Evaluation of coronary angiographic projections to balance the clinical yield with the radiation risk
TL;DR: In this paper, an algorithm was developed to combine published data detailing the quality of information derived for the major coronary artery segments through the use of a common set of views in angiography with data relating to the dose-area product and scatter radiation associated with these views.
Abstract: Objective: Radiation safety principles dictate that imaging procedures should minimise the radiation risks involved, without compromising diagnostic performance. This study aims to define a core set of views that maximises clinical information yield for minimum radiation risk. Angiographers would supplement these views as clinically indicated. Methods: An algorithm was developed to combine published data detailing the quality of information derived for the major coronary artery segments through the use of a common set of views in angiography with data relating to the dose–area product and scatter radiation associated with these views. Results: The optimum view set for the left coronary system comprised four views: left anterior oblique (LAO) with cranial (Cr) tilt, shallow right anterior oblique (AP-RAO) with caudal (Ca) tilt, RAO with Ca tilt and AP-RAO with Cr tilt. For the right coronary system three views were identified: LAO with Cr tilt, RAO and AP-RAO with Cr tilt. An alternative left coronary view set including a left lateral achieved minimally superior efficiency (,5%), but with an ,8% higher radiation dose to the patient and 40% higher cardiologist dose. Conclusion: This algorithm identifies a core set of angiographic views that optimises the information yield and minimises radiation risk. This basic data set would be supplemented by additional clinically determined views selected by the angiographer for each case. The decision to use additional views for diagnostic angiography and interventions would be assisted by referencing a table of relative radiation doses for the views being considered.
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Sapienza University of Rome1, Charité2, Leiden University Medical Center3, Autonomous University of Barcelona4, Innsbruck Medical University5, Leipzig University6, Semmelweis University7, National University of Ireland8, Lithuanian University of Health Sciences9, Centro Hospitalar de Vila Nova de Gaia/Espinho10, University of Glasgow11, Turku University Hospital12
TL;DR: In this paper, two mistakes were made in the original version of this article, published on 16 December 2019, which unfortunately contained two mistakes, and they were corrected in the final version.
Abstract: The original version of this article, published on 16 December 2019, unfortunately contained two mistakes.
4 citations
01 Jan 2013
TL;DR: Coronary angiography is a common interventional diagnostic procedure that is used to diagnose cardiovascular conditions such as heart attack, heart failure and angina, Breast dose in CA is conventionally believed to be low and breast cancers arising.
Abstract: Coronary angiography (CA) is a common interventional diagnostic procedure that is used to diagnose cardiovascular conditions such as heart attack, heart failure and angina, Breast dose in CA is conventionally believed to be low and breast cancers arising
4 citations
TL;DR: The mean values of DAP in this study were lower than in previous published literature, and deep tube angulation led to increase DAP rates, so it is recommended to use minimum tubeAngulation for avoiding unnecessary radiation exposure.
Abstract: 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.
3 citations
TL;DR: In this paper , the shielding effect of an optimized X-ray blanket during cardiac catheterization and estimate the potential reduction in annual operator dose based on DICOM Radiation Dose Structured Report (RDSR) data reflecting everyday clinical practice.
Abstract: Background There is increasing concern and focus in the interventional cardiology community on potential long term health issues related to radiation exposure and heavy wearable protection. Optimized shielding measures may reduce operator dose to levels where lighter radioprotective garments can safely be used, or even omitted. X-ray blankets (XRB) are commercially available but suffer from small size and lack of stability. A larger XRB may reduce operator dose but could hamper vascular access and visualization. The aim of this study is to assess shielding effect of an optimized XRB during cardiac catheterization and estimate the potential reduction in annual operator dose based on DICOM Radiation Dose Structured Report (RDSR) data reflecting everyday clinical practice. Methods Data accumulated from 7681 procedures over three years in our RDSR repository was used to identify projection angles and radiation doses during cardiac catheterization. Using an anthropomorphic phantom and a scatter radiation detector, radiation dose to the operator (mSv) and patient (dose area product—DAP) was measured for each angiographic projection for three different shielding setups. Relative operator dose (mSv/DAP) was calculated and multiplied by DAP per projection to estimate effect on operator dose. Results Adding an optimized XRB to a standard shielding setup comprising a table- and ceiling-mounted shield resulted in a 94.9% reduction in estimated operator dose. The largest shielding effect was observed in left and cranial projections where the ceiling-mounted shield offered less protection. Conclusions An optimized XRB is a simple shielding measure that has the potential to reduce operator dose.
References
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01 Jul 1959
TL;DR: Recommendations are presented which represent concepts and practices evolved from recent discussions at formal and informal meetings of the Commission and its Committees.
Abstract: The International Commission on Radiological Protection has been functioning since 1928 when it was established, under the name of International X- ray and Radium Protection Commission, by the Second International Congress of Radiology held in Stockholm, Sweden. It assumed the present name and organizational form in 1950 in order to cover more effectively the rapidly expanding field of radiation protection. Recommendations are presented which represent concepts and practices evolved from recent discussions at formal and informal meetings of the Commission and its Committees. (auth)
6,166 citations
TL;DR: Effective dose provides an approximate indicator of potential detriment from ionizing radiation and should be used as one parameter in evaluating the appropriateness of examinations involving ionizing Radiation.
Abstract: Medical uses of radiation have grown very rapidly over the past decade, and, as of 2007, medical uses represent the largest source of exposure to the U.S. population. Most physicians have difficulty assessing the magnitude of exposure or potential risk. Effective dose provides an approximate indicator of potential detriment from ionizing radiation and should be used as one parameter in evaluating the appropriateness of examinations involving ionizing radiation. The purpose of this review is to provide a compilation of effective doses for radiologic and nuclear medicine procedures. Standard radiographic examinations have average effective doses that vary by over a factor of 1000 (0.01-10 mSv). Computed tomographic examinations tend to be in a more narrow range but have relatively high average effective doses (approximately 2-20 mSv), and average effective doses for interventional procedures usually range from 5-70 mSv. Average effective dose for most nuclear medicine procedures varies between 0.3 and 20 mSv. These doses can be compared with the average annual effective dose from background radiation of about 3 mSv.
1,736 citations
TL;DR: Physicians ordering and performing cardiac imaging should be very familiar with the dosage of radiation from cardiac diagnostic tests and ways in which dose can be minimized, including nuclear scintigraphy, CT for calcium scoring and coronary angiography (CTCA), and conventional coronary angIography (CCA).
Abstract: The volume of cardiac diagnostic procedures involving the use of ionizing radiation has increased rapidly in recent years. Whereas in 1990, fewer than 3 million nuclear cardiology studies were performed in the United States, by 2002 this figure more than tripled to 9.9 million.1 Cardiac computed tomographic (CT) volume doubled between 2002 and 2003, to 485 000 cases,2 and has continued to grow since then. The volume of procedures performed in cardiac catheterization labs increased from 2.45 million in 1993 to 3.85 million in 2002.3
The powerful diagnostic and risk-stratification data provided by these procedures play a central role in clinical cardiology and have contributed to the decrease in morbidity and mortality from coronary heart disease. Nevertheless, performance of any diagnostic test requires a careful assessment of the risks and benefits of the test and optimization of protocols to minimize risks to patients, staff members, and the public. Procedures that utilize ionizing radiation should be performed in accordance with the As Low As Reasonably Achievable (ALARA) philosophy. Thus, physicians ordering and performing cardiac imaging should be very familiar with the dosage of radiation from cardiac diagnostic tests and ways in which dose can be minimized. In this report we discuss the measurement of radiation and the dosimetry of commonly performed cardiac diagnostic imaging tests, including nuclear scintigraphy, CT for calcium scoring and coronary angiography (CTCA), and conventional coronary angiography (CCA). For each modality, we address the terminology and methodology used to quantify radiation received by patients, doses to patients with typical protocols, and dose-reduction techniques.
Biological effects of ionizing radiation can be classified as deterministic or stochastic. Deterministic effects such as skin injuries and cataract formation occur predictably when dose exceeds a certain threshold, whereas stochastic effects such as cancer incidence and germ cell mutations occur with …
792 citations
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307 citations
TL;DR: The objective of the present project was the determination of the dose received by patients during cardiac procedures, such as coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and stent implantation, which showed the contribution of cinefluorography to the total DAP was higher than that of fluoroscopy.
Abstract: The objective of the present project was the determination of the dose received by patients during cardiac procedures, such as coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and stent implantation. Thermoluminescent dosemeters (TLDs), suitably calibrated, were used for the measurement of the dose received at four anatomical locations on the patient's skin. A dose-area product (DAP) meter was also used. The contribution of cinefluorography to the total DAP was higher than that of fluoroscopy. A DAP to effective dose conversion factor equal to 0.183 mSv Gy-1 cm-2 was estimated with the help of a Rando phantom. Thus, the effective dose received by the patients could be assessed. Mean values of effective dose equal to 5.6 mSv, 6.9 mSv, 9.3 mSv, 9.0 mSv and 13.0 mSv were estimated for coronary angiography, PTCA, coronary angiography and ad hoc PTCA, PTCA followed by stent implantation and coronary angiography and ad hoc PTCA followed by stent implantation, respectively.
171 citations