| Autor: |
Shekhar, Shashank, Ajay, Abhishek, Kumar, Anirudh, Kaur, Manpreet, Isogai, Toshiaki, Saad, Anas M, Abushouk, Abdelrahman, Abdelfattah, Omar M, Lak, Hassan Mehmood, Farwati, Medhat, Wunderle, Kevin, Ellis, Stephen G, Khatri, Jaikirshan, Krishnaswamy, Amar, Kapadia, Samir R |
| Zdroj: |
Circulation (Ovid); November 2021, Vol. 144 Issue: Supplement 1 pA11507-A11507, 1p |
| Abstrakt: |
Introduction:Radiation reduction measures were incorporated in the Cleveland Clinic Catheterization laboratories to mitigate the hazards from radiation exposure to patients and personnel during diagnostic and interventional coronary procedures. We report our experience with these improved systems over a 10-year period.Methods:Fluoroscopes were modified in 2013 by reducing the default fluoroscopic pulse rate from 10 to 7.5 pules/s, added default low-dose acquisitions, revised field-of-view dose factors, and instructed operators to use larger fields-of-view with appropriate collimation. A retrospective data analysis of all patients undergoing diagnostic catheterization from 2009 to 2012 (pre-initiative group), and 2013 to 2019 (post-initiative group) was done using Siemens CARE analytics software. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (Ka,r), and fluoroscopy- and acquisition-mode air kerma in patients in the two groups after propensity matching them based on age, sex, BSA, and total fluoroscopic time.Results:The total fluoroscopic time for the pre-initiative group (N=18,181) was 8.02 seconds while that for the post-initiative group (N=25,868) was 8.05 seconds. After matching 18,181 patients in both the groups (mean age, 64 years; 62% males), a significant reduction (54.4%) in the mean Ka,rwas observed in the post- in comparison to the pre-initiative group (420.94 mGy vs. 921.21 mGy; p<2.2e-16). Further analysis revealed a reduction in the mean acquisition- (59.3%; 217.33 mGy vs. 533.50 mGy; p<2.2e-16) and fluoroscopy-mode (47.5%; 203.61 mGy vs. 387.71 mGy; p<2.2e-16) air kerma in the post-initiative group. A sub-analysis of patients matched on the basis of their exact fluoroscopy and acquisition times also revealed a significant reduction in Ka,r, acquisition- and fluoroscopy-mode air kerma in the post-initiative group relative to the pre-initiative group (43.95%, 44.04%, 43.78% respectively).Conclusions:Optimization of imaging systems can significantly reduce patient radiation exposures which directly affect the radiation exposure of the Cath lab personnel. Similar algorithms can be applied in other labs to achieve a reduction in radiation exposure. |
| Databáze: |
Supplemental Index |
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