Factors influencing fluoroscopy time and dose–area product values duringad hocone-vessel percutaneous coronary angioplasty

Abstract

X-ray exposure during radiologically guided interventional procedures may have some deleterious effects. The aim of our study was to analyse the factors affecting patient dose during percutaneous coronary angioplasty (PTCA). We evaluated radiation dose during coronary angiography followed by one-vessel PTCA in 402 consecutive patients who were treated by three experienced physicians using both femoral and radial techniques. Fluoroscopy time (t) and patient dose measured by a dose-area product (DAP) meter were recorded. A good correlation was observed between t and the DAP (r=0.78, p<0.001). To assess the factors affecting radiation exposure, we studied the differences between operators, arterial catheterization access and stenting strategy. Median (25th to 75th percentiles) values for t were 19 (13 to 26) min and for DAP were 191 (145 to 256) Gy cm(2) for operator 3 compared with t=12 (9 to 18) min and DAP=137 (91 to 208) Gy cm(2) for operator 2 (p<0.005 versus operator 3) and t=13 (9 to 17) min, and DAP=134 (93 to 190) Gy cm(2) for operator 1 (p<0.001 versus operator 3). Differences between the radial and the femoral techniques were: t=17 (13 to 24) min versus 12 (8 to 17) min, (p<0.001) and DAP=175 (128 to 246) Gy cm(2) versus 138 (93 to 197) Gy cm(2), (p<0.001). In comparison with stenting without pre-dilation, direct stenting significantly reduced t and DAP [t=12 (9 to 16) min versus 16 (11 to 22) min, (p<0.001) and DAP=130 (95 to 186) Gy cm(2) versus 163 (119 to 230) Gy cm(2), respectively, (p<0.01)]. Radiation exposure to patients and staff are strongly dependent on operators, stenting strategy and the arterial access chosen for ad hoc one-vessel PTCA.

Radiation exposure and patient experience during percutaneous coronary intervention using radial and femoral artery access

“…Vascular complications were more frequent for femoral access at 5.9% compared to 2.1% for radial access. Larrazet et al [18] report a higher DAP with radial access, median 175 Gy cm 2 compared to 138 for femoral access. Their study was not randomised and resulted in DAP values considerably higher than in the present study.…”

Operator Radiation Exposure During Percutaneous Coronary Procedures Through the Left or Right Radial Approach

“…Because some variables such as body mass index, the treatment of complex lesions, and the different angulation of the X-ray tube may have biased the radiation dose, [11][12][13] we also tested our hypothesis in 6 cases of simultaneous left and right radial cannulation during fluoroscopy in the anteroposterior position of the X-ray tube. In these cases, a snapshot evaluation of the radiation dose to the operator's left arm Radiation dose at the wrist was significantly higher compared with the rest of the body, but this difference was significant only in the right radial approach group.…”

Comparison of fluoroscopy time during coronary angiography and interventions by radial and femoral routes- can we decrease the fluoroscopy time with increased experience? An observational study

“…However, concerns have been raised about prolonged procedure time and increased radiation exposure to the operators by using radial route of access (4)(5)(6). Although, some studies have shown that with increasing operator experience radiation exposure can be minimized with transradial approach (TRA) and hence majority of radial operators assume that special radiation exposure precautions are unnecessary (7,8).…”