Feasibility of using ultra‐low pulse rate fluoroscopy during routine diagnostic coronary angiography

Badawy, Mohamed Khaldoun; Scott, Matthew; Farouque, Omar; Horrigan, Mark; Clark, David; Chan, Robert

doi:10.1002/jmrs.293

Cited by 12 publications

(18 citation statements)

References 12 publications

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“…The side effects of radiation exposure include cancer, cataracts, non-malignant skin damage, and impaired fertility ( 3 ). Several studies have confirmed the increased incidence of cancer as well as posterior subcapsular lens opacities in interventional cardiologists ( 4 ). There are also concerns over the possibility of a causal relationship between left sided brain tumors and occupational radiation exposure in interventional cardiologists ( 5 ).…”

Section: Introductionmentioning

confidence: 90%

Radiation Exposure Reduction and Patient Outcome by Using Very Low Frame Rate Fluoroscopy Protocol (3.8 + 7.5 fps) During Percutaneous Coronary Intervention

Gupta¹,

Chhikara

Vijayvergiya

et al. 2021

Front. Cardiovasc. Med.

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Objectives: In this study, we intend to analyze the feasibility and efficacy of very low frame rate fluoroscopy (VLFF) protocol using a combination of 3.8 and 7.5 fps while performing Percutaneous Coronary Intervention (PCI).Methods: A retrospective cohort including 193 patients undergoing PCI under the VLFF protocol (Post-VLFF group) was compared with a retrospective cohort of 133 patients, who underwent PCI prior to implementation of VLFF protocol (Pre-VLFF group). In the Pre-VLFF group, all PCIs were performed using fluoroscopy frame rate of 15 fps. In the Post-VLFF group, 3.8 fps was used to guide catheter engagement, coronary lesion wiring, pre-and post-dilation, and 7.5 fps was used for lesion assessment and stent placement. Increasing use of fluoroscopic storage in place of cineangiography was also encouraged. Cine acquisition in both groups was performed at 15 fps. Primary endpoint was radiation exposure measured by Air Kerma. Secondary endpoints were procedure related outcomes and patient related outcomes (Major Adverse Cardiac Events including all-cause mortality, Target Lesion Failure, Myocardial Infarction, and Stroke).RESULTS: Post-VLFF group showed 74.7% reduction in Air Kerma as compared to Pre-VLFF group (433 ± 27 mGy vs. 1,714 ± 140 mGy; p < 0.0001), with no increase in the fluoroscopy time (15.38 ± 0.98 min Post-VLFF vs. 17.06 ± 1.29 min Pre-VLFF; p = 0.529) and contrast volume (116.5 ± 4.9 ml Post-VLFF vs. 116.7 ± 6 ml Pre-VLFF; p = 0.700). Both groups had comparable procedural success and complications rates as well as incidence of MACE.Conclusions: The very low frame rate fluoroscopy protocol is a feasible, effective, and safe method to significantly reduce the radiation exposure during PCI without any compromise on procedural and patient outcomes.

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Section: Introductionmentioning

confidence: 90%

Radiation Exposure Reduction and Patient Outcome by Using Very Low Frame Rate Fluoroscopy Protocol (3.8 + 7.5 fps) During Percutaneous Coronary Intervention

Gupta¹,

Chhikara

Vijayvergiya

et al. 2021

Front. Cardiovasc. Med.

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“…It depends mainly on individual application settings. Thus, algorithms developed to support diagnostic angiography, performed with the aim of subsequent emergent blood ow restoration, should correspond to the following requirements: input video frame rate of 7.5-15 frames per second 39,40 , the duration of the procedure less than 25 minutes, and individual preferences of the operator 41 . We concluded that neural network architectures with an inference time of less than 66 milliseconds are suitable for this task (Table 4.…”

Section: Image Processing Speedmentioning

confidence: 99%

Real-Time Coronary Artery Stenosis Detection Based on Modern Neural Networks

Danilov

Klyshnikov

Gerget

et al. 2020

Preprint

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Invasive coronary angiography remains the gold standard for diagnosing coronary artery disease, which may be complicated by both, patient-specific anatomy and image quality. Deep learning techniques aimed at detecting coronary artery stenoses may facilitate the diagnosis. However, previous studies have failed to achieve superior accuracy and performance for real-time labeling. Our study is aimed at confirming the feasibility of real-time coronary artery stenosis detection using deep learning methods. To reach this goal we trained and tested eight promising detectors based on different neural network architectures (MobileNet, ResNet-50, ResNet-101, Inception ResNet, NASNet) using clinical angiography data of 100 patients.Three neural networks have demonstrated superior results. The network based on Faster-RCNN Inception ResNet V2 is the most accurate and it achieved the mean Average Precision of 0.954 and the prediction rate of 3 fps on the validation subset. The relatively lightweight SSD MobileNet V2 network proved itself as the fastest one with an mAP of 0.830 and a mean prediction rate of 38 fps. The model based on RFCN ResNet-101 V2 has demonstrated an optimal accuracy-to-speed ratio. Its mAP makes up 0.94, while the prediction speed is 10 fps.The resultant performance-accuracy balance of the modern neural networks has confirmed the feasibility of real-time coronary artery stenosis detection supporting the decision-making process of the Heart Team interpreting coronary angiography findings.

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“…The study by Badawy et al also has implications for the radiation dose to the staff present, particularly the primary operator, who stands closest to the patient during these procedures. Radiation exposure to staff working in cath labs can be significant.…”

Section: Implications For Staff Radiation Dosementioning

confidence: 99%

“…The paper by Badawy et al demonstrates the impact that proactive staff working in the cath lab can have on the radiation exposure of the patient. Using an X‐ray system ‘straight out of the box’ without some form of customisation to the local environment is ill‐advised.…”

Section: Radiation Safety Implicationsmentioning

confidence: 99%

“…Normally, fluoroscopy pulse rates of between 7.5 and 15 pulses per second (PPS) are used for coronary angiography and the choice of pulse rate is dependent on the operator's preference. The publication by Badawy et al . in Journal of Medical Radiation Sciences explores the possibility of using a new image processing protocol and fluoroscopy pulse rates as low as 3 PPS.…”

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confidence: 99%

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Lowering fluoroscopy pulse rates to reduce radiation dose during cardiac procedures

Crowhurst

Whitby

2018

J of Medical Radiation Sci

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Radiation dose to patients undergoing cardiac imaging procedures in cardiac catheterisation laboratories (cath labs) can be relatively high, so implementing strategies to reduce dose is important. Lowering the fluoroscopy pulse rate is a simple, yet effective method to reduce radiation dose. Sensible, iterative changes made in this area have the potential for significant patient and staff radiation dose reduction.

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Feasibility of using ultra‐low pulse rate fluoroscopy during routine diagnostic coronary angiography

Cited by 12 publications

References 12 publications

Radiation Exposure Reduction and Patient Outcome by Using Very Low Frame Rate Fluoroscopy Protocol (3.8 + 7.5 fps) During Percutaneous Coronary Intervention

Radiation Exposure Reduction and Patient Outcome by Using Very Low Frame Rate Fluoroscopy Protocol (3.8 + 7.5 fps) During Percutaneous Coronary Intervention

Real-Time Coronary Artery Stenosis Detection Based on Modern Neural Networks

Lowering fluoroscopy pulse rates to reduce radiation dose during cardiac procedures

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