Effects of Radiation Exposure From Cardiac Imaging

Einstein, Andrew J.

doi:10.1016/j.jacc.2011.08.079

Cited by 197 publications

(120 citation statements)

References 58 publications

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“…The mean reported x-ray exposure doses to patients during diagnostic and therapeutic interventional procedures exhibit tremendous variability between sites and between studies [12,13]. Data regarding patient exposure during interventional procedures (CA, CA + PCI) of our study fall within the reported range of average doses provided in the literature.…”

Section: Discussionsupporting

confidence: 54%

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: Discussionsupporting

confidence: 54%

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

2016

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“…18 More than 10% of the entire U.S. population radiation burden was related to MPI. 19 Half of all nuclear medicine procedures and quarter of all X-ray studies worldwide are performed in U.S. which has 5% of world population. 20 Representative effective dose values of Tl-201 stress/rest study is the highest (25 mSv) followed by Tc-99m sestamibi one-day stress/ rest (10 mSv) and N-13 ammonia stress/rest (3 mSv).…”

Section: Radiation Dose Reductionmentioning

confidence: 99%

The tools are ready, are we?

Cho

Jabin

Lee

et al. 2019

Journal of Nuclear Cardiology

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In this issue of the Journal of Nuclear Cardiology, Lee and colleagues elegantly review the recent advances in the instrumentations for nuclear cardiac imaging. 1 Solid-state radiation detectors incorporating cadmium zinc telluride (CZT) become the detector of choice for dedicated cardiac imaging systems. CZT single-photon emission computed tomography (SPECT) has improved image quality and shortened acquisition time of myocardial perfusion imaging (MPI) thanks to its direct energy conversion mechanism, narrow energy resolution, and pixelated nature of electrical circuit. The measurement of absolute myocardial blood flow (MBF) as well as coronary flow reserve (CFR) using CZT SPECT is now under active investigation and is showing clinical feasibility. Multimodality imaging systems which hybridized SPECT and positron emission tomography (PET) with CT widened clinical application of cardiac imaging studies. Quantitative SPECT/CT provides additive information of coronary calcium burden, attenuation correction for both visual and quantitative assessment of myocardial perfusion, and enables quantification of myocardial blood flow and flow reserve. Cardiac PET is also an active progress. Adoption of silicon photomultipliers (SiPMs) leads to enhancements in image quality and count rates. The application of accurate time-of-flight (TOF) information reduced emission-transmission mismatch artifacts. Information of the extracted coronary arteries from CT angiography allows non-linear motion correction of PET plaque images. Replacement of photomultiplier tubes with semiconductor photosensors such as the avalanche photodiode (APD) and SiPM has made it possible to integrate PET with magnetic resonance (MR). PET/MR system is now clinically available in hybrid as well as parallel camera structure.The recently introduced nuclear cardiac imaging tools are ready to provide more information in better quality than ever before. It is fair to question whether we are ready to apply these tools in clinical fields. There are challenges to overcome before we can use the state-ofthe-art imaging tools. MEASUREMENT OF MBF AND CFRSeveral studies showed clinical feasibility of measuring MBF and CFR by dynamic image acquisition using Tc-99m sestamibi and CZT SPECT/CT cameras. 2,3 It does not directly mean that it can be accepted as a clinical tool in daily practice. Measuring MBF and CFR by cardiac PET is a mature technology but is not widely used in clinics. Several obstacles are noted. 4 First of all, resting MBF is variable according to hemodynamic and metabolic changes. MBF and CFR cannot differentiate epicardial obstructive and microvascular diseases or provide anatomical localization of coronary obstruction. The complex interplay among different MBF parameters has not been fully unveiled. Different MBF parameters stand for different coronary pathophysiologies, and are not interchangeable. 5 For example, a relative MBF ratio namely relative flow reserve (RFR) could be more suitable for the diagnosis of focal significant coronary stenosis in ...

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“…Thus, SPECT is by far the most popular technique, with over 7 million scans performed in the U.S. annually. 9 SPECT MPI is, however, limited to visual analysis or, at most, relative perfusion quantification. 10 Even if PET MPI is performed, flow quantification is not always obtained, since it may require the latest PET/CT equipment with high count rate capability and specialized software.…”

Section: Why Is Flow Quantification Not Widely Used?mentioning

confidence: 99%