Radiation Dose During Coronary Angiogram: Relation to Body Mass Index

Shah, Ashish; Das, Paul; Subkovas, Eduardas; Buch, Ashesh N.; Rees, Michael R.; Bellamy, Christopher M.

doi:10.1016/j.hlc.2014.05.018

Cited by 51 publications

(38 citation statements)

References 20 publications

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“…The multivariate analysis demonstrates that after correcting for all other variables in the model, risk of exposure to high P KA and OD values was highest in obese patients. This is consistent with previous research where obesity was demonstrated to significantly increase the radiation dose used during coronary angiography . However, the present study supplements these findings with the additional information that a high patient BMI is the strongest predictor for both a high patient and operator dose across a range of diagnostic procedures.…”

Section: Discussionsupporting

confidence: 92%

Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography

Crowhurst

Whitby

Savage

et al. 2018

J of Medical Radiation Sci

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Introduction Diagnostic coronary angiography (CA) uses ionising radiation with relatively high doses, which impact on both patients and staff. This study sought to identify which patient and procedural factors impact patient and operator dose the most during CA. Methods Patient and procedure related variables impacting on Kerma area product (PKA) and operator dose (OD) were collected for 16 months. Procedures were separated into 10 different procedure categories. PKA was used for patient dose and OD was measured with an instantly downloadable dosimeter (IDD) – downloaded at the end of each procedure. High and low radiation dose was defined by binary variables based on the 75th percentile of the continuous measures. Univariate and multivariate regression were used to identify predictors. Results Of 3860 patients included, the IDD was worn for 2591 (61.7%). Obesity (BMI > 30 compared to BMI < 25) was the strongest predictor for both a PKA (odds ratio (OR) = 19.1 (95% CI 13.5–26.9) P < 0.001) and OD (OR = 3.3 (2.4–4.4) P < 0.001) above the 75th percentile. Male gender, biplane imaging, the X‐ray unit used, operator experience and procedure type also predicted a high PKA. Radial access, male gender, biplane imaging and procedure type also predicted a high OD. Conclusion Radiation dose during CA is multifactorial and is dependent on patient and procedure related variables. Many factors impact on both PKA and OD but obesity is the strongest predictor for both patients and operators to receive a high radiation dose.

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Section: Discussionsupporting

confidence: 92%

Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography

Crowhurst

Whitby

Savage

et al. 2018

J of Medical Radiation Sci

View full text Add to dashboard Cite

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“…Patients with high BMI have higher tissue thickness for the X-rays to penetrate, resulting in higher X-ray beam intensity created by the X-ray tube. 11 CTO PCI in prior CABG patients can be more complex, in part due to greater calcification and longer duration of occlusion. 12 Application of multiple crossing techniques during the same procedure can also lead to higher procedure time and radiation dose.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry

Christakopoulos

Christopoulos

Karmpaliotis

et al. 2017

Canadian Journal of Cardiology

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Background High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to procedural failure and radiation skin injury. Methods We examined the association between several clinical and angiographic variables on patient air kerma (AK) radiation dose among 748 consecutive CTO PCIs performed at 9 experienced US centers between May 2012 and May 2015. Results Mean age was 65±10 years, 87% of patients were men, and 35% had prior coronary artery bypass graft surgery (CABG). Technical and procedural success was 92% and 90%, respectively. The median patient AK dose was 3.40 (2.00, 5.40) Gray and 34% of the patients received >4.8 Gray (high radiation exposure). On univariable analysis male gender (p=0.016), high body mass index (p<0.001), history of hyperlipidemia (p=0.023), prior CABG (p<0.001), moderate or severe calcification (p<0.001), tortuosity (p<0.001), proximal cap ambiguity (p=0.001), distal cap at a bifurcation (p=0.006), longer CTO occlusion length (p<0.001), blunt/no blunt stump (p<0.001), and center (<0.001) were associated with higher patient AK dose. On multivariable analysis high body mass index (p<0.001), prior CABG (p=0.005), moderate or severe calcification (p=0.005), longer CTO occlusion length (p<0.001), and center (p<0.001) were independently associated with higher patient AK dose. Conclusions Approximately 1 in 3 patients undergoing CTO PCI receives high AK radiation dose (>4.8 Gray). Several baseline clinical and angiographic characteristics can help predict the likelihood of high radiation dose and assist with intensifying efforts to reduce radiation exposure for the patient and the operator.

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“…Radiation doses imparted to patients during angiography are influenced by several factors such as body mass index (BMI) of the patient, fluoroscopic time, dose rates, tube angulations/projection, and number of cine acquisitions 10 , 11 . It is reported that CA procedures involving oblique projections coupled with shallow or steep cranial or caudal angulation would help in visualizing cardiac vessels distinctly without any overlap, thus providing sufficient reference image for intervening the lesions 12 , 13 , 14 .…”

Section: Introductionmentioning

confidence: 99%

Radiation doses and estimated risk from angiographic projections during coronary angiography performed using novel flat detector

Varghese

Livingstone

Varghese

et al. 2016

J Applied Clin Med Phys

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Coronary angiography (CA) procedure uses various angiographic projections to elicit detailed information of the coronary arteries with some steep projections involving high radiation dose to patients. This study intends to evaluate radiation doses and estimated risk from angiographic projections during CA procedure performed using novel flat detector (FD) system with improved image processing and noise reduction techniques. Real‐time monitoring of radiation doses using kerma‐area product (KAP) meter was performed for 140 patients using Philips Clarity FD system. The CA procedure involved seven standard projections, of which five were extensively selected by interventionalists. Mean fluoroscopic time (FT), KAP, and reference air kerma (Ka,r) for CA procedure were 3.24 min (0.5–10.51), 13.99 Gycm2 (4.02–37.6), and 231.43 mGy (73.8–622.15), respectively. Effective dose calculated using Monte Carlo‐based PCXMC software was found to be 4.9 mSv. Left anterior oblique (LAO) 45° projection contributed the highest radiation dose (28%) of the overall KAP. Radiation‐induced risk was found to be higher in females compared to males with increased risk of lung cancer. An increase of 10%–15% in radiation dose was observed when one or more additional projections were adopted along with the seven standard projections. A 14% reduction of radiation dose was achieved from novel FD system when low‐dose protocol during fluoroscopy and medium‐dose protocol during cine acquisitions were adopted, compared to medium‐dose protocol.PACS number(s): 87.50.cm, 87.55.de, 87.55.N, 87.59.cf, 87.59.Dj

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Radiation Dose During Coronary Angiogram: Relation to Body Mass Index

Abstract: Obese patients require more than double the radiation dose in comparison to those with normal BMI. The operator should be aware of the increased dose of radiation required when performing CAG in patients with increased BMI, and especially in LAO cranial and caudal views.

Cited by 51 publications

References 20 publications

Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography

Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography

Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry

Radiation doses and estimated risk from angiographic projections during coronary angiography performed using novel flat detector

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