Latest-generation catheterization systems enable invasive submillisievert coronary angiography

Kuon, Eberhard; Weitmann, Kerstin; Hummel, Astrid; Dörr, Marcus; Reffelmann, Thorsten; Riad, Alexander; Busch, M.; Felix, Stephan B.; Hoffmann, Wolfgang; Empen, Klaus

doi:10.1007/s00059-013-4015-8

Cited by 9 publications

(14 citation statements)

References 27 publications

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“…Citation Format: nique"; (3) copper filtering; (4) adequate low-level pulse rates and detector entrance dose levels; (5) lower irradiating angulations and only adequate magnification; (6) full inspiration during radiography; (7) long source-to-skin and short patient-to-detector distances and (8) sufficiently rested operators. Each of these steps toward improved radiation safety practice was discussed in depth with published data [21,23,24], demonstrated in the cath lab and/or illustrated by educational videos.…”

Section: Study Design Setting and Patientsmentioning

confidence: 99%

“…Although fluoroscopy time may characterize interventional experience in invasive cardiology, it is of minor relevance for total DAP -at least during CA. Fluoroscopy contributes to~20 % of the total radiation exposure, and radiographic dose intensity amounted to 20 to 30 times the fluoroscopy intensity ( • " Table 4) [24]. The influence of the operator's individual experience and team leadership on radiation safety performance was a compelling focus of this study.…”

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confidence: 99%

“…BMI, male sex and age were positively correlated to dose-related parameters, owing to the increasing complexity of expected coronary heart disease [19,20]. Higher patient doses upon use of advanced flat-panel technology can be explained by a tendency to employ higher pulse rates and/or greater pre-set detector-dose intensities during radiography [21,24]. Consistent translation of heart-rate adaptive and advanced detector settings, however, has recently enabled reduction of radiographic and fluoroscopic dose intensities by 70 and 80 %, respectively [24].…”

mentioning

confidence: 99%

“…Higher patient doses upon use of advanced flat-panel technology can be explained by a tendency to employ higher pulse rates and/or greater pre-set detector-dose intensities during radiography [21,24]. Consistent translation of heart-rate adaptive and advanced detector settings, however, has recently enabled reduction of radiographic and fluoroscopic dose intensities by 70 and 80 %, respectively [24]. Although fluoroscopy time may characterize interventional experience in invasive cardiology, it is of minor relevance for total DAP -at least during CA.…”

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confidence: 99%

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Role of Experience, Leadership and Individual Protection in the Cath Lab – A Multicenter Questionnaire and Workshop on Radiation Safety

Kuon¹,

Weitmann

Hoffmann

et al. 2015

Fortschr Röntgenstr

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Purpose: Radiation exposure in invasive cardiology remains considerable. We evaluated the acceptance of radiation protective devices and the role of operator experience, team leadership, and technical equipment in radiation safety efforts in the clinical routine. Materials and Methods: Cardiologists (115 from 27 centers) answered a questionnaire and documented radiation parameters for 10 coronary angiographies (CA), before and 3.1 months after a 90-min. mini-course in radiation-reducing techniques. Results: Mini-course participants achieved significant median decreases in patient dose area products (DAP: from 26.6 to 13.0?Gy???cm2), number of radiographic frames (??29?%) and runs (??18?%), radiographic DAP/frame (??32?%), fluoroscopic DAP/s (??39?%), and fluoroscopy time (??16?%). Multilevel analysis revealed lower DAPs with decreasing body mass index (??1.4?Gy???cm2 per kg/m2), age (??1.2?Gy???cm2/decade), female sex (??5.9?Gy???cm2), participation of the team leader (??9.4?Gy???cm2), the mini-course itself (??16.1?Gy???cm2), experience (??0.7?Gy???cm2/1000 CAs throughout the interventionalist?s professional life), and use of older catheterization systems (??6.6?Gy???cm2). Lead protection included apron (100?%), glass sheet (95?%), lengthwise (94?%) and crosswise (69?%) undercouch sheet, collar (89?%), glasses (28?%), cover around the patients? thighs (19?%), foot switch shield (7?%), gloves (3?%), and cap (1?%). Conclusion: Radiation-protection devices are employed less than optimally in the clinical routine. Cardiologists with a great variety of interventional experience profited from our radiation safety workshop ? to an even greater extent if the interventional team leader also participated. Key Points: ??Radiation protection devices are employed less than optimally in invasive cardiology. ??The presented radiation-safety mini-course was highly efficient. ??Cardiologists at all levels of experience profited from the mini-course ? considerably more so if the team leader also took part. ??Interventional experience was less relevant for radiation reduction. ??Consequently both fellows and trainers should be encouraged to practice autonomy in radiation safety. Citation Format: ??Kuon E, Weitmann K, Hoffmann W et?al. Role of Experience, Leadership and Individual Protection in the Cath Lab ? A Multicenter Questionnaire and Workshop on Radiation Safety. Fortschr R?ntgenstr 2015; 187: 899???905

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Section: Study Design Setting and Patientsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Role of Experience, Leadership and Individual Protection in the Cath Lab – A Multicenter Questionnaire and Workshop on Radiation Safety

Kuon¹,

Weitmann

Hoffmann

et al. 2015

Fortschr Röntgenstr

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“…6 Recently, however, the radiation dose associated with ICA could be reduced to submillisievert levels. 7 By design, ICA carries all the risks associated with invasive coronary catheterization, such as stroke, bleeding and dissection of the vessels within the access route. There are, however, several limitations with ICA related to its simple planar silhouette visualization of the lumen.…”

Section: Current Anatomical Modalities For Detection Of Myocardial Ismentioning

confidence: 99%

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

Bucher¹,

Cecco²,

Schoepf³

et al. 2014

BJR

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The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy firstpass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.

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ECG-gated coronary angiography enables submillisievert imaging in invasive cardiology

Kuon¹,

Felix

Weitmann

et al. 2014

Herz

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Latest-generation catheterization systems enable invasive submillisievert coronary angiography

Abstract: Consistent application of radiation-reducing techniques with the latest-generation flat-panel systems enables submillisievert coronary angiography in invasive cardiology.

Cited by 9 publications

References 27 publications

Role of Experience, Leadership and Individual Protection in the Cath Lab – A Multicenter Questionnaire and Workshop on Radiation Safety

Role of Experience, Leadership and Individual Protection in the Cath Lab – A Multicenter Questionnaire and Workshop on Radiation Safety

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

ECG-gated coronary angiography enables submillisievert imaging in invasive cardiology

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