Coronary angiography (CA) procedure uses various angiographic projections to elicit detailed information of the coronary arteries with some steep projections involving high radiation dose to patients. This study intends to evaluate radiation doses and estimated risk from angiographic projections during CA procedure performed using novel flat detector (FD) system with improved image processing and noise reduction techniques. Real-time monitoring of radiation doses using kerma-area product (KAP) meter was performed for 140 patients using Philips Clarity FD system. The CA procedure involved seven standard projections, of which five were extensively selected by interventionalists. Mean fluoroscopic time (FT), KAP, and reference air kerma (Ka,r) for CA procedure were 3.24 min (0.5–10.51), 13.99Gycm2 (4.02–37.6), and 231.43 mGy (73.8–622.15), respectively. Effective dose calculated using Monte Carlo-based PCXMC software was found to be 4.9mSv. Left anterior oblique (LAO) 45° projection contributed the highest radiation dose (28%) of the overall KAP. Radiation-induced risk was found to be higher in females compared to males with increased risk of lung cancer. An increase of 10%–15% in radiation dose was observed when one or more additional projections were adopted along with the seven standard projections. A 14% reduction of radiation dose was achieved from novel FD system when low-dose protocol during fluoroscopy and medium-dose protocol during cine acquisitions were adopted, compared to medium-dose protocol.

Radiation doses and estimated risk from angiographic projections during coronary angiography performed using novel flat detector

Introduction: Cardiac catheterization procedure through the trans-radial access (TRA) have shown many clinical advantages over the trans-femoral (TFA), but despite its advantages, there are serious concerns regarding higher possible radiation dose for the patients and operators in TRA. This study was planned to compare the patients’ radiation dose associated with TRA and TFA during coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA).
Methods: Of 700 candidates for angiography, 326 patients were entered the study. All the procedures were carried out by one interventional cardiologist employing the same angiography unit in Aalinasab hospital and the patients’ dose area product (DAP), air kerma (AK), fluoroscopy time (FT) and cine film time (CFT) were then determined in both access groups (TRA,TFA) in CA, PTCA and CA+PTCA procedures. 
Results: The mean FT, CFT and AK values in both TRA & TFA groups were the same in all procedures (P > 0.05). The mean DAP in CA+PTCA procedures was 6704.01 ± 3243.23 µGym2 in femoral access compare with 5647.46 ± 2797.74 µGym2 in radial access, which were significantly less than that in TFA with P = 0.02.
Conclusion: On the basis of the results obtained in this study, no differences were found in patients’ radiation dose in both access groups, therefore with regard to comparatively more clinical advantages associated with the Trans-radial access technique it might be a good substitute for Trans-femoral access.

https://jcvtr.tbzmed.ac.ir/PDF/JCVTR-8-77.pdf

Comparison of the patient radiation exposure during coronary angiography and angioplasty procedures using trans-radial and trans-femoral access.

OBJECTIVE We aimed to compare the operator and patient radiation exposure in standard projections during elective diagnostic coronary angiography procedures via transradial (TRA) versus transfemoral (TFA) approaches. METHODS In this analytical cross-sectional study, a total of 202 consecutive patients who were candidates for diagnostic coronary angiography were randomized to undergo the procedure via TFA or TRA approaches (101 in each group). Patients with abnormal Allen test and history of coronary artery bypass surgery, valvular heart disease, and unsuccessful coronary angiography were excluded from the study. A single operator performed all of the procedures using a single angiography system. Patient and operator radiation exposure were measured using diamentor and an electronic personal dosimeter, respectively. Each procedure comprised a standardized sequence of projections including four standard views for the left coronary system and two standard views for the right coronary system. RESULTS Left anterior oblique (LAO) caudal (50°/30°) and right anterior oblique RAO (30°) projections were associated with the highest and lowest patient radiation exposure, respectively. The operator received a significantly higher radiation exposure in the TRA approach for LAO cranial (for both left and right coronary systems) and LAO caudal (for left coronary system) projections during coronary angiography compared with the TFA approach. CONCLUSION Though a similar amount of patient radiation exposure in each projection was observed among TFA and TRA groups; LAO cranial and LAO caudal projections were associated with a significantly higher operator radiation exposure in the TRA group. These findings need to be considered when choosing the optimal arterial approach for patients scheduled for coronary angiography.

Beam projections and radiation exposure in transradial and transfemoral approaches during coronary angiography.

Background

Trans-radial approach for cardiac catheterisation procedures has long been associated with high operator and patient radiation dose. The aim of the present study was to determine the effect of pelvic and radial shields on decreasing coronary procedure radiation doses.
Methods

A total of 418 patients randomly underwent diagnostic and therapeutic cardiac procedures with and without the pelvic and rad-board lead shields during the procedures. The operator and patient doses were then determined by means of a personal dosimeter and dose area product (DAP), respectively.
Results

The shields decreased the operator radiation dose by 40% in coronary angiography (CA) and by 45% during angioplasty (PCI). These results were achieved at the cost of increased patient radiation dose.
Conclusion

Pelvic lead shields combined with rad-board shields are highly effective in reducing operator radiation dose in trans-radial approach, but it is only achieved at the cost of increased patient DAP.

Impact of pelvic and rad-board lead shields on operator and patient radiation dose in trans-radial coronary procedures.

Background: Interventional cardiology (IC) procedures such as percutaneous coronary intervention (PCI) could generate a high radiation dose to both patients and medical staff. In this study, a comprehensive analysis was performed on patient dose during PCI procedures and evaluating the effect beam angulation on dose-area product (DAP) rate in cardiac catheterization laboratory. Materials and Methods: We studied 30 PCI procedures in angiography department during four months. A calibrated DAP meter was used to record patients’ dosimetric characteristics. Effective dose (ED) was calculated using DAP values along with DAP to ED conversion factor. Local diagnostic reference levels (DRLs) of the DAP, fluoroscopy time, and number of CINE frames were calculated as third quartile values of these parameters. Results: The mean ± SD of DAP value per procedure was 31.4 ± 17.1 Gy.cm2, while corresponding values for fluoroscopy and CINE-acquisition (CINE) were 17.1 ± 11.2 Gy.cm2 and 14.4 ± 8.2 Gy.cm2, respectively. The estimated mean value of effective dose per procedure was 5.7 ± 3.1 mSv. The projection 40o LAO/ 30o caudal had the highest DAP rate value during CINE across various projections. Local DRLs were proposed as follows: 39.6 Gy.cm2, 6.9 min, and 679 frames. Conclusion: The mean values of DAP in this study were lower than in previous published literature. Further, deep tube angulation led to increase DAP rates. It is recommended to use minimum tube angulation for avoiding unnecessary radiation exposure.

Comprehensive assessment of radiation dose in patients undergoing percutaneous coronary intervention: the effect of beam angulation on patient dose optimization

Introduction: We aimed to determine angiography projections with lower Dose Area Product (DAP) rate by measuring the mean DAP and fluoroscopy times in coronary angiography (CAG) and percutaneous coronary intervention (PCI) and calculating DAP rate in different projections. Methods: DAP and fluoroscopy times were measured in all employed projections in real-time in 75 patients who underwent CAG or PCI by a single cardiologist in Madani Cardiovascular University Hospital (45 in CAG group and 30 in PCI group). DAP rate was calculated in both groups and in all projections. The projections with highest and lowest DAP rate were determined. Results: Mean DAP was 436.73±315.85 dGy×cm2 in CAG group and 643.26±359.58 dGy×cm2 in PCI group. The projection 40° LAO/0° had the highest DAP rate in CAG group (28.98 dGy×cm2/ sec) and it was highest in 20° RAO/30° CR in PCI group (29.83 dGy×cm2/sec). The latter projection was also the most employed projection in PCI group. Conclusion: The amount of radiation dose in this study is in consistent with the previous reports. Specific angiographic projections expose patients to significantly higher radiation and they should be avoided and replaced by less irradiating projections whenever possible.

https://jcvtr.tbzmed.ac.ir/PDF/JCVTR-6-247.pdf

Ebrahim Khayati Shal

Papers

Patient's Radiation Exposure in Coronary Angiography and Angioplasty: The Impact of Different Projections