Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR<sup>®</sup>

Fazel, Reza; Curtis, Jeptha P.; Wang, Yongfei; Einstein, Andrew J.; Smith‐Bindman, Rebecca; Tsai, Thomas T.; Chen, Jersey; Shah, Nilay D.; Krumholz, Harlan M.; Nallamothu, Brahmajee K.

doi:10.1002/ccd.24996

Cited by 30 publications

(23 citation statements)

References 23 publications

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“…20 Variables that were associated with higher fluoroscopy times for diagnostic catheterization were brachial arterial access (6.0 minutes of added fluoroscopy time), radial access (3.6 minutes), congenital heart disease (3.2 minutes), concomitant right heart catheterization (2.7 minutes), and university hospital setting (2.6 minutes). For PCI, coronary dissection or perforation (7.7 minutes), use of atherectomy, thrombectomy, or extraction catheter or laser (7.1 minutes), brachial artery access (7.2 minutes), and number of lesions intervened upon (4.9 minutes) were the factors associated with the greatest prolongation of fluoroscopy time.…”

Section: Discussionmentioning

confidence: 99%

“…First operator radiation exposure was lower in the Bleeper Sv group both for diagnostic angiography (7 [4][5][6][7][8][9][10][11] versus 10 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] μSv; P<0.001) and for PCI (11 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] versus 14 [6][7][8][9][10][11][12][13][14][15][16][17]…”

Section: Procedural Outcomesmentioning

confidence: 99%

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Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

Christopoulos

Papayannis

Alomar

et al. 2014

Circ: Cardiovascular Interventions

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Background— The Radiation Reduction During Cardiac Catheterization Using Real-Time Monitoring study sought to examine the effect of a radiation detection device that provides real-time operator dose reporting through auditory feedback (Bleeper Sv; Vertec Scientific Ltd; Berkshire, UK) on patient dose and operator exposure during cardiac catheterization. Methods and Results— Between January 2012 and May 2014, 505 patients undergoing coronary angiography, percutaneous coronary intervention, or both were randomized to use (n=253) or no use (n=252) of the Bleeper Sv radiation monitor. Operator radiation exposure was measured in both groups using a second, silent radiation exposure monitoring device. Mean patient age was 65±8 years, most patients (99%) were men, and 30% had prior coronary artery bypass graft surgery. Baseline clinical characteristics were similar in the 2 study groups. Radial access was used in 18% and chronic total occlusion percutaneous coronary intervention constituted 7% of the total procedures. Median procedure time was 17 (12–27) minutes for diagnostic angiography, 42 (28–70) minutes for percutaneous coronary intervention, and 27 (14–51) minutes in the overall study population, with similar distribution between the study groups. First (9 [4–17] versus 14 [7–25] μSv; P <0.001) and second (5 [2–10] versus 7 [4–14] μSv; P <0.001) operator radiation exposure was significantly lower in the Bleeper Sv group. Use of the device did not result in a significant reduction in patient radiation dose. The effect of the Bleeper Sv device on operator radiation exposure was consistent among various study subgroups. Conclusions— Use of a real-time radiation monitoring device that provides auditory feedback can significantly reduce operator radiation exposure during cardiac catheterization. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01510353.

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Section: Discussionmentioning

confidence: 99%

Section: Procedural Outcomesmentioning

confidence: 99%

Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

Christopoulos

Papayannis

Alomar

et al. 2014

Circ: Cardiovascular Interventions

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“…16 Although following the principles of As Low as Reasonably Achievable and maintain careful attention toward limiting fluoroscopic time will limit patient and physician exposure, as much as 80% of x-ray time is determined by patient characteristics and procedural complexity that cannot be modified by the operator. 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.…”

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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“…In the United States explained by patient characteristics and procedural complexity, nearly one fifth was because of operator and hospital level factors, suggesting that radiation-reducing protocols are not standardized. 16 The Patient's Exposure to X-ray During Coronary Angiography and Percutaneous Transluminal Coronary Intervention (RAY' ACT) study, a nationwide analysis of radiation parameters in ≈34 000 diagnostic and 28 000 PCI procedures in 2010 in France also demonstrated high variability across centers. The majority of centers registered both fluoroscopy time and kerma air product, and heterogeneity was more pronounced for kerma air product.…”

Section: What About Fluoroscopy Time?mentioning

confidence: 99%

Controlling Radiation Exposure in Interventional Cardiology

Abbott

2014

Circ: Cardiovascular Interventions

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Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR^®

Cited by 30 publications

References 23 publications

Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

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

Controlling Radiation Exposure in Interventional Cardiology

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Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR®

Cited by 30 publications

References 23 publications

Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

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

Controlling Radiation Exposure in Interventional Cardiology

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Product

Resources

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Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR^®