Fluoroscopy pulse rate reduction during diagnostic and therapeutic imaging in the cardiac catheterization laboratory: An evaluation of radiation dose, procedure complications and outcomes

Hansen, James; Foy, Andrew; Schmidt, Torrey; Ghahramani, Mehrdad; Chambers, Charles E.

doi:10.1002/ccd.26555

Cited by 13 publications

(2 citation statements)

References 15 publications

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“…In addition, Sadamatsu et al [20] described that a change in the frame rate from 15 f/s to 7.5 f/s for fluoroscopy could significantly reduce AK (701.4 ± 427.9 mGy vs. 936.8 ± 623.9 mGy; p=0.02). Moreover, Hansen et al [21] found that when the frame rate was decreased from 10 to 7.5 f/s during the PCI procedure, AK significantly reduced (703.0 vs. 621.0; p=0.041). There was no difference between the two groups with regard to complications and MACE at 30 days and 6 months.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Dose Management Protocol in the Cardiac Catheterization Laboratory: Evaluating the Effects of Reducing Frame Rate and Cine Dose Together for Angiography

Jin¹,

Li²,

Zhu³

et al. 2018

Angiol

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Background: Although radiation is beneficial for invasive procedures, it can be harmful. Several factors such as equipment settings, patient characteristics, and a physician's procedure affect the dose of such radiations. Here we aimed to evaluate the X-ray dose and image quality after reducing both the default rate (frames per second: f/s) and cine exposure dose for coronary angiography. Methods: The study retrospectively reviewed 215 patients who underwent with a standard frame rate and standard cine dose (15 f/s and 0.200 μGy/fr) or a low frame rate and low cine dose (7.5 f/s and 0.120 μGy/fr, referred to as dose management protocol: DMP group). All the patients were performed diagnostic angiogram without additional therapy. The primary endpoint was total air kerma (AK; mGy), and the secondary endpoints were radiation time, contrast volume, procedure complication rate, and a 10-point scale to assess the image quality. Results: There were no differences with regard to baseline demographics and risk factors between both the groups. Total X-ray dose was significantly low in the DMP group compared with the standard group (181.4 mGy vs. 352.7 mGy; p<0.01). There were no differences with respect to radiation time, contrast volume, and complication rate between both the groups. The diagnostic value in the DMP group was not inferior to that in the standard group (8.79 ± 1.05 vs. 8.91 ± 0.91; p=0.37). Conclusions: Our innovative alteration of reducing both the frame rate and cine dose for angiography can dramatically decrease the total AK without sacrificing image quality.

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Section: Discussionmentioning

confidence: 99%

Utilization of Dose Management Protocol in the Cardiac Catheterization Laboratory: Evaluating the Effects of Reducing Frame Rate and Cine Dose Together for Angiography

Jin¹,

Li²,

Zhu³

et al. 2018

Angiol

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“…A study on cardiac catheterization showed reducing fluoroscopy pulse rate from 10 frame/second (f/s) to 7.5 f/s can reduce radiation dose by 21%. 59 A study on carotid artery stenting showed that a reduction of pulse rate from 7.5 to 4 f/s reduced radiation dose by about 51%, with no increase in procedure complication. 60 Operators should find out the minimal pulse rate appropriate for the specific procedure and provide training to staff.…”

Section: X-ray Positioning and Modesmentioning

confidence: 99%

Occupational hazard of fluoroscopy: An invisible threat to orthopaedic surgeons

Wan

Chau

Tso

et al. 2021

Journal of Orthopaedics, Trauma and Rehabilitation

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The use of fluoroscopy is widespread within different medical specialties. Improper protection may cause significant radiation hazard to medical personnel. To evaluate the concepts on radiation safety and fluoroscopy use among orthopaedic surgeons and to reflect our current training on this issue, a survey was distributed to perform an audit in our department, an academic unit. Twenty-eight orthopaedic surgeons replied. Amongst our participants, 96.4% used a lead apron at all times. Only 33% used a thyroid shield, 67% never used radiation goggles and 96% never used radiation protection gloves. 53.6% and 46.4% of participants position the fluoroscopy incorrectly in the anteroposterior and lateral positions, respectively, during use. There is clearly a need for improved safety amongst orthopaedic surgeons. A literature review was further performed, showing the hazards of fluoroscopy for doctors, including the risk of cataracts, radiation dermatitis, skin cancer and thyroid cancer. Hazards specific to females, including breast cancer risk, and in-utero irradiation of foetus were also thoroughly discussed. Recommendations towards radiation safety and practical measures to reduce fluoroscopy radiation hazard during procedure were made. Education and training to doctors on this invisible hazard is strongly advised.

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Reduced radiation exposure in the cardiac catheterization laboratory with a novel vertical radiation shield

Panetta

Galbraith

Yanavitski

et al. 2019

Cathet Cardio Intervent

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ObjectivesInvestigation of novel vertical radiation shield (VRS) in reducing operator radiation exposure.BackgroundRadiation exposure to the operator remains an occupational health hazard in the cardiac catheterization laboratory (CCL).MethodsA mannequin simulating an operator was placed near a computational phantom, simulating a patient. Measurement of dose equivalent and Air Kerma located the angle with the highest radiation, followed by a common magnification (8 in.) and comparison of horizontal radiation absorbing pads (HRAP) with or without VRS with two different: CCL, phantoms, and dosimeters. Physician exposure was subsequently measured prospectively with or without VRS during clinical procedures.ResultsDose equivalent and Air Kerma to the mannequin was highest at left anterior oblique (LAO)‐caudal angle (p < .005). Eight‐inch magnification increased mGray by 86.5% and μSv/min by 12.2% compared to 10‐in. (p < .005). Moving 40 cm from the access site lowered μSv/min by 30% (p < .005). With LAO‐caudal angle and 8‐in. magnification, VRS reduced μSv/min by 59%, (p < .005) in one CCL and μSv by 100% (p = .016) in second CCL in addition to HRAP. Prospective study of 177 procedures with HRAP, found VRS lowered μSv by 41.9% (μSv: 15.2 ± 13.4 vs. 26.2 ± 31.4, p = .001) with no difference in mGray. The difference was significant after multivariate adjustment for specified variables (p < .001).ConclusionsOperator radiation exposure is significantly reduced utilizing a novel VRS, HRAP, and distance from the X‐ray tube, and consideration of lower magnification and avoiding LAO‐caudal angles to lower radiation for both operator and patient.

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Fluoroscopy pulse rate reduction during diagnostic and therapeutic imaging in the cardiac catheterization laboratory: An evaluation of radiation dose, procedure complications and outcomes

Cited by 13 publications

References 15 publications

Utilization of Dose Management Protocol in the Cardiac Catheterization Laboratory: Evaluating the Effects of Reducing Frame Rate and Cine Dose Together for Angiography

Utilization of Dose Management Protocol in the Cardiac Catheterization Laboratory: Evaluating the Effects of Reducing Frame Rate and Cine Dose Together for Angiography

Occupational hazard of fluoroscopy: An invisible threat to orthopaedic surgeons

Reduced radiation exposure in the cardiac catheterization laboratory with a novel vertical radiation shield

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