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

Abstract

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.

Impact of dose reducing software on patient and staff temple dose during fluoroscopically guided pacemaker insertion, closure devices implantation and coronary angiography procedures

“…Reductions in DAP of 69% during percutaneous coronary interventions were also recorded by Kastrati et al [ 30 ], which is comparable to the 73% found in this investigation. Numerous authors outlined the reduction in dose during procedures to revascularize chronic total occlusions of the coronary arteries [ 13 , 28 , 32 , 33 ]. There is not a high volume of treatments undertaken for chronic total occlusions at the center in which this study was undertaken, so these procedures were included in the percutaneous coronary intervention data.…”

“…However, the results contrast with other studies investigating the effect of DRS on occupational dose. Salinas et al reported a 36% reduction in DAP during chronic total occlusion intervention, but also noted no reduction in occupational dose and, in fact, an increase in scatter dose [ 13 ]. This was also found by Sanchez et al in a study comparing dose in over 5000 procedures with the explanation that, while there is a reduction in radiation, due to the additional filtration, there was an increase in the average energy of the photons in the primary beam and an associated increase in scattered radiation [ 14 ].…”

“…However, there are differing results on the effect of dose reducing software (DRS) on occupational dose. Some authors report a reduction in dose to the staff during (non-cardiac) endovascular procedures [ 10 – 12 ], while others indicate that DRS results in an increase in scattered radiation and consequently causing an increase in occupational dose to staff [ 13 , 14 ]. There are a number of procedures for which the effects of DRS have not been well studied [ 15 ], including the insertion of closure devices for the treatment of pathologies such as patent foramen ovale (PFO), atrial septal defect (ASD), as well as atrial appendage closures in the clinical setting.…”

Strategy to Reduce the Collective Equivalent Dose for the Lens of the Physician’s Eye Using Short Radiation Protection Curtains to Prevent Cataracts

“…The limitations of this study are that P KA was assumed to be proportional to H Lens , and the conversion coefficient from P KA to H Lens was fixed as t. Therefore, if the physician's standing position, the fluorographic imaging unity, the fluorography conditions set, other protective devices simultaneously used, or other factors differ, there is a possibility that t will change significantly with each case, and the collective equivalent dose for the lens of the physician's eye cannot be correctly evaluated [31][32][33]. In addition, at medical institutions where a high percentage of fluoroscopic techniques can be done with the use of a long curtain, there is a possibility that not much reduction can be expected in the collective equivalent dose for the lens of the physician's eye with short curtains.…”

Radiation diligence must continue when using newer fluoroscopes

“…The article by Salinas, et.al., 1 in this issue of CCI documents some of the subtleties involved in correlating patient and staff dose. The paper compares radiation information derived from CTOs performed by the same operators on two generations of fluoroscopes (standard dose system [SDS] and low‐dose system [LDS]).…”