scholarly journals A minimally fluoroscopic approach in AVNRT ablation reduces radiation exposure and number of RF applications without compromising safety, effectiveness and procedural time

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Kasbari ◽  
B Robaye ◽  
F Dormal ◽  
E Ballant ◽  
B Collet ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Conventional Group ◽  
Complication Rates ◽  
Reduce Radiation Exposure ◽  
Acute Success ◽  
Procedural Time ◽  
Rf Applications ◽  
Safety Effectiveness ◽  
Mapping Systems

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency ablation (RF) of atrioventricular nodal reentry tachycardia (AVNRT) using conventional fluoroscopy is associated with a significant radiation exposure to both patients and operators. 3D electro-anatomical mapping systems (EAMS) can reduce radiation exposure, but specific clinical studies on their use in AVNRT ablation still lack. Purpose The aim of this study was to determine if EAMS use in AVNRT ablation can reduce radiation exposure and to analyse its effects on clinical and procedural outcomes. Methods We selected 277 patients who underwent AVNRT RF ablation in a single center in Belgium between July 2015 and November 2019 and performed a retrospective analysis of 136 and 141 patients who respectively and consecutively underwent AVNRT ablation with a conventional fluoroscopic approach (Conventional group) and a minimally fluoroscopic approach using a 3D electro-anatomical mapping system to guide the procedure (Minimal fluoroscopy group). Conventional fluoroscopy was used in both groups to confirm AVNRT induction to avoid costs related to the use of EAMS catheters in case of non-induction.  We compared radiation dose, acute success/complication rates, procedural time and the number/time of RF applications in both groups. Results Radiation dose in the minimal fluoroscopy group was significantly lower compared to the conventional group (1179 vs. 2686 mgray.cm2, p < 0,0001) and fluoroscopic time was shorter (2,5 vs. 8,6 minutes, p < 0,0001). Procedural time (70 vs. 69 min, p = NS) and acute success rate (99% vs. 98%, p = NS) were not significantly different in the minimal fluoroscopy group compared to the conventional group, and no complications were observed in both groups. The number of RF applications was significantly lower when EAMS was used (6,2 ± 4,8 vs. 8,6 ± 7,6 RF application, p = 0,01) while the RF application time was not significantly different (56,8 ± 51,2 1 vs. 65,3 ± 86 seconds, p = NS). Conclusion AVNRT catheter ablation using a minimally fluoroscopic approach with 3D electro-anatomical mapping systems reduces radiation exposure without compromising safety, effectiveness and procedural time. EAMS use is associated with a reduction in the number of RF applications suggesting a higher precision and stability of ablation catheters during RF application.

scholarly journals Efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH

2020 ◽  
Author(s):  
qiang shi ◽  
Deyi Sun
Keyword(s):  
Radiation Exposure ◽  
Corrective Osteotomy ◽  
Operation Time ◽  
Conventional Group ◽  
The Novel ◽  
Efficacy And Safety ◽  
Reduce Radiation Exposure ◽  
Surgical Methods ◽  
Significant Difference ◽  
Navigation Template

Abstract Background: This present study is aimed to retrospectively evaluate the efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH.Methods: Twenty-nine consecutive patients with DDH who underwent proximal femoral corrective osteotomy were evaluated between August 2013 and June 2017. Based on the different surgical methods, they were divided into the conventional group (n = 14) and navigation template group (n = 15). The osteotomy degrees, radiation exposure, and operation time were compared between the two groups.Results: No major complications relating to osteotomy surgery such as redislocation or avascular necrosis occurred in the navigation template group, which had more accurate osteotomy degrees, less radiation exposure, and shorter operation time when compared with the conventional group (P<0.05). Moreover, there was significant difference according to the McKay criteria between the two groups (P=0.0362).Conclusions: The novel personalized navigation template in proximal femoral corrective osteotomy is effective and safe, which could improve the femoral osteotomy accuracy, reduce radiation exposure, and shorten operation time.

Development of an Evaluation Tool of Radiation Dose Rate in Primary Containment Vessel for Hamaoka BWR Plants

2008 ◽  
Author(s):  
Hiromitsu Inagaki
Keyword(s):  
Radiation Dose ◽  
Water Chemistry ◽  
Radiation Exposure ◽  
Dose Rate ◽  
Rate Code ◽  
Evaluation Tool ◽  
Radiation Dose Rate ◽  
Reduce Radiation Exposure ◽  
Containment Vessel ◽  
Rate Evaluation

We are developing a radiation dose rate evaluation tool for work areas in the primary containment vessel (PCV) of the Hamaoka BWR plant in order to reduce radiation exposure to workers. The evaluation tool is composed of two calculation codes; a water chemistry code and a radiation dose rate code. The radiation dose rate calculates radiation maps of the work areas in the PCV of Hamaoka plant. We compared measured values with calculated values in order to improve the accuracy of the tool.

scholarly journals Efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH

2020 ◽  
Author(s):  
qiang shi ◽  
Deyi Sun
Keyword(s):  
Radiation Exposure ◽  
Corrective Osteotomy ◽  
Operation Time ◽  
Femoral Osteotomy ◽  
Conventional Group ◽  
Efficacy And Safety ◽  
Reduce Radiation Exposure ◽  
Surgical Methods ◽  
Significant Difference ◽  
Navigation Template

Abstract Background This present study is aimed to retrospectively evaluate the efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH.Methods Twenty-nine consecutive patients with DDH who underwent proximal femoral corrective osteotomy were evaluated between August 2013 and June 2017. Based on the different surgical methods, they were divided into the conventional group (n = 14) and navigation template group (n = 15). The osteotomy degrees, radiation exposure, and operation time were compared between the two groups.Results No major complications relating to osteotomy surgery such as redislocation or avascular necrosis occurred in the navigation template group, which had more accurate osteotomy degrees, less radiation exposure, and shorter operation time when compared with the conventional group (P < 0.05). Moreover, there was significant difference according to the McKay criteria between the two groups (P = 0.0362).Conclusions The a novel personalized navigation template in proximal femoral corrective osteotomy is effective and safe, which could improve the femoral osteotomy accuracy, reduce radiation exposure, and shorten operation time.

Sonography of Magnetically Controlled Growing Rods: A Quality Initiative in the Creation of a Multidisciplinary Clinic

2020 ◽  
Vol 36 (6) ◽  
pp. 520-528
Author(s):  
Monique C. Riemann ◽  
Smita S. Bailey ◽  
Nicholas Rubert ◽  
Craig E. Barnes ◽  
Judson W. Karlen
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Average Length ◽  
Imaging Data ◽  
Growing Rods ◽  
Reduce Radiation Exposure ◽  
Reduce Radiation Dose ◽  
The Difference ◽  
Magnetically Controlled Growing Rods ◽  
Dicom Imaging

Objective: The MAGEC (Magnetic Expansion Control) rods were introduced to a medical institution in 2015. The rod expansion procedures were initially evaluated with radiographs. The staff undertook a quality initiative to reduce radiation exposure by utilizing sonography. Material and Methods: The radiation dose for a typical visit was measured by examining DICOM imaging data, stored in PACS. Imaging visit time was determined from the difference between times of first radiograph/sonogram before distraction to last radiograph/sonogram after distraction. Results: The 21 patients (8 male, 13 female) were an average age of 11.4 ± 2.82 years (age at implant = 7.5 ± 1.94) when evaluated. The average length of time for a radiographic visit was 40.7 ± 20.7 minutes, whereas a sonography visit was 10.7 ± 3.7 minutes. Radiation dose per study visit prior to the introduction of the MAGEC clinic was 0.42 ± 0.39 mSv. Given an ideal patient schedule, the MAGEC clinic could reduce radiation dose by 1.3 to 2.5 mSv annually, with 95% confidence. Conclusion: This quality improvement study demonstrated a reduction in radiation exposure and imaging time. The added benefits were providing a successful multidisciplinary imaging clinic and creation of a new exam that aligned with the “ultrasound first” initiative.

scholarly journals Preoperative versus intraoperative image-guided localization of multiple ipsilateral lung nodules

2019 ◽  
Author(s):  
Yin-Kai Chao ◽  
Hsin-Yueh Fang ◽  
Kuang-Tse Pan ◽  
Chih-Tsung Wen ◽  
Ming-Ju Hsieh
Keyword(s):  
Radiation Exposure ◽  
General Anaesthesia ◽  
Cone Beam Ct ◽  
Operating Time ◽  
Pulmonary Nodules ◽  
Complication Rates ◽  
Navigation Systems ◽  
Ct Guided ◽  
Preoperative Ct ◽  
Procedural Time

Abstract OBJECTIVES Computed tomography (CT)-guided localization of multiple ipsilateral pulmonary nodules remains challenging. Hybrid operating rooms equipped with cone-beam CT and laser navigation systems have the potential for improving clinical workflows and patient outcomes. METHODS Patients with multiple ipsilateral pulmonary nodules requiring localization were divided according to the localization method [preoperative CT-guided (POCT group) localization versus intraoperative CT-guided (IOCT group) localization]. The 2 groups were compared in terms of procedural efficacy, safety and radiation exposure. RESULTS Patients in the IOCT (n = 12) and POCT (n = 42) groups did not differ in terms of demographic and tumour characteristics. Moreover, the success and complication rates were similar. Notably, the IOCT approach allowed multiple nodules to be almost simultaneously localized—resulting in a shorter procedural time [mean difference (MD) −15.83 min, 95% confidence interval (CI) −7.97 to −23.69 min] and lower radiation exposure (MD −15.59 mSv, 95% CI −7.76 to −23.42 mSv) compared with the POCT approach. However, the total time under general anaesthesia was significantly longer in the IOCT group (MD 34.96 min, 95% CI 1.48–68.42 min), despite a similar operating time. The excess time under anaesthesia in the IOCT group can be attributed not only to the procedure per se but also to a longer surgical preparation time (MD 21.63 min, 95% CI 10.07–33.19 min). CONCLUSIONS Compared with the POCT approach, IOCT-guided localization performed in a hybrid operating room is associated with a shorter procedural time and less radiation exposure, albeit at the expense of an increased time under general anaesthesia.

Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience

2020 ◽  
Vol 30 (9) ◽  
pp. 1266-1272
Author(s):  
Sevket Balli ◽  
Mehmet Kucuk
Keyword(s):  
Atrial Tachycardia ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Electroanatomic Mapping ◽  
Left Ventricular Ejection ◽  
Complication Rates ◽  
Acute Success ◽  
Focal Atrial Tachycardia ◽  
The Mean ◽  
Mapping Systems

AbstractObjective:Focal atrial tachycardia accounts for up to 10–15% of supraventricular tachycardiasubstrates in patients < 30 years. In this study, we aimed to demonstrate the outcome of transcatheter ablation procedures performed through three-dimensional electroanatomic mapping systems using minimal fluoroscopy in a paediatric cohort with focal atrial tachycardia.Methods:Forty-nine consecutive patients with focal atrial tachycardia who underwent an electrophysiologic study and a transcatheter ablation procedure in our hospital from September 2014 to February 2020 were included into the study.Results:The mean weight of the patients was 48.63 ± 15.4 kg, and the mean age was 14.56 ± 3.5 (5.5–18.4) years. The tachycardia was defined as incessant in 26 patients. Thirteen patients had left ventricular systolic dysfunction with a mean left ventricular ejection fraction of 38.47 ± 12.4% on echocardiography. The mean procedure time was 148.7 ± 94.5 minutes. Transseptal puncture and thus fluoroscopy were required in nine patients. The mean fluoroscopy time was 4.51 ± 5.9 minutes. No fluoroscopy was needed in ablations performed in the right atrium. The acute success rate of the ablation procedures was 97.9%. The mean follow-up period was 50.71 ± 23.5 months. Recurrence was noted in two patients (4.2%).Conclusion:The outcomes of three-dimensional electroanatomic mapping-guided transcatheter ablation procedures are promising with high acute success, low recurrence and complication rates in children with focal atrial tachycardia. The use of fluoroscopy can be significantly decreased with three-dimensional mapping systems in this group of patients.

Utilising electroanatomic mapping during ablation in patients with CHD to reduce radiation exposure

2021 ◽  
pp. 1-5
Author(s):  
Maryam Rahman ◽  
Jeremy P. Moore ◽  
John Papagiannis ◽  
Grace Smith ◽  
Chris Anderson ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Three Dimensional ◽  
Fluoroscopy Time ◽  
Electroanatomic Mapping ◽  
Complication Rates ◽  
Procedure Time ◽  
Reduce Radiation Exposure ◽  
Three Dimensional Mapping ◽  
Procedural Success

Abstract Background: Patients with CHD can be exposed to high levels of cumulative ionising radiation. Utilisation of electroanatomic mapping during catheter ablation leads to reduced radiation exposure in the general population but has not been well studied in patients with CHD. This study evaluated the radiation sparing benefit of using three-dimensional mapping in patients with CHD. Methods: Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy multi-institutional registry. Patients with CHD were selected. Those with previous ablations, concurrent diagnostic or interventional catheterisation and unknown arrhythmogenic foci were excluded. The control cohort was matched for operating physician, arrhythmia mechanism, arrhythmia location, weight and age. The procedure time, rate of fluoroscopy use, fluoroscopy time, procedural success, complications, and distribution of procedures per year were compared between the two groups. Results: Fifty-six patients with congenital heart disease and 56 matched patients without CHD were included. The mean total procedure time was significantly higher in patients with CHD (212.6 versus 169.5 minutes, p = 0.003). Their median total fluoroscopy time was 4.4 minutes (compared to 1.8 minutes), and their rate of fluoroscopy use was 23% (compared to 13%). The acute success and minor complication rates were similar and no major complications occurred. Conclusions: With the use of electroanatomic mapping during catheter ablation, fluoroscopy use can be reduced in patients with CHD. The majority of patients with CHD received zero fluoroscopy.

scholarly journals Reduction of radiation exposure to operating physician and assistant using a real-time auditory feedback dosimeter during femoral artery puncturing: a study on swine model

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Muhammad Umair Ahmad Khan ◽  
Byung-Ju Yi
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Real Time ◽  
Auditory Feedback ◽  
Swine Model ◽  
Radiation Measurement ◽  
Radiation Dose Rate ◽  
Left Hand ◽  
Body Side ◽  
Reduce Radiation Exposure

Abstract Background Real-time dosimeters may create a relatively safer environment not only for the patient but also for the physician and the assistant as well. We propose the use of a real-time radiation measurement dosimeter having auditory feedback to reduce radiation exposure. Methods Radiation dose rates were measured for 30 fluoroscopy-guided puncturing procedures of femoral arteries in swine. Fifteen puncturing procedures were performed with real-time radiation measurement dosimeter having auditory feedback and other 15 were performed without auditory feedback dosimeter by an interventional cardiologist with 10 years of experience. Results The left body side of the operating physician (38%, p < 0.001) and assistant (25%, p < 0.001) was more exposed as compared to the right body side. Radiation dose rate to the left hand, left arm and left leg were reduced from 0.96 ± 0.10 to 0.79 ± 0.12 mSv/h (17% reduction, p < 0.001), from 0.11 ± 0.02 to 0.07 ± 0.01 mSv/h (36% reduction, p < 0.001) and from 0.22 ± 0.06 to 0.15 ± 0.02 mSv/h (31% reduction, p < 0.001) with the use of auditory feedback dosimeter, respectively. The mean fluoroscopic time was reduced from 4.8 ± 0.43 min to 4.2 ± 0.53 min (p < 0.001). The success rate of performing arterial puncturing was 100%. Conclusions The use of auditory feedback dosimeter resulted in reduction in effective dose. The sound beep alerted the physician from the danger of exposure, and this approach induced awareness and protective mindset to the operating physician and assistant.

Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with “ALARA” principles profoundly lowers total dose

2014 ◽  
Vol 25 (5) ◽  
pp. 963-968 ◽  
Author(s):  
Robert H. Pass ◽  
Gregory G. Gates ◽  
Laura A. Gellis ◽  
Lynn Nappo ◽  
Scott R. Ceresnak
Keyword(s):  
Radiation Exposure ◽  
Supraventricular Tachycardia ◽  
Group Versus ◽  
Group 14 ◽  
Dose Area Product ◽  
Patient Demographics ◽  
Acute Success ◽  
Procedural Time ◽  
Area Product ◽  
Patient Radiation Exposure

AbstractBackground: “ALARA – As Low As Reasonably Achievable” protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose. Methods: From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2–3 frames/second), low fluoro dose/frame (6–18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with “fast anatomical mapping” (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols. Results: A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical–fluoroscopy technique. Conclusions: Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.

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