Radiation exposure in transcatheter patent ductus arteriosus closure: time to tune?

AbstractObjectivesThe aims of this study were to describe radiation level at our institution during transcatheter patent ductus arteriosus occlusion and to evaluate the components contributing to radiation exposure.BackgroundTranscatheter occlusion relying on X-ray imaging has become the treatment of choice for patients with patent ductus arteriosus. Interventionists now work hard to minimise radiation exposure in order to reduce risk of induced cancers.MethodsWe retrospectively reviewed all consecutive children who underwent transcatheter closure of patent ductus arteriosus from January 2012 to January 2016. Clinical data, anatomical characteristics, and catheterisation procedure parameters were reported. Radiation doses were analysed for the following variables: total air kerma, mGy; dose area product, Gy.cm2; dose area product per body weight, Gy.cm2/kg; and total fluoroscopic time.ResultsA total of 324 patients were included (median age=1.51 [Q1–Q3: 0.62–4.23] years; weight=10.3 [6.7–17.0] kg). In all, 322/324 (99.4%) procedures were successful. The median radiation doses were as follows: total air kerma: 26 (14.5–49.3) mGy; dose area product: 1.01 (0.56–2.24) Gy.cm2; dose area product/kg: 0.106 (0.061–0.185) Gy.cm2/kg; and fluoroscopic time: 2.8 (2–4) min. In multivariate analysis, a weight >10 kg, a ductus arteriosus width <2 mm, complications during the procedure, and a high frame rate (15 frames/second) were risk factors for an increased exposure.ConclusionLower doses of radiation can be achieved with subsequent recommendations: technical improvement, frame rate reduction, avoidance of biplane cineangiograms, use of stored fluoroscopy as much as possible, and limitation of fluoroscopic time. A greater use of echocardiography might even lessen the exposure.

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Effects of reducing frame rate from 7.5 to 4 frames per second on radiation exposure in transcatheter atrial septal defect closure

Cardiology in the Young ◽

10.1017/s1047951118001257 ◽

2018 ◽

Vol 28 (11) ◽

pp. 1323-1328 ◽

Cited By ~ 2

Author(s):

Younes Boudjemline

Keyword(s):

Atrial Septal Defect ◽

Radiation Exposure ◽

Septal Defect ◽

Frame Rate ◽

Atrial Septal Defect Closure ◽

Dose Area Product ◽

Air Kerma ◽

Septal Defects ◽

Atrial Septal Defects ◽

Area Product

AbstractObjectivesThe aim of this study was to evaluate the reduction of frame rate from 7.5 to 4 frames per second on radiation exposure and to provide new standards of radiation exposure.BackgroundFrame rate is a large contributor to radiation exposure. The use of 4 frames per second for closure of atrial septal defects has been reported not to affect the level of radiation exposure.MethodsWe retrospectively reviewed radiation data from all patients referred to our catheterisation laboratory for closure of an atrial septal defect between January, 2015 and June, 2017. Fluoroscopic time, dose area product (μGy.m2), and total air kerma (mGy) were collected. These values were compared according to the frame rate used for closure of atrial septal defects.ResultsA total of 49 atrial septal defects were closed using 7.5 frames per second and 85 using 4 frames per second. Baseline characteristics were similar in both groups. Procedural success was similar in both groups (100 versus 98.8%). Median total air kerma and dose area product were statistically lower in the 4 frames per second group (4 versus 1.3 mGy [p=0.00012]), 43.7 versus 13.1 μGy.m2 [p<0.00001]). There was no increase in median procedure and fluoroscopic times (respectively, 10 and 1.1 min for 7.5 and 4 frames per second), or complications (4.1 versus 2.3%, p>0.05).ConclusionReduction of frame rate allows reducing significantly the radiation exposure while maintaining excellent clinical results in transcatheter closure of atrial septal defects. We recommend implementing this little change in every laboratory in order to achieve drastic reduction of radiation exposure to the patients and laboratory personnel.

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Reduction of radiation exposure using low pulse rate fluoroscopy during neuroendovascular surgery

Interventional Neuroradiology ◽

10.1177/1591019920949319 ◽

2020 ◽

pp. 159101992094931

Author(s):

Takeshi Shimizu ◽

Shingo Toyota ◽

Kanji Nakagawa ◽

Tomoaki Murakami ◽

Tetsuya Kumagai ◽

...

Keyword(s):

Carotid Artery ◽

Minimally Invasive ◽

Radiation Exposure ◽

Pulse Rate ◽

Carotid Artery Stenting ◽

Dose Area Product ◽

Radiation Data ◽

Air Kerma ◽

Fluoroscopic Time ◽

Area Product

Introduction Endovascular surgery is minimally invasive, but the radiation exposure can be problematic. There is no report assessing whether radiation exposure can be reduced by using a low pulse rate during carotid artery stenting (CAS). The aim of this study was to evaluate whether reducing the pulse rate from 7.5 to 4 frames per second (f/s) can reduce the radiation exposure while maintaining safety during CAS procedure. Methods We retrospectively reviewed the radiation data and clinical features of all 100 patients who underwent CAS between 2014 and 2019. We changed the pulse rate from 7.5 to 4 f/s in 2017. The fluoroscopic time (FT), dose area product (DAP), and total air kerma (AK) were collected. Statistical analyses were performed between the pulse rate and clinical outcomes, including radiation exposure.

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Estimation of Radiation Exposure in the Pediatric Cath Lab in Ain Shams University; Cross-Sectional Observational Study

QJM ◽

10.1093/qjmed/hcab090.003 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed Abdelrazik ◽

Youssef Amin ◽

Alaa Roushdy ◽

Maiy El Sayed

Keyword(s):

Radiation Exposure ◽

Radiation Dosage ◽

University Hospital ◽

Heart Catheterization ◽

Radiation Doses ◽

Device Closure ◽

Cross Sectional ◽

Dose Area Product ◽

Area Product ◽

Hospital Pediatric

Abstract Aim and objectives The aim of the study is to assess the average radiation doses recorded per procedure in Ain Shams University Hospital pediatric cath lab to set benchmarks of radiation exposure in our institute. Patients and Methods The study included 198 patients who presented to Ain Shams cardiac pediatric cath lab who undergone interventional (BPV, BAV, ASD device closure, VSD device closure, PDA coil/device closure, Coarctation Stent/balloon) and diagnostic (Hemodynamics study, Diagnostic cath) heart catheterization. Radiation doses were measured without any interference with the operator’s preferences. Results Radiation dosages were measured in total AirKerma, Dose area product (DAP), and fluoroscopy time to set the benchmarks for radiation exposure in our institute per procedure. VSD device closure showed the highest radiation exposure followed by Coarctation stenting. Lowest radiation dosage was in PDA coil closure followed by ASD device closure then BPV. Conclusion Benchmarks for radiation exposure per procedure in pediatric cath lab in our institute were set and compared to each other.

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Radiation exposure in transcatheter patent ductus arteriosus closure: Time to tune?

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2017.11.161 ◽

2018 ◽

Vol 10 (1) ◽

pp. 143

Author(s):

O. Villemain ◽

S. Malekzadeh-Milani ◽

F. Sitefane ◽

Y. Boudjemline

Keyword(s):

Patent Ductus Arteriosus ◽

Radiation Exposure ◽

Ductus Arteriosus ◽

Closure Time ◽

Patent Ductus Arteriosus Closure ◽

Patent Ductus

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Minimal radiation exposure transcatheter patent ductus arteriosus closure using only venous access – A novel technique

Indian Heart Journal ◽

10.1016/j.ihj.2017.09.137 ◽

2017 ◽

Vol 69 ◽

pp. S41

Author(s):

Nurul Islam ◽

N. Hemant Kumar

Keyword(s):

Patent Ductus Arteriosus ◽

Radiation Exposure ◽

Ductus Arteriosus ◽

Venous Access ◽

Novel Technique ◽

Patent Ductus Arteriosus Closure ◽

Patent Ductus

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Effective Reduction of Radiation Exposure during Cardiac Catheterization

Texas Heart Institute Journal ◽

10.14503/thij-17-6548 ◽

2019 ◽

Vol 46 (3) ◽

pp. 167-171 ◽

Cited By ~ 2

Author(s):

Alejandro Gutiérrez-Barrios ◽

Hugo Camacho-Galán ◽

Francisco Medina-Camacho ◽

Dolores Cañadas-Pruaño ◽

Antonio Jimenez-Moreno ◽

...

Keyword(s):

Radiation Exposure ◽

Cardiac Catheterization ◽

Fine Tuning ◽

Radiation Doses ◽

Dose Area Product ◽

Catheterization Laboratory ◽

Cardiac Catheterization Laboratory ◽

Percutaneous Coronary ◽

Procedural Complications ◽

Area Product

Exposure to ionizing radiation during cardiac catheterization can have harmful consequences for patients and for the medical staff involved in the procedures. Minimizing radiation doses during the procedures is essential. We investigated whether fine-tuning the radiation protocol reduces radiation doses in the cardiac catheterization laboratory. In January 2016, we implemented a new protocol with reduced radiation doses in the Hospital de Jerez catheterization laboratory. We analyzed 170 consecutive coronary interventional procedures (85 of which were performed after the new protocol was implemented) and the personal dosimeters of the interventional cardiologists who performed the procedures. Overall, the low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%–70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%–90.1%; P <0.001) during percutaneous coronary interventions. We also found that the annual deep (79%, P=0.026) and shallow (62.2%, P=0.035) radiation doses to which primary operators were exposed decreased significantly under the low-radiation protocol. These dose reductions were achieved without increasing the volume of contrast media, fluoroscopy time, or rates of procedural complications, and without reducing the productivity of the laboratory. Optimizing the radiation safety protocol effectively reduced radiation exposure in patients and operators during cardiac catheterization procedures.

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Using 7.5 frames per second reduces radiation exposure in lower extremity peripheral vascular interventions

Vascular ◽

10.1177/1708538114549592 ◽

2014 ◽

Vol 23 (3) ◽

pp. 240-244 ◽

Cited By ~ 2

Author(s):

Nuri I Akkus ◽

George S Mina ◽

Abdulrahman Abdulbaki ◽

Fereidoon Shafiei ◽

Neeraj Tandon

Keyword(s):

Radiation Dose ◽

Radiation Exposure ◽

Success Rate ◽

Frame Rate ◽

Fluoroscopy Time ◽

Peripheral Vascular ◽

Dose Area Product ◽

Group A ◽

Group B ◽

Area Product

Background Peripheral vascular interventions can be associated with significant radiation exposure to the patient and the operator. Objective In this study, we sought to compare the radiation dose between peripheral vascular interventions using fluoroscopy frame rate of 7.5 frames per second (fps) and those performed at the standard 15 fps and procedural outcomes. Methods We retrospectively collected data from consecutive 87 peripheral vascular interventions performed during 2011 and 2012 from two medical centers. The patients were divided into two groups based on fluoroscopy frame rate; 7.5 fps (group A, n = 44) and 15 fps (group B, n = 43). We compared the demographic, clinical, procedural characteristics/outcomes, and radiation dose between the two groups. Radiation dose was measured as dose area product in micro Gray per meter square. Results Median dose area product was significantly lower in group A (3358, interquartile range (IQR) 2052–7394) when compared to group B (8812, IQR 4944–17,370), p < 0.001 with no change in median fluoroscopy time in minutes (18.7, IQR 11.1–31.5 vs. 15.7, IQR 10.1–24.1), p = 0.156 or success rate (93.2% vs. 95.3%), p > 0.999. Conclusion Using fluoroscopy at the rate of 7.5 fps during peripheral vascular interventions is associated with lower radiation dose compared to the standard 15 fps with comparable success rate without associated increase in the fluoroscopy time or the amount of the contrast used. Therefore, using fluoroscopy at the rate of 7.5 fps should be considered in peripheral vascular interventions.

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Spot fluoroscopy: a novel innovative approach to reduce radiation dose in neurointerventional procedures

Acta Radiologica ◽

10.1177/0284185116658682 ◽

2016 ◽

Vol 58 (5) ◽

pp. 600-608 ◽

Cited By ~ 4

Author(s):

Ljubisa Borota ◽

Lars Jangland ◽

Per-Erik Åslund ◽

Elisabeth Ronne-Engström ◽

Christoffer Nyberg ◽

...

Keyword(s):

Radiation Dose ◽

Region Of Interest ◽

Field Of View ◽

Endovascular Coiling ◽

Dose Area Product ◽

Air Kerma ◽

Promising Tool ◽

Fluoroscopic Time ◽

Area Product ◽

Neurointerventional Procedures

Background Increased interest in radiation dose reduction in neurointerventional procedures has led to the development of a method called “spot fluoroscopy” (SF), which enables the operator to collimate a rectangular or square region of interest anywhere within the general field of view. This has potential advantages over conventional collimation, which is limited to symmetric collimation centered over the field of view. Purpose To evaluate the effect of SF on the radiation dose. Material and Methods Thirty-five patients with intracranial aneurysms were treated with endovascular coiling. SF was used in 16 patients and conventional fluoroscopy in 19. The following parameters were analyzed: the total fluoroscopic time, the total air kerma, the total fluoroscopic dose-area product, and the fluoroscopic dose-area product rate. Statistical differences were determined using the Welch’s t-test. Results The use of SF led to a reduction of 50% of the total fluoroscopic dose-area product (CF = 106.21 Gycm2, SD = 99.06 Gycm2 versus SF = 51.80 Gycm2, SD = 21.03 Gycm2, p = 0.003884) and significant reduction of the total fluoroscopic dose-area product rate (CF = 1.42 Gycm2/min, SD = 0.57 Gycm2/s versus SF = 0.83 Gycm2/min, SD = 0.37 Gycm2/min, p = 0.00106). The use of SF did not lead to an increase in fluoroscopy time or an increase in total fluoroscopic cumulative air kerma, regardless of collimation. Conclusion The SF function is a new and promising tool for reduction of the radiation dose during neurointerventional procedures.

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Abstract 14656: Fusion of Fluoroscopy and Echocardiography During the Mitraclip® Procedure Reduces Time to Transseptal Puncture and Radiation Exposure

Circulation ◽

10.1161/circ.142.suppl_3.14656 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sarah Slaven ◽

Joseph Burke ◽

Jacob Hammers ◽

Robert A Quaife ◽

Pei-ni Jone ◽

...

Keyword(s):

Radiation Exposure ◽

Transseptal Puncture ◽

Dose Area Product ◽

The Third ◽

Air Kerma ◽

Time Period ◽

Measured Time ◽

Radiation Equipment ◽

Area Product ◽

Reduced Time

Introduction: Transseptal puncture (TSP) is an essential step in percutaneous structural heart interventions, such as the MitraClip® procedure. Radiation exposure is a hazard for Interventional Cardiologists, Echocardiographers, and patients. Advancements in shielding and radiation equipment have reduced this exposure, but further reduction is desired. EchoNav® (Philips) fuses fluoroscopy and echocardiography resulting in a single multimodal image display. Prior studies demonstrated reduced time to TSP with use of EchoNav® but failed to show significant reduction in radiation. We hypothesized that increased experience using EchoNav® would further decrease TSP time and radiation dose. Methods: Single center, retrospective analysis evaluated 202 patients undergoing MitraClip® procedure pre and post-EchoNav® from 6/2010 to 12/2019: 8 pre and 194 post. We measured time to TSP and radiation exposure by Air Kerma and dose area product (DAP). For the post-EchoNav® cases, we evaluated these variables by 2-year time periods to examine change over time. Results: Comparing pre and post-EchoNav ® procedures, time to TSP was non-significantly reduced overall (40.00±14.95 to 33.63±15.92, p=0.23). However, post-EchoNav ® had a decreasing trend (48.00±28.39, 43.47±15.86, 28.45±11.94, 27.55±10.64; R 2 =0.89, p =0.009) that was significantly less than pre-EchoNav ® by the third time period (40.00±14.95 vs 28.45±11.94, p=0.05) and remained less in the fourth (40.00±14.95 vs 27.55±10.64, p=0.03). Radiation was reduced post-EchoNav ® by both DAP (264.52±150.03 to 109.00±97.68) (p=0.02) and Air Kerma (1472.92±883.50 to 582.49±485.28) (p=0.05). Significant radiation reduction occurred by the third time period for Air Kerma (1472.92±883.50 vs 494.12±413,79, p=0.03) and second time period for DAP (264.52±150.03 to 127.51±110.35, p=0.03). Conclusion: These results suggest that use of EchoNav® has a learning curve, but ultimately reduces time to TSP and radiation.

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