Radiation dose among different cardiac and vascular invasive procedures: The RODEO study

Sciahbasi, Alessandro; Ferrante, Giuseppe; Fischetti, Dionigi; Miklin, Daniel; Sarandrea, Alessandro; Schirripa, Valentina; Guarracini, Fabrizio; Arya, Arash; Loreni, Giorgio; Bruni, Antonio; Rigattieri, Stefano; Marini, Massimiliano; Vagnarelli, Simone; G, Scevola; Reimers, Bernhard; Hindricks, Gerhard; Cohen, Mauricio G.

doi:10.1016/j.ijcard.2017.03.031

Cited by 23 publications

(14 citation statements)

References 16 publications

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“…Procedure times in 2 patients (28 and 29 min) were slightly longer than those previously reported for simple lesion R-PCI, but still within the range of normal variability. Patient radiation exposure from fluoroscopic imaging was similar to or below that observed for manual PCI for type A lesions [12], [13], [14]. The patients did not report any symptoms during the procedure nor did they express any subjective lack of confidence in the operator or procedure.…”

Section: Discussionmentioning

confidence: 65%

Long Distance Tele-Robotic-Assisted Percutaneous Coronary Intervention: A Report of First-in-Human Experience

2019

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BackgroundRobotic-assisted percutaneous coronary intervention (R-PCI) has been successfully employed in the United States since 2011. Performing R-PCI from a remote location has never been reported but if feasible would extend availability of treatment to many patients with coronary artery disease (CAD) who would otherwise go without.ObjectiveTo assess the feasibility of remote tele-R-PCI with the operator 20 miles away from the patients.MethodsFive patients with single, type A coronary artery lesions treatable by PCI consented to participate. The primary endpoint was procedural success with no major adverse cardiac events (MACE) before discharge. Procedural success was defined as achieving < 10% diametric stenosis of the occluded target vessel utilizing tele-R-PCI balloon angioplasty and stent deployment (CorPath GRX®, Corindus Vascular Robotics, USA) without converting to in-lab manual PCI by an on-site standby team. Procedural, angiographic, and safety data were collected as were questionnaire scores from the remote operator evaluating the robot-network composite, image clarity, and overall confidence in the procedure.ResultsThe primary endpoint was achieved in 100% of patients. No procedural complications or adverse events occurred, and all patients were discharged the following day without MACE. The operator scores were favorable with the operators rating the procedure as equivalent to an in-lab procedure.ConclusionsPerforming long distance tele-R-PCI in patients with CAD is feasible with predictably successful outcomes if reliable network connectivity and local cardiac catheterization facilities are available.

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Section: Discussionmentioning

confidence: 65%

Long Distance Tele-Robotic-Assisted Percutaneous Coronary Intervention: A Report of First-in-Human Experience

2019

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“…Another limitation is that the LAWT method depends on contrast‐enhanced MDCT acquisition, which is contraindicated in patients with severe kidney failure, needs special preparation in patients with contrast medium allergy, and implies radiation exposure. Nevertheless, fluoroscopic requirements for the presented method are lower than what has been reported on multicenter international registries 22 and what has been found on recent prospective trials 23 . Therefore, even though the need for a MDCT might imply additional radiation exposure, the overall radiation dose administered is still reasonable.…”

Section: Discussionmentioning

confidence: 79%

Left atrial wall thickness of the pulmonary vein reconnection sites during atrial fibrillation redo procedures

Terés

Soto‐Iglesias

Penela

et al. 2021

Pacing Clinical Electrophis

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Background Left atrial wall thickness (LAWT) has been related to pulmonary vein (PV) reconnections after atrial fibrillation (AF) ablation. The aim was to integrate 3D‐LAWT maps in the navigation system and analyze the relationship with local reconnection sites during AF‐redo procedures. Methods Consecutive patients referred for AF‐redo ablation were included. Procedure was performed using a single catheter technique. LAWT maps obtained from multidetector computerized tomography (MDCT) were imported into the navigation system. LAWT of the circumferential PV line, the reconnected segment and the reconnected point, were analyzed. Results Sixty patients [44 (73%) male, age 61 ± 10 years] were included. All reconnected veins were isolated using a single catheter technique with 55 min (IQR 47–67) procedure time and 75 s (IQR 50–120) fluoroscopy time. Mean LAWT of the circumferential PV line was 1.46 ± 0.22 mm. The reconnected segment was thicker than the rest of segments of the circumferential PV line (2.05 + 0.86 vs. 1.47 + 0.76, p < .001 for the LPVs; 1.55 + 0.57 vs. 1.27 + 0.57, p < .001 for the RPVs). Mean reconnection point wall thickness (WT) was at the 82nd percentile of the circumferential line in the LPVs and at the 82nd percentile in the RPVs. Conclusion A single catheter technique is feasible and efficient for AF‐redo procedures. Integrating the 3D‐LAWT map into the navigation system allows a direct periprocedural estimation of the WT at any point of the LA. Reconnection points were more frequently present in thicker segments of the PV line. The use of 3D‐LAWT maps can facilitate reconnection point identification during AF‐redo ablation.

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“…2,4 Additionally, the same patient may often require repeated cardiac catheterization procedures that further increase the radiation exposure and risk. 36 Pantos et al 6 reviewed doses to adult patients from 72 relevant published studies in international scientific literature. Published results indicated that patients' radiation doses vary widely among different cardiac catheterization procedures and even among equivalent studies.…”

Section: Discussionmentioning

confidence: 99%

“…35,37 Establishing local benchmark radiation dose data are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization. [36][37][38][39][40][41][42][43][44][45][46][47] The International Commission on Radiological Protection (ICRP) does not give dose limits for patients undergoing medical diagnostic exposures, but requires adherence to the principle of justification and optimization by comparing patient doses with diagnostic reference levels (DRLs) for common procedures. 4 DRL is used in medical imaging using ionizing radiation as a guide to whether, under routine conditions, a patient dose from a specific procedure is unusually high or low for that procedure.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of patients radiation dose during cardiac catheterization procedures

Osei

Johnston

et al. 2019

The British Journal of Radiology

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Objective: Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory. Methods: We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient’s clinical radiation dose data [kerma–area–product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital’s RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software. Results: The overall patient median age was 67.0 (range: 26.0–97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9–61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1–203.2), 80.2 (18.9–208.5), 83.7 (48.0–246.1), 113.8 (60.9–284.5), 91.7 (6.0–426.0) and 51.1 (7.0–175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3–3794.0), 1384.7 (291.7–4021.8), 1607.0 (883.5–4448.3), 2260.2 (867.4–5311.9), 1589.3 (100.2–7237.4) and 463.8 (67.7–1695.9) mGy respectively. Conclusion: We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories. Advances in knowledge: We have investigated local patients’ radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.

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Radiation dose among different cardiac and vascular invasive procedures: The RODEO study

Cited by 23 publications

References 16 publications

Long Distance Tele-Robotic-Assisted Percutaneous Coronary Intervention: A Report of First-in-Human Experience

Long Distance Tele-Robotic-Assisted Percutaneous Coronary Intervention: A Report of First-in-Human Experience

Left atrial wall thickness of the pulmonary vein reconnection sites during atrial fibrillation redo procedures

Retrospective study of patients radiation dose during cardiac catheterization procedures

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