Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: Analysis in relation to radiation exposure parameters

Bernardi, Guglielmo; Padovani, R.; Morocutti, Giorgio; Vañó, Eliseo; Malisan, M.R.; Rinuncini, Massimo; Spedicato, Leonardo; Fioretti, P.

doi:10.1002/1522-726x(200009)51:1<1::aid-ccd1>3.0.co;2-k

Cited by 83 publications

(40 citation statements)

References 28 publications

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“…T F is widely considered to be a main criterion for the complexity of PCI and the operator's efforts to reduce patient DAP [2,6,9,11,14,21,39,41,43]. Mean values were reported in the range of 8.2-21 min for PCI [14,22,39,46], of 8.7-16 min for PCI plus stenting [9-11, 21, 22], and of 10.1-12.6 min for direct stenting [9][10][11]21].…”

Section: Discussionmentioning

confidence: 99%

“…Typical DAP (dose area kerma product) patient levels for percutaneous coronary interventions (PCI) are high and vary extensively in a range from 34 to 119 Gy · cm 2 for coronary intervention [6,14,17,18,22,39,46,49] and from 47 up to 191 Gy · cm 2 for combined interventions [7,34,43,49]. Upon application of accepted thoracic conversion factors [7,25,35], these findings correspond to equivalent effective doses (ED) in ranges from 7 to 24 and from 9 to 38 mSv.…”

Section: Introductionmentioning

confidence: 99%

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Radiation Exposure to Patients Undergoing Percutaneous Coronary Interventions

Kuon¹,

Empen

Rohde³

et al. 2004

Herz

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This study, carried through by consistent use of radiation-reducing techniques, enables a reliable scoring of patient radiation exposure according to complexity and target vessel of the intended PCI. Our 95th percentiles for elective PCI, for recanalizations of chronic occlusions, and for emergency PCI advise reference levels of 22, 32, and 42 Gy.cm(2) for DAP, of 16, 25, and 24 min for T(F), and of 400, 600, and 700 cinegraphic frames, respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiation Exposure to Patients Undergoing Percutaneous Coronary Interventions

Kuon¹,

Empen

Rohde³

et al. 2004

Herz

View full text Add to dashboard Cite

show abstract

“…It is known that the complexity of the procedure also has to be taken into account, since this would justify higher patient exposure [30]; however, for this study the procedures have not been grouped according to their complexity.…”

Section: Methodsmentioning

confidence: 99%

Preliminary reference levels in interventional cardiology

et al. 2003

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This article describes the European DIMOND approach to defining reference levels (RLs) for radiation doses delivered to patients during two types of invasive cardiology procedures, namely coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Representative centres of six European countries recorded patients' doses in terms of dose-area product (DAP), fluoroscopy time and number of radiographic exposures, using X-ray equipment that has been subject to constancy testing. In addition, a DAP trigger level for cardiac procedures which should alert the operator to possible skin injury, was set to 300 Gyxcm2. The estimation of maximum skin dose was recommended in the event that a DAP trigger level was likely to be exceeded. The proposed RLs for CA and PTCA were for DAP 45 Gyxcm2 and 75 Gyxcm2, for fluoroscopy time 7.5 min and 17 min and for number of frames 1250 and 1300, respectively. The proposed RLs should be considered as a first approach to help in the optimisation of these procedures. More studies are required to establish certain "tolerances" from the proposed levels taking into account the complexity of the procedure and the patient's size.

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“…direct stent or pre-dilation, different X-ray equipment, different awareness and education of staff in radiation dose estimation, etc. [14]. Various advisory bodies use the conservative assumption that no level of radiation is without excess risk, that is, the zero threshold hypothesis [15,16].…”

Section: Exposure To Medical Radiationmentioning

confidence: 99%

Sustainability in the cardiac cath lab

Picaño

Santoro

Vañó

2006

Int J Cardiovasc Imaging

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Use of radiation for medical examinations and test is the largest man-made source of radiation exposure. Interventional procedures are only 2% of all radiological procedures, but contribute to about 20% of the total collective dose per head per year. On average, a left ventriculography and coronary angiography corresponds to a radiation exposure for the patient of about 300, a coronary stent to 1,000, a peripheral artery intervention to 1,500 to 2,500, and a cardiac radiofrequency ablation to 900-1,500 chest x-rays. Invasive cardiology procedures increased tenfold in the last ten years and growth in the field has been accompanied by concern for the safety of the staff. Interventional cardiologists have an exposure per-head per year two- to three times higher than that of radiologists, with an annual exposure equivalent to around 250 chest x-rays per head. A reduction of occupational doses by a factor of ten can be achieved simply by and intensive training program. The awareness of radiation effects may be suboptimal in the medical community. It is recommended by professional guidelines and reinforced by the European law that the responsibility of all physicians is to minimize the radiation injury hazard to their patients, to their professional staff and to themselves.

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Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: Analysis in relation to radiation exposure parameters

Cited by 83 publications

References 28 publications

Radiation Exposure to Patients Undergoing Percutaneous Coronary Interventions

Radiation Exposure to Patients Undergoing Percutaneous Coronary Interventions

Preliminary reference levels in interventional cardiology

Sustainability in the cardiac cath lab

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