Radiation Exposure to Patient's Skin During Percutaneous Coronary Intervention for Various Lesions, Including Chronic Total Occlusion

Suzuki, Shigeru; Furui, Shigeru; Kohtake, Hiroshi; Yokoyama, Naoyuki; Kozuma, Ken; Yamamoto, Yorimasa

doi:10.1253/circj.70.44

Cited by 76 publications

(48 citation statements)

References 20 publications

(8 reference statements)

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“…The risk of radiation injury and contrast nephropathy potentially affect CTO-angioplasty. In our center, the mean fluoroscopy time of 57.9 ± 3.2 minutes and contrast volume of 525.9 ± 20.9 mL were relatively higher than the average CTO angioplasty in other centers, which should be considered in further procedures to be reduced [9,10]. The rate of complications and in-hospital major cardiac events in our center were comparable with other centers' results [9,11,12].…”

Section: Discussionsupporting

confidence: 65%

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Safi

Namazi

Sadeghi

et al. 2016

ijcp

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Introduction: New techniques for the percutaneous treatment of coronary chronic total occlusions (CTO) have had a high success rate since a few years ago, so the interest for this treatment has been increasing these days. Methods: The current observational study was performed in Modarres hospital as a tertiary referral center. All the patients with documented stable angina who had failed to response to full guideline-mediated medical therapy, referred to our hospital, were candidates for coronary angiography. Antegrade strategy was applied for all these patients. The length of the lesion, the fluoroscopy time of the CTO angioplasty, consumed contrast volume, the number of guide wires used, whether a corsair or tornus micro-catheter was used or not, and the success rate of the angioplasty were documented for further analysis. Results: A total of 47 patients with documented stable angina were finally included. The median age was 59 (45-78) and 70.2% were male. The mean length of the lesion was 34.0 ± 1.1 .The mean fluoroscopy time and contrast volume were 57.9 ± 3.2 minutes and 525.9 ± 20.9 mL, respectively. In average, 2.2 guide wires were used. Corsair and tornus micro-catheters were applied in 30 (63.8%) and 5 (10.6%) of the cases, respectively. Seven complications (all including coronary dissection) occurred. In-hospital major adverse cardiac events (MACE) rate was 10.6%, all of which were non-Q wave myocardial infarction. The success rate was 85.1%. The higher number of used wires, use of corsair, and tornus micro-catheter were not significantly concordant with success rate (P-value > 0.05); in addition, longer lesions was not concordant with unsuccessfulness rate (P-value > 0.05). Conclusions: Patient selection for CTO-angioplasty should be performed more carefully. Patients' quality of life and risk of probable procedural complications and future cardiac events should be assessed to decide the best treatment approach. Radiation exposure, contrast consumption and fluoroscopy time are recommended to be monitored during the procedure and thresholds should be defined to enhance safety and efficacy.

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Section: Discussionsupporting

confidence: 65%

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Safi

Namazi

Sadeghi

et al. 2016

ijcp

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“…According to Suzuki et al, the average TFT and average total number of cine frames during the procedures for CTO were approximately 3-fold higher than those during the procedures for 1 stenosis. 10 Therefore, interventionists should estimate the patients' skin dose and make efforts to prevent radiation skin injuries during PCI, especially for CTO.…”

Section: Patient Esd During Pci For Ctomentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Recent studies show that successful PCI of a CTO is associated with improved survival; 8,9 however, the total fluoroscopic time (TFT) tends to be long in this procedure compared with PCI for non-CTO. 10 The patient's entrance skin doses (ESD) are higher 10,11 and severe skin injury can occur, so the physician must estimate the ESD in order to prevent radiation skin injuries during the procedure. However, there is inadequate assessment of this issue in the literature.…”

mentioning

confidence: 99%

Factors Affecting the Patient's Skin Dose During Percutaneous Coronary Intervention for Chronic Total Occlusion

Suzuki

Furui

Isshiki

et al. 2007

Circ J

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hronic total occlusion (CTO) has been considered as a relative contraindication for percutaneous coronary intervention (PCI), because of its low success rate and high restenosis rate. The results have improved because of recent advances in technology and increased operator experience. [1][2][3][4][5][6][7] Recent studies show that successful PCI of a CTO is associated with improved survival; 8,9 however, the total fluoroscopic time (TFT) tends to be long in this procedure compared with PCI for non-CTO. 10 The patient's entrance skin doses (ESD) are higher 10,11 and severe skin injury can occur, so the physician must estimate the ESD in order to prevent radiation skin injuries during the procedure. However, there is inadequate assessment of this issue in the literature.The purpose of this research was to measure the patient's ESD during PCI for CTO, analyze the factors that affect it and assess the methods used to estimate the maximum ESD from both patient and angiographic data. Circulation Journal Vol.71, February 2007 Methods Patient PopulationThis study focused on 23 consecutive patients (6 women, 17 men) who underwent PCI for CTO with evaluation of the ESDs from July 2004 to September 2005. The average patient age was 68.9±7.7 years (range: 53.6-82.2). AngiographyAdvantX LC and AdvantX LC/LP equipment (General Electric Medical Systems, Milwaukee, WI, USA) were used for angiography. The image intensifiers of both units were renewed in April 2004. Each unit had an undercouch tube and an overcouch image intensifier with 3 fields of view: 9, 6, and 4.5 inches in diameter. A 6-inch field of view was used mainly in this assessment. In both units, the total filtration was equivalent to 2.7 mm aluminum. Procedures were performed using pulse-mode fluoroscopy. The period of use was 9 years for each unit. PCI and ESD MeasurementThe patient wore a jacket with 52 radiosensitive indicators (Nichiyu Giken Kogyo Co, Ltd, Saitama, Japan) placed on the back. Radiosensitive indicators use a functional dye in which the color changes from translucent to red with Xray absorption. Indicators were arranged in 6 rows (from top to bottom: 1, 2, 3, 4, 5, and 6) and 8 columns (from left to right: A, B, C, D, E, F, G, and H) at intervals of 7 cm. An additional 4 indicators were placed in the 7th row (C7, D7, E7, and F7), except for 2 patients. Four experienced cardiologists performed the procedures using standard tech- Background The aim of this study was to measure the patient entrance skin dose (ESD) during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), and assess the factors that affect it. Methods and ResultsRadiosensitive indicators were used to measure ESDs during 23 procedures. Multiple regression analysis identified the strength of the linear relationship of the dependent variable (the natural logarithm of the maximum ESD) with the set of multiple independent variables (the natural logarithm of both the patient and angiographic data). The methods for estimating the maximum ESD and the estimated ESDs w...

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“…First of all, the dose to the patient increases with increasing body mass index (BMI) [1][2][3]. Second, dose, fluoroscopy time and number of cine frames might differ depending on the number of treated vessels and/or stenoses [4][5][6], localisation and severity of lesions [2,7], stage of occlusion [7,8], tortuosity of treated vessels [6][7][8], number of stents and balloons [2,4,[7][8][9], and artery approach [10,11]. With the aim of optimising the interventional cardiology procedures (i.e.…”

mentioning

confidence: 99%

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Journy

Sinno‐Tellier²,

Maccia³

et al. 2012

BJR

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Objective: The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. Methods: We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. Results: The mean MSD and DAP were respectively 389 mGy and 65 Gy cm 22 for CAs, and 916 mGy and 69 Gy cm 22 for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r50.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. Conclusion: Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions. Interventional cardiology procedures such as repeated diagnostic coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) may cause radio-induced skin damage. Deterministic skin effects might occur as soon as the dose to the patient's skin exceeds 2 Gy and might correspond to a range of lesions from erythema to necrosis [1]. In relation to the risk of skin lesions, the X-ray dose depends on clinical, therapeutic and technical factors. First of all, the dose to the patient increases with increasing body mass index (BMI) [1][2][3]. Second, dose, fluoroscopy time and number of cine frames might differ depending on the number of treated vessels and/or stenoses [4][5][6], localisation and severity of lesions [2,7], stage of occlusion [7,8], tortuosity of treated vessels [6][7][8], number of stents and balloons [2,4,[7][8][9], and artery approach [10,11]. With the aim of optimising the interventional cardiology procedures (i.e. minimising the X-ray dose to the patient while preserving the quality of treatment), the use of low fluoroscopy pulse rate, image intensifier field size and collimation are recommended [1,12,13]. However, the studies that concluded that there was an impact on dose of some technical parameters had mostly used descriptive or univariate analyses and/or were carried out on a phantom [2,...

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Radiation Exposure to Patient's Skin During Percutaneous Coronary Intervention for Various Lesions, Including Chronic Total Occlusion

Cited by 76 publications

References 20 publications

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Factors Affecting the Patient's Skin Dose During Percutaneous Coronary Intervention for Chronic Total Occlusion

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

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