Effective techniques for reduction of radiation dosage to patients undergoing invasive cardiac procedures

Kuon, Eberhard; Glaser, Carolina E.; Dahm, Johannes B.

doi:10.1259/bjr/82051842

Cited by 105 publications

(99 citation statements)

References 20 publications

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“…These means involve the use of protective shielding, maintaining the distance from the x-ray source and being mindful of the positioning of basic equipment, the limitation of the time of exposure, and optimization of the x-ray emission parameters (table 1) [4,8,25]. Data on x-ray optimization parameters (FR, resolution, exposure dose expressed as air kerma and DAP) are by default provided in all modern angiography equipment for radiation exposure monitoring in real time.…”

Section: Discussionmentioning

confidence: 99%

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

2016

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Ionizing radiation management is among the most important safety issues in interventional cardiology. Multiple radiation protection measures allow the minimization of x-ray exposure during interventional procedures.Our purpose was to assess the utilization and effectiveness of radiation protection and optim ization techniques among interventional cardiologists in Lithuania.Interventional cardiologists of five cardiac centres were interviewed by anonymized questionnaire, addressing personal use of protective garments, shielding, table/detector positioning, frame rate (FR), resolution, field of view adjustment and collimation. Effective patient doses were compared between operators who work with and without x-ray optimization.Thirty one (68.9%) out of 45 Lithuanian interventional cardiologists participated in the survey. Protective aprons were universally used, but not the thyroid collars; 35.5% (n = 11) operators use protective eyewear and 12.9% (n = 4) wear radio-protective caps; 83.9% (n = 26) use overhanging shields, 58.1% (n = 18)-portable barriers; 12.9% (n = 4)-abdominal patient's shielding; 35.5% (n = 11) work at a high table position; 87.1% (n = 27) keep an image intensifier/receiver close to the patient; 58.1% (n = 18) reduce the fluoroscopy FR; 6.5% (n = 2) reduce the fluoro image detail resolution; 83.9% (n = 26) use a 'store fluoro' option; 41.9% (N = 13) reduce magnification for catheter transit; 51.6% (n = 16) limit image magnification; and 35.5% (n = 11) use image collimation. Median effective patient doses Practical Matter Society for Radiological ProtectionOriginal content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI. were significantly lower with x-ray optimization techniques in both diagnostic and therapeutic interventions. Many of the ionizing radiation exposure reduction tools and techniques are underused by a considerable proportion of interventional cardiology operators. The application of basic radiation protection tools and techniques effectively reduces ionizing radiation exposure and should be routinely used in practice.

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Section: Discussionmentioning

confidence: 99%

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

2016

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“…For example, substantial dose reduction (both E and scatter) can be achieved by making active use of collimation, and ensuring that the fluoroscopy and fluorography frame rates (as well as the detector entrance dose rates in these modes) are as low as necessary for the clinical task [19,20]. Furthermore, scatter dose to the cardiologist can be significantly reduced through the use of appropriate personal protective equipment, as well as table-, floor-and ceiling-mounted operator shielding.…”

Section: Radiation Use Optimisation In Cardiac Angiographymentioning

confidence: 99%

Evaluation of coronary angiographic projections to balance the clinical yield with the radiation risk

Smith

Cameron²,

Mengersen³

et al. 2012

BJR

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Objective: Radiation safety principles dictate that imaging procedures should minimise the radiation risks involved, without compromising diagnostic performance. This study aims to define a core set of views that maximises clinical information yield for minimum radiation risk. Angiographers would supplement these views as clinically indicated. Methods: An algorithm was developed to combine published data detailing the quality of information derived for the major coronary artery segments through the use of a common set of views in angiography with data relating to the dose-area product and scatter radiation associated with these views. Results: The optimum view set for the left coronary system comprised four views: left anterior oblique (LAO) with cranial (Cr) tilt, shallow right anterior oblique (AP-RAO) with caudal (Ca) tilt, RAO with Ca tilt and AP-RAO with Cr tilt. For the right coronary system three views were identified: LAO with Cr tilt, RAO and AP-RAO with Cr tilt. An alternative left coronary view set including a left lateral achieved minimally superior efficiency (,5%), but with an ,8% higher radiation dose to the patient and 40% higher cardiologist dose. Conclusion: This algorithm identifies a core set of angiographic views that optimises the information yield and minimises radiation risk. This basic data set would be supplemented by additional clinically determined views selected by the angiographer for each case. The decision to use additional views for diagnostic angiography and interventions would be assisted by referencing a table of relative radiation doses for the views being considered.

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“…minimising the X-ray dose to the patient while preserving the quality of treatment), the use of low fluoroscopy pulse rate, image intensifier field size and collimation are recommended [1,12,13]. However, the studies that concluded that there was an impact on dose of some technical parameters had mostly used descriptive or univariate analyses and/or were carried out on a phantom [2,4,14,15]. Few studies have used multivariate methods to analyse the dose variation on patients' skin [13,16].…”

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confidence: 99%

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Journy

Sinno‐Tellier²,

Maccia³

et al. 2012

BJR

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Objective: The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. Methods: We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. Results: The mean MSD and DAP were respectively 389 mGy and 65 Gy cm 22 for CAs, and 916 mGy and 69 Gy cm 22 for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r50.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. Conclusion: Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions. Interventional cardiology procedures such as repeated diagnostic coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) may cause radio-induced skin damage. Deterministic skin effects might occur as soon as the dose to the patient's skin exceeds 2 Gy and might correspond to a range of lesions from erythema to necrosis [1]. In relation to the risk of skin lesions, the X-ray dose depends on clinical, therapeutic and technical factors. First of all, the dose to the patient increases with increasing body mass index (BMI) [1][2][3]. Second, dose, fluoroscopy time and number of cine frames might differ depending on the number of treated vessels and/or stenoses [4][5][6], localisation and severity of lesions [2,7], stage of occlusion [7,8], tortuosity of treated vessels [6][7][8], number of stents and balloons [2,4,[7][8][9], and artery approach [10,11]. With the aim of optimising the interventional cardiology procedures (i.e. minimising the X-ray dose to the patient while preserving the quality of treatment), the use of low fluoroscopy pulse rate, image intensifier field size and collimation are recommended [1,12,13]. However, the studies that concluded that there was an impact on dose of some technical parameters had mostly used descriptive or univariate analyses and/or were carried out on a phantom [2,...

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Effective techniques for reduction of radiation dosage to patients undergoing invasive cardiac procedures

Cited by 105 publications

References 20 publications

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

Evaluation of coronary angiographic projections to balance the clinical yield with the radiation risk

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

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