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>3.3.co;2-b

Cited by 26 publications

(36 citation statements)

References 17 publications

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“…Indeed, previous works that aimed at defining a predictive score of the fluoroscopy duration revealed that other therapeutic characteristics had a significant impact: the number of complex lesions (according to American Heart Association/American College of Cardiology classification [27]), the bifurcation and ostial stenting, the severity of occlusions and the degree of the tortuosity of treated vessels [6,25]. Furthermore, our results cannot be easily extrapolated, since patients were not randomly sampled from different interventional cardiology units.…”

Section: Discussionmentioning

confidence: 83%

“…The procedure complexity and the practitioner's attitude towards radioprotection involve other mechanisms that affect the dose level ( Table 3). The impact of the practitioner may be attributable to a selection bias, but clinical and therapeutic variables (although insufficient to model the complexity of procedures as a whole [6,25]) allowed adjusting on such a potential bias. Moreover, the technical data collected in this sample allowed for studying precisely how the parameters of procedure optimisation impacted on the dose imparted to patients.…”

Section: Discussionmentioning

confidence: 99%

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Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Journy

Sinno‐Tellier²,

Maccia³

et al. 2012

BJR

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Objective: The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. Methods: We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. Results: The mean MSD and DAP were respectively 389 mGy and 65 Gy cm 22 for CAs, and 916 mGy and 69 Gy cm 22 for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r50.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. Conclusion: Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions. Interventional cardiology procedures such as repeated diagnostic coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) may cause radio-induced skin damage. Deterministic skin effects might occur as soon as the dose to the patient's skin exceeds 2 Gy and might correspond to a range of lesions from erythema to necrosis [1]. In relation to the risk of skin lesions, the X-ray dose depends on clinical, therapeutic and technical factors. First of all, the dose to the patient increases with increasing body mass index (BMI) [1][2][3]. Second, dose, fluoroscopy time and number of cine frames might differ depending on the number of treated vessels and/or stenoses [4][5][6], localisation and severity of lesions [2,7], stage of occlusion [7,8], tortuosity of treated vessels [6][7][8], number of stents and balloons [2,4,[7][8][9], and artery approach [10,11]. With the aim of optimising the interventional cardiology procedures (i.e. minimising the X-ray dose to the patient while preserving the quality of treatment), the use of low fluoroscopy pulse rate, image intensifier field size and collimation are recommended [1,12,13]. However, the studies that concluded that there was an impact on dose of some technical parameters had mostly used descriptive or univariate analyses and/or were carried out on a phantom [2,...

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Journy

Sinno‐Tellier²,

Maccia³

et al. 2012

BJR

View full text Add to dashboard Cite

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“…17 In fact, technical and anatomic factors during procedures likely have the largest effect on an individual case x-ray exposure. 18,19 As the principal determinant of occupational radiation exposure for operators is patient scatter, reducing total energy to patients directly affects physician and staff exposures as well. 20 Clearly, efforts to reduce radiation exposure for both patient and staff need to be a critical part of every catheterization laboratory's quality improvement mission.…”

Section: Discussionmentioning

confidence: 99%

Effect of Reduction of the Pulse Rates of Fluoroscopy and CINE-Acquisition on X-Ray Dose and Angiographic Image Quality During Invasive Cardiovascular Procedures

Pyne

Gadey

Jeon

et al. 2014

Circ: Cardiovascular Interventions

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Background— Reducing digital pulse rates (PR) are known to reduce total energy during invasive cardiovascular procedures, which likely has benefits for patients and staff. Physicians may be reluctant to reduce these parameters because they fear a decline in image quality that could affect procedural outcomes. We sought to assess the effect of default rates of fluoroscopy (Fluoro) and CINE-acquisition (CINE) on total x-ray dose and image quality during invasive cardiovascular procedures. Methods and Results— We retrospectively reviewed procedures done with 2 default PRs: a standard dose cohort (PR, 15 for Fluoro and CINE), and a reduced dose cohort (PR, 10 for Fluoro and CINE). Total x-ray dose, Fluoro time, and contrast use were compared between groups. A blinded angiographic image quality assessment was then performed using an objective 10-point angiographic quality score. There were no significant differences between cohorts for fluoroscopy time or contrast use. The reduced dose cohort has a significant reduction in mean total x-ray dose (PR 15, 1763.1 mGy; PR 10, 1179.1 mGy; P <0.0001). When adjusted for potential confounders, a 38% reduction in total x-ray dose was identified ( P <0.0001). There was no difference in adjusted angiographic quality score between the cohorts (PR 15, 7.90; PR 10, 8.00; P =0.67), indicating no decline in image quality with PR reduction. Conclusions— Reducing default PRs during invasive cardiovascular procedures yields large and significant reductions in total x-ray energy with no decline in angiographic image quality.

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“…Because some variables such as body mass index, the treatment of complex lesions, and the different angulation of the X-ray tube may have biased the radiation dose, [11][12][13] we also tested our hypothesis in 6 cases of simultaneous left and right radial cannulation during fluoroscopy in the anteroposterior position of the X-ray tube. In these cases, a snapshot evaluation of the radiation dose to the operator's left arm Radiation dose at the wrist was significantly higher compared with the rest of the body, but this difference was significant only in the right radial approach group.…”

Section: Discussionmentioning

confidence: 99%

Operator Radiation Exposure During Percutaneous Coronary Procedures Through the Left or Right Radial Approach

Sciahbasi

Romagnoli²,

Trani³

et al. 2011

Circ: Cardiovascular Interventions

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Background-Transradial percutaneous coronary procedures may be effectively performed through the right radial approach (RRA) or the left radial approach (LRA), but data on radiation dose absorbed by operators comparing the two approaches are lacking. The aim of the present study was to evaluate radiation dose absorbed by operators during coronary procedures through the RRA and LRA. Methods and Results-Three operators were equipped with 5 different dosimeters (left wrist, shoulder, thorax outside the lead apron, thorax under the lead apron, and thyroid) during RRA or LRA for coronary procedures. Each month, the dosimeters were analyzed to determine the radiation dose absorbed. Pϭ0.27). The dose at the wrist was significantly higher for the RRA (2.44Ϯ1.12 mSv) compared with the LRA (1Ϯ0.8 mSv, Pϭ0.002). In both radial approaches, the thoracic radiation dose under the lead apron was undetectable. Conclusions-Compared with RRA, LRA for coronary procedures is associated with similar radiation dose for operators at the body, shoulder, or thyroid level, with a possible significant advantage at the wrist. The cumulative radiation dose for both approaches is well under to the annual dose-equivalent limit. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00282646.

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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 26 publications

References 17 publications

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Effect of Reduction of the Pulse Rates of Fluoroscopy and CINE-Acquisition on X-Ray Dose and Angiographic Image Quality During Invasive Cardiovascular Procedures

Operator Radiation Exposure During Percutaneous Coronary Procedures Through the Left or Right Radial Approach

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