d'Imagerie Diagnostique et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France
| | | | - Estelle Osmond
- Pôle d'Imagerie Diagnostique et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France
| | | | | | - Bruno Pereira
- Biostatistics Unit (Délégation Recherche Clinique & Innovation), CHU, 63003, Clermont-Ferrand, France
| | - Louis Boyer
- Pôle d'Imagerie Diagnostique et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France.,ISIT, UMR 6284 CNRS, Université d'Auvergne, 63001, Clermont-Ferrand, France
| | - Joel Guersen
- Pôle d'Imagerie Diagnostique et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France
| | - Lucie Cassagnes
- Pôle d'Imagerie Diagnostique et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France.,ISIT, UMR 6284 CNRS, Université d'Auvergne, 63001, Clermont-Ferrand, France
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12
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Assessment of peak skin dose in interventional cardiology: A comparison between Gafchromic film and dosimetric software em.dose. Phys Med 2017; 38:16-22. [DOI: 10.1016/j.ejmp.2017.05.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/08/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022] Open
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Greffier J, Moliner G, Pereira F, Cornillet L, Ledermann B, Schmutz L, Lomma M, Cayla G, Beregi JP. Assessment of Patient's Peak Skin Dose Using Gafchromic Films During Interventional Cardiology Procedures: Routine Experience Feedback. RADIATION PROTECTION DOSIMETRY 2017; 174:395-405. [PMID: 27522056 DOI: 10.1093/rpd/ncw191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 04/22/2016] [Indexed: 06/06/2023]
Abstract
To assess the interest of Gafchromic films in detection of patient's peak skin dose (PSD) in interventional cardiology. A prospective study of 112 patients was conducted (July-December 2015). Three diagnostic and therapeutic procedures were evaluated: coronary angiography (CA), coronary angiography and coronary angioplasty for one or two vessels disease (CA-PTCA) and coronary angioplasty of complex chronic total occlusion (CTO). Dosimetric indicators (DIs) were collected and PSD were measured with Gafchromic films. Dose distribution was evaluated within 10 'Thorax Body-zone' defined by the system. Correlations between PSD and DI or dose distribution were computed. Delivered dose increased in complex procedures. The PSD were 0.121 ± 0.063 Gy for CA, 0.256 ± 0.142 Gy for CA-PTCA and 1.116 ± 0.721 Gy for CTO. High correlations were observed for PSD and DI as well for dose distribution within the 'Thorax Body-zone'. Film dosimetry is suggested for CTO procedures since the threshold of 2 Gy for skin injuries is likely to be exceeded.
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Affiliation(s)
- J Greffier
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - G Moliner
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - F Pereira
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - L Cornillet
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - B Ledermann
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - L Schmutz
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - M Lomma
- Department of Biostatistics, Epidemiology, Public Health and Bio-informatics, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - G Cayla
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - J P Beregi
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
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Ten Cate T, van Wely M, Gehlmann H, Mauti M, Camaro C, Reifart N, Suryapranata H, de Boer MJ. Novel X-ray image noise reduction technology reduces patient radiation dose while maintaining image quality in coronary angiography. Neth Heart J 2015; 23:525-30. [PMID: 26369914 PMCID: PMC4608924 DOI: 10.1007/s12471-015-0742-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AIMS The consequences of high radiation dose for patient and staff demand constant improvements in X-ray dose reduction technology. This study assessed non-inferiority of image quality and quantified patient dose reduction in interventional cardiology for an anatomy-specific optimised cine acquisition chain combined with advanced real-time image noise reduction algorithms referred to as 'study cine', compared with conventional angiography. METHODS Fifty patients underwent two coronary angiographic acquisitions: one with advanced image processing and optimised exposure system settings to enable dose reduction (study cine) and one with standard image processing and exposure settings (reference cine). The image sets of 39 patients (18 females, 21 males) were rated by six experienced independent reviewers, blinded to the patient and image characteristics. The image pairs were randomly presented. Overall 85 % of the study cine images were rated as better or equal quality compared with the reference cine (95 % CI 0.81-0.90). The median dose area product per frame decreased from 55 to 26 mGy.cm(2)/frame (53 % reduction, p < 0.001). CONCLUSION This study demonstrates that the novel X-ray imaging technology provides non-inferior image quality compared with conventional angiographic systems for interventional cardiology with a 53 % patient dose reduction.
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Affiliation(s)
- T Ten Cate
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands.
| | - M van Wely
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - H Gehlmann
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - M Mauti
- Philips Healthcare, Best, The Netherlands
| | - C Camaro
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - N Reifart
- Main-Taunus-Privatklinik, Bad Soden, Germany
| | - H Suryapranata
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - M J de Boer
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
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15
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Farajollahi A, Rahimi A, Khayati Shal E, Ghaffari S, Ghojazadeh M, Tajlil A, Aslanabadi N. Patient's Radiation Exposure in Coronary Angiography and Angioplasty: The Impact of Different Projections. J Cardiovasc Thorac Res 2015; 6:247-52. [PMID: 25610557 PMCID: PMC4291604 DOI: 10.15171/jcvtr.2014.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction: We aimed to determine angiography projections with lower Dose Area Product (DAP) rate by measuring the mean DAP and fluoroscopy times in coronary angiography (CAG) and percutaneous coronary intervention (PCI) and calculating DAP rate in different projections.
Methods: DAP and fluoroscopy times were measured in all employed projections in real-time in 75 patients who underwent CAG or PCI by a single cardiologist in Madani Cardiovascular University Hospital (45 in CAG group and 30 in PCI group). DAP rate was calculated in both groups and in all projections. The projections with highest and lowest DAP rate were determined.
Results: Mean DAP was 436.73±315.85 dGy×cm2 in CAG group and 643.26±359.58 dGy×cm2 in PCI group. The projection 40° LAO/0° had the highest DAP rate in CAG group (28.98 dGy×cm2/ sec) and it was highest in 20° RAO/30° CR in PCI group (29.83 dGy×cm2/sec). The latter projection was also the most employed projection in PCI group.
Conclusion: The amount of radiation dose in this study is in consistent with the previous reports. Specific angiographic projections expose patients to significantly higher radiation and they should be avoided and replaced by less irradiating projections whenever possible.
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Affiliation(s)
- Alireza Farajollahi
- Medical Education Research Center, Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran ; Medical Physics Department, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Atena Rahimi
- Medical Physics Department, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou Tajlil
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
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16
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Georges JL, Belle L, Ricard C, Cattan S, Albert F, Hirsch JL, Monsegu J, Dibie A, Khalife K, Caussin C, Maccia C, Livarek B, Hanssen M. Patient exposure to X-rays during coronary angiography and percutaneous transluminal coronary intervention: Results of a multicenter national survey. Catheter Cardiovasc Interv 2014; 83:729-38. [DOI: 10.1002/ccd.25327] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/24/2013] [Accepted: 11/28/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Jean-Louis Georges
- Service de Cardiologie; Centre Hospitalier de Versailles; Le Chesnay France
- College National des Cardiologues des Hopitaux; Paris France
| | - Loic Belle
- College National des Cardiologues des Hopitaux; Paris France
- Service de Cardiologie and RENAU; Centre Hospitalier d'Annecy; Annecy France
| | - Cécile Ricard
- Service de Cardiologie and RENAU; Centre Hospitalier d'Annecy; Annecy France
| | - Simon Cattan
- College National des Cardiologues des Hopitaux; Paris France
| | - Franck Albert
- College National des Cardiologues des Hopitaux; Paris France
| | - Jean-Lou Hirsch
- College National des Cardiologues des Hopitaux; Paris France
| | - Jacques Monsegu
- College National des Cardiologues des Hopitaux; Paris France
| | - Alain Dibie
- College National des Cardiologues des Hopitaux; Paris France
| | - Khalife Khalife
- College National des Cardiologues des Hopitaux; Paris France
| | | | - Carlo Maccia
- Service de Cardiologie; Centre Hospitalier de Versailles; Le Chesnay France
| | - Bernard Livarek
- Service de Cardiologie; Centre Hospitalier de Versailles; Le Chesnay France
- College National des Cardiologues des Hopitaux; Paris France
| | - Michel Hanssen
- College National des Cardiologues des Hopitaux; Paris France
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17
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Wang W, Zhang M, Zhang Y. Overall measurements of dose to patients in common interventional cardiology procedures. RADIATION PROTECTION DOSIMETRY 2013; 157:348-354. [PMID: 23770572 DOI: 10.1093/rpd/nct147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study was designed to measure peak skin dose (PSD), dose-area product (DAP), cumulative dose (CD) and fluoroscopy time (FT) for interventional cardiology procedures and to evaluate whether patient doses were higher than that in other published data. Three cardiac procedure types, including coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA) and radio frequency (RF) ablation, were entered into the study. Data of four special metrics (PSD, DAP, CD and FT) for these procedures were collected and measured. A total of 238 patients who underwent interventional radiology procedures participated in this study. For every procedure, data about PSD were resulted from six TLD arrays and DAP, CD and FT were collected from the displayed monitor. The mean, standard deviation (SD), range and third quartile of the distribution of PSD, DAP, CD and FT recorded and measured on spot were calculated for all procedures. High-dose cases were specifically recorded. There was wide variation in the doses observed for different instances of the same procedure. PSD for PTCA and RF ablation ranged from 0.1 Gy to more than 3 Gy. Of 238 instances, there were 22 (9.2 %) with PSDs greater than 2 Gy and 4 (1.7 %) than 3 Gy. The third quartile of the distribution for PTCA had exceeded the DIMOND preliminary reference levels by 41.1 % in DAP and 25.0 % in FT. Mean DAP was in the range of reported values for CAG procedure, but higher than all data obtained in literatures for PTCA. Data from this study are in the range of most reported values for CAG and RF ablation procedure, while higher than that obtained in some literatures for PTCA. In case of a constant delivering of high doses to patient and physician himself, thorough training of interventionalists and staff is necessary, and the legislation has to be revised and set dose constrains especially for the interventional high-dose procedures.
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Affiliation(s)
- Weipeng Wang
- Shandong Medical Imaging Research Institute, Jingwu road No.324, Jinan 250021, P. R. China
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18
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Wilson WM, Bagnall AJ, Spratt JC. In case of procedure failure: facilitating future success. Interv Cardiol 2013. [DOI: 10.2217/ica.13.54] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Bar O. Understanding and Minimising Occupational Radiation in the Catheterisation Laboratory with PISAX and the ACIST CVi® Contrast Delivery System. Interv Cardiol 2013; 8:36-40. [PMID: 29588748 PMCID: PMC5808475 DOI: 10.15420/icr.2013.8.1.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/10/2013] [Indexed: 11/04/2022] Open
Abstract
This paper provides an overview of radiation exposure and its associated risks in the cardiac catheterisation laboratory (cath lab), as well as strategies to minimise radiation exposure for operators, cath lab staff and patients. The benefits of using a mobile 2 mm lead equivalent radiation shield (PISAX) and adoption of an automated contrast injection system (the ACIST CVi® Contrast Delivery System) are discussed, and the potential advantages of their combination are reviewed.
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Affiliation(s)
- Olivier Bar
- Based on an interview with Olivier Bar, Interventional Cardiologist, Saint Gatien Clinic, Tours, France
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20
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Balter S. Where's the dose? Catheter Cardiovasc Interv 2012; 80:575. [PMID: 22996923 DOI: 10.1002/ccd.24616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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