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.

Abstract 188: Implementation of Choosing Wisely Recommendations for Stress-First Nuclear Myocardial Perfusion Imaging

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
David E Winchester ◽  
Randy Jeffrey ◽  
Carsten Schmalfuss ◽  
David C Wymer ◽  
Vicente Taasan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Perfusion Imaging ◽  
Radiation Dose ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Radiation Exposure ◽  
Perfusion Imaging ◽  
Coronary Intervention ◽  
Imaging Protocol ◽  
Percutaneous Coronary

Introduction: Current guidelines for myocardial perfusion imaging (MPI) encourage facilities to adopt patient-centered risk mitigation strategies such as individualized radiotracer dosing and stress-first imaging. Reducing radiation exposure is also a key recommendation of multiple societies participating in the Choosing Wisely campaign. The stated goal is for over 50% of studies to be performed with <9 millisieverts (mSv) of radiation exposure. We hypothesized that adoption of a stress-first/stress-only imaging protocol would substantially reduce the median radiation dose administered in our nuclear lab. Methods: We switched the standard imaging protocol at the Malcom Randall VA Medical Center nuclear cardiology laboratory from rest-stress to stress-rest. To achieve this, a physician was required to review the stress images at the time they were obtained to determine if further imaging was indicated. Estimated effective radiation doses (in mSv) were calculated based on the radiotracer activity administered (in millicuries) used industry standards techniques. We compared 2 cohorts of patients: rest-stress studies consecutively done between 7/17/17 and 11/12/17 and stress-first studies consecutively done between 11/13/17 and 5/17/17. As a balancing measure, we compared the rate of normal studies between the cohorts. A normal MPI was defined as no evidence of ischemia or infarction with a preserved ejection fraction. Results: In the stress-first cohort, the median dose was 2.8 millisieverts (mSv) compared with 14.1 mSv in the rest-stress cohort (80.1% reduction, p<0.0001). During the observed period, we estimate that 4,780 mSv of effective dose were avoided. In the rest-stress cohort, 424 studies were performed. In the stress-first cohort, 716 tests were performed, 423 stress only studies (59.1%) and 293 stress-rest studies (40.1%). The rate of normal studies in the stress-first cohort was not different from the rest-stress cohort (stress-first: 73.5%, (526/716) versus rest-stress: 71.7%, p=0.54, odds ratio 0.92, 95% CI 0.69-1.21) In the rest-stress cohort, 3 patients (1.0%) underwent coronary angiography and 2 patients (0.7%) underwent percutaneous coronary intervention (PCI). In the stress-first cohort 8 patients (1.1%) underwent coronary angiography and 2 patient (0.3%) underwent percutaneous coronary intervention (PCI). Conclusion: By switching from a rest-stress to a stress-first imaging protocol, we reduced the median radiation dose in our lab by 80%. We observed no change in the proportion of normal tests, suggesting no potential for harm with this strategy.

scholarly journals Radiation Exposure Reduction and Patient Outcome by Using Very Low Frame Rate Fluoroscopy Protocol (3.8 + 7.5 fps) During Percutaneous Coronary Intervention

2021 ◽  
Vol 8 ◽  
Author(s):  
Ankush Gupta ◽  
Sanya Chhikara ◽  
Rajesh Vijayvergiya ◽  
Parag Barwad ◽  
Krishna Prasad ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Exposure ◽  
Retrospective Cohort ◽  
Coronary Intervention ◽  
Frame Rate ◽  
Cardiac Events ◽  
Air Kerma ◽  
Guide Catheter ◽  
Percutaneous Coronary ◽  
Low Frame Rate

Objectives: In this study, we intend to analyze the feasibility and efficacy of very low frame rate fluoroscopy (VLFF) protocol using a combination of 3.8 and 7.5 fps while performing Percutaneous Coronary Intervention (PCI).Methods: A retrospective cohort including 193 patients undergoing PCI under the VLFF protocol (Post-VLFF group) was compared with a retrospective cohort of 133 patients, who underwent PCI prior to implementation of VLFF protocol (Pre-VLFF group). In the Pre-VLFF group, all PCIs were performed using fluoroscopy frame rate of 15 fps. In the Post-VLFF group, 3.8 fps was used to guide catheter engagement, coronary lesion wiring, pre-and post-dilation, and 7.5 fps was used for lesion assessment and stent placement. Increasing use of fluoroscopic storage in place of cineangiography was also encouraged. Cine acquisition in both groups was performed at 15 fps. Primary endpoint was radiation exposure measured by Air Kerma. Secondary endpoints were procedure related outcomes and patient related outcomes (Major Adverse Cardiac Events including all-cause mortality, Target Lesion Failure, Myocardial Infarction, and Stroke).RESULTS: Post-VLFF group showed 74.7% reduction in Air Kerma as compared to Pre-VLFF group (433 ± 27 mGy vs. 1,714 ± 140 mGy; p &lt; 0.0001), with no increase in the fluoroscopy time (15.38 ± 0.98 min Post-VLFF vs. 17.06 ± 1.29 min Pre-VLFF; p = 0.529) and contrast volume (116.5 ± 4.9 ml Post-VLFF vs. 116.7 ± 6 ml Pre-VLFF; p = 0.700). Both groups had comparable procedural success and complications rates as well as incidence of MACE.Conclusions: The very low frame rate fluoroscopy protocol is a feasible, effective, and safe method to significantly reduce the radiation exposure during PCI without any compromise on procedural and patient outcomes.

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.

scholarly journals Percutaneous Coronary Intervention in Pregnancy: Modeling of the Fetal Absorbed Dose

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Kfier Kuba ◽  
Diana Wolfe ◽  
Alan H. Schoenfeld ◽  
Anna E. Bortnick
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Absorbed Dose ◽  
Coronary Intervention ◽  
Cardiac Procedures ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Absorbed Radiation Dose ◽  
In Pregnancy

There is a gap in the literature regarding fetal radiation exposure from interventional cardiac procedures. With an increasingly large and complex cohort of pregnant cardiac patients, it is necessary to evaluate the safety of invasive cardiac procedures and interventions in this population. Here we present a case of a patient with multiple medical comorbidities and non-ST elevation myocardial infarction (NSTEMI) at 15 weeks’ gestation, managed with percutaneous coronary intervention (PCI). We were able to minimize the maternal and estimated fetal absorbed radiation dose to <1 milliGray (mGy), significantly less than the threshold dose for fetal adverse effects at this gestational age.

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