Identification of less-irradiating tube angulations in invasive cardiology

Kuon, Eberhard; Dahm, Johannes B.; Empen, Klaus; Robinson, Daniel M.; Reuter, G; Wucherer, Michael

doi:10.1016/j.jacc.2004.06.057

Cited by 134 publications

(122 citation statements)

References 28 publications

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“…The sagittal angulations of the X-ray beam were not taken into account in this figure. The lateral projection (LAO90) is the most frequent projection leading to the MSD, in agreement with Kuon et al [17].…”

Section: Maximum Skin Dosesupporting

confidence: 90%

A large-scale multicentre study of patient skin doses in interventional cardiology: dose–area product action levels and dose reference levels

Bogaert¹,

Bacher²,

Lemmens³

et al. 2009

BJR

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ABSTRACT. For 318 patients in 8 different Belgian hospitals, the entire skin-dose distribution was mapped using a grid of 70 thermoluminescence dosemeters per patient, allowing an accurate determination of the maximum skin dose (MSD). Dosearea product (DAP) values, exposure parameters and geometry, together with procedure, patient and cardiologist characteristics, were also registered. Procedures were divided into two groups: diagnostic procedures (coronary angiography) and therapeutic procedures (dilatation, stent, combined procedures (e.g. coronary angiography + dilatation + stent)). The mean value of the MSD was 0.310 Gy for diagnostic and 0.699 Gy for therapeutic procedures. The most critical projection for receiving the MSD is the LAO90 (left anterior oblique) geometry. In 3% of cases, the MSD exceeded the 2 Gy dose threshold for deterministic effects. Action levels in terms of DAP values as the basis for a strategy for follow-up of patients for deterministic radiation skin effects were derived from measured MSD and cumulative DAP values. Two DAP action levels are proposed. A first DAP action level of 125 Gy cm 2 corresponding to the dose threshold of 2 Gy would imply an optional radiopathological follow-up depending on the cardiologist's decision. A second DAP action level of 250 Gy cm 2 corresponding to the 3 Gy skin dose would imply a systematic follow-up. Dose reference levels -71.3 Gy cm 2 for diagnostic and 106.0 Gy cm 2 for therapeutic procedures -were derived from the 75 percentile of the DAP distributions. As a conclusion, we propose that total DAP is registered in patient's record file, as it can serve to improve the follow-up of patients for radiation-induced skin injuries.

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Section: Maximum Skin Dosesupporting

confidence: 90%

A large-scale multicentre study of patient skin doses in interventional cardiology: dose–area product action levels and dose reference levels

Bogaert¹,

Bacher²,

Lemmens³

et al. 2009

BJR

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“…In our study, the contribution of radiation doses to the overall KAP from LAO45°‐CAU35° and PA‐CAU40° were 16% and 11%, respectively, due to high tube potential of 120 kV and tube current of 21.4 mA compared to other angiographic projections (Table 2). Kuon et al (16) reports that LAO45°‐CAU35° involves a 2.6 fold increase in KAP/sec and 7.6 fold increase in operator doses compared to PA‐CAU30°. However these measurements were extensively carried out using an anthropomorphic RANDO phantom.…”

Section: Discussionmentioning

confidence: 99%

“…There is an increased number of interventions performed annually, (15) and contribution of radiation doses from individual projections is not widely reported in clinical setup to the extent of providing awareness among interventionalists as the study protocols may vary. However, there are studies in literature on radiation doses from various projections on anthropomorphic phantoms (16) . Hence it is necessary to monitor radiation doses and their associated risks during cardiovascular interventions.…”

Section: Introductionmentioning

confidence: 99%

Radiation doses and estimated risk from angiographic projections during coronary angiography performed using novel flat detector

Varghese

Livingstone

Varghese

et al. 2016

J Applied Clin Med Phys

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Coronary angiography (CA) procedure uses various angiographic projections to elicit detailed information of the coronary arteries with some steep projections involving high radiation dose to patients. This study intends to evaluate radiation doses and estimated risk from angiographic projections during CA procedure performed using novel flat detector (FD) system with improved image processing and noise reduction techniques. Real‐time monitoring of radiation doses using kerma‐area product (KAP) meter was performed for 140 patients using Philips Clarity FD system. The CA procedure involved seven standard projections, of which five were extensively selected by interventionalists. Mean fluoroscopic time (FT), KAP, and reference air kerma (Ka,r) for CA procedure were 3.24 min (0.5–10.51), 13.99 Gycm2 (4.02–37.6), and 231.43 mGy (73.8–622.15), respectively. Effective dose calculated using Monte Carlo‐based PCXMC software was found to be 4.9 mSv. Left anterior oblique (LAO) 45° projection contributed the highest radiation dose (28%) of the overall KAP. Radiation‐induced risk was found to be higher in females compared to males with increased risk of lung cancer. An increase of 10%–15% in radiation dose was observed when one or more additional projections were adopted along with the seven standard projections. A 14% reduction of radiation dose was achieved from novel FD system when low‐dose protocol during fluoroscopy and medium‐dose protocol during cine acquisitions were adopted, compared to medium‐dose protocol.PACS number(s): 87.50.cm, 87.55.de, 87.55.N, 87.59.cf, 87.59.Dj

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“…This evaluation was largely based on deriving clinical information and did not balance the clinical information yield with the radiation consequence of the selection of projections. Papers such as the one by Kuon et al [13] have shown that significant dose reduction can be achieved in situations where multiple view options exist by selecting the view with the lowest per unit exposure.…”

mentioning

confidence: 99%

Evaluation of coronary angiographic projections to balance the clinical yield with the radiation risk

Smith

Cameron²,

Mengersen³

et al. 2012

BJR

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Objective: Radiation safety principles dictate that imaging procedures should minimise the radiation risks involved, without compromising diagnostic performance. This study aims to define a core set of views that maximises clinical information yield for minimum radiation risk. Angiographers would supplement these views as clinically indicated. Methods: An algorithm was developed to combine published data detailing the quality of information derived for the major coronary artery segments through the use of a common set of views in angiography with data relating to the dose-area product and scatter radiation associated with these views. Results: The optimum view set for the left coronary system comprised four views: left anterior oblique (LAO) with cranial (Cr) tilt, shallow right anterior oblique (AP-RAO) with caudal (Ca) tilt, RAO with Ca tilt and AP-RAO with Cr tilt. For the right coronary system three views were identified: LAO with Cr tilt, RAO and AP-RAO with Cr tilt. An alternative left coronary view set including a left lateral achieved minimally superior efficiency (,5%), but with an ,8% higher radiation dose to the patient and 40% higher cardiologist dose. Conclusion: This algorithm identifies a core set of angiographic views that optimises the information yield and minimises radiation risk. This basic data set would be supplemented by additional clinically determined views selected by the angiographer for each case. The decision to use additional views for diagnostic angiography and interventions would be assisted by referencing a table of relative radiation doses for the views being considered.

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Identification of less-irradiating tube angulations in invasive cardiology

Abstract: The PA views and RAO views >or=40 degrees , heretofore unconventional in clinical routine, should be favored over steep LAO projections >or=40 degrees whenever possible. Tube angulations that are radiation intensive to the patient exponentially increase the operator's radiation risk.

Cited by 134 publications

References 28 publications

A large-scale multicentre study of patient skin doses in interventional cardiology: dose–area product action levels and dose reference levels

A large-scale multicentre study of patient skin doses in interventional cardiology: dose–area product action levels and dose reference levels

Radiation doses and estimated risk from angiographic projections during coronary angiography performed using novel flat detector

Evaluation of coronary angiographic projections to balance the clinical yield with the radiation risk

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