Radiation exposure after heart transplantation: Trends and significance

Noor, Muhammad; Shekhdar, Jane; Banner, Nicholas R.

doi:10.1016/j.healun.2010.09.010

Cited by 20 publications

(15 citation statements)

References 24 publications

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“…The first year accounted for about 40% of the total radiation dose (versus 56% in the current study). Although the adults in both studies received a higher mean dose of radiation than in the current pediatric study, the authors of these studies concluded that this mean dose increased the risk of cancer by only 0.55% [3] and 0.34% [14] respectively so was of minimal concern. The third study included kidney transplant patients and showed that their mean annual dose of radiation from DI (16.3 mSv) was in the same range as that for patients on hemodialysis not being considered for transplant (18 mSv) [15], demonstrating that patients with chronic illness often have extensive DI with or without a transplant.…”

Section: Discussionmentioning

confidence: 78%

“…A mean of 161 DI studies and 138 mSv effective radiation exposure were documented during a mean of 6.5 years follow-up for 107 lung transplant recipients [3]. A study of 202 heart transplant recipients followed for up to 10 years reported a mean of 66 DI studies and 84 mSv effective radiation exposure post-transplant [14]. The first year accounted for about 40% of the total radiation dose (versus 56% in the current study).…”

Section: Discussionmentioning

confidence: 88%

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Radiation Exposure from Diagnostic Imaging in a Cohort of Pediatric Transplant Recipients

et al. 2017

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Recipients of solid organ transplants (SOT) have extensive diagnostic imaging (DI). The purpose of this study was to quantify this exposure. Children from northern Alberta with SOTs at Stollery Children’s Hospital, Edmonton, Alberta January 1, 2006, to July 31, 2012, were included. Effective doses of radiation were estimated using published norms for DI performed post-transplant up to October 16, 2014. The 54 eligible children had 6215 DI studies (5628 plain films, 293 computerized tomography (CT) scans, 149 positron emission topography (PET) -CT scans, 47 nuclear medicine scans and 98 cardiac catheterizations). Children less than 5 years of age underwent more DI studies than did older children (median (IQR) 140 (66–210) vs 49 (19–105), p = 0.010). Children with post-transplant lymphoproliferative disorder (N = 8) had more CT scans (median (IQR) 13 (5.5–36) vs 1 (0–5), p<0.001) and PET-CT scans (median (IQR) 3.5 (1.5–8) vs 0 (0–0), p<0.001) than did other children. The estimated cumulative effective dose attributed to DI studies post-transplant was median (range) 78 (4.1–400) millisievert (mSv), and 19 of 54 children (35%; 95% confidence interval 24–49%) had a dose >100 mSv. In conclusion, a significant proportion of pediatric transplant recipients have sufficient radiation exposure post-transplant for DI to be at potential risk for radiation-induced malignancies.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 88%

Radiation Exposure from Diagnostic Imaging in a Cohort of Pediatric Transplant Recipients

et al. 2017

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“…With this technological advancement, there is an expected decrease in the physiologic insult to the patient compared to open repair 1–3 , however this comes with increased radiation and contrast exposure risk during the procedures 4 . Flouroscopy is an important radiation source in contemporary practice, and an increasing focus on the effects of cumulative radiation exposure to patients and providers is present in the literature 4–14 . Notably, a recent report has demonstrated that FEVAR is one of the most radiation intensive procedures that vascular specialists perform 4 .…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional fusion computed tomography decreases radiation exposure, procedure time, and contrast use during fenestrated endovascular aortic repair

McNally

Scali

Feezor

et al. 2015

Journal of Vascular Surgery

122

104

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Objectives Endovascular surgery has revolutionized the treatment of aortic aneurysms; however these improvements have come at the cost of increased radiation and contrast exposure, particularly for more complex procedures. Three dimensional (3D) fusion computed tomographic (CT) imaging is a new technology that may facilitate these repairs. The purpose of this analysis was to determine the impact of utilizing intraoperative 3D fusion CT on performance of fenestrated endovascular aortic repair. Methods A review of our institutional database was performed to identify patients undergoing fenestrated/branched endovascular aortic repair (FEVAR). Subjects treated using 3D fusion CT were compared to patients treated in the immediate 12-month period prior to implementation of this technology when procedures were performed in a standard hybrid operating room without CT fusion capabilities. Primary endpoints included patient radiation exposure (air kerma area product: milliGray; mGy*cm2), fluoroscopy time (minutes; min), contrast usage (mL) and procedure time (min). Patients were grouped by number of aortic graft fenestrations revascularized with a stentgraft and operative outcomes were compared. Results A total of 72 patients (N = 41 before vs. N = 31 after 3D fusion CT implementation) underwent FEVAR from September 2012 through March 2014. For 2-vessel fenestrated endografts, there was a significant decrease in radiation exposure (3400±1900 vs. 1380±520 mGy*cm2; P=.001), fluoroscopy time (63±29 vs. 41±11min; P=.02), and contrast usage (69±16 vs. 26±8 mL; P=.0002) with intraoperative 3D fusion CT. Similarly, for combined 3 and 4-vessel FEVAR, significantly decreased radiation exposure (5400±2225 vs. 2700±1400 mGy*cm2; P<.0001), fluoroscopy time (89±36 vs 6±21min; P=.02), contrast usage (90±25 vs. 39±17mL; P<.0001), as well as procedure time (330±100 vs. 230±50min; P=.002) was noted. Estimated blood loss was significantly less (P<.0001) and length of stay had a trend (P=.07) toward being lower for all patients in the 3D CT group. Conclusions These results demonstrate that use of intraoperative 3D fusion CT imaging during FEVAR can significantly decrease radiation exposure and procedure time, as well as contrast usage, which may also decrease the overall physiologic impact of the repair.

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“…15,16 Patients having undergone transplantation are also at a higher risk for malignancies. 15,16 Patients having undergone transplantation are also at a higher risk for malignancies.…”

Section: Adverse Eventsmentioning

confidence: 99%

Burden and consequences of retained cardiovascular implantable electronic device lead fragments after heart transplantation

Álvarez

Sperry

Pérez

et al. 2018

American Journal of Transplantation

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We performed a retrospective review of 402 consecutive patients who underwent heart transplantation at our institution between January 2009 and March 2017. A retained cardiovascular implantable electronic device (CIED) fragment was identified after transplantation in 49 of the 301 patients (16.2%) with CIED at baseline. Patients with retained fragments had leads with longer dwell times (median 2596 [1982, 3389] vs 1384 [610, 2202] days, P < .001), higher prevalence of previously abandoned leads (14.3% vs 2.8%, P = .003), and dual-coil defibrillator leads (98% vs 81%, P = .001) compared with patients without retained fragments. Five patients (10%) with retained CIED fragments underwent magnetic resonance imaging without adverse events. There was no difference in overall mortality between patients with and without CIED fragments (12% vs 11%, P = .81) Patients with retained fragments located in the superior vena cava had significantly higher fluoroscopic times (3.3 vs 2.9 minutes, P = .024) during subsequent endomyocardial biopsies. In a competing risk analysis, presence of a retained CIED fragment was associated with upper extremity deep venous thrombosis (sub hazard ratio [HR] 2.19, 95% confidence interval [CI] 1.17-4.10, P = .014) but not bloodstream infection after adjusting for potential confounders. In summary, retained CIED fragments are common after heart transplantation, and are associated with longer radiation exposure during biopsy procedures and upper extremity deep venous thrombosis.

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Radiation exposure after heart transplantation: Trends and significance

Cited by 20 publications

References 24 publications

Radiation Exposure from Diagnostic Imaging in a Cohort of Pediatric Transplant Recipients

Radiation Exposure from Diagnostic Imaging in a Cohort of Pediatric Transplant Recipients

Three-dimensional fusion computed tomography decreases radiation exposure, procedure time, and contrast use during fenestrated endovascular aortic repair

Burden and consequences of retained cardiovascular implantable electronic device lead fragments after heart transplantation

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