A retrospective study of radiation dose measurements comparing different cath lab X‐ray systems in a sample population of patients undergoing percutaneous coronary intervention for chronic total occlusions

McNeice, Andrew; Brooks, Matthew; Hanratty, Colm G.; Stevenson, Michael; Spratt, James C.; Walsh, Simon

doi:10.1002/ccd.27541

Cited by 17 publications

(6 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings regarding reduced patient's exposure are supported by previous studies, showing AK and DAP reductions with LDS compared to SDS in endovascular aortic and iliac procedures, coronary angiography and CTO PCI 3,18 . A study of CTO PCI did not find statistically significant differences of mean DAP values comparing the same systems as in our study (Philips Allura Xper FD10 vs Allura Clarity FD 10), although they found a trend toward lower DAP values with more modern systems compared to the older ones 4 …”

Section: Discussionsupporting

confidence: 87%

“…Our study population was representative of contemporary, reported series in terms of complexity, success rate or procedure time 16,17 . Our radiation protection performance was similar if not better than previous reports (median DAP 100.5 Gy · cm2 vs. mean DAP of 120 Gy · cm2 in the study by McNeice et al, a range of 169–235 Gy · cm2 in the study by Balter et al or a mean of 252 Gy · cm2 in the study by Maccia et al) 3,4,15 …”

Section: Discussionsupporting

confidence: 76%

“…Several novel dose‐reducing fluoroscopic systems developed in recent years for this purpose are now commercially available. However, information of the net benefit for the patient and professionals in real practice is scarce 3‐7 . This is important as actual figures of radiation exposure may deviate strongly from bench values due to real‐life factors, such as high‐body mass index, number of treated lesions, complex procedures like CTO PCI, 8 operator's experience and implementation of radiation protection strategies (fluoroscopy vs. cine acquisition, collimation, gantry position, and ancillary protection devices 9 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dose‐reducing fluoroscopic system decreases patient but not occupational radiation exposure in chronic total occlusion intervention

Salinas

Sanchez

Gonzalo

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

Aims Several novel low‐dose fluoroscopic systems (LDS) developed recently, but real practice information of the net benefit for the patient and professionals is scarce. We evaluated separately patient and operator radiation exposure during percutaneous interventions of chronic total occlusions (CTO). Methods A total of 116 consecutive CTOs were analyzed (60 in LDS and 56 in standard‐dose fluoroscopic system [SDS]). Digital dosimetry of patient and occupational (operator and scatter dose) exposure was prospectively recorded. Results Biometrics, demographics, CTO variables, and operators were distributed evenly. Patient radiation exposure was effectively decreased in LDS (dose area product [DAP] by 36%, Air Kerma [AK] by 47%). However, occupational data showed no statistical differences between LDS and SDS. The LDS uses less radiation amount but with higher energy (due to additional filtration) compared to SDS, therefore increasing the scatter dose. When comparing the C‐arm scatter dose to the DAP we found higher scatter dose with the LDS (0.0139 mSv/gray (Gy)*cm2 vs. 0.0082 mSv/Gy*cm2, p < .001). This was confirmed in a larger dataset comprising 5,221 coronary procedures. Conclusions LDS was safer for patients reducing DAP and AK compared to SDS. However, occupational doses were not lower and scatter dose higher. Radiological protection measures must be kept maximized even in LDS.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dose‐reducing fluoroscopic system decreases patient but not occupational radiation exposure in chronic total occlusion intervention

Salinas

Sanchez

Gonzalo

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…The impact of new X‐ray equipment technology for CTO PCI was highlighted in a study by McNeice et al, 41 which compared DAP between machines with a development span of 20 years and saw reductions of 40% in some of the settings. In that report, the lowest mean DAP was 8,772 cGy*cm 2 , as compared to a mean of 4,955 in Group 2 in our study, which is lower by a further 44%.…”

Section: Discussionmentioning

confidence: 99%

Modulated radiation protocol achieves marked reduction of radiation exposure for chronic total coronary occlusion intervention

Werner

Yaginuma

Koch

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objective To evaluate the feasibility of a new acquisition protocol to reduce radiation exposure. Background Percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO) are characterized by the highest radiation exposure among PCI procedures. Methods We analyzed 552 consecutive CTO procedures between January 2018 and October 2019. After 366 procedures (Group 1) a modified radiation acquisition protocol was implemented for the subsequent 186 procedures (Group 2). Besides a low fluoroscopy frame rate of 6/s and cine frame rate of 7.5/s for both groups, additional modifications consisted of increased copper filtering with lower entry dose in combination with a modified image postprocessing. Radiation exposure was assessed as air kerma (AK; mGy), and dose–area product (DAP; cGy*cm2). Results There was no significant difference in lesion or procedural complexity between the study groups with 46 and 43% of the procedures done via the retrograde approach. While fluoroscopy time remained similar (median: 32.7 vs. 34.3 min), the protocol modifications resulted in a drastic reduction of AK by 68% from 2,040 (1,321–3,339) mGy to 655 (415–1,113) mGy (p < .001) without affecting the procedural success rate. DAP was equally decreased by 71%. These considerable reductions were observed even in obese patients of BMI > 30. In Group 2, not a single procedure exceeded the 5 Gy threshold as compared to 10.4% in Group 1. Conclusions Radiation exposure decreased considerably with a new acquisition protocol without affecting procedure duration and success. These modifications were applicable also to patients with a high BMI.

show abstract

“…A stenosis, labelled with FFR ICA � 0.75 has to be treated, mostly by stent implantation or bypass-surgery [8,9]. ICA comes with a regular radiation burden of 8 to 10 mSv per treatment [10] and potential massive radiation doses in complex recanalization procedures like chronic total occlusions [11] to which also the interventionalist is exposed to [10]. Furthermore, ICA relies on the use of iodinated contrast agents, leading to possible damage of the kidney [12] or allergic reactions [13,14].…”

Section: Introductionmentioning

confidence: 99%

Image-derived mean velocity measurement for prediction of coronary flow reserve in a canonical stenosis phantom using magnetic particle imaging

et al. 2021

View full text Add to dashboard Cite

Introduction Aim of this study is to evaluate whether magnetic particle imaging (MPI) is capable of measuring velocities occurring in the coronary arteries and to compute coronary flow reserve (CFR) in a canonical phantom as a preliminary study. Methods For basic velocity measurements, a circulation phantom was designed containing replaceable glass tubes with three varying inner diameters, matching coronary-vessel diameters. Standardised boluses of superparamagnetic-iron-oxide-nanoparticles were injected and visualised by MPI. Two image-based techniques were competitively applied to calibrate the respective glass tube and to compute the mean velocity: full-duration-at-half-maximum (FDHM) and tracer dilution (TD) method. For CFR-calculation, four necessary settings of the circulation model of a virtual vessel with an inner diameter of 4 mm were generated using differently sized glass tubes and a stenosis model. The respective velocities in stenotic glass tubes were computed without recalibration. Results On velocity level, comparison showed a good agreement (rFDHM = 0.869, rTD = 0.796) between techniques, preferably better for 4 mm and 6 mm inner diameter glass tubes. On CFR level MPI-derived CFR-prediction performed considerably inferior with a relative error of 20–44%. Conclusions MPI has the ability to reliably measure coronary blood velocities at rest as well as under hyperaemia and therefore may be suitable for CFR calculation. Calibration-associated accuracy of CFR-measurements has to be improved substantially in further studies.

show abstract

A retrospective study of radiation dose measurements comparing different cath lab X‐ray systems in a sample population of patients undergoing percutaneous coronary intervention for chronic total occlusions

Abstract: There is a significant impact on DAP values resulting from the generation of X-ray system used, measured during PCI for CTOs, with the most modern systems producing the lowest radiation doses.

Cited by 17 publications

References 25 publications

Dose‐reducing fluoroscopic system decreases patient but not occupational radiation exposure in chronic total occlusion intervention

Dose‐reducing fluoroscopic system decreases patient but not occupational radiation exposure in chronic total occlusion intervention

Modulated radiation protocol achieves marked reduction of radiation exposure for chronic total coronary occlusion intervention

Image-derived mean velocity measurement for prediction of coronary flow reserve in a canonical stenosis phantom using magnetic particle imaging

Contact Info

Product

Resources

About