scholarly journals Non-Lead Protective Aprons for the Protection of Interventional Radiology Physicians from Radiation Exposure in Clinical Settings: An Initial Study

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1613
Author(s):  
Mamoru Kato ◽  
Koichi Chida ◽  
Masato Munehisa ◽  
Tadaya Sato ◽  
Yohei Inaba ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Radiation Protection ◽  
Clinical Setting ◽  
Coronary Intervention ◽  
Initial Study ◽  
Radiation Shielding ◽  
Shielding Effect ◽  
Clinical Settings ◽  
Percutaneous Coronary ◽  
Cardiac Catheterizations

Radiation protection/evaluation during interventional radiology (IVR) poses a very important problem. Although IVR physicians should wear protective aprons, the IVR physician may not tolerate wearing one for long procedures because protective aprons are generally heavy. In fact, orthopedic problems are increasingly reported in IVR physicians due to the strain of wearing heavy protective aprons during IVR. In recent years, non-Pb protective aprons (lighter weight, composite materials) have been developed. Although non-Pb protective aprons are more expensive than Pb protective aprons, the former aprons weigh less. However, whether the protective performance of non-Pb aprons is sufficient in the IVR clinical setting is unclear. This study compared the ability of non-Pb and Pb protective aprons (0.25- and 0.35-mm Pb-equivalents) to protect physicians from scatter radiation in a clinical setting (IVR, cardiac catheterizations, including percutaneous coronary intervention) using an electric personal dosimeter (EPD). For radiation measurements, physicians wore EPDs: One inside a personal protective apron at the chest, and one outside a personal protective apron at the chest. Physician comfort levels in each apron during procedures were also evaluated. As a result, performance (both the shielding effect (98.5%) and comfort (good)) of the non-Pb 0.35-mm-Pb-equivalent protective apron was good in the clinical setting. The radiation-shielding effects of the non-Pb 0.35-mm and Pb 0.35-mm-Pb-equivalent protective aprons were very similar. Therefore, non-Pb 0.35-mm Pb-equivalent protective aprons may be more suitable for providing radiation protection for IVR physicians because the shielding effect and comfort are both good in the clinical IVR setting. As non-Pb protective aprons are nontoxic and weigh less than Pb protective aprons, non-Pb protective aprons will be the preferred type for radiation protection of IVR staff, especially physicians.

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

scholarly journals High Incidence of Cataracts in the Follow-Up of Patients Undergoing Percutaneous Coronary Intervention for Chronic Coronary Total Occlusion

2021 ◽  
Vol 10 (21) ◽  
pp. 5002
Author(s):  
Ricardo Rivera-López ◽  
Celia García-López ◽  
José M. Sánchez-Moreno ◽  
Rafael A. Rivera-López ◽  
Julio Almansa-López ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Cox Regression ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Study Objective ◽  
Percutaneous Coronary ◽  
Cataract Development ◽  
Cardiac Catheterizations

Development of cataracts is a well-known adverse effect of ionizing radiation, but little information is available on their incidence in patients after other medical procedures, such as cardiac catheterizations. The study objective was to determine the incidence of cataracts in a cohort of patients undergoing percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) and its association with radiation dose. The study analyzed the incidence of cataracts during the follow-up of 126 patients who underwent chronic total coronary PCI, using Cox regression to identify predictive factors of cataract development. The study included 126 patients, 86.9% male, with a mean age of 60.5 years (range, 55.0–68.0 years). Twenty-three (18.2% n = 23) developed cataracts during a mean follow-up of 49.5 months (range 37.3–64.5 months). A higher incidence was observed in patients who received more than 5 Gy (29.0% vs. 14.7%, Hazard ratio (HR = 2.84 [1.19–6.77]). Multivariate analysis revealed a relationship between cataract development during the follow-up and a receipt of radiation dose >5 Gy (HR = 2.60, 95% confidence interval [CI 1.03–6.61]; p = 0.03), presence or history of predisposing eye disease (HR = 4.42, CI:1.57–12.40), diabetes (HR = 3.33 [1.22–9.24]), and older age, as in >57 (HR, 6.40 [1.81–22.61]). An elevated incidence of cataracts was observed in patients after PCI for CTO. The onset of cataracts is related to the radiation dose during catheterization, which is a potentially avoidable effect of which operators should be aware.

The ‘golden rules’ of percutaneous coronary intervention

2010 ◽  
pp. 81-87
Author(s):  
Rod H. Stables
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Adverse Events ◽  
Clinical Setting ◽  
Coronary Intervention ◽  
Therapeutic Options ◽  
Case Selection ◽  
Percutaneous Coronary ◽  
Core Concepts ◽  
Almost All ◽  
Educational Meetings

In the practice of percutaneous coronary intervention (PCI), the usual aim is to deliver maximum clinical gain—at the lowest possible risk—achievable in that specific clinical setting. Most interventionists will accept that PCI has established limitations. The enthusiasm to recommend and perform this form of therapy should be tempered in the light of this reality. Clinical gain can be real but is often modest. Performance can be associated with morbidity and mortality. Alternative therapeutic options exist and are effective. Other chapters in this textbook will seek to guide on case selection, to refine technique, and to provide an appreciation of available technologies and pharmacotherapy. I believe, however, that substantial improvements in both elements of the ‘risk:benefit’ ratio can be achieved with a re-examination and more universal application of some core, fundamental principles underpinning optimal PCI practice. A talk describing my ‘golden rules of PCI’ has been well-received, by trainees and experienced operators alike, at educational meetings over the last decade and most recipients come to accept my assertion that almost all procedure-related adverse events or suboptimal outcomes can be traced back to a breach of these core concepts.

scholarly journals Aspirin-free antiplatelet regimens after PCI: insights from the GLOBAL LEADERS trial and beyond

2021 ◽  
Author(s):  
Rutao Wang ◽  
Sijing Wu ◽  
Amr Gamal ◽  
Chao Gao ◽  
Hironori Hara ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Primary Treatment ◽  
Clinical Settings ◽  
P2y12 Inhibitors ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Clinical Benefits ◽  
Patient Groups ◽  
Artery Disease ◽  
Ischemic Events

Abstract Historically, aspirin has been the primary treatment for the prevention of ischemic events in patients with coronary artery disease. For patients undergoing percutaneous coronary intervention (PCI) standard treatment has been 12-months of dual anti-platelet therapy (DAPT) with aspirin and clopidogrel, followed by aspirin monotherapy; however, DAPT is undeniably associated with an increased risk of bleeding. For over a decade novel P2Y12 inhibitors, which have increased specificity, potency and efficacy have been available, prompting studies which have tested whether these newer agents can be used in aspirin-free anti-platelet regimens to augment clinical benefits in patients post-PCI. Among these studies, the GLOBAL LEADERS trial is the largest by cohort size, and so far has provided a wealth of evidence in a variety of clinical settings and patient groups. This article summarizes the state-of-the-art evidence obtained from the GLOBAL LEADERS and other trials of aspirin-free strategies.

scholarly journals The role of intracoronary imaging in acute coronary syndromes: OCT in focus

2017 ◽  
Vol 2016 (4) ◽  
Author(s):  
Ahmad Samir ◽  
Ahmed ElGuindy
Keyword(s):  
Acute Coronary Syndromes ◽  
Imaging Modality ◽  
Coronary Intervention ◽  
Underlying Mechanism ◽  
Clinical Settings ◽  
Intracoronary Imaging ◽  
Plaque Disruption ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Optical coherence tomography (OCT) has emerged as a powerful intravascular imaging modality in recent years. The introduction of frequency-domain OCT has simplified the procedure and enabled its safe utilisation in different clinical settings including acute coronary syndromes, where it can determine the mechanism of plaque disruption, thrombus burden, and guide percutaneous coronary intervention. In patients presenting with stent failure (stent thrombosis and instent restenosis), OCT can also be very useful in determining the underlying mechanism and guiding therapy thereafter. This article aims to review the role of OCT in acute coronary syndromes as well as its potential clinical applications. 

scholarly journals Radiation Reduction and Protection for Radiosensitive Organs (Lens, Thyroid, and Genital Organs) of Patients Receiving Percutaneous Coronary Intervention—Real-World Measurement of Radiation Dose in a Single Center

2021 ◽  
Vol 8 (8) ◽  
pp. 99
Author(s):  
Wen-Hwa Wang ◽  
Kai-Che Wei ◽  
Wei-Chun Huang ◽  
Yuan-Yin Yen ◽  
Guang-Yuan Mar
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Radiation Protection ◽  
Coronary Intervention ◽  
Frame Rate ◽  
Protective Equipment ◽  
Radiation Doses ◽  
Percutaneous Coronary ◽  
Radiosensitive Organs

Backgrounds: Reducing radiation exposure is the basic principle for performing percutaneous coronary intervention (PCI). Many studies have confirmed the effect of radiation protection for medical staff, but studies about the effectiveness of protection for patients and real measurement of radiation dose in patients’ specific organs are lacking. Aim: To measure the radiation doses absorbed by patients’ radiosensitive organs during PCI and the effectiveness of radiation protection. Methods: A total of 120 patients were included and allocated into three groups as the ratio of 1:1:2. A total of 30 patients received PCI at 15 frames rate per second (fps), 30 patients at 7.5 fps, and 60 patients wore radiation protective hat and glasses during PCI at 7.5 fps. The radiation doses were measured at right eyebrow (lens), neck (thyroid), back (skin), and inguinal area (genital organs) by using thermoluminescent dosimeters (TLDs). Results: Dose-area product (DAP) reduced by 58.8% (from 534,454 ± 344,660 to 220,352 ± 164,101 mGy·cm2, p < 0.001) after reducing the frame rate, without affecting successful rate of PCI. Radiation doses measured on skin, lens, genital organs, and thyroid decreased by 73.3%, 40.0%, 40.0%, and 35.3%, respectively (from 192.58 ± 349.45 to 51.10 ± 59.21; 5.29 ± 4.27 to 3.16 ± 2.73; 0.25 ± 0.15 to 0.15 ± 0.15; and 17.42 ± 12.11 to 11.27 ± 8.52 μSv, p < 0.05). By providing radiation protective equipment, radiation doses at lens and thyroid decreased further by 71.8% and 65.9% (from 3.16 ± 2.73 to 0.89 ± 0.79; 11.27 ± 8.52 to 3.84 ± 3.49 μSv, p < 0.05). Conclusions: By lowering the frame rate and providing protective equipment, radiation exposure in radiosensitive organs can be effectively reduced in patients.

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