Effectiveness of Low Rate Fluoroscopy at Reducing Operator and Patient Radiation Dose During Transradial Coronary Angiography and Interventions

Abdelaal, Eltigani; Plourde, Guillaume; MacHaalany, Jimmy; Arsenault, Jean; Rimac, Goran; Déry, Jean‐Pierre; Barbeau, Gérald; Larose, Éric; Larochellière, Robert De; Nguyen, Can M.; Allende, Ricardo; Ribeiro, Henrique Barbosa; Costerousse, Olivier; Mongrain, Rosaire; Bertrand, Olivier

doi:10.1016/j.jcin.2014.02.005

Cited by 97 publications

(55 citation statements)

References 35 publications

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“…A recent randomized controlled trial of 7.5 versus 15 frames-per-second fluoroscopy during transradial coronary angiography and intervention demonstrated a 30% (P<0.0001) relative reduction in operator exposure and 19% (P=0.022) relative reduction in patient dose area product. 19 Use of x-ray equipment with novel radiation protocols can also reduce radiation exposure. Wassef et al studied a novel radiation reduction protocol (EPO; Philips, Netherlands) that reduces detector dose rate in acquisition imaging, decreases the frame rate, fine tunes the x-ray parameters (peak tube voltage, cathode current, spectral filter) to the examination and patient's size, and increases the thickness of the x-ray beam spectral filters.…”

Section: Discussionmentioning

confidence: 99%

“…24 It is estimated that radiation exposure results in a lifetime attributable cancer risk of ≈1:100 for high-volume operators. 7,19,24 Based on the RadiCure trial results, use of monitoring devices during catheterization procedures is expected to reduce this risk by approximately one third, a large and clinically meaningful effect.…”

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: Discussionmentioning

confidence: 99%

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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“…These data support the "as low as reasonably achievable" (ALARA) principle, which encourages reductions in LDIR dose for a given imaging or therapeutic procedure and the selection of non-LDIR-related imaging whenever medically appropriate. 8 Indeed, pursuant with this principle of as low as reasonably achievable, reductions in LDIR dose with advanced imaging have been achieved over time through the use of increased detector rows and more rapid gantry rotation time (CT scans) 15 and through lead-draping practices, collimation, and reductions in fluoroscopic frame rates (cardiac catheterization), 16,17 to name a few improvements, and LDIR doses in the current imaging era are in most cases lower than in previous years. Additionally, physicians are encouraged to choose non-LDIR-emitting alternative imaging when it is equivalent to LDIR-emitting imaging.…”

Section: Discussionmentioning

confidence: 99%

“…by guest on May 12, 2018 http://circ.ahajournals.org/ Downloaded from using primary diagnoses from the death-associated hospitalization. Mortality causes for non-hospitalization-related mortalities were not ascertained with this algorithm.…”

Section: Mortalitymentioning

confidence: 99%

Exposure to Low-Dose Ionizing Radiation From Cardiac Procedures in Patients With Congenital Heart Disease

et al. 2016

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Background— The burden of low-dose ionizing radiation (LDIR) exposure from medical procedures among individuals with congenital heart disease (CHD) is unknown. In this longitudinal population-based study, we sought to determine exposure to LDIR-related cardiac imaging and therapeutic procedures in children and adults with CHD. Methods and Results— In an analysis of the Quebec CHD database, exposure to the following LDIR-related cardiac procedures was recorded: catheter-based diagnostic procedures, structural heart interventions, coronary interventions, computed tomography scans of the chest, nuclear procedures, and pacemaker/implantable cardioverter-defibrillator insertion and repair. From 1990 to 2005, there were 16 253 LDIR-exposed patients with CHD with 317 988 patient-years of available follow-up. The total number of LDIR-related procedures increased from 18.5 to 51.9 per 1000 CHD patients per year ( P <0.0001). This increase was attributable to increases in rates per 1000 CHD patients in diagnostic cardiac catheterizations (11.7 to 13.7 per 1000), structural heart interventions (1.0 to 5.2 per 1000), coronary interventions (1.0 to 2.4 per 1000), pacemaker/implantable cardioverter-defibrillator insertions (1.6 to 4.4 per 1000), nuclear procedures (4.2 to 13.8 per 1000), and computed tomography scans of the chest (2.5 to 12.3 per 1000). Over time, among children with CHD, the median age at first LDIR procedure decreased from 5.0 years to 9.6 months. Severity of CHD significantly predicted extent of exposure. Conclusions— From 1990 to 2005, patients with CHD were exposed to increasing numbers of LDIR-emitting cardiac procedures. This exposure occurred at progressively younger ages. These findings provide an important perspective on longitudinal LDIR exposure in this at-risk population.

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Optimizing Radiation Safety in the Cardiac Catheterization Laboratory

Christopoulos

Makke

Christakopoulos

et al. 2015

Cathet Cardio Intervent

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Reducing radiation exposure during cardiovascular catheterization is of paramount importance for both patient and staff safety. Over the years, advances in equipment and application of radiation safety protocols have significantly reduced patient dose and operator exposure. This review examines the current status of radiation protection in the cardiac and vascular catheterization laboratory and summarizes best practices for minimizing radiation exposure.

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Effectiveness of Low Rate Fluoroscopy at Reducing Operator and Patient Radiation Dose During Transradial Coronary Angiography and Interventions

Abstract: Fluoroscopy at 7.5 FPS, compared with 15 FPS, is a simple and effective method in reducing operator and patient radiation dose during TRA DCA and PCI.

Cited by 97 publications

References 35 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

Exposure to Low-Dose Ionizing Radiation From Cardiac Procedures in Patients With Congenital Heart Disease

Optimizing Radiation Safety in the Cardiac Catheterization Laboratory

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