Abstract 17014: Getting to Zero: Impact of Electroanatomical Mapping on Fluoroscopy Use in Pediatric Catheter Ablation

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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Fluoroscopy time is not accurate as a surrogate for radiation exposure

Vascular ◽

10.1177/1708538117698342 ◽

2017 ◽

Vol 25 (5) ◽

pp. 466-471 ◽

Cited By ~ 5

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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The impact of the fluoroscopic view on radiation exposure in pelvic surgery: organ involvement, effective dose and the misleading concept of only measuring fluoroscopy time or the dose area product

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-03111-z ◽

2021 ◽

Author(s):

Hannes Kuttner ◽

Emanuel Benninger ◽

Valentin Fretz ◽

Christoph Meier

Keyword(s):

Radiation Exposure ◽

Effective Dose ◽

Organ Involvement ◽

Pelvic Surgery ◽

Fluoroscopy Time ◽

Dose Area Product ◽

Area Product ◽

The Impact

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Imaging Advances of the Cardiopulmonary System

Clinical Technologies ◽

10.4018/978-1-60960-561-2.ch812 ◽

2011 ◽

pp. 2183-2190

Author(s):

Holly Llobet ◽

Paul Llobet ◽

Michelle LaBrunda

Keyword(s):

Radiation Dose ◽

Radiation Exposure ◽

High Speed ◽

Imaging Techniques ◽

Radioactive Material ◽

Imaging Modalities ◽

Mri Imaging ◽

Imaging Technology ◽

Magnetic Resonance Imaging Mri ◽

Ct And Mri

A technological explosion has been revolutionizing imaging technology of the heart and lungs over the last decade. These advances have been transforming the health care industry, both preventative and acute care medicine. Ultrasound, nuclear medicine, computed tomography (CT), and magnetic resonance imaging (MRI) are examples of radiological techniques which have allowed for more accurate diagnosis and staging (determination of severity of disease). The most notable advances have occurred in CT and MRI. Most medical subspecialties rely on CT and MRI as the dominant diagnostic tools an exception being cardiology. CT and MRI are able to provide a detailed image of any organ or tissue in the body without the necessity of invasive or painful procedures. Virtually any individual could be tested as long as they are able to remain immobile for the duration of the study. Image generation traditionally has been limited by the perpetual motion of the human body. For example, the human heart is continually contracting and relaxing without a stationary moment during which an image could be obtained. Lung imaging has been more successful than cardiac imaging, but studies were limited to the length of time an ill person is able to hold his or her breath. Historically, imaging technology was limited by inability to take a picture fast enough of a moving object while maintaining a clinically useful level of resolution. Recent technologic innovation, resulting in high speed electrocardiogram- gated CT and MRI imaging, now allows the use of these imaging modalities for evaluation of the heart and lungs. These novel innovations provide clinicians with new tools for diagnosis and treatment of disease, but there are still unresolved issues, most notably radiation exposure. Ultrasound and MRI studies are the safest of the imaging modalities and subjects receive no radiation exposure. Nuclear studies give an approximate radiation dose of 10mSv and as high as 27mSv (Conti, 2005). In CT imaging, radiation dose can vary depending on the organ system being imaged and the type of scanner being used. The average radiation dose for pulmonary studies is 4.2mSv (Conti, 2005). The use of multi-detector CT (MDCT) to evaluate the heart can range from 6.7—13mSv. To put it into perspective, according to the National Institute of Health, an average individual will receive a radiation dose of 360mSv per year from the ambient environment. It is unlikely that the radiation doses received in routine imaging techniques will lead to adverse reactions such as cancer, but patients should be informed of the risks and benefits of each procedure so that they can make informed decisions. It is especially important that patients be informed when radioactive material is to be injected into their bodies. The reasons for this will be discussed later on in the chapter.

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The radiation doses and radiation protection on the endoscopic retrograde cholangiopancreatography procedures

British Journal of Radiology ◽

10.1259/bjr.20210399 ◽

2021 ◽

pp. 20210399

Author(s):

Mamoru Takenaka ◽

Makoto Hosono ◽

Shiro Hayashi ◽

Tsutomu Nishida ◽

Masatoshi Kudo

Keyword(s):

Radiation Dose ◽

Radiation Exposure ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Radiation Doses ◽

Average Dose ◽

Endoscopic Retrograde ◽

X Ray ◽

Endoscopic Procedures ◽

Dose Area Product ◽

Therapeutic Ercp

Although many interventions involving radiation exposure have been replaced to endoscopic procedure in the gastrointestinal and hepatobiliary fields, there remains no alternative for enteroscopy and endoscopic retrograde cholangiopancreatography (ERCP), which requires the use of radiation. In this review, we discuss the radiation doses and protective measures of endoscopic procedures, especially for ERCP. For the patient radiation dose, the average dose area product for diagnostic ERCP was 14–26 Gy.cm², while it increased to as high as 67–89 Gy.cm² for therapeutic ERCP. The corresponding entrance skin doses for diagnostic and therapeutic ERCP were 90 and 250 mGy, respectively. The mean effective doses were 3– 6 mSv for diagnostic ERCP and 12–20 mSv for therapeutic ERCP. For the occupational radiation dose, the typical doses were 94 μGy and 75 μGy for the eye and neck, respectively. However, with an over-couch-type X-ray unit, the eye and neck doses reached as high as 550 and 450 μGy, with maximal doses of up to 2.8 and 2.4 mGy/procedure, respectively. A protective lead shield was effective for an over couch X-ray tube unit. It lowered scattered radiation by up to 89.1% in a phantom study. In actual measurements, the radiation exposure of the endoscopist closest to the unit was reduced to approximately 12%. In conclusion, there is a clear need for raising awareness among medical personnel involved endoscopic procedures to minimise radiation risks to both the patients and staff.

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Analysis of Radiation Exposure during Endovascular Aneurysm Repair

The American Surgeon ◽

10.1177/000313481207801003 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1029-1032 ◽

Cited By ~ 3

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.

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Imaging Advances of the Cardiopulmonary System

Encyclopedia of Information Science and Technology, Second Edition ◽

10.4018/978-1-60566-026-4.ch287 ◽

2011 ◽

pp. 1824-1829

Author(s):

Holly Llobet ◽

Paul Llobet ◽

Michelle LaBrunda

Keyword(s):

Radiation Dose ◽

Radiation Exposure ◽

High Speed ◽

Imaging Techniques ◽

Radioactive Material ◽

Imaging Modalities ◽

Mri Imaging ◽

Imaging Technology ◽

Magnetic Resonance Imaging Mri ◽

Ct And Mri

A technological explosion has been revolutionizing imaging technology of the heart and lungs over the last decade. These advances have been transforming the health care industry, both preventative and acute care medicine. Ultrasound, nuclear medicine, computed tomography (CT), and magnetic resonance imaging (MRI) are examples of radiological techniques which have allowed for more accurate diagnosis and staging (determination of severity of disease). The most notable advances have occurred in CT and MRI. Most medical subspecialties rely on CT and MRI as the dominant diagnostic tools an exception being cardiology. CT and MRI are able to provide a detailed image of any organ or tissue in the body without the necessity of invasive or painful procedures. Virtually any individual could be tested as long as they are able to remain immobile for the duration of the study. Image generation traditionally has been limited by the perpetual motion of the human body. For example, the human heart is continually contracting and relaxing without a stationary moment during which an image could be obtained. Lung imaging has been more successful than cardiac imaging, but studies were limited to the length of time an ill person is able to hold his or her breath. Historically, imaging technology was limited by inability to take a picture fast enough of a moving object while maintaining a clinically useful level of resolution. Recent technologic innovation, resulting in high speed electrocardiogram- gated CT and MRI imaging, now allows the use of these imaging modalities for evaluation of the heart and lungs. These novel innovations provide clinicians with new tools for diagnosis and treatment of disease, but there are still unresolved issues, most notably radiation exposure. Ultrasound and MRI studies are the safest of the imaging modalities and subjects receive no radiation exposure. Nuclear studies give an approximate radiation dose of 10mSv and as high as 27mSv (Conti, 2005). In CT imaging, radiation dose can vary depending on the organ system being imaged and the type of scanner being used. The average radiation dose for pulmonary studies is 4.2mSv (Conti, 2005). The use of multi-detector CT (MDCT) to evaluate the heart can range from 6.7—13mSv. To put it into perspective, according to the National Institute of Health, an average individual will receive a radiation dose of 360mSv per year from the ambient environment. It is unlikely that the radiation doses received in routine imaging techniques will lead to adverse reactions such as cancer, but patients should be informed of the risks and benefits of each procedure so that they can make informed decisions. It is especially important that patients be informed when radioactive material is to be injected into their bodies. The reasons for this will be discussed later on in the chapter.

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Use of three-dimensional mapping in young patients decreases radiation exposure even without a goal of zero fluoroscopy

Cardiology in the Young ◽

10.1017/s1047951115002449 ◽

2015 ◽

Vol 26 (7) ◽

pp. 1297-1302 ◽

Cited By ~ 3

Author(s):

Cheyenne Beach ◽

Lee Beerman ◽

Sharon Mazzocco ◽

Maria M. Brooks ◽

Gaurav Arora

Keyword(s):

Radiation Exposure ◽

Three Dimensional ◽

Young Patients ◽

Fluoroscopy Time ◽

Complication Rates ◽

Three Dimensional Mapping ◽

Group 3 ◽

Group 2 ◽

Dimensional Mapping ◽

Zero Fluoroscopy

AbstractAt present, three-dimensional mapping is often used during cardiac ablations with an explicit goal of decreasing radiation exposure; three-dimensional mapping was introduced in our institution in 2007, but not specifically to decrease fluoroscopy time. We document fluoroscopy use and catheterisation times in this setting. Data were obtained retrospectively from patients who underwent ablation for atrioventricular nodal re-entrant tachycardia from January, 2004 to December, 2011. A total of 93 patients were included in the study. Among them, 18 patients who underwent radiofrequency ablation without three-dimensional mapping were included in Group 1, 13 patients who underwent cryoablation without three-dimensional mapping were included in Group 2, and 62 patients who underwent cryoablation with three-dimensional mapping were included in Group 3. Mean fluoroscopy times differed significantly (34.3, 23.4, and 20.3 minutes, p<0.001) when all the groups were compared. Group 3 had a shorter average fluoroscopy time that did not reach significance when compared directly with Group 2 (p=0.29). An unadjusted linear regression model showed a progressive decrease in fluoroscopy time (p=0.002). Mean total catheterisation times differed significantly (180, 211, and 210 minutes, p=0.02) and were related to increased ablation times inherent to cryoablation techniques. Acute success was achieved in 89, 100, and 97% of patients (p=0.25), and chronic success was achieved in 80, 92, and 93% of patients (p=0.38). Complication rates were similar (17, 23, and 7%, p=0.14). In conclusion, three-dimensional mapping systems decrease fluoroscopy times even without an explicit goal of zero fluoroscopy. Efficacy and safety of the procedure have not changed.

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Longitudinal Improvements in Radiation Exposure in Cardiac Catheterization for Congenital Heart Disease

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.119.008172 ◽

2020 ◽

Vol 13 (5) ◽

Cited By ~ 1

Author(s):

Brian P. Quinn ◽

Priscila Cevallos ◽

Aimee Armstrong ◽

David Balzer ◽

Howaida El-said ◽

...

Keyword(s):

Quality Improvement ◽

Radiation Dose ◽

Radiation Exposure ◽

Cardiac Catheterization ◽

Exposure Dose ◽

Dose Area Product ◽

Targeted Interventions ◽

Area Product ◽

Patient Radiation Exposure ◽

Percent Decrease

Background: The C3PO-QI (Congenital Cardiac Catheterization Project on Outcomes – Quality Improvement), a multicenter registry launched in 2015, instituted quality improvement (QI) initiatives to reduce patient radiation exposure. Through regular collaboration, this initiative would allow for harmony among active participants, maximizing efforts and efficiency at achieving radiation best practices. This study sought to report these efforts with a detailed methodology for which institutions can target initiatives, reducing radiation exposure, and increasing patient safety. Methods: Data were collected prospectively by 8 C3PO-QI institutions between January 1, 2015 and December 31, 2017. Radiation exposure was measured in dose area product per body weight (dose area product/kg; µGy*m 2 /kg) and reported by expected radiation exposure categories (REC) and institution for 40 published unique procedure types. Targeted interventions addressing selected strategic domains for radiation reduction were implemented in the pediatric catheterization labs of the C3PO-QI institutions. Results: The study consisted of 15 257 unique cases. Median exposure (dose area product/kg) was decreased by 30% for all procedures. Dose area product/kg was reduced in all 3 REC, with the greatest improvement observed in REC I (REC I, −37%; REC II, −23%; REC III, −27%). Although the baseline radiation exposures and exact percent decrease varied across all C3PO-QI sites, each institution demonstrated improvements in radiation dose over time. These improvements occurred with the implementation of institution-specific QI interventions accelerated by participation in the C3PO-QI multicenter collaborative. Conclusions: Substantial radiation dose reductions can be achieved using targeted QI methodology and interventions. Participation in a multicenter QI collaborative may accelerate improvement across all centers due to enhanced engagement and shared learning between sites.

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