Radiation safety program for the cardiac catheterization laboratory

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: Methodsmentioning

confidence: 99%

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

Rev. Bras. Cardiol. Invasiva

“…Radiation reduction methods are outdated, and new proposals have been presented. [14][15][16][17][18] It has been stipulated that ionising radiation exposure should be as low as possible when it is inevitable. The "as low as reasonably achievable" (ALARA) principle, 19,20 established in 1977, essentially states that radiation exposure should be kept as low as reasonably achievable.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, medical societies are encouraging more training programs and education measures to reduce the biological risks. 1,16,17 The area exposed to biological radiation effects and the potential stochastic risks of neoplasia are as important as the total radiation dose. The present study demonstrated that there is a strong relation between the total received dose and the irradiated area, regardless of the patient's weight.…”

Section: Discussionmentioning

confidence: 99%

Impacto do peso corporal dos pacientes na exposição radiológica durante procedimentos cardiológicos invasivos

Vargas

Silva

Cardoso

et al. 2012

Background: Invasive cardiac procedures expose patients and physicians to ionising radiation. The aim of this study was to determine the impact of body weight on radiation exposure during cardiac procedures. Methods: A prospective cohort study of patients undergoing cardiac catheterisation or percutaneous coronary intervention (PCI) between August of 2010 and December of 2011. Clinical, angiographic, and radiation exposure characteristics were recorded in a dedicated database. Radiation exposure patterns were established in three groups: A (≤ 79 kg), B (80-99 kg), and C (≥ 100 kg). Data were analysed using the Statistical Package for Social Sciences (SPSS), version 18.0, and the results were presented as the mean, standard deviation, percentage, percentile, and interquartile interval. The independent predictors of increased radiation exposure were identified using a multiple logistic regression analysis. Results: The sample included a total of 671 patients, 363 in group A, 252 in group B, and 56 in group C. The mean dose of radiation exposure was 484.29 mGy, 735.69 mGy, and 900.36 mGy for groups A, B, and C, respectively (P < 0.001). The median dose area product was 29.327 mGy.cm², 43.319 mGy.cm², and 57.987 mGy.cm² for groups A, B, and C, respectively (P < 0.001). The predictors of increased radiation exposure were weight (odds ratio [OR] 1.03, confidence interval [CI] 1.01-1.05, P = 0.003), confidence interval (CI) 1.01-1.05, P = 0.003], elective PCI (OR 11.9, CI 4.26-33.24, P < 0.001), and ad hoc PCI (OR 15.46,.87, P < 0.001). Conclusions: Patient weight has a significant impact on radiation exposure during invasive cardiac procedures. Overweight patients are significantly more exposed to higher doses of ionising radiation.

Cathet Cardio Intervent

“…Interventionists should strive to minimize radiation doses during PCI [111][112][113][114] as outlined in Table IV. A radiation safety program that uses a qualified physicist, dosimetry monitoring, shielding, and training is essential [113].…”

Section: Managing Radiation Dosesmentioning

confidence: 99%

“…If K a,r > 10 Gy is delivered during a procedure, a qualified physicist should calculate the actual peak skin dose and assess potential tissue injury (Table IV). Appropriate steps for patient follow-up based on radiation dose should be followed [113].…”

Section: Managing Radiation Dosesmentioning

confidence: 99%

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Blankenship

Moussa

Chambers

et al. 2011

Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI [1]. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article [4]. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable [5]. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed [6]. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.V C 2011 Wiley Periodicals, Inc.