scholarly journals Radiation exposure in interventional cardiology: relationship between patient radiation dose, demographic characteristics and procedural factors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C McCaughey ◽  
R Kumar ◽  
J Kumar ◽  
S Matiullah
Keyword(s):  
Regression Analysis ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Multivariate Regression Analysis ◽  
Operator Technique ◽  
Femoral Access ◽  
Radial Access ◽  
The Impact

Abstract Introduction There has been a significant increase in Interventional Cardiology (IC) procedures over last few decades across the globe. The introduction of newer techniques and procedure types in IC has contributed to an overall increase in radiation exposure to both operators and patients alike. Unlike diagnostic imaging, IC procedures are heterogeneous and vary in their complexity based on a myriad of factors, such as patient disease characteristics, anatomy, nature of lesions and operator technique. Purpose The aim of the study is to evaluate the demographic and procedural characteristics associated with increased radiation dose. Limited studies exist on the impact of demographic and procedural characteristics on cumulative radiation dose. Methods Single-centre retrospective observational study of elective Percutaneous Coronary Intervention (PCI) patients from October 2018 to December 2018 in a 24/7 Irish pPCI centre. Patient level data including weight, height, demographic and procedural characteristics were collected for 65 consecutive elective PCI cases. Radiation exposure metrics, including Kerma Area Product (Pka), Reference Air Kerma (Ka,r) and Fluoroscopy Time (FT), were also collected. A Mann-Whitney U Test was used to assess for differences in radiation exposure between groups and a multivariate regression analysis was performed in order to identify those variables which contributed to radiation exposure. Results Median total radiation exposure for our cohort was (Q1–3) -Pka 109 (61–154) Gy·cm2, Ka,r 1746 (1,082–2,530)mGy and FT 16 (10–25)mins. Males (n=48) had a significantly higher radiation exposure Pka 126 (84–171) vs 56 (27–114)Gy·cm2 p=0.001; Ka,r 2094 (1256–2936) mGy p=0.006) than females. Those who underwent femoral access had significantly lower radiation exposure (Pka 50 (38–77) vs 114 (63–158) Gy·cm2 p=0.019; Ka,r (897 (725–1094) vs 2020 (1092–2618) mGy; p=0.018) when compared to radial access. Increasing body mass index (BMI) (p=0.03), multi vessel PCI (p=0.001) and the use of a “sheathless” technique (p=0.029) were associated with increasing radiation exposure (r2=0.630 Pka; Ka,r r2=0.611). Stent characteristics and all other clinical risk factors (HTN, smoking, DM, renal impairment, previous PCI) had no significant impact on radiation exposure. Conclusion Radiation exposure during IC in our cohort was within the range of most European Diagnostic Reference Levels (DRL's). Increased BMI and male gender were associated with increased radiation exposure. Procedural characteristics such as radial access, multi vessel PCI and the use of sheathless technique were independently associated with increasing radiation exposure. We recommend dose documentation of all procedures for these patients to avoid radiation hazards; with periodic assessment of statistical dose recording and planned follow up. Regression analysis Funding Acknowledgement Type of funding source: None

scholarly journals Study on the Effect of Individual Factors on the Radiation Dose in Chest CT

2020 ◽  
Author(s):  
Dechuan Zhang ◽  
Longling Fan ◽  
Xuqian Liang ◽  
Teiying Yin ◽  
Qigen Li ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Radiation Dose ◽  
Ct Scan ◽  
Ct Scanning ◽  
Multivariate Regression Analysis ◽  
Major Effect ◽  
Chest Ct ◽  
Individual Factors ◽  
Dose Length Product ◽  
Ct Radiation

Abstract Objective To explore the influence of patient’s individual factors on the radiation dose in chest computed tomography (CT) scan. Methods Based on the clinical chest CT scan scheme and the scanning conditions were unified, Basic data of 103 patients who underwent chest CT scanning, including gender, age, height, weight and underlying diseases, were prospectively collected, and the dose length product (DLP) of each patient was recorded, Multivariate regression analysis was made on the obtained data. Results Under the same scanning parameters, image quality had no significant effect on chest CT radiation dose (P = 0.404 > 0.05); among the 103 cases, there were 20 kinds of basic diseases, only calcified lesion has a significant effect on chest CT radiation dose (P = 0.009 < 0.05), the other had no significant effects (P > 0.05); the major effect individual factors of radiation dose in CT scan were: gender (P = 0.000003 < 0.05), age (P = 0.016 < 0.05), height (P = 0.000021 < 0.05), weight (P = 4.30E-16 < 0.05). Age (P = 8.08E-8 < 0.05) and weight (P = 5.52E-21 < 0.05) were the only decisive factors in multiple regression analysis, while other influencing factors were not decisive (P > 0.05). The regression model was as follows: DLP=-39.45 + 2.19*age + 5.54*weight, the coefficient of multiple correlation R being 0.786, F(2,100) = 77.128, P < 0.01. Mean that gradually increase in age was related with 2.19 mGy∙cm increase in the DLP value, 1 kg increase in weight was associated with 5.54 mGy∙cm increase in the DLP value. Conclusion For chest CT, age and weight are the major impact individual factors of radiation dose. This model has shown obvious clinical significance and can provide solid theoretical basis for clinical application in reducing the radiation dose in chest CT.

IMPACT OF THE TABLE HEIGHT AND THE OPERATOR’S HEIGHT ON THE LEVEL OF RADIATION DELIVERED TO INTERVENTIONAL CARDIOLOGISTS

2019 ◽  
Vol 187 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Laurent Faroux ◽  
Thierry Blanpain ◽  
Anthony Fernandez ◽  
Pierre Nazeyrollas ◽  
Sophie Tassan-Mangina ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Primary Endpoint ◽  
Health Professionals ◽  
Maximum Distance ◽  
X Ray ◽  
Coronary Interventions ◽  
Coronary Procedures ◽  
The Impact

ABSTRACT Interventional cardiologists count among the health professionals that are most exposed to ionising radiation. To minimise exposure, it is recommended that the patient be placed at the maximum distance possible from the X-ray source, but this recommendation has not been clinically validated. We aimed to investigate the impact of the average table height on the level of radiation delivered to cardiologists performing coronary interventions. The population for analysis included all invasive coronary procedures performed in our centre from March to June 2017. The primary endpoint was operator radiation exposure, as assessed using personal electronic dosimeters located on the operator’s left arm. In total, 225 invasive coronary procedures were analysed. When the average table height was 1126 mm or more, the operators received a radiation dose that was, on average, 53% lower than when the table was lower than 1126 mm. This reduction remained significant by multivariate analysis adjusted for the operator.

scholarly journals Radiation Dose Reduction during Radial Cardiac Catheterization: Evaluation of a Dedicated Radial Angiography Absorption Shielding Drape

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Andrew Ertel ◽  
Jeffrey Nadelson ◽  
Adhir R. Shroff ◽  
Ranya Sweis ◽  
Dean Ferrera ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Cardiac Catheterization ◽  
Patient Comfort ◽  
Bleeding Complications ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Radiation Scatter ◽  
The Right ◽  
The Impact

Objectives. Radiation scatter protection shield drapes have been designed with the goal of decreasing radiation dose to the operators during transfemoral catheterization. We sought to investigate the impact on operator radiation exposure of various shielding drapes specifically designed for the radial approach. Background. Radial access for cardiac catheterization has increased due to improved patient comfort and decreased bleeding complications. There are concerns for increased radiation exposure to patients and operators. Methods. Radiation doses to a simulated operator were measured with a RadCal Dosimeter in the cardiac catheterization laboratory. The mock patient was a 97.5 kg fission product phantom. Three lead-free drape designs were studied. The drapes were placed just proximal to the right wrist and extended medially to phantom’s trunk. Simulated diagnostic coronary angiography included 6 minutes of fluoroscopy time and 32 seconds of cineangiography time at 4 standard angulated views (8 s each), both 15 frames/s. ANOVA with Bonferroni correction was used for statistical analysis. Results. All drape designs led to substantial reductions in operator radiation exposure compared to control (P<0.0001). The greatest decrease in radiation exposure (72%) was with the L-shaped design. Conclusions. Dedicated radial shielding drapes decrease radiation exposure to the operator by up to 72% during simulated cardiac catheterization.

scholarly journals 494 Glycoprotein IIB/IIIA inhibitors may modulate the clinical benefit of radial access as compared to femoral access in primary percutaneous coronary intervention: a meta-regression and a meta-analysis of randomized trials

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Ernesto Cristiano ◽  
Francesco Cava ◽  
Maria Lo Monaco ◽  
Federica Tempestini ◽  
Francesca Giovannelli ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Risk Difference ◽  
Controlled Trials ◽  
Femoral Access ◽  
Randomized Controlled ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Meta Regression

Abstract Aims Several randomized controlled trials (RCTs) consistently reported better clinical outcomes with radial as compared to femoral access for primary percutaneous coronary intervention (PCI). Nevertheless, heterogeneous use of potent antiplatelet drugs, such as Gp IIb/IIIa inhibitors (GPI), across different studies could have biased the results in favour of radial access. We performed an updated meta-analysis and meta-regression of RCTs in order to appraise whether the use of GPI had an impact on pooled estimates of clinical outcomes according to vascular access. Methods and results We computed pooled estimates by the random effects model for the following outcomes: mortality, major adverse cardiovascular events (death, myocardial infarction, stroke, and target vessel revascularization), and major bleedings. Additionally, we performed meta-regression analysis to investigate the impact of GPI use on pooled estimates of clinical outcomes. We analysed 14 randomized controlled trials and 11 090 patients who were treated by radial (5497) and femoral access (5593), respectively. Radial access was associated with better outcomes for mortality [risk difference 0.01 (0.00, 0.01), P = 0.03], MACE [risk difference 0.01 (0.00, 0.02), P = 0.003], and major bleedings [risk difference 0.01 (0.00, 0.02), P = 0.02]. At meta-regression, we observed a significant correlation of mortality with both GPI use (P = 0.011) and year of publication (P = 0.0073), whereas no correlation was observed with major bleedings. Conclusions In this meta-analysis, the use of radial access for primary PCI was associated with better clinical outcomes as compared to femoral access. However, the effect size on mortality was modulated by GPI rate, with greater benefit of radial access in studies with larger use of these drugs.

scholarly journals Increased Colonic Expression of ACE2 Associates with Poor Prognosis in Crohn’s Disease

2021 ◽  
Author(s):  
Takahiko Toyonaga ◽  
Kenza Araba ◽  
Meaghan Kennedy ◽  
Benjamin Keith ◽  
Elisabeth Wolber ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Protein Expression ◽  
Cox Regression ◽  
Multivariate Regression Analysis ◽  
Rna Seq ◽  
Cox Regression Analysis ◽  
Molecular Stratification ◽  
The Impact

Abstract Background and Aims: The host receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), is highly expressed in small intestine. Our aim was to study colonic ACE2 expression in Crohn's disease (CD) and non-inflammatory bowel disease (non-IBD) controls. We hypothesized that the colonic expression levels of ACE2 impacts CD course. Methods: We examined the expression of colon ACE2 using RNA-seq and quantitative (q) RT-PCR from 69 adult CD and 14 NIBD control patients. In a subset of this cohort we validated ACE2 protein expression and localization in formalin-fixed, paraffin-embedded matched colon and ileal tissues using immunohistochemistry. The impact of increased ACE2 expression in CD for the risk of surgery was evaluated by a multivariate regression analysis and a Kaplan-Meier estimator. To provide critical support for the generality of our findings, we analyzed previously published RNA-seq data from two large independent cohorts of CD patients. Results: Colonic ACE2 expression was significantly higher in a subset of adult CD patients (ACE2-high CD). IHC in a sampling of ACE2-high CD patients confirmed high ACE2 protein expression in the colon and ileum compared to ACE2-low CD and NIBD patients. Notably, we found that ACE2-high CD patients are significantly more likely to undergo surgery within 5 years of diagnosis, with a Cox regression analysis finding that high ACE2 levels is an independent risk factor (OR 2.18; 95%CI, 1.05-4.55; p=0.037). Conclusion: Increased intestinal expression of ACE2 is associated with deteriorated clinical outcomes in CD patients. These data point to the need for molecular stratification that may impact CD disease-related outcomes.

scholarly journals Comparison of Distal Radial, Proximal Radial, and Femoral Access in Patients with ST-Elevation Myocardial Infarction

2021 ◽  
Vol 10 (15) ◽  
pp. 3438
Author(s):  
Oh-Hyun Lee ◽  
Yongcheol Kim ◽  
Nak-Hoon Son ◽  
Ji Woong Roh ◽  
Eui Im ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Femoral Access ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Feasible Alternative ◽  
Experienced Operator ◽  
St Elevation

Recent studies have indicated that distal radial access (DRA) is feasible in patients undergoing percutaneous coronary intervention (PCI). The present study aimed to compare DRA, proximal radial access (PRA), and femoral access (FA) in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. Data were analyzed for 109 patients with STEMI treated via primary PCI from March 2020 to May 2021. The success rate of DRA was 83.3% (35/42), including seven cases of failed puncture (puncture failure = 5, severe radial artery spasm = 2). Primary PCI via the DRA was successful in all 35 patients. After classifying the patients requiring crossover into a separate group, the percentage of the puncture time in the door-to-wiring time was 2.7% [2.2–4.3], 3.3% [2.3–4.0], 2.6% [1.2–4.9], and 27.0% [13.5–29.3] in the DRA (n = 35), PRA (n = 24), FA (n = 26), and crossover (n = 9) groups, respectively (p < 0.01). Only two local hematomas (≤5 cm) occurred in the DRA group, while one patient in the FA group required surgical treatment and a transfusion for an access-site vascular injury. When performed by an experienced operator, DRA may represent a feasible alternative to other access routes in select patients with STEMI undergoing PCI, such as those with a high risk of bleeding.

scholarly journals Glycoprotein IIb/IIIa Inhibitors May Modulate the Clinical Benefit of Radial Access as Compared to Femoral Access in Primary Percutaneous Coronary Intervention: A Meta-Regression and Meta-Analysis of Randomized Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Stefano Rigattieri ◽  
Ernesto Cristiano ◽  
Francesca Giovannelli ◽  
Antonella Tommasino ◽  
Francesco Cava ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Risk Difference ◽  
Controlled Trials ◽  
Femoral Access ◽  
Randomized Controlled ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Meta Regression

Objectives. Several randomized controlled trials (RCTs) consistently reported better clinical outcomes with radial as compared to femoral access for primary percutaneous coronary intervention (PCI). Nevertheless, heterogeneous use of potent antiplatelet drugs, such as Gp IIb/IIIa inhibitors (GPI), across different studies could have biased the results in favor of radial access. We performed an updated meta-analysis and meta-regression of RCTs in order to appraise whether the use of GPI had an impact on pooled estimates of clinical outcomes according to vascular access. Methods. We computed pooled estimates by the random-effects model for the following outcomes: mortality, major adverse cardiovascular events (death, myocardial infarction, stroke, and target vessel revascularization), and major bleedings. Additionally, we performed meta-regression analysis to investigate the impact of GPI use on pooled estimates of clinical outcomes. Results. We analyzed 14 randomized controlled trials and 11090 patients who were treated by radial (5497) and femoral access (5593), respectively. Radial access was associated with better outcomes for mortality (risk difference 0.01 (0.00, 0.01), p = 0.03 ), MACE (risk difference 0.01 (0.00, 0.02), p = 0.003 ), and major bleedings (risk difference 0.01 (0.00, 0.02), p = 0.02 ). At meta-regression, we observed a significant correlation of mortality with both GPI use ( p = 0.011 ) and year of publication ( p = 0.0073 ), whereas no correlation was observed with major bleedings. Conclusions. In this meta-analysis, the use of radial access for primary PCI was associated with better clinical outcomes as compared to femoral access. However, the effect size on mortality was modulated by GPI rate, with greater benefit of radial access in studies with larger use of these drugs.

scholarly journals The Impact of Basel III Capital Regulation on Credit Risk: A Hybrid Model

2020 ◽  
Vol 9 (2) ◽  
pp. 56-71
Author(s):  
NADIM ANASS ALFOUHAILI ◽  
Frédéric GAUTIER ◽  
Iyad ZAAROUR
Keyword(s):  
Regression Analysis ◽  
Credit Risk ◽  
Hybrid Model ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Capital Regulation ◽  
Basel Iii ◽  
Spearman Correlation ◽  
Spearman Correlation Test ◽  
The Impact

This research examined the impact of Basel III capital regulation (BCR) on credit risk (CR) using a sample of 25 commercial banks in Lebanon over the period 2012–2017. BCR is measured using the capital adequacy ratio (CAR) and the common equity tier one ratio (CET1 ratio), CR is measured using net provision for credit losses /total assets. To analyze the data, we constructed a hybrid model based on 3 statistical approaches. First, we modelled the dual impact of BCR and CR using probabilistic inference in the framework of Bayesian Belief Network formalism (BBN). Second, to highlight more about the correlation between BCR and CR, we used Spearman correlation test as a nonparametric approach. Third to study the simultaneous effect of CAR and CET1 ratio on CR we applied multivariate regression analysis. By analyzing the probabilistic inference for the first approach we concluded that there is an effect of BCR on CR especially for the high level of CET1 ratio, but when we investigated more if this effect is significant using the Spearman correlation test and the multivariate regression analysis, we concluded that there is no effect statistically significant of Basel III capital regulation (BCR) on credit risk (CR).

scholarly journals Prolonged SARS-CoV-2 Viral Shedding in Patients with COVID-19 was Associated with Delayed Initiation of Arbidol Treatment: a retrospective cohort study

2020 ◽  
Author(s):  
Yaya Zhou ◽  
Xinliang He ◽  
Jianchu Zhang ◽  
Yu’e Xue ◽  
Mengyuan Liang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Virus Shedding ◽  
Illness Onset ◽  
Factors Associated ◽  
Viral Shedding ◽  
Union Hospital ◽  
Delayed Initiation ◽  
The Impact

AbstractObjectivesEvaluate the risk factors of prolonged SARS-CoV-2 virus shedding and the impact of arbidol treatment on SARS-CoV-2 virus shedding.MethodsData were retrospective collected from adults hospitalized with COVID-19 in Wuhan Union Hospital. We described the clinical features and SARS-CoV-2 RNA shedding of patients with COVID-19 and evaluated factors associated with prolonged virus shedding by multivariate regression analysis.ResultsAmong 238 patients, the median age was 55.5 years, 57.1% were female, 92.9% (221/238) used arbidol, 58.4% (139/238) used arbidol combination with interferon. The median time from illness onset to start arbidol was 8 days (IQR, 5-14 days) and the median duration of SARS-CoV-2 virus shedding was 23 days (IQR, 17.8–30 days). SARS-CoV-2 RNA clearance was significantly delayed in patients who received arbidol >7 days after illness onset, compared with those in whom arbidol treatment was started≤7 days after illness onset (HR, 1.738 [95% CI, 1.339–2.257], P < .001). Multivariate regression analysis revealed that prolonged viral shedding was significantly associated with initiation arbidol more than seven days after symptom onset (OR 2.078, 95% CI [1.114-3.876], P .004), more than 7 days from onset of symptoms to first medical visitation (OR 3.321, 95% CI[1.559-7.073], P .002), illness onset before Jan.31, 2020 (OR 3.223, 95% CI[1.450-7.163], P .021). Arbidol combination with interferon was also significantly associated with shorter virus shedding (OR .402, 95% CI[.206-.787], P .008).ConclusionsEarly initiation of arbidol and arbidol combination with interferon as well as consulting doctor timely after illness onset were helpful for SARS-CoV-2 clearance.

Sign in / Sign up

Export Citation Format

Share Document