Long-term strategies support autonomy in radiation safety in invasive cardiology

Kuon, Eberhard; Felix, Stephan B.; Weitmann, Kerstin; Büchner, Ingo; Empen, Klaus

doi:10.1016/j.jjcc.2015.08.012

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…Depending on the energy source for PVI, cryoablation was associated with higher dose area product 7820 (4195-13,853) cGycm 2 versus 7178 (3668-13,423) cGycm 2 (p < .001). In contrast to our data, the fluoroscopy time in this study was not different for radiofrequency catheter ablation with 24 min in comparison to cryoablation with 22(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) min.In a multicenter study, comparing contact force (CF)-guided radiofrequency (RF) with second-generation cryoballoon (CB) ablation Squara et al26 reported a DAP of 4853 cGycm 2 at a mean fluoroscopy time off 19.3 ± 8.2 min in the CB group and a DAP of 4273 cGycm 2 at mean fluoroscopy time of 17.6 ± 11 min in the RF group with comparable efficacy and complication rates in both groups. Procedure times were shorter in the CB group (109.6 ± 40 min) as compared to the RF group (122.5 ± 40.7 min).…”

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confidence: 99%

“…There is a large discrepancy between a tow fold difference in the fluoroscopy time and the at least sevenfold difference in the DAP comparing to the data from Casella et al 4 from a large high volume‐electrophysiology center with experienced operators with the results of our study. The possible reason for this remarkable difference in the resulting DAP for PVI could be both: different awareness of the operators 27 , 28 and the technical settings of the fluoroscopy (7.5 pulses per min for fluoroscopy, FOV by 20 cm, no collimation in the Casella study).…”

Section: Discussionmentioning

confidence: 99%

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X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

Heinroth

Blum

Drexler

et al. 2022

Journal of Arrhythmia

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Background Facing an increasing number of radiofrequency ablation (RF) and cryoballoon ablation (CB) procedures for treatment of AF radiation exposure and its reduction is a focus point for interventional electrophysiologists. Objective This study evaluated the procedural parameters of the different ablation methods focusing on radiation exposure and the BMI of the patients. Methods One thousand one hundred and thirty‐three first procedural cases of pulmonary vein isolation in patients with paroxysmal and persistent AF treated with RF and CB‐based techniques were analyzed retrospectively over a period of 7 years focusing on the endpoints dose area product (DAP, cGycm2), fluoroscopy time (FT, min) and procedural time (PT, min). Results Of the 1133 patients (mean age 63.4 ± 11.4 years, BMI 28.9 ± 4.7) 335 patients received an RF procedure, 211 patients were treated with the cryoballoon first generation (CB1), and 587 patients with cryoballoon second generation (CB2), respectively. The mean DAP for the PVI was 508 ± 654 cGycm2 in RF procedures, 1077 ± 683 cGycm2 in CB1‐procedures, and 587 ± 489 cGycm2 in CB2‐procedures with fluoroscopy times significantly shorter in RF procedures (9.6 ± 5.2 min) as compared to 17.7 ± 5.9 min in CB1‐ and 16.3 ± 6.3 min in CB2‐procedures (p < .001). At the same time, the procedure duration using RF (115 ± 33.5 min) was significantly longer than both in CB1 (96 ± 16.8 min) and CB2 procedures (75 ± 15.9 min). Conclusions Despite longer fluoroscopy durations in the CB technique, the CB2 resulted in a comparable low radiation exposure in PVI as compared to RF, accompanied by shorter procedure durations.

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confidence: 99%

Section: Discussionmentioning

confidence: 99%

X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

Heinroth

Blum

Drexler

et al. 2022

Journal of Arrhythmia

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Radiation dose reduction during neuroendovascular procedures

Morris

Geer

Singh

et al. 2017

J NeuroIntervent Surg

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Combining Optimized Image Processing With Dual Axis Rotational Angiography: Toward Low‐Dose Invasive Coronary Angiography

Buytaert

Drieghe

Heuverswyn

et al. 2020

JAHA

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Background Dual axis rotational coronary angiography ( DARCA ) reduces radiation exposure during coronary angiography on older x‐ray systems. The purpose of the current study is to quantify patient and staff radiation exposure using DARCA on a modality already equipped with dose‐reducing technology. Additionally, we assessed applicability of 1 dose area product to effective dose conversion factor for both DARCA and conventional coronary angiography ( CCA ) procedures. Methods and Results Twenty patients were examined using DARCA and were compared with 20 age‐, sex‐, and body mass index–matched patients selected from a prior study using CCA on the same x‐ray modality. All irradiation events are simulated using PCXMC ( STUK , Finland) to determine organ and effective doses. Moreover, for DARCA each frame is simulated. Staff dose is measured using active personal dosimeters (DoseAware, Philips Healthcare, The Netherlands). With DARCA , median cumulative dose area product is reduced by 57% (ie, 7.41 versus 17.19 Gy·cm 2 ). Effective dose conversion factors of CCA and DARCA are slightly different, yet this difference is not statistically significant. The occupational dose at physician's chest, leg, and collar level are reduced by 60%, 56%, and 16%, respectively, of which the first 2 reached statistical significance. Median effective dose is reduced from 4.75 mSv in CCA to 2.22 mSv in DARCA procedures, where the latter is further reduced to 1.79 mSv when excluding ventriculography. Conclusions During invasive coronary angiography, DARCA reduces radiation exposure even further toward low‐dose values on a system already equipped with advanced image processing and noise reduction algorithms. For both DARCA and CCA procedures, using 1 effective dose conversion factor of 0.30 mSv·Gy −1 ·cm −2 is feasible.

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Long-term strategies support autonomy in radiation safety in invasive cardiology

Abstract: Our data highlight the efficacy of various radiation-reducing strategies by autonomous control and iterative training in radiation safety toward submillisievert levels for CA, and define realizable benchmarks for comparison with the performance data of any individual.

Cited by 3 publications

References 22 publications

X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

Radiation dose reduction during neuroendovascular procedures

Combining Optimized Image Processing With Dual Axis Rotational Angiography: Toward Low‐Dose Invasive Coronary Angiography

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