Exposure to Ionizing Radiation in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation

Villecourt, Aurélien; Faroux, Laurent; Blanpain, Thierry; Kinnel, Marine; Mora, C.; Tassan-Mangina, Sophie; Heroguelle, Virginie; Nazeyrollas, Pierre; Metz, Damien

doi:10.1016/j.amjcard.2019.09.028

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…During the TAVI procedure itself, patients are exposed to only 11% of the overall ED, whereas the CT scan accounts for 75% of the overall ED. 25 It is clinically important to reduce the radiation dose in TAVI-CT. Our present analyses revealed that using DLR can reduce the radiation dose by 28% for CCTA and 47% for aortoiliac CTA because the noise is inversely related to the square root of the tube current. 17,26 Deep learning reconstruction thus has the potential to reduce the radiation dose in TAVI-CT.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Deep Learning–Based Reconstruction for Low-Tube-Voltage CT Angiography for Transcatheter Aortic Valve Implantation

Kojima

Yamasaki²,

Matsuura³

et al. 2023

J Comput Assist Tomogr

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Objective The purpose of this study is to evaluate the efficacy of deep learning reconstruction (DLR) on low-tube-voltage computed tomographic angiography (CTA) for transcatheter aortic valve implantation (TAVI). Methods We enrolled 30 patients who underwent TAVI-CT on a 320-row CT scanner. Electrocardiogram-gated coronary CTA (CCTA) was performed at 100 kV, followed by nongated aortoiliac CTA at 80 kV using a single bolus of contrast material. We used hybrid-iterative reconstruction (HIR), model-based IR (MBIR), and DLR to reconstruct these images. The contrast-to-noise ratios (CNRs) were calculated. Five-point scales were used for the overall image quality analysis. The diameter of the aortic annulus was measured in each reconstructed image, and we compared the interobserver and intraobserver agreements. Results In the CCTA, the CNR and image quality score for DLR were significantly higher than those for HIR and MBIR (P < 0.01). In the aortoiliac CTA, the CNR for DLR was significantly higher than that for HIR (P < 0.01) and significantly lower than that for MBIR (P ≤ 0.02). The image quality score for DLR was significantly higher than that for HIR (P < 0.01). No significant differences were observed between the image quality scores for DLR and MBIR. The measured aortic annulus diameter had high interobserver and intraobserver agreement regardless of the reconstruction method (all intraclass correlation coefficients, >0.89). Conclusions In low tube voltage TAVI-CT, DLR provides higher image quality than HIR, and DLR provides higher image quality than MBIR in CCTA and is visually comparable to MBIR in aortoiliac CTA.

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Section: Discussionmentioning

confidence: 99%

The Feasibility of Deep Learning–Based Reconstruction for Low-Tube-Voltage CT Angiography for Transcatheter Aortic Valve Implantation

Kojima

Yamasaki²,

Matsuura³

et al. 2023

J Comput Assist Tomogr

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“…For our other safety outcomes, we did not identify any cases where an SDCT finding inappropriately altered clinical care and there were no other significant complications during the SDCT scan itself. Radiation dose from the SDCT (which included ECG‐gated imaging through most of the cardiac cycle) was relatively high, but comparable to other similar chest to pelvis imaging, such as transcatheter valve implantation 31,32 …”

Section: Discussionmentioning

confidence: 86%

Early head‐to‐pelvis computed tomography in out‐of‐hospital circulatory arrest without obvious etiology

Branch

Strote

Gunn

et al. 2021

Academic Emergency Medicine

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Objectives Patients resuscitated from an out‐of‐hospital circulatory arrest (OHCA) commonly present without an obvious etiology. We assessed the diagnostic capability and safety of early head‐to‐pelvis computed tomography (CT) imaging in such patients. Methods From November 2015 to February 2018, we enrolled 104 patients resuscitated from OHCA without obvious cause (idiopathic OHCA) to an early sudden‐death CT (SDCT) scan protocol within 6 h of hospital arrival. The SDCT protocol included a noncontrast CT head, an electrocardiogram‐gated cardiac and thoracic CT angiogram, and a nongated venous‐phase abdominopelvic CT angiogram. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate SDCT were excluded. Cardiac CT analyses were blinded, but other SDCT findings were clinically available. Primary endpoints were the number of OHCA causes identified by SDCT compared to the adjudicated cause and critical diagnoses identified by SDCT, including resuscitation complications. Safety endpoints were acute kidney injury (AKI) and inappropriate treatments based on SDCT findings. Acute coronary syndrome was the presumed etiology if any major coronary artery had a >50% stenosis without another OHCA cause. Results SDCT scans occurred within 1.9 ± 1.0 h of hospital arrival and identified 39% (41/104) of all OHCA causes and 95% (39/41) of causes potentially identifiable by SDCT. Critical findings were identified by SDCT in 98% (43/44) of patients that included potentially life‐threatening resuscitation complications of liver or spleen laceration (n = 6); pneumothorax or thoracic organ laceration (n = 8); and mediastinal, pericardial, or vascular hemorrhage (n = 3). SDCT exclusively identified 13 (13%) OHCA causes that would otherwise not be identified without SDCT imaging. No inappropriate treatments resulted from SDCT findings. AKI was common (28%) but only one (1%) patient required new dialysis. Conclusions This observational cohort study suggests that early SDCT scanning is safe, can expedite the diagnosis of potential causes, and can meaningfully change clinical management after idiopathic OHCA.

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“…Throughout the whole procedure, the patient receives radiation from the TAVI examination itself, pre-TAVI CT, and post-procedure intervention, with the majority of the dose arising from the CT examination. 10 As CT is a high-dose modality, dose evaluation and influencing factors should be considered, and based on the "as low as reasonably achievable" (ALARA) concept. 11,12 Both prospective and retrospective techniques, with a small padding window, or DSCT might be a better way to reduce patient dose in the pre-TAVI CT examination, which should be included in future studies.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Radiation Dose in Computed Tomography Angiography before Transcatheter Aortic Valve Implantation

Ritlumlert

Tweeatsani

Jongjirasiri

et al. 2022

J Health Sci Med Res

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Objective: To investigate the effective radiation dose and image quality of computed tomography angiography (CTA) before transcatheter aortic valve implantation (TAVI). Material and Methods: This study involved 65 participants, diagnosed with aortic valve stenosis and examined with CTA before TAVI. The total mAs, kVp, volume CT dose index (CTDIvol), and dose–length product (DLP) in each scanning phase were recorded. The effective dose was calculated by multiplying the DLP by the conversion coefficient (k=0.015 mSv/[mGy.cm]). For quantitative image analysis, circular regions of interest were placed on six levels of the aorta in the axial images. The CT attenuation value, image noise, signal-to-noise ratio, and contrast-to-noise ratio were measured. For qualitative analysis, two radiologists rated the image quality of the aortic root and aortoiliac pathway. Results: The mean CTDIvol and DLP were 23.59±5.19 mGy and 881.01±193.41 mGy.cm., respectively. The mean effective dose was 13.22±2.90 mSv; the whole-aorta CTA phase received the highest dose, followed by the coronary CTA and coronary artery calcium scoring phases (9.62±2.60, 2.44±1.13, and 1.16±0.55 mSv, respectively). Image quality ranged from good to excellent in all segments of the aorta. Conclusion: The mean effective radiation dose of the pre-TAVI CT examination using 256-multidetector CT was 22.91± 5.03 mSv. The image quality in the aorta was good to excellent. The main factors that affected the radiation dose were: body mass index, total mAs, and kVp.

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Exposure to Ionizing Radiation in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation

Cited by 6 publications

References 28 publications

The Feasibility of Deep Learning–Based Reconstruction for Low-Tube-Voltage CT Angiography for Transcatheter Aortic Valve Implantation

The Feasibility of Deep Learning–Based Reconstruction for Low-Tube-Voltage CT Angiography for Transcatheter Aortic Valve Implantation

Early head‐to‐pelvis computed tomography in out‐of‐hospital circulatory arrest without obvious etiology

Evaluation of Radiation Dose in Computed Tomography Angiography before Transcatheter Aortic Valve Implantation

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