Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates
| Autor: | Matthias Koch, Peggy Glaser, Karlheinz Tischer, Anja Coenen, Hiller Moehlis, Reinhold Klingenbeck, Gerald S. Werner |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment Percutaneous coronary intervention General Medicine 030204 cardiovascular system & hematology 030218 nuclear medicine & medical imaging Lesion 03 medical and health sciences Kerma 0302 clinical medicine Dose area product Cohort Conventional PCI medicine Fluoroscopy Radiology Nuclear Medicine and imaging Radiology medicine.symptom Cardiology and Cardiovascular Medicine business Reduction (orthopedic surgery) |
| Zdroj: | Catheterization and Cardiovascular Interventions. 89:1005-1012 |
| ISSN: | 1522-1946 |
| Popis: | Background The increasing complexity of percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) leads to a significant increase of radiation exposure for both patient and operator. Objective To study the potential of modified settings of the X-ray equipment combined with operator protocols to reduce radiation dose despite increasing procedural complexity. Patients and Methods We analyzed a consecutive cohort of 984 PCIs for CTOs in 863 patients between January 2010 and July 2015. During that period, the X-ray equipment was changed from an analog to a digital detector system, and a subsequent filter and imaging modification was implemented. The fluoroscopy settings were reduced from 15 pulses/s to 7.5, and then to 6. The cine framerate was reduced from 15 to 7.5/s. For the last time period, with optimized settings, procedural, and lesion related factors influencing the radiation exposure were analyzed. Results The lesion complexity increased from a J-CTO score of 1.64 to 2.33 with an increase of retrograde procedures from 21.6 to 50.4%. With a similar fluoroscopy time, the dose area product was reduced from period 1 to 2 by 20%, and further by 7% to period 3. There was a significant reduction of Air Kerma from period 2 to 3 from 3.5 to 2.7 Gy. The operator exposure was reduced by more than half. The patient's weight and the complexity of the procedure were the main determinants of radiation exposure. Conclusions The radiation exposure for patient and operator was decreased considerably during the three observation periods despite an increase in lesion and procedural complexity. Rigorous implementation of radiation device settings did reduce radiation exposure without impeding procedural success. © 2017 Wiley Periodicals, Inc. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text