scholarly journals Do we need imaging support to minimize radiation exposure in cryo-ablation for atrial fibrillation? The VLADIMIR strategy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Guisasola Cienfuegos ◽  
C Lazaro Rivera ◽  
A Marco Del Castillo ◽  
M.M Otero Escudero ◽  
J Ramos Jimenez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiation Exposure ◽  
Intracardiac Echocardiography ◽  
Fluoroscopy Time ◽  
End Points ◽  
Dose Area Product ◽  
Reduce Radiation Exposure ◽  
Funding Sources ◽  
Novel Strategy ◽  
Area Product

Abstract Introduction and objective Cryoballoon pulmonary vein isolation (CB-VPI) is non-inferior to radiofrequency ablation in patients with atrial fibrillation. Although protocols aiming to reduce radiation exposure have been developed, most of them use intracardiac echocardiography (ICE) or electroanatomic mapping (EAM) systems, which significantly increase procedure costs or may not be widely available. Previous studies aiming at fluoroscopy reduction have been published, achieving median fluoroscopy times around 10 minutes. We developed a novel strategy to achieve Very Low rADIoscopic exposure to Minimize Ionizing Radiation during cryoablation of atrial fibrillation (VLADIMIR) (Table 1). The aim of this study was to assess its impact in acute procedural and clinical outcomes. Methods Consecutive patients undergoing CB-VPI were prospectively enrolled, treated with the VLADIMIR strategy and compared to a retrospective cohort of patients having undergone CB-VPI performed by the same operators with conventional fluoroscopy strategy. Primary end-points were fluoroscopy time and total dose area product (DAP). Secondary end-points were intraprocedural or early post-procedural complications. Results A total of 84 patients were enrolled. 50 patients underwent CB-VPI with conventional fluoroscopy strategy and in 34 patients the Vladimir strategy was applied. Vladimir group had significant lower median fluoroscopy time (2.98 min vs 20.65 min, p<0.001) and significant lower median DAP (4.15 Gy·cm2 vs 34.12 Gy·cm2, p<0.001) as compared with conventional fluoroscopy strategy group. Results from prespecified subgroup analysis between operators (senior vs fellow trainee) were consistent. No significant differences were found between both groups in periprocedural complications (Table 2). Conclusion The Vladimir protocol significantly reduces fluoroscopy time and radiation exposure during CB-VPI without affecting the rate of periprocedural complications. FUNDunding Acknowledgement Type of funding sources: None. Table 1. The VLADIMIR strategy Table 2

scholarly journals Radioprotection during interventional cardiology procedures

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Noval-Morillas ◽  
D Canadas-Pruano ◽  
E Izaga ◽  
A Gutierrez-Barrios
Keyword(s):  
Radiation Exposure ◽  
Radiation Protection ◽  
Real World ◽  
Interventional Procedures ◽  
Interventional Cardiology ◽  
Dose Area Product ◽  
Reduce Radiation Exposure ◽  
Funding Sources ◽  
Different Types ◽  
Area Product

Abstract Background The use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and the medical staff. Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has demonstrated to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real-world procedures. Methods and results In this non-randomized all-comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n=59) and the non-RPC group (n=60). No significant changes in patients and procedures characteristics, average contrast volume, air kerma (AK), dose area-product (PDA) and fluoroscopy time between both groups were apparent. In RPC group, the first operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures. Conclusions Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real-world setting. FUNDunding Acknowledgement Type of funding sources: None.

Analysis of Radiation Exposure during Endovascular Aneurysm Repair

2012 ◽  
Vol 78 (10) ◽  
pp. 1029-1032 ◽  
Author(s):  
Michael Butler ◽  
Madhukar S. Patel ◽  
Samuel E. Wilson
Keyword(s):  
Radiation Exposure ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysm Repair ◽  
Fluoroscopy Time ◽  
Potential Hazard ◽  
Dose Area Product ◽  
Contrast Volume ◽  
Using Data ◽  
Area Product ◽  
Aneurysm Repair

Endovascular aneurysm repair (EVAR) is now the preferred procedure for abdominal aortic aneurysm repair. As a result of the need for fluoroscopy during EVAR, radiation exposure is a potential hazard. We studied the quantity of radiation delivered during EVAR to identify risks for excessive exposure. Fluoroscopy time, contrast volume used, and procedural details were recorded prospectively during EVARs. Using data collected from similar EVARs, an equation was derived to calculate approximate dose-area product (DAP) from fluoroscopy time. DAP values were then compared between procedures in which a relevant postdeployment procedure (PDP) was necessary intraoperatively with those without. Clinical data on 17 patients were collected. The mean age of patients was 68 (±9) years. Fluoroscopy times and approximate DAP values were found to be significantly higher in the seven patients with a PDP compared with the 10 patients without an intraoperative PDP (31.2 [±9.6] vs 22.7 [±6.0] minutes, P = 0.033 and 537 [±165] vs 390 [±103] Gy-cm2, P = 0.033, respectively). The average amount of contrast volume used was not significantly different between groups. Radiation emitted during EVARs with PDPs was significantly greater relative to those without PDPs. Device design and operators should thus aim to decrease PDPs and to minimize fluoroscopy time.

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

Vascular ◽  
2014 ◽  
Vol 23 (3) ◽  
pp. 240-244 ◽  
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.

scholarly journals Reduction of Radiation Exposure in Adrenal Vein Sampling: Impact of the Rapid Cortisol Assay

2021 ◽  
Author(s):  
Anne Marie Augustin ◽  
Giulia Dalla Torre ◽  
Carmina Teresa Fuss ◽  
Martin Fassnacht ◽  
Thorsten Alexander Bley ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Adrenal Vein ◽  
Fluoroscopy Time ◽  
Technical Success ◽  
Renal Veins ◽  
Adrenal Vein Sampling ◽  
Sampling Protocol ◽  
Dose Area Product ◽  
Group I ◽  
Area Product

Purpose To determine radiation exposure associated with adrenal vein sampling and its reduction by implementing the rapid cortisol assay and modification of the sampling protocol. Materials and Methods A single-center retrospective study of adrenal vein sampling performed between August 2009 and March 2020 revealed data from 151 procedures. Three subgroups were determined. In group I, a sampling protocol including sampling from the renal veins without the rapid cortisol assay was applied. In group II, blood was sampled using the same protocol but applying the rapid cortisol assay. In group III, a modified sampling protocol was used, in which the additional sampling from the renal veins was dispensed with, while the rapid cortisol assay was retained. Primary endpoints were radiation exposure parameters with dose area product, fluoroscopy time, and effective dose. As secondary endpoints, procedural data including technical success, lateralization, the correlation between patient BMI and radiation exposure, and concordance of lateralization with cross-sectional imaging were investigated. Furthermore, the correlation of aldosterone-cortisol ratios between the adrenal and ipsilateral renal vein was calculated to assess the benefit of sampling from the renal veins. Results For all procedures performed in the study collective, the median dose area product was 60.01 Gy*cm2 (5.71–789.31), the median fluoroscopy time was 14.90 min (3.27–80.90), and the calculated median effective dose was 12.60 mSv (1.20–165.76). Significant differences in radiation exposure parameters between the study subgroups could be revealed. Dose area product resulted in reductions of 57.94 % after implementation of the rapid cortisol assay and a further 40.44 % after revision of the sampling protocol. Fluoroscopy time was reduced by 40.48 % after integration of the rapid cortisol assay and a further 40.47 % after protocol refinement. Radiation doses were increased in cases of resampling (dose area product 51.31 vs. 118.11 Gy*cm2, fluoroscopy time of 12.48 vs. 28.70 min). A strong correlation between patient BMI and procedural dose area product could be found. After the introduction of the rapid cortisol assay, successive improvement of the technical success rate could be found (33.33 % in group I, 90.22 % in group II and 92.11 % in group III). The correlation of aldosterone-cortisol ratios between adrenal and renal veins was poor. Conclusion The introduction of the rapid cortisol assay significantly decreased the radiation exposure and increased the technical success rate. Renal vein sampling did not provide further benefit in the evaluation of primary aldosteronism subtype and its omission resulted in a further reduction of radiation dose. Key Points: Citation Format

scholarly journals Radiation Exposure to the Patient During Diagnostic Coronary Angiogram at Dhulikhel Hospital

2015 ◽  
Vol 13 (1) ◽  
pp. 61-63
Author(s):  
S Humagain ◽  
R Maharjan ◽  
R Koju
Keyword(s):  
Radiation Exposure ◽  
Background Radiation ◽  
Cumulative Effect ◽  
Interventional Cardiology ◽  
Fluoroscopy Time ◽  
Coronary Angiogram ◽  
Dose Area Product ◽  
Area Product ◽  
Necessary Evil ◽  
Age Range

Background Radiation is a necessary evil in Coronary Angiogram. The Interventional Cardiology procedure provides huge benefit to the patient but at the cost of radiation. There is evidence of cumulative effect of radiation. Therefore it is essential to keep the radiation dose as minimum as possible.Objective The aim of this study is to find out radiation exposed to the patient undergoing diagnostic coronary angiogram.Method A retrospective study was done. Those patients who underwent diagnostic coronary angiogram were selected for the study. There were total of 166 patients. Radiation exposure in terms of fluoroscopy time in minute and dose area product (DAP) in Gy.cm2 was recorded.Result Out 166 patients 92 were male and 74 female. Age range was from 39 to 79 years with mean age 58.13±9.14. Amount of contrast used was in range of 30 to 100 ml with mean of 45.54±14.06. Range of fluoroscopy time was 2.60 to 37.00 minutes with mean 11.38±6.80. Mean fluoroscopy time in male was 10.92±5.82 minutes and in females it was 11.92±7.68 minutes, with p 0.331. The range of DAP was 11.00 Gy.cm2 to 106.00 Gy.cm2 with mean 40.73±23.58 Gy.cm2. The mean DAP in male and female was 38.77±23.26 Gy.cm2 and 43.16±23.90 Gy.cm2 respectively with p 0.234.Conclusion From this study we can conclude that the radiation exposure to our patient undergoing coronary angiogram is similar to the international values in terms DAP but more in terms of fluoroscopy time. When males and females compared there is no difference.Kathmandu University Medical Journal Vol.13(1) 2015; 61-63

Noninvasive patient tracker mask for spinal 3D navigation: does the required large-volume 3D scan involve a considerably increased radiation exposure?

2020 ◽  
Vol 33 (6) ◽  
pp. 838-844
Author(s):  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
Christoph Scholz ◽  
Florian Volz ◽  
Marc Hohenhaus ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Image Data ◽  
3D Image ◽  
Flat Panel ◽  
3D Navigation ◽  
Data Set ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
3D Scan ◽  
Area Product

OBJECTIVEIntraoperative 3D imaging and navigation is increasingly used for minimally invasive spine surgery. A novel, noninvasive patient tracker that is adhered as a mask on the skin for 3D navigation necessitates a larger intraoperative 3D image set for appropriate referencing. This enlarged 3D image data set can be acquired by a state-of-the-art 3D C-arm device that is equipped with a large flat-panel detector. However, the presumably associated higher radiation exposure to the patient has essentially not yet been investigated and is therefore the objective of this study.METHODSPatients were retrospectively included if a thoracolumbar 3D scan was performed intraoperatively between 2016 and 2019 using a 3D C-arm with a large 30 × 30–cm flat-panel detector (3D scan volume 4096 cm3) or a 3D C-arm with a smaller 20 × 20–cm flat-panel detector (3D scan volume 2097 cm3), and the dose area product was available for the 3D scan. Additionally, the fluoroscopy time and the number of fluoroscopic images per 3D scan, as well as the BMI of the patients, were recorded.RESULTSThe authors compared 62 intraoperative thoracolumbar 3D scans using the 3D C-arm with a large flat-panel detector and 12 3D scans using the 3D C-arm with a small flat-panel detector. Overall, the 3D C-arm with a large flat-panel detector required more fluoroscopic images per scan (mean 389.0 ± 8.4 vs 117.0 ± 4.6, p < 0.0001), leading to a significantly higher dose area product (mean 1028.6 ± 767.9 vs 457.1 ± 118.9 cGy × cm2, p = 0.0044).CONCLUSIONSThe novel, noninvasive patient tracker mask facilitates intraoperative 3D navigation while eliminating the need for an additional skin incision with detachment of the autochthonous muscles. However, the use of this patient tracker mask requires a larger intraoperative 3D image data set for accurate registration, resulting in a 2.25 times higher radiation exposure to the patient. The use of the patient tracker mask should thus be based on an individual decision, especially taking into considering the radiation exposure and extent of instrumentation.

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

QJM ◽  
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.

scholarly journals Radiation exposure of adrenal vein sampling: a German Multicenter Study

2018 ◽  
Vol 179 (4) ◽  
pp. 261-267 ◽  
Author(s):  
C T Fuss ◽  
M Treitl ◽  
N Rayes ◽  
P Podrabsky ◽  
W K Fenske ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Adrenal Vein ◽  
University Hospitals ◽  
Adrenal Vein Sampling ◽  
Dose Area Product ◽  
Systematic Assessment ◽  
Sampling Locations ◽  
Subtype Differentiation ◽  
Area Product ◽  
Design And Methods

Objective Adrenal vein sampling (AVS) represents the current diagnostic standard for subtype differentiation in primary aldosteronism (PA). However, AVS has its drawbacks. It is invasive, expensive, requires an experienced interventional radiologist and comes with radiation exposure. However, exact radiation exposure of patients undergoing AVS has never been examined. Design and methods We retrospectively analyzed radiation exposure of 656 AVS performed between 1999 and 2017 at four university hospitals. The primary outcomes were dose area product (DAP) and fluoroscopy time (FT). Consecutively the effective dose (ED) was approximately calculated. Results Median DAP was found to be 32.5 Gy*cm2 (0.3–3181) and FT 18 min (0.3–184). The calculated ED was 6.4 mSv (0.1–636). Remarkably, values between participating centers highly varied: Median DAP ranged from 16 to 147 Gy*cm2, FT from 16 to 27 min, and ED from 3.2 to 29 mSv. As main reason for this variation, differences regarding AVS protocols between centers could be identified, such as number of sampling locations, frames per second and the use of digital subtraction angiographies. Conclusion This first systematic assessment of radiation exposure in AVS not only shows fairly high values for patients, but also states notable differences among the centers. Thus, we not only recommend taking into account the risk of radiation exposure, when referring patients to undergo AVS, but also to establish improved standard operating procedures to prevent unnecessary radiation exposure.

Fluoroscopy time is not accurate as a surrogate for radiation exposure

Vascular ◽  
2017 ◽  
Vol 25 (5) ◽  
pp. 466-471 ◽  
Author(s):  
Edvard Skripochnik ◽  
Shang A Loh
Keyword(s):  
Radiation Exposure ◽  
Medical Center ◽  
Pearson Correlation ◽  
Academic Medical Center ◽  
Surrogate Marker ◽  
Correlation Coefficients ◽  
Frame Rate ◽  
Fluoroscopy Time ◽  
Poor Correlation ◽  
Dose Area Product

Objective The Food and Drug Administration and the Vascular Quality Initiative still utilize fluoroscopy time as a surrogate marker for procedural radiation exposure. This study demonstrates that fluoroscopy time does not accurately represent radiation exposure and that dose area product and air kerma are more appropriate measures. Methods Lower extremity endovascular interventions ( N = 145) between 2013 and 2015 performed at an academic medical center on a Siemens Artis-Zee floor mounted c-arm were identified. Data was collected from the summary sheet after every case. Scatter plots with Pearson correlation coefficients were created. A strong correlation was indicated by an r value approaching 1. Results Overall mean AK and DAP was 380.27 mGy and 4919.2 µGym2. There was a poor correlation between fluoroscopy time and total AK or DAP ( r = 0.27 and 0.32). Total DAP was strongly correlated to cine DAP and fluoroscopy DAP ( r = 0.92 vs. 0.84). The number of DSA runs and average frame rate did not affect AK or DAP levels. Mean magnification level was significantly correlated with total AK ( r = 0.53). Conclusions Fluoroscopy time shows minimal correlation with radiation delivered and therefore is a poor surrogate for radiation exposure during fluoroscopy procedures. DAP and AK are more suitable markers to accurately gauge radiation exposure.

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