Patient’s Radiation Exposure in Coronary Angiography and Angioplasty: The Impact of Different Projections

Livingstone

J Applied Clin Med Phys

et al. 2016

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

Section: Discussionsupporting

confidence: 90%

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

Livingstone

J Applied Clin Med Phys

et al. 2016

“…Radiation dose and beam angulations contribute to the total amount of received radiation ( 3 – 5 ). As multiple projections may be used for optimal visualization of the coronary lesions, the amount of the radiation exposure during fluoroscopy and cine acquisition could vary with beam projection being a determining factor.…”

Section: Introductionmentioning

confidence: 99%

“…As the transradial approach is gaining more popularity ( 11 – 13 ), it is important to note that most of the studies focusing on the amount of radiation in various projections have been conducted via the transfemoral approach ( 3 , 4 ). There is only one study in the literature that has examined the radiation dose from different projections during coronary angiography via transradial approach ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Beam projections and radiation exposure in transradial and transfemoral approaches during coronary angiography

Tarighatnia¹,

Mohammadalian²,

Ghojazade³

et al. 2017

Anatol J Cardiol

Objective:We aimed to compare the operator and patient radiation exposure in standard projections during elective diagnostic coronary angiography procedures via transradial (TRA) versus transfemoral (TFA) approaches.Methods:In this analytical cross-sectional study, a total of 202 consecutive patients who were candidates for diagnostic coronary angiography were randomized to undergo the procedure via TFA or TRA approaches (101 in each group). Patients with abnormal Allen test and history of coronary artery bypass surgery, valvular heart disease, and unsuccessful coronary angiography were excluded from the study. A single operator performed all of the procedures using a single angiography system. Patient and operator radiation exposure were measured using diamentor and an electronic personal dosimeter, respectively. Each procedure comprised a standardized sequence of projections including four standard views for the left coronary system and two standard views for the right coronary system.Results:Left anterior oblique (LAO) caudal (50°/30°) and right anterior oblique RAO (30°) projections were associated with the highest and lowest patient radiation exposure, respectively. The operator received a significantly higher radiation exposure in the TRA approach for LAO cranial (for both left and right coronary systems) and LAO caudal (for left coronary system) projections during coronary angiography compared with the TFA approach.Conclusion:Though a similar amount of patient radiation exposure in each projection was observed among TFA and TRA groups; LAO cranial and LAO caudal projections were associated with a significantly higher operator radiation exposure in the TRA group. These findings need to be considered when choosing the optimal arterial approach for patients scheduled for coronary angiography.

J Cardiovasc Thorac Res

“…It is expected that the total number of these procedures will increase several folds by 2020 with the development of new angiography systems and with an increase in skills necessary for carrying out complex coronary artery treatment procedures. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

Comparison of the patient radiation exposure during coronary angiography and angioplasty procedures using trans-radial and trans-femoral access

Tarighatnia

Ah²,

Ghojazadeh

et al. 2016

Self Cite

Introduction: Cardiac catheterization procedure through the trans-radial access (TRA) have shown many clinical advantages over the trans-femoral (TFA), but despite its advantages, there are serious concerns regarding higher possible radiation dose for the patients and operators in TRA. This study was planned to compare the patients’ radiation dose associated with TRA and TFA during coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Methods: Of 700 candidates for angiography, 326 patients were entered the study. All the procedures were carried out by one interventional cardiologist employing the same angiography unit in Aalinasab hospital and the patients’ dose area product (DAP), air kerma (AK), fluoroscopy time (FT) and cine film time (CFT) were then determined in both access groups (TRA,TFA) in CA, PTCA and CA+PTCA procedures. Results: The mean FT, CFT and AK values in both TRA & TFA groups were the same in all procedures (P>0.05). The mean DAP in CA+PTCA procedures was 6704.01±3243.23 µGym2 in femoral access compare with 5647.46±2797.74 µGym2 in radial access, which were significantly less than that in TFA with P= 0.02. Conclusion: On the basis of the results obtained in this study, no differences were found in patients’ radiation dose in both access groups, therefore with regard to comparatively more clinical advantages associated with the Trans-radial access technique it might be a good substitute for Trans-femoral access.