Establishing a priori and a posteriori predictive models to assess patients’ peak skin dose in interventional cardiology. Part 2: results of the VERIDIC project

2021 ◽  
pp. 028418512110620
Author(s):  
Joelle Ann Feghali ◽  
Julie Delépierre ◽  
Olivera Ciraj Belac ◽  
Jérémie Dabin ◽  
Marine Deleu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Predictive Models ◽  
A Priori ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Skin Dose ◽  
A Posteriori ◽  
Tube Voltage ◽  
Percutaneous Coronary ◽  
Peak Skin Dose

Background Optimizing patient exposure in interventional cardiology is key to avoid skin injuries. Purpose To establish predictive models of peak skin dose (PSD) during percutaneous coronary intervention (PCI), chronic total occlusion percutaneous coronary intervention (CTO), and transcatheter aortic valve implantation (TAVI) procedures. Material and Methods A total of 534 PCI, 219 CTO, and 209 TAVI were collected from 12 hospitals in eight European countries. Independent associations between PSD and clinical and technical dose determinants were examined for those procedures using multivariate statistical analysis. A priori and a posteriori predictive models were built using stepwise multiple linear regressions. A fourfold cross-validation was performed, and models’ performance was evaluated using the root mean square error (RMSE), mean absolute percentage error (MAPE), coefficient of determination (R²), and linear correlation coefficient (r). Results Multivariate analysis proved technical parameters to overweight clinical complexity indices with PSD mainly affected by fluoroscopy time, tube voltage, tube current, distance to detector, and tube angulation for PCI. For CTO, these were body mass index, tube voltage, and fluoroscopy contribution. For TAVI, these parameters were sex, fluoroscopy time, tube voltage, and cine acquisitions. When benchmarking the predictive models, the correlation coefficients were r = 0.45 for the a priori model and r = 0.89 for the a posteriori model for PCI. These were 0.44 and 0.67, respectively, for the CTO a priori and a posteriori models, and 0.58 and 0.74, respectively, for the TAVI a priori and a posteriori models. Conclusion A priori predictive models can help operators estimate the PSD before performing the intervention while a posteriori models are more accurate estimates and can be useful in the absence of skin dose mapping solutions

RADIATION DOSE TO PATIENTS IN CORONARY INTERVENTIONAL PROCEDURES: A SURVEY

2018 ◽  
Vol 184 (1) ◽  
pp. 1-4 ◽  
Author(s):  
A Brindhaban
Keyword(s):  
Interventional Procedures ◽  
Coronary Intervention ◽  
Skin Dose ◽  
Radiation Doses ◽  
Dose Area Product ◽  
Maximum Value ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Area Product ◽  
Peak Skin Dose

Abstract The objective of this study was to evaluate dose–area product (DAP) and peak skin dose (PSD) for coronary angiography (CA) and percutaneous coronary intervention (PCI). The DAP and PSD of 300 randomly selected patients who were referred to CA and/or PCI, over a period of 3 months were recorded and analyzed. The mean DAP of 32 Gy cm2 and mean PSD of 412 mGy for CA were lower than 118 Gy cm2 and 857 mGy, respectively, for PCI. The DAP range of 2–84 Gy cm2 for CA and 12–378 mGy for PCI were also established. The maximum value of PSD for PCI procedures reached above the 2 Gy threshold for erythema. However, these values are similar to those available in literature. Periodic surveys may be required to monitor and/or reduce radiation doses in coronary interventional procedures.

AN ASSESSMENT OF RADIATION EXPOSURE DOSES IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION BASED ON ANGIOGRAPHIC RECORDS

2018 ◽  
Vol 183 (4) ◽  
pp. 475-482 ◽  
Author(s):  
M Maghbool ◽  
M A Hosseini
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Primary Percutaneous Coronary Intervention ◽  
Standard Dose ◽  
Coronary Intervention ◽  
Skin Dose ◽  
Dose Area Product ◽  
Percutaneous Coronary ◽  
Using Data ◽  
Area Product

Abstract The stochastic and non-stochastic (deterministic) effects of radiation dose in patients undergoing primary percutaneous coronary intervention (PPCI) have been investigated using data recorded by an angiographic monitoring system. A total of 132 patients with acute myocardial infarction referred to the angiography department of Vali-Asr hospital, Fasa, Iran, during the second half of 2016 were recruited. Quantities like dose–area product (DAP), total air kerma (Ka,r) and fluoroscopy time (FT) were calculated and converted into effective dose (ED) and peak skin dose (PSD). The values for Ka,r, DAP and FT equaled 80 399.20 ± 63 312 mGy cm2, 1392.80 ± 1155.373 mGy and 524.11 ± 423.057 s, respectively, which were within the ranges reported in previous studies. After considering standard dose thresholds for Ka,r and PSD, it was revealed that only a small portion of patients had reached these thresholds and exceeded them (<3%). Moreover, ED < 20 mSv for the majority of patients was fairly consistent with results from a recent research in eight Belgian hospitals. It was shown that angiographic records are reliable for assessing radiation dose in patients.

The ‘golden rules’ of percutaneous coronary intervention

2018 ◽  
pp. 75-80
Author(s):  
Rod Stables
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Adverse Events ◽  
Personal Experience ◽  
Best Practice ◽  
Systematic Approach ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Strategic Approach ◽  
Percutaneous Coronary ◽  
Core Concepts

This chapter identifies general principles for the practice of interventional cardiology. The focus is on general strategic approach and the exposition of core concepts rather than details of equipment selection and manipulation. Although framed for percutaneous coronary intervention, the philosophy will translate to all forms of interventional cardiology. In contemporary activity adverse events are fortunately rare and it is very difficult for an individual operator to identify ‘best practice’ on the basis of personal experience and individual reflection. These ‘golden rules’ are based on lessons, sometimes learned at cost to patients and operators, over three decades. Knowledge of these issues and a more systematic approach may provide a framework for safe and effective practice.

scholarly journals Percutaneous Coronary Intervention in Chronic Total Occlusion - In Hospital Outcome

1970 ◽  
Vol 1 (2) ◽  
pp. 156-160
Author(s):  
N Kar ◽  
M Ullah ◽  
PK Karmakar ◽  
AEM Mazharul Islam ◽  
AQM Reza ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Chronic Stable Angina ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Hospital Outcome ◽  
Number Of Patients ◽  
Percutaneous Coronary ◽  
Cardiac Catheterizations

Background- Although a total coronary occlusion is identified approximately in one third of the diagnostic cardiac catheterizations, still an attempted revascularization of total occlusion accounts for less than 8% of all percutaneous coronary interventions (PCI). Percutaneous Coronary Intervention (PCI) of chronic total occlusion (CTO) is one of the major challenges in interventional cardiology. It is now an well-accepted revascularization procedure.  Methods: It was a prospective observational study conducted in National Institute of Cardiovascular Diseases, Dhaka, from July 2004 to June 2005. 50 consecutive patients with chronic total occlusion undergoing PCI were included in the study. Patients were observed during procedure and during the hospital stay. Result: The mean age of the patients was 46.7 ± 9.3 and 48.0% were in the age range of 45-54 years. 24 patients had post MI angina, 20 patients had chronic stable angina and 6 patients had unstable angina. Technical success was in 98% cases and procedural success was in 94% cases. One patient developed vessel perforation and was treated by prolonged balloon inflation. There was no death or STEMI and only 2 patients developed NSTEMI. Conclusion: In our study with the use of available facilities PCI in CTOs was possible with a high success rate. But dealing of more complicated lesion will require more improved technology and hardware. A study with larger number of patients and longer duration of follow up to determine the efficacy of the procedure in improving morbidity and mortality is needed. Keywords : Chronic total occlusion; Percutaneous Coronary Intervention; In hospital outcome DOI: http://dx.doi.org/10.3329/cardio.v1i2.8122 Cardiovasc. j. 2009; 1(2) : 156-160

Influence of the target vessel on the location and area of maximum skin dose during percutaneous coronary intervention

2007 ◽  
Vol 48 (8) ◽  
pp. 846-850 ◽  
Author(s):  
K. Chida ◽  
K. Fuda ◽  
Y. Kagaya ◽  
H. Saito ◽  
Y. Takai ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Heart Association ◽  
Coronary Intervention ◽  
Field Size ◽  
Skin Dose ◽  
Skin Injury ◽  
Mapping Software ◽  
Percutaneous Coronary ◽  
Dose Mapping ◽  
The Right

Background: A number of cases involving radiation-associated patient skin injury attributable to percutaneous coronary intervention (PCI) have been reported. Knowledge of the location and area of the patient's maximum skin dose (MSD) in PCI is necessary to reduce the risk of skin injury. Purpose: To determine the location and area of the MSD in PCI, and separately analyze the effects of different target vessels. Material and Methods: 197 consecutive PCI procedures were studied, and the location and area of the MSD were calculated by a skin-dose mapping software program: Caregraph. The target vessels of the PCI procedures were divided into four groups based on the American Heart Association (AHA) classification. Results: The sites of the MSD for AHA #1–3, AHA #4, and AHA #11–15 were located mainly on the right back skin, the lower right or center back skin, and the upper back skin areas, respectively, whereas the MSD sites for the AHA #5–10 PCI were widely spread. The MSD area for the AHA #4 PCI was larger than that for the AHA #11–15 PCI ( P<0.0001). Conclusion: Although the radiation associated with PCI can be widely spread and variable, we observed a tendency regarding the location and area of the MSD when we separately analyzed the data for different target vessels. We recommend the use of a smaller radiation field size and the elimination of overlapping fields during PCI.

Robotic percutaneous coronary intervention

2018 ◽  
pp. 731-736
Author(s):  
Giora Weisz
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Patient Safety ◽  
Remote Control ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Navigation Systems ◽  
Safety And Efficacy ◽  
New Era ◽  
Percutaneous Coronary ◽  
Orthopaedic Injuries

Percutaneous coronary intervention (PCI) has seen steady technological progress over the past four decades. Despite improved patient safety and efficacy, modern interventionalists continue to face significant occupational hazards, including radiation exposure, cataracts, and orthopaedic injuries. Robotic remote navigation systems have been developed to address the risks and procedural challenges associated with conventional PCI. The development of novel robotic remote control navigation systems represents the dawn of a new era of interventional cardiology.

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