Relationship of Beam Angulation and Radiation Exposure in the Cardiac Catheterization Laboratory

Agarwal, Shikhar; Parashar, Akhil; Bajaj, Navkaranbir S.; Khan, Imran; Ahmad, Imran; Heupler, Fredrick A.; Bunte, Matthew C.; Modi, Dhruv; Tuzcu, E. Murat; Kapadia, Samir

doi:10.1016/j.jcin.2013.12.203

Cited by 64 publications

(59 citation statements)

References 15 publications

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“…One of the most important procedure-related factors governing the amount of radiation scattered is the beam orientation. Previous studies [17] showed that all extreme projections were associated with a particular high degree of Air Kerma rates and in particular in left caudal and right caudal. Kuon et al [18] showed that during transfemoral approach the left caudal view resulted in as much radiation exposure to the interventionalist as a left cranial view.…”

Section: Discussionmentioning

confidence: 84%

Operator radiation exposure during right or left transradial coronary angiography: A phantom study

Sciahbasi

Rigattieri

Sarandrea³

et al. 2015

Cardiovascular Revascularization Medicine

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Section: Discussionmentioning

confidence: 84%

Operator radiation exposure during right or left transradial coronary angiography: A phantom study

Sciahbasi

Rigattieri

Sarandrea³

et al. 2015

Cardiovascular Revascularization Medicine

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“…17 The relative contribution of each of the above elements in the reduction of operator radiation exposure observed in RadiCure cannot be determined; however, fluoroscopy time was numerically lower in the Bleeper Sv group, whereas use of disposable radiation shields was similar in the 2 study groups. Image intensifier angulation can significantly affect radiation scatter, 18 and part of the operator radiation reduction shown in RadiCure may have resulted from repositioning the C-arm to less angulated projections.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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“…Based on our observations of factors that govern radiation dosimetry, 20 we developed this initiative toward radiation dose reduction. The components of this initiative included the following measures:…”

Section: Radiation Dose Reduction Initiativementioning

confidence: 99%

“…lower dose x-rays. [17][18][19] Based on our observations of factors that govern radiation dosimetry, 20 we developed a comprehensive initiative toward radiation dose reduction.…”

mentioning

confidence: 99%

Measures to Reduce Radiation in a Modern Cardiac Catheterization Laboratory

Agarwal

Parashar

Ellis

et al. 2014

Circ: Cardiovascular Interventions

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Background— X-ray use in the catheterization laboratory is guided by the principle of as low as reasonably achievable . In accordance with this principle, we reduced the default fluoroscopic frame rate from 10 to 7.5 frames/s and increased the emphasis on the use of low-dose acquisition starting January 1, 2013. We aimed to study the impact of these measures on the total air kerma during diagnostic catheterization (DC) and percutaneous interventions (PCI). Methods and Results— Propensity matching based on age, sex, body surface area, total fluoroscopy time, and total acquisition time was used to select matched patients for 2012 and 2013, further stratified by DC or PCI. The total air kerma was subsequently compared between 2012 and 2013, separately for DC and PCI. Median total air kerma during DC in 2013 was 625 mGy, which was significantly lower than the corresponding values in 2012 (median, 798 mGy; P <0.001). Similarly, median total air kerma during PCI in 2013 was 1675 mGy, which was significantly less than corresponding values in 2012 (median 2463 mGy, P <0.001). On comparison of air kerma rates between corresponding projections in 2 years, we observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates in 2013, after institution of radiation reduction measures in all projections. Conclusions— With reduction in the default fluoroscopic frame rate and a greater use of low-dose acquisition, there has been a marked reduction in the total air kerma and air kerma rates for DC and PCI.

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Relationship of Beam Angulation and Radiation Exposure in the Cardiac Catheterization Laboratory

Cited by 64 publications

References 15 publications

Operator radiation exposure during right or left transradial coronary angiography: A phantom study

Operator radiation exposure during right or left transradial coronary angiography: A phantom study

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

Measures to Reduce Radiation in a Modern Cardiac Catheterization Laboratory

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