Comparison of Contrast Volume, Radiation Dose, Fluoroscopy Time, and Procedure Time in Previously Published Studies of Rotational Versus Conventional Coronary Angiography

Abstract BACKGROUND The transradial access (TRA) is rapidly gaining popularity for neuroendovascular procedures as there is strong evidence for its benefits compared to the traditional transfemoral access (TFA). However, the transition to TRA bears some challenges including optimization of the interventional suite set-up and workflow as well as its impact on fellowship training. OBJECTIVE To compare the learning curves of TFA and TRA for diagnostic cerebral angiograms in neuroendovascular fellowship training. METHODS We prospectively collected diagnostic angiogram procedural data on the performance of 2 neuroendovascular fellows with no prior endovascular experience who trained at our institution from July 2018 until June 2019. Metrics for operator proficiency were minutes of fluoroscopy time, procedure time, and volume of contrast used. RESULTS A total of 293 diagnostic angiograms were included in the analysis. Of those, 57.7% were TRA and 42.3% were TFA. The median contrast dose was 60 cc, and the median radiation dose was 14 000 μGy. The overall complication rate was 1.4% consisting of 2 groin hematomas, 1 wrist hematoma, and 1 access-site infection using TFA. The crossover rate to TFA was 2.1%. Proficiency was achieved after 60 femoral and 95 radial cases based on fluoroscopy time, 52 femoral and 77 radial cases based on procedure time, and 53 femoral and 64 radial cases based on contrast volume. CONCLUSION Our study demonstrates that the use of TRA can be safely incorporated into neuroendovascular training without causing an increase in complications or significantly prolonging procedure time or contrast use.

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The Effect of Functional and Intra-Coronary Imaging Techniques on Fluoroscopy Time, Radiation Dose and Contrast Volume during Coronary Angiography

Scientific Reports ◽

10.1038/s41598-020-63791-1 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

Fernando De la Garza-Salazar ◽

Diana Lorena Lankenau-Vela ◽

Bertha Cadena-Nuñez ◽

Arnulfo González-Cantú ◽

Maria Elena Romero-Ibarguengoitia

Keyword(s):

Radiation Dose ◽

Coronary Angiography ◽

Imaging Techniques ◽

Fluoroscopy Time ◽

Coronary Imaging ◽

Contrast Volume

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Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Journal of Endovascular Therapy ◽

10.1177/1526602820960444 ◽

2020 ◽

pp. 152660282096044

Author(s):

Sabrina A. N. Doelare ◽

Stefan P. M. Smorenburg ◽

Theodorus G. van Schaik ◽

Jan D. Blankensteijn ◽

Willem Wisselink ◽

...

Keyword(s):

Radiation Dose ◽

Image Fusion ◽

Data Extraction ◽

Meta Analysis ◽

Endovascular Aneurysm Repair ◽

Fusion Imaging ◽

Fluoroscopy Time ◽

Control Group ◽

Procedure Time ◽

Contrast Volume

Purpose: To determine if image fusion will reduce contrast volume, radiation dose, and fluoroscopy and procedure times in standard and complex (fenestrated/branched) endovascular aneurysm repair (EVAR). Materials and Methods: A search of the PubMed, Embase, and Cochrane databases was performed in December 2019 to identify articles describing results of standard and complex EVAR procedures using image fusion compared with a control group. Study selection, data extraction, and assessment of the methodological quality of the included publications were performed by 2 reviewers working independently. Primary outcomes of the pooled analysis were contrast volume, fluoroscopy time, radiation dose, and procedure time. Eleven articles were identified comprising 1547 patients. Data on 140 patients satisfying the study inclusion criteria were added from the authors’ center. Mean differences (MDs) are presented with the 95% confidence interval (CI). Results: For standard EVAR, contrast volume and procedure time showed a significant reduction with an MD of −29 mL (95% CI −40.5 to −18.5, p<0.001) and −11 minutes (95% CI −21.0 to −1.8, p<0.01), respectively. For complex EVAR, significant reductions in favor of image fusion were found for contrast volume (MD −79 mL, 95% CI −105.7 to −52.4, p<0.001), fluoroscopy time (MD −14 minutes, 95% CI −24.2 to −3.5, p<0.001), and procedure time (MD −52 minutes, 95% CI −75.7 to −27.9, p<0.001). Conclusion: The results of this meta-analysis confirm that image fusion significantly reduces contrast volume, fluoroscopy time, and procedure time in complex EVAR but only contrast volume and procedure time for standard EVAR. Though a reduction was suggested, the radiation dose was not significantly affected by the use of fusion imaging in either standard or complex EVAR.

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Abstract 2598: Radiation Exposure, Procedure Time And Contrast Load In Patients Referred For Coronary Angiography: Head-to-head Comparison Of Dual Source Ct With Conventional Coronary Angiography.

Circulation ◽

10.1161/circ.116.suppl_16.ii_575-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Carlos A Van Mieghem ◽

Annick C Weustink ◽

Marcel Kofflard ◽

A. Schreve-Steensma ◽

Niels A Matheijssen ◽

...

Keyword(s):

Coronary Angiography ◽

Radiation Exposure ◽

Contrast Material ◽

Conventional Coronary Angiography ◽

Dual Source Ct ◽

Procedure Time ◽

X Ray ◽

Iodinated Contrast ◽

Dual Source ◽

The Mean

Introduction and aim: Dual Source CT (DSCT) scanners, with an increased temporal resolution (83 ms), are becoming widely available. To evaluate the current potential of this scanner in the clinical arena, we performed a head-to-head comparison with conventional coronary angiography (CCA) taking into account the following parameters: radiation exposure, procedure time and contrast load. Methods: During a one-year period (april 2006 to march 2007) we compared a consecutive patient group who underwent DSCT (318 patients, 222 male, mean age 68±11 years) and CCA (352 patients, 258 male, mean age 61±12) respectively. Patients with previous bypass surgery were excluded. In DSCT, the volume of iodinated contrast material was adapted to the scan time. A contrast bolus was injected in an antecubital vein at a flow rate of 5.0 ml/s followed by a saline chaser of 40 ml at 5.0 ml/s. Each tube provided 412 mAs/rot (maximum), and full X-ray tube current was given during 25–70% of the RR-interval. Exposure data were collected using the x-ray dosimetrical reports from DSCT and CCA. Results: The mean procedure time using DSCT and CCA was 16.1±4.7 min and 44.1±25.5 min (p<0.001), respectively. The mean contrast load in DSCT and CCA was 77.9±7.6 ml and 175.3±4.3ml (p<0.001), respectively. The overall radiation exposure for DSCT and CCA was calculated as 15.3±4.0 mSv and 5.7±4.3 mSv, respectively. Radiation exposure with DSCT was significantly lower (p<0.001) in patients with a heart rate of >70 bpm (12.9±3.1 mSv ) as compared with patients with heart rates <70 bpm (16.4±3.8 mSv). Conclusion: In today’s practice currently available DSCT scanners perform favorably as compared with CCA, considering procedure time and patient contrast load. Radiation exposure with DSCT remains higher but should not be considered a major disadvantage taking into account the relatively old age group that generally undergoes coronary angiography and the major benefit of not being exposed to the risks of an invasive procedure.

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TCT-232: Procedure Time, Fluoroscopy Time And Radiation Dose As Predictors Of Competence In Radial Versus Femoral Angiography

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.08.252 ◽

2009 ◽

Vol 104 (6) ◽

pp. 88D

Keyword(s):

Radiation Dose ◽

Fluoroscopy Time ◽

Procedure Time

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Abstract 5802: Whole-Heart Coronary Angiography using Volume Computed Tomography in Comparison to Conventional Coronary Angiography

Circulation ◽

10.1161/circ.118.suppl_18.s_106 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Marc Dewey ◽

Elke Zimmermann ◽

Florian Deissenrieder ◽

Michael Laule ◽

Hans-Peter Dübel ◽

...

Keyword(s):

Computed Tomography ◽

Radiation Dose ◽

Coronary Angiography ◽

Coronary Ct Angiography ◽

Conventional Coronary Angiography ◽

Effective Radiation Dose ◽

Initial Report ◽

Coronary Ct ◽

Whole Heart ◽

Effective Radiation

This is an initial report on the use of the recently introduced whole-heart 320-slice computed tomography (CT) scanner for noninvasive coronary angiography compared with conventional coronary angiography (CCA). Whole-heart CT avoids overscanning and overranging as necessary for helical coronary CT acquisitions thereby significantly reducing the effective radiation dose. Twelve patients with suspected coronary artery disease (4 women, 8 men; mean age 64.6 ± 11 years) have undergone coronary CT angiography using a 320-slice scanner (Aquilion ONE, Toshiba; 0.35 s gantry rotation time, 120 kV, and 350 – 450 mA) prior to clinically indicated CCA. CT images were manually reconstructed in motion-free phases with 0.5-mm slice thickness and 0.25-mm slice increment. Independent blinded assessment of CT and CCA (using quantitative analysis) was performed to detect significant (at least 50%) diameter stenoses. Of the 12 patients, in 8 patients, single-heart beat CT acquisition was performed, resulting in an effective dose of 5.6 ± 1.1 mSv and an image reconstruction window length of 175 msec. In the other 4 patients, because of higher heart rates, 2 or 3 heart beats were used for acquisition, resulting in higher radiation exposure (on average 17 mSv) and the possibility to perform multisegment reconstruction with improved temporal resolution (88 and 58 msec image reconstruction windows, respectively). Per-patient sensitivity and specificity for CT compared to CCA were 100%. Per-vessel sensitivity and specificity were 88% and 95%, respectively. Intraindividual comparison of CT with CCA revealed a nonsignificantly smaller effective radiation dose (9.4 ± 7.2 mSv vs. 10.5 ± 5.3 mSv, p<0.69) but significantly smaller contrast agent amount (80 ±0 ml vs. 107.3 ± 17.8 ml, p<0.01) for 320-slice CT. Whole-heart CT significantly reduces the contrast agent amount compared to CCA while radiation exposure is reduced in patients with slow heart rates. This initial report also indicates that diagnostic accuracy of coronary CT angiography using up to 320 simultaneous detector rows remains high as compared with CCA as the reference standard.

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Procedural comparison of a standard PTA balloon for fistula and graft maintenance procedures with the novel Chameleon™ PTA balloon catheter

The Journal of Vascular Access ◽

10.1177/1129729820979479 ◽

2020 ◽

pp. 112972982097947

Author(s):

Joel Crawford ◽

Antonios Gasparis ◽

Pamela Kim ◽

Manish Jotwani ◽

Satyaki Banerjee ◽

...

Keyword(s):

Balloon Catheter ◽

Fluoroscopy Time ◽

Control Group ◽

The Novel ◽

Procedure Time ◽

Injection Port ◽

Contrast Volume ◽

Group A ◽

Artery Disease ◽

Group B

Introduction: The incidence of cephalic arch (CA) and central venous (CV) stenosis has been reported in the range of 30% in the literature. The purpose of this study is to compare contrast use, fluoroscopy time, and procedure time between standard imaging by injection of contrast through the access sheath versus injection of contrast through a novel PTA balloon with an integrated injection port. Methods: A multi-centered, retrospective evaluation of consecutive patients treated for CA and CV stenosis was performed. Data captured included demographics, co-morbidities, lesion characteristics/location, procedural details, volume of contrast used, fluoroscopy time, and procedure time. The control group was imaged and treated using standard practice with pre and post imaging performed through the sheath and intervention using standard PTA balloon. Imaging and treatment were performed using the Chameleon™ PTA catheter in the treatment arm. Results: A total of 68 consecutive patients were included. There were 34 patients in Group A and 34 patients in Group B. Average age was 65.2 versus 66.5 ( p = 0.284), respectively. There were no significant gender differences between groups. Prevalence of co-morbidities of hypertension, coronary artery disease, and diabetes was similar to national rates in both groups. Contrast volume, fluoroscopy time, and procedure time in Group B were significantly less when compared by multiple regression to Group A, correcting for potential confounders ( p = 0.0001, 0.0180, and 0.0008, respectively). Conclusion: Use of a PTA balloon with an integrated injection port shows potential for significant reduction in contrast dose, fluoroscopy time, and procedure time.

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Distal Radial Artery Access for Superficial Femoral Artery Interventions

Journal of Endovascular Therapy ◽

10.1177/1526602820963022 ◽

2020 ◽

pp. 152660282096302

Author(s):

Zoltán Ruzsa ◽

Ádám Csavajda ◽

Balázs Nemes ◽

Mónika Deák ◽

Péter Sótonyi ◽

...

Keyword(s):

Radiation Dose ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Fluoroscopy Time ◽

Complication Rates ◽

Procedure Time ◽

Technical Success ◽

Access Site ◽

Femoral Access ◽

Crossover Rate

Purpose: To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. Materials and Methods: Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. Results: Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). Conclusion: SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.

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Radiation Dose Assessment of the Fog Lead Acrylic Shields during Coronary Angiography: A Phantom Study

Applied Sciences ◽

10.3390/app112210743 ◽

2021 ◽

Vol 11 (22) ◽

pp. 10743

Author(s):

Hsin-Hon Lin ◽

Lu-Han Lai ◽

Kuo-Ting Tang ◽

Chien-Yi Ting ◽

Cheng-Shih Lai

Keyword(s):

Radiation Dose ◽

Coronary Angiography ◽

Image Intensifier ◽

Optically Stimulated Luminescence ◽

Dose Assessment ◽

Conventional Coronary Angiography ◽

Average Dose ◽

Lead Glass ◽

Post Surgery ◽

Thyroid Glands

This study aimed to evaluate the effects of fogging on the effectiveness of a lead glass shield in protecting an operator from radiation exposure during conventional coronary angiography (CAG). Optically stimulated luminescence dosimeters (OSLDs) were used to measure the effects of fogged lead glass shields (FLSs) and clear lead glass shields (CLSs) on the radiation doses of a cardiac catheterization surgeon. We simulated the scatter radiation incident on the operator with five angiographic projections with 10-s exposures. Experiments were conducted with a field of view of 25 cm, maximum of 100 cm between the X-ray tube and image intensifier, and 80 cm between the image intensifier and operator. Lead glass fogging had no significant effect at any angiographic projection. The average dose at the lens of the eye, thyroid glands, and gonads did not differ significantly between FLS and CLS. Although most surgeons view ceiling-suspended shields as hindrances during surgical procedures, the radiation dose at the operator’s eyes and thyroid glands increased by 13 and 10 times without the shield. The fogging of the shield is probably caused by post-surgery UV decontamination or detergents. An operator has no cause for concern regarding the radiation protection afforded by an FLS during CAG procedures.

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