Radiation Dose Reduction in the Cardiac Catheterization Laboratory Utilizing a Novel Protocol

Wassef, Anthony; Hiebert, Brett; Ravandi, Amir; Ducas, John; Minhas, Kunal; Vo, Minh; Kass, Malek; Parmar, Gurpreet; Hussain, Farrukh

doi:10.1016/j.jcin.2013.11.022

Cited by 67 publications

(58 citation statements)

References 11 publications

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“…Wassef et al studied a novel radiation reduction protocol (EPO; Philips, Netherlands) that reduces detector dose rate in acquisition imaging, decreases the frame rate, fine tunes the x-ray parameters (peak tube voltage, cathode current, spectral filter) to the examination and patient's size, and increases the thickness of the x-ray beam spectral filters. 12 Implementation of the EPO protocol resulted in a 35% (P<0.0001) reduction in patient AK radiation dose with 15 frames-per-second fluoroscopy and a 62% reduction (P<0.0001) with 7.5 frames-per-second fluoroscopy. The effect of the Bleeper Sv device in reducing operator radiation exposure in our study was consistent, whether 7.5 or 15 frames-per-second fluoroscopy was used (Figure 4).…”

Section: Discussionmentioning

confidence: 91%

“…Similarly, second operator radiation exposure was significantly lower in the Bleeper Sv group (5 [2-10] versus 7 [4][5][6][7][8][9][10][11][12][13][14] μSv; P<0.001; 29% relative reduction; Figure 3). Second operator radiation exposure was lower in the Bleeper Sv group both for diagnostic angiography (4 [2][3][4][5][6][7][8] …”

Section: Procedural Outcomesmentioning

confidence: 98%

“…First operator radiation exposure was lower in the Bleeper Sv group both for diagnostic angiography (7 [4][5][6][7][8][9][10][11] versus 10 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] μSv; P<0.001) and for PCI (11 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] versus 14 [6][7][8][9][10][11][12][13][14][15][16][17]…”

Section: Procedural Outcomesmentioning

confidence: 99%

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Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

Christopoulos

Papayannis

Alomar

et al. 2014

Circ: Cardiovascular Interventions

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Background— The Radiation Reduction During Cardiac Catheterization Using Real-Time Monitoring study sought to examine the effect of a radiation detection device that provides real-time operator dose reporting through auditory feedback (Bleeper Sv; Vertec Scientific Ltd; Berkshire, UK) on patient dose and operator exposure during cardiac catheterization. Methods and Results— Between January 2012 and May 2014, 505 patients undergoing coronary angiography, percutaneous coronary intervention, or both were randomized to use (n=253) or no use (n=252) of the Bleeper Sv radiation monitor. Operator radiation exposure was measured in both groups using a second, silent radiation exposure monitoring device. Mean patient age was 65±8 years, most patients (99%) were men, and 30% had prior coronary artery bypass graft surgery. Baseline clinical characteristics were similar in the 2 study groups. Radial access was used in 18% and chronic total occlusion percutaneous coronary intervention constituted 7% of the total procedures. Median procedure time was 17 (12–27) minutes for diagnostic angiography, 42 (28–70) minutes for percutaneous coronary intervention, and 27 (14–51) minutes in the overall study population, with similar distribution between the study groups. First (9 [4–17] versus 14 [7–25] μSv; P <0.001) and second (5 [2–10] versus 7 [4–14] μSv; P <0.001) operator radiation exposure was significantly lower in the Bleeper Sv group. Use of the device did not result in a significant reduction in patient radiation dose. The effect of the Bleeper Sv device on operator radiation exposure was consistent among various study subgroups. Conclusions— Use of a real-time radiation monitoring device that provides auditory feedback can significantly reduce operator radiation exposure during cardiac catheterization. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01510353.

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Section: Discussionmentioning

confidence: 91%

Section: Procedural Outcomesmentioning

confidence: 98%

Section: Procedural Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

Christopoulos

Papayannis

Alomar

et al. 2014

Circ: Cardiovascular Interventions

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“…In addition, procedural success and operative complication rates were comparable, and there was no case in which we changed the frame rate during the procedure. Previous studies on this topic did not report any increases in either the contrast volume or fluoroscopy time with low frame fluoroscopy (9,10), and the image quality score has previously been indicated to be comparable (5,6). Thus, with advances in technology, the flickering that occurs as a result of the low frame rate is no longer considered to be a problem.…”

Section: Discussionmentioning

confidence: 98%

The Effect of Low Frame Rate Fluoroscopy on the X-ray Dose during Coronary Intervention

Sadamatsu

Nakano

2016

Intern. Med.

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Objective The aim of this study was to investigate whether the use of low frame rate fluoroscopy at 7.5 frames per second during coronary intervention could reduce radiation exposure in Japanese patients. Methods From December 10, 2014 to March 20, 2015, 84 consecutive patients with coronary artery disease who underwent coronary intervention in our institution were retrospectively collected and then divided into two groups: the LR group (fluoroscopy at 7.5 frames per second) and the OR group (fluoroscopy at 15 frames per second), according to the frame rate of fluoroscopy that was used in their treatment. Results There were no differences in the patient backgrounds or the procedural characteristics of the two groups. Although there were no differences in the contrast volume or fluoroscopy time, the total air kerma at the interventional reference point, which is used to monitor the patient's radiation dose, was significantly lower in the LR group than in the OR group (701.4 427.9 vs. 936.8 623.9 mGy, p=0.02). Conclusion Low frame rate fluoroscopy at 7.5 frames per second is safe and feasible for use during coronary interventions and an easy and useful strategy for reducing the radiation to which patients are exposed during coronary intervention.

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“…Although a direct link between operator radiation exposure and brain tumors, and more specifically left-sided tumors, has not been established, these reports do raise concerns and highlight potential associations. Radiation safety is a very important aspect of the practice of interventional cardiology, and a number of safety precautions including collimation, use of Eco Dose Fluoroscopy,19 and operator education20 have significantly reduced radiation exposure. Despite these efforts, the long-term risk of complications associated with chronic radiation exposure can never be completely eliminated.…”

Section: Robotics In Interventional Cardiologymentioning

confidence: 99%

The Development of Robotic Technology in Cardiac and Vascular Interventions

Pourdjabbar¹,

Ang²,

Reeves³

et al. 2017

Rambam Maimonides Med J

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Robotic technology has been used in cardiovascular medicine for over a decade, and over that period its use has been expanded to interventional cardiology and percutaneous coronary and peripheral vascular interventions. The safety and feasibility of robotically assisted interventions has been demonstrated in multiple studies ranging from simple to complex coronary lesions, and in the treatment of iliofemoral and infrapopliteal disease. These studies have shown a reduction in operator exposure to harmful ionizing radiation, and the use of robotics has the intuitive benefit of alleviating the occupational hazard of operator orthopedic injuries. In addition to the interventional operator benefits, robotically assisted intervention has the potential to also be beneficial for patients by allowing more accurate lesion length measurement, stent placement, and patient radiation exposure; however, more investigation is required to elucidate these benefits fully.

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Radiation Dose Reduction in the Cardiac Catheterization Laboratory Utilizing a Novel Protocol

Abstract: We demonstrate a highly significant 48.5% adjusted radiation dose reduction using a novel algorithm, which needs strong consideration among interventional cardiology practice.

Cited by 67 publications

References 11 publications

Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

The Effect of Low Frame Rate Fluoroscopy on the X-ray Dose during Coronary Intervention

The Development of Robotic Technology in Cardiac and Vascular Interventions

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