scholarly journals Longitudinal Improvements in Radiation Exposure in Cardiac Catheterization for Congenital Heart Disease

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Brian P. Quinn ◽  
Priscila Cevallos ◽  
Aimee Armstrong ◽  
David Balzer ◽  
Howaida El-said ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Cardiac Catheterization ◽  
Exposure Dose ◽  
Dose Area Product ◽  
Targeted Interventions ◽  
Area Product ◽  
Patient Radiation Exposure ◽  
Percent Decrease

Background: The C3PO-QI (Congenital Cardiac Catheterization Project on Outcomes – Quality Improvement), a multicenter registry launched in 2015, instituted quality improvement (QI) initiatives to reduce patient radiation exposure. Through regular collaboration, this initiative would allow for harmony among active participants, maximizing efforts and efficiency at achieving radiation best practices. This study sought to report these efforts with a detailed methodology for which institutions can target initiatives, reducing radiation exposure, and increasing patient safety. Methods: Data were collected prospectively by 8 C3PO-QI institutions between January 1, 2015 and December 31, 2017. Radiation exposure was measured in dose area product per body weight (dose area product/kg; µGy*m 2 /kg) and reported by expected radiation exposure categories (REC) and institution for 40 published unique procedure types. Targeted interventions addressing selected strategic domains for radiation reduction were implemented in the pediatric catheterization labs of the C3PO-QI institutions. Results: The study consisted of 15 257 unique cases. Median exposure (dose area product/kg) was decreased by 30% for all procedures. Dose area product/kg was reduced in all 3 REC, with the greatest improvement observed in REC I (REC I, −37%; REC II, −23%; REC III, −27%). Although the baseline radiation exposures and exact percent decrease varied across all C3PO-QI sites, each institution demonstrated improvements in radiation dose over time. These improvements occurred with the implementation of institution-specific QI interventions accelerated by participation in the C3PO-QI multicenter collaborative. Conclusions: Substantial radiation dose reductions can be achieved using targeted QI methodology and interventions. Participation in a multicenter QI collaborative may accelerate improvement across all centers due to enhanced engagement and shared learning between sites.

scholarly journals Relationships Between Radiation Exposure Dose, Time, and Projection in Videofluoroscopic Swallowing Studies

2019 ◽  
Vol 28 (3) ◽  
pp. 1053-1059 ◽  
Author(s):  
Heather Shaw Bonilha ◽  
Janina Wilmskoetter ◽  
Sameer Tipnis ◽  
Janet Horn ◽  
Bonnie Martin-Harris ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Exposure Time ◽  
Exposure Dose ◽  
Wilcoxon Test ◽  
Barium Swallow ◽  
Lateral Projection ◽  
Dose Area Product ◽  
Dose Time ◽  
Area Product ◽  
Patient Radiation Exposure

Purpose Clinicians are trained to rely on radiation exposure time as an indicator of patient radiation exposure in Videofluoroscopic Swallowing Studies (VFSSs). However, it has been shown in other medical uses of fluoroscopy that dose area product (DAP), the amount of radiation delivered to the patient, is a better indicator of overall patient radiation exposure than radiation exposure time. This study sought to understand the relationship of DAP in VFSSs with radiation exposure time and projection used (lateral vs. posterior–anterior [PA]). Method DAP, radiation exposure time, and projection were recorded in 200 adults undergoing clinically indicated VFSSs conducted in accordance with the Modified Barium Swallow Impairment Profile guidelines. Data were analyzed using Spearman correlation and related sample Wilcoxon test. Results DAP and radiation exposure time did not correlate significantly in the lateral or upper PA projections. DAP was significantly higher in the PA compared to lateral projection ( p < .01); however, time was shorter in PA versus lateral ( p < .01). The average mGy-cm 2 per second was 7 for lateral projections, 14 for upper PA projections, 17 for middle PA projections, and 34 for lower PA projections. Conclusions Radiation exposure time and DAP do not strongly correlate across VFSSs. Specifically, this means that 1 patient can have a low radiation exposure time with a high DAP relative to another person with a higher radiation exposure time but a lower DAP. The results of this study question the common clinical practice of using time (specifically the 5-min indicator) as a threshold for radiation exposure during a VFSSs.

scholarly journals Effective Reduction of Radiation Exposure during Cardiac Catheterization

2019 ◽  
Vol 46 (3) ◽  
pp. 167-171 ◽  
Author(s):  
Alejandro Gutiérrez-Barrios ◽  
Hugo Camacho-Galán ◽  
Francisco Medina-Camacho ◽  
Dolores Cañadas-Pruaño ◽  
Antonio Jimenez-Moreno ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Cardiac Catheterization ◽  
Fine Tuning ◽  
Radiation Doses ◽  
Dose Area Product ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Percutaneous Coronary ◽  
Procedural Complications ◽  
Area Product

Exposure to ionizing radiation during cardiac catheterization can have harmful consequences for patients and for the medical staff involved in the procedures. Minimizing radiation doses during the procedures is essential. We investigated whether fine-tuning the radiation protocol reduces radiation doses in the cardiac catheterization laboratory. In January 2016, we implemented a new protocol with reduced radiation doses in the Hospital de Jerez catheterization laboratory. We analyzed 170 consecutive coronary interventional procedures (85 of which were performed after the new protocol was implemented) and the personal dosimeters of the interventional cardiologists who performed the procedures. Overall, the low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%–70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%–90.1%; P &lt;0.001) during percutaneous coronary interventions. We also found that the annual deep (79%, P=0.026) and shallow (62.2%, P=0.035) radiation doses to which primary operators were exposed decreased significantly under the low-radiation protocol. These dose reductions were achieved without increasing the volume of contrast media, fluoroscopy time, or rates of procedural complications, and without reducing the productivity of the laboratory. Optimizing the radiation safety protocol effectively reduced radiation exposure in patients and operators during cardiac catheterization procedures.

Using 7.5 frames per second reduces radiation exposure in lower extremity peripheral vascular interventions

Vascular ◽  
2014 ◽  
Vol 23 (3) ◽  
pp. 240-244 ◽  
Author(s):  
Nuri I Akkus ◽  
George S Mina ◽  
Abdulrahman Abdulbaki ◽  
Fereidoon Shafiei ◽  
Neeraj Tandon
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Success Rate ◽  
Frame Rate ◽  
Fluoroscopy Time ◽  
Peripheral Vascular ◽  
Dose Area Product ◽  
Group A ◽  
Group B ◽  
Area Product

Background Peripheral vascular interventions can be associated with significant radiation exposure to the patient and the operator. Objective In this study, we sought to compare the radiation dose between peripheral vascular interventions using fluoroscopy frame rate of 7.5 frames per second (fps) and those performed at the standard 15 fps and procedural outcomes. Methods We retrospectively collected data from consecutive 87 peripheral vascular interventions performed during 2011 and 2012 from two medical centers. The patients were divided into two groups based on fluoroscopy frame rate; 7.5 fps (group A, n = 44) and 15 fps (group B, n = 43). We compared the demographic, clinical, procedural characteristics/outcomes, and radiation dose between the two groups. Radiation dose was measured as dose area product in micro Gray per meter square. Results Median dose area product was significantly lower in group A (3358, interquartile range (IQR) 2052–7394) when compared to group B (8812, IQR 4944–17,370), p < 0.001 with no change in median fluoroscopy time in minutes (18.7, IQR 11.1–31.5 vs. 15.7, IQR 10.1–24.1), p = 0.156 or success rate (93.2% vs. 95.3%), p > 0.999. Conclusion Using fluoroscopy at the rate of 7.5 fps during peripheral vascular interventions is associated with lower radiation dose compared to the standard 15 fps with comparable success rate without associated increase in the fluoroscopy time or the amount of the contrast used. Therefore, using fluoroscopy at the rate of 7.5 fps should be considered in peripheral vascular interventions.

scholarly journals Multicenter Assessment of Radiation Exposure during Pediatric Cardiac Catheterizations Using a Novel Imaging System

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Luke J. Lamers ◽  
Brian H. Morray ◽  
Alan Nugent ◽  
Michael Speidel ◽  
Petch Suntharos ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Multicenter Study ◽  
Imaging System ◽  
Atrial Septal Defect Closure ◽  
Dose Area Product ◽  
Similar Patient ◽  
Area Product ◽  
Cardiac Catheterizations ◽  
Patient Radiation Exposure ◽  
Valve Implantation

Objectives. To quantify radiation exposure during pediatric cardiac catheterizations performed by multiple operators on a new imaging platform, the Artis Q.zen (Siemens Healthcare, Forchheim, Germany), and to compare these data to contemporary benchmark values. Background. The Artis Q.zen has been shown to achieve significant radiation reduction during select types of pediatric cardiac catheterizations in small single-center studies. No large multicenter study exists quantifying patient dose exposure for a broad spectrum of procedures. Methods. Retrospective collection of Air Kerma (AK) and dose area product (DAP) for all pediatric cardiac catheterizations performed on this new imaging platform at four institutions over a two-year time period. Results. A total of 1,127 pediatric cardiac catheterizations were analyzed. Compared to dose data from earlier generation Artis Zee imaging systems, this study demonstrates 70–80% dose reduction (AK and DAP) for similar patient and procedure types. Compared to contemporary benchmark data for common interventional procedures, this study demonstrates an average percent reduction in AK and DAP from the lowest dose saving per intervention of 39% for AK and 27% for DAP for transcatheter pulmonary valve implantation up to 77% reduction in AK and 70% reduction in DAP for atrial septal defect closure. Conclusion. Use of next-generation imaging platforms for pediatric cardiac catheterizations can substantially decrease patient radiation exposure. This multicenter study defines new low-dose radiation measures achievable on a novel imaging system.

scholarly journals Measurement of the radiation level dose to patient from fluoroscopy device during cardiac catheterization

2020 ◽  
Vol 2 (1) ◽  
pp. 35-41
Author(s):  
Luma Naji Joudha
Keyword(s):  
Dose Rate ◽  
Cardiac Catheterization ◽  
Exposure Dose ◽  
Radiation Doses ◽  
X Ray ◽  
Dose Area Product ◽  
Dose Rates ◽  
Wide Range ◽  
Area Product ◽  
Permissible Dose

Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a screen, it is used in a wide range of examination and procedures for diagnosis such as in cardiac catheterization. Fluoroscopy can result in relatively high radiation doses, especially for complex interventional procedures that it needed to monitor radiation to reduce exposure. The purpose of this study is to determine the radiation doses for patients during cardiac catheterization exam and compare it with the permissible dose limits. The main parameters which are studied in this work are the time of exposure dose rate, x-ray techniques (milliamper. second), tube voltage (kilovolt) and Dose Area Product (DAP). Twenty-seven patients were included and  absorbed doses were measured and distributed according to Fluoroscopy (Fluo) time, mAs and Dose Area Product (DPA). It was found that the absorbed dose received by the patients has a  linear relationship with the Fluoroscopy time, mAs and DAP. Exposure dose rates were measured and compared with the maximum permissible dose (100 mGy/min), the estimated patient dose rate varied from (12-81.6) mGy/min) for 24 patients as a permissible dose in the safe side, and 3 patients exposed to higher values of the exposure dose rates ) over permissible dose) range (107.4-108) mGy/min

Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with “ALARA” principles profoundly lowers total dose

2014 ◽  
Vol 25 (5) ◽  
pp. 963-968 ◽  
Author(s):  
Robert H. Pass ◽  
Gregory G. Gates ◽  
Laura A. Gellis ◽  
Lynn Nappo ◽  
Scott R. Ceresnak
Keyword(s):  
Radiation Exposure ◽  
Supraventricular Tachycardia ◽  
Group Versus ◽  
Group 14 ◽  
Dose Area Product ◽  
Patient Demographics ◽  
Acute Success ◽  
Procedural Time ◽  
Area Product ◽  
Patient Radiation Exposure

AbstractBackground: “ALARA – As Low As Reasonably Achievable” protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose. Methods: From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2–3 frames/second), low fluoro dose/frame (6–18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with “fast anatomical mapping” (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols. Results: A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical–fluoroscopy technique. Conclusions: Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.

Noninvasive patient tracker mask for spinal 3D navigation: does the required large-volume 3D scan involve a considerably increased radiation exposure?

2020 ◽  
Vol 33 (6) ◽  
pp. 838-844
Author(s):  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
Christoph Scholz ◽  
Florian Volz ◽  
Marc Hohenhaus ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Image Data ◽  
3D Image ◽  
Flat Panel ◽  
3D Navigation ◽  
Data Set ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
3D Scan ◽  
Area Product

OBJECTIVEIntraoperative 3D imaging and navigation is increasingly used for minimally invasive spine surgery. A novel, noninvasive patient tracker that is adhered as a mask on the skin for 3D navigation necessitates a larger intraoperative 3D image set for appropriate referencing. This enlarged 3D image data set can be acquired by a state-of-the-art 3D C-arm device that is equipped with a large flat-panel detector. However, the presumably associated higher radiation exposure to the patient has essentially not yet been investigated and is therefore the objective of this study.METHODSPatients were retrospectively included if a thoracolumbar 3D scan was performed intraoperatively between 2016 and 2019 using a 3D C-arm with a large 30 × 30–cm flat-panel detector (3D scan volume 4096 cm3) or a 3D C-arm with a smaller 20 × 20–cm flat-panel detector (3D scan volume 2097 cm3), and the dose area product was available for the 3D scan. Additionally, the fluoroscopy time and the number of fluoroscopic images per 3D scan, as well as the BMI of the patients, were recorded.RESULTSThe authors compared 62 intraoperative thoracolumbar 3D scans using the 3D C-arm with a large flat-panel detector and 12 3D scans using the 3D C-arm with a small flat-panel detector. Overall, the 3D C-arm with a large flat-panel detector required more fluoroscopic images per scan (mean 389.0 ± 8.4 vs 117.0 ± 4.6, p < 0.0001), leading to a significantly higher dose area product (mean 1028.6 ± 767.9 vs 457.1 ± 118.9 cGy × cm2, p = 0.0044).CONCLUSIONSThe novel, noninvasive patient tracker mask facilitates intraoperative 3D navigation while eliminating the need for an additional skin incision with detachment of the autochthonous muscles. However, the use of this patient tracker mask requires a larger intraoperative 3D image data set for accurate registration, resulting in a 2.25 times higher radiation exposure to the patient. The use of the patient tracker mask should thus be based on an individual decision, especially taking into considering the radiation exposure and extent of instrumentation.

scholarly journals Radiation exposure dose of fluoroscopy-guided gastrointestinal procedures: A single-center retrospective study

2020 ◽  
Vol 08 (12) ◽  
pp. E1872-E1877
Author(s):  
Shiro Hayashi ◽  
Tsutomu Nishida ◽  
Shinji Kuriki ◽  
Li-sa Chang ◽  
Kazuki Aochi ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Balloon Dilatation ◽  
Exposure Dose ◽  
Sigmoid Volvulus ◽  
Tube Placement ◽  
Injection Sclerotherapy ◽  
Single Center ◽  
Endoscopic Injection ◽  
Dose Area Product ◽  
Esophageal Balloon

Abstract Background and study aims Fluoroscopy-guided gastrointestinal procedures (FGPs) are increasingly common. However, the radiation exposure (RE) to patients undergoing FGPs is still unclear. We examined the actual RE of FGPs. Patients and methods This retrospective, single-center cohort study included consecutive FGPs, including endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), enteral stenting, balloon-assisted enteroscopy, tube placement, endoscopic injection sclerotherapy (EIS), esophageal balloon dilatation and repositioning for sigmoid volvulus, from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm2), and fluoroscopy time (FT, min) for each procedure. Results In total, 3831 patients were enrolled. Overall, 2778 ERCPs were performed. The median AK, DAP, and FT were as follows: ERCP: 109 mGy, 13.3 Gycm2 and 10.0 min; self-expandable enteral stenting (SEMS): 62 mGy, 12.4 Gycm2 and 10.4 min; tube placement: 40 mGy, 13.8 Gycm2 and 11.1 min; balloon-assisted enteroscopy: 43 mGy, 22.4 Gycm2 and 18.2 min; EUS cyst drainage (EUS-CD): 96 mGy, 18.3 Gycm2 and 10.4 min; EIS: 36 mGy, 8.1 Gycm2 and 4.4 min; esophageal balloon dilatation: 9 mGy, 2.2 Gycm2 and 1.8 min; and repositioning for sigmoid volvulus: 7 mGy, 4.7 Gycm2 and 1.6 min. Conclusion This large series reporting actual RE doses of various FGPs could serve as a reference for future prospective studies.

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