Background:
Consistent with the increasing prevalence of obesity in the general population, obesity has become more prevalent among patients undergoing cardiac catheterization. This study evaluated the association between patient body mass index (BMI) and physician radiation dose during coronary angiography.
Methods and Results:
Real-time radiation exposure data were collected during consecutive coronary angiography procedures. Patient radiation dose was estimated using dose area product. Physician radiation dose in each case was recorded by a dosimeter worn by the physician and is reported as the personal dose equivalent (H
p
10). Patient BMI was categorized as <25.0, 25.0 to 29.9, 30.0 to 34.9, 35.0 to 39.9, and ≥40. Among 1119 coronary angiography procedures, significant increases in dose area product and physician radiation dose were observed across increasing patient BMI categories (
P
<0.001). Compared with a BMI <25, a patient BMI ≥40 was associated with a 2.1-fold increase in patient radiation dose (dose area product, 91.8 [59.6–149.2] versus 44.5 [25.7–70.3] Gy×cm
2
;
P
<0.001) and a 7.0-fold increase in physician radiation dose (1.4 [0.2–7.1] versus 0.2 [0.0–2.9] μSv;
P
<0.001). By multiple regression analysis, patient BMI remained independently associated with physician radiation dose (dose increase, 5.2% per unit increase in BMI; 95% CI, 3.0%–7.5%;
P
<0.0001).
Conclusions:
Among coronary angiography procedures, increasing patient BMI was associated with a significant increase in physician radiation dose. Additional studies are needed to determine whether patient obesity might have adverse effects on physicians, in the form of increased radiation doses during coronary angiography.
The relatively simple approach of using accessory lead shields to protect staff members during cardiac catheterization was associated with a nearly two-thirds reduction in radiation exposure among nurses and technologists.
Objective: This study evaluated the impact of network latency on telestenting performance.Background: The feasibility of long-distance robotic telestenting was recently demonstrated, yet the impact of network performance on telestenting remains unknown.Methods: Ex vivo and in vivo telestenting models were constructed by connecting a robotic drive over a wired network to a robotic control system up to 103 miles away.During consecutive attempts to robotically wire a coronary artery, investigators randomly added signal latencies from 0 to 1,000 ms. Outcomes included wiring success, wiring time (time to advance wire to preselected target landmark), and perceived latency score (5 = imperceptible; 4 = noticeable but minor; 3 = noticeable; 2 = noticeable and major; 1 = unacceptable).
Results:Wiring success was achieved in 95 of 95 attempts in the ex vivo model and in 57 of 57 attempts in vivo. No significant difference in wiring time was observed across added latencies from 0 to 1,000 ms in the ex vivo (p = .64) or in vivo (p = .40) models. Compared to an added latency of 0 ms, perceived latency scores were not significantly different for added latencies of 150 and 250 ms (p = NS for both), but were significantly lower for latencies ≥400 ms (p < .001).Conclusions: Added latencies up to 250 ms were not associated with perceived latency, but latencies ≥400 ms were perceptible. Based on these findings, future telestenting studies should utilize networks with latencies ≤250 ms if perceived latency is to be avoided.
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