Long-term strategies support autonomy in radiation safety in invasive cardiology.

Background And Purpose: Despite comprehensive radiation safety programs, radiation exposure in invasive cardiology remains considerable. According to the 2013 German Registry, median in-hospital dose area products (DAP) amount to 19.8Gycm(2) for invasive coronary angiography (CA).

Role of Experience, Leadership and Individual Protection in the Cath Lab--A Multicenter Questionnaire and Workshop on Radiation Safety.

Purpose: Radiation exposure in invasive cardiology remains considerable. We evaluated the acceptance of radiation protective devices and the role of operator experience, team leadership, and technical equipment in radiation safety efforts in the clinical routine.

Materials And Methods: Cardiologists (115 from 27 centers) answered a questionnaire and documented radiation parameters for 10 coronary angiographies (CA), before and 3.

Multicenter long-term validation of a minicourse in radiation-reducing techniques in the catheterization laboratory.

Patient radiation exposure in invasive cardiology is considerable. We aimed to investigate, in a multicenter field study, the long-term efficacy of an educational 90-minute workshop in cardiac invasive techniques with reduced irradiation. Before and at a median period of 2.

ECG-gated coronary angiography enables submillisievert imaging in invasive cardiology.

Background: The median dose area products (DAP) and effective doses (ED) of patients arising from coronary angiography (CA) are considerable: According the 2013 National German Registry, they amount to 19.8 Gy × cm(2) and 4.0 mSv, respectively.

Efficacy of a minicourse in radiation-reducing techniques in invasive cardiology: a multicenter field study.

Objectives: Our goal was to validate an educational 90-min minicourse in lower-irradiating cardiac invasive techniques.

Background: Despite comprehensive radiation safety programs, patient radiation exposure in invasive cardiology remains considerable.

Methods: Before and at a median period of 3.

Latest-generation catheterization systems enable invasive submillisievert coronary angiography.

Background: The radiation risk of patients undergoing invasive cardiology remains considerable and includes skin injuries and cancer. To date, submillisievert coronary angiography has not been considered feasible.

Patients And Methods: In 2011, we compared results from 100 consecutive patients undergoing elective coronary angiography using the latest-generation flat-panel angiography system (FPS) with results from examinations by the same operator using 106 historic controls with a conventional image-intensifier system (IIS) that was new in 2002.

Long-term efficacy of a mini-course in radiation-reducing techniques in invasive cardiology.

Purpose: To validate the long-term efficacy of a 90-min. educational mini-course in less-irradiating cardiac interventional techniques.

Materials And Methods: Before, two months after, and two years after the mini-course (periods I, II, and III), we analyzed the following radiation dose parameters for ten coronary angiographies (CA), performed by each of 7 cardiologists: total dose-area product (DAP), radiographic and fluoroscopic DAP fractions, number of radiographic frames and runs, and fluoroscopy time.

Comparison of rotational with conventional coronary angiography.

Background: Patient radiation exposure and consumption of contrast medium are considered major risks of diagnostic coronary angiography (CA). Rotation of the C-arm during CA could provide similar diagnostic accuracy and lower radiation exposure and contrast medium consumption.

Methods: To compare feasibility, safety, diagnostic accuracy, patient radiation exposure, and consumption of contrast medium of rotational CA with the invasive standard technique, intraindividual comparisons of the results obtained by both techniques were performed in 235 patients with an indication for first-time elective CA.

A new angiographic method to assess coronary flow reserve-validation in humans.

Background: Coronary flow reserve (CFR) is defined as the ratio between coronary artery flow during maximal hyperemia and rest. It is considered as a marker for the integrity of the epicardial coronary circulation and the microcirculation. CFR measurement typically requires the introduction of a guide wire into a diseased coronary artery.

Radiation-reducing planning of cardiac catheterisation.

Any radiation exposition for medical purposes should be kept as low as is reasonably achievable. Mean patient radiation exposure of diagnostic cardiac catheterisation is high (16-106 Gy x cm2) and for this reason the International Commission on Radiological Protection (ICRP) recommends credentialing radiation protection training programmes. Twenty cardiologists each documented various dose parameters of 10 cardiac catheterisations, before and after a 90-minute mini-course of the ELICIT study group ("Encourage to Less Irradiating Cardiologic Interventional Techniques"), and could achieve a reduction of the mean dose-area product by 15.

[Fluoroscopy time -- an overestimated factor for patient radiation exposure in invasive cardiology].

Purpose: To analyze the effects of an optimized fluoroscopy time on patient radiation exposure in the course of coronary angiography (CA) and percutaneous coronary interventions (PTCA), in comparison to those with consistent collimation to the region of interest (ROI). Furthermore, to analyze efforts concerning reduction of radiographic frames as well as concerning adequate instead of best possible image quality.

Material And Methods: For 3,115 elective CAs and 1,713 PTCA performed by one interventionist since 1997, we documented the radiographic dose-area products (DAP (R)) and fluoroscopic dose-area products (DAP (F)), the number of radiographic frames and the fluoroscopy times during selected 2-month intervals.

The challenge presented by right atrial myxoma.

Background And Purpose: Right atrial myxoma can be heralded by nonspecific constitutional symptoms-i. e., remittent or lasting fever; weight loss; chronic anemia and general arthralgia-and may escape timely diagnosis until severe complications develop: i.

Identification of less-irradiating tube angulations in invasive cardiology.

Objectives: We sought to identify tube angulations in invasive cardiology, which promise minimal radiation exposure to patients and operators.

Background: Radiation exposure in invasive cardiology is high.

Methods: We mapped the fluoroscopic dose-area product per second (DAP/s), applied to an anthropomorphic Alderson-Rando phantom and, in absence of radiation protection devices, the mean personal dose in the operator's position in 10 degrees steps from the 100 degrees right anterior oblique (RAO) to the 100 degrees left anterior oblique (LAO) projection, as well as for all geometrically feasible craniocaudal tube angulations.

Single coronary artery--a rarity in the catheterization laboratory: case report and current review.

A single coronary artery is a rare anomaly but has been associated with sudden cardiac death. A 73-year-old man with atypical chest pain and exercise-induced ischemia arising from a single coronary artery with the left main coronary stem originating from the proximal right coronary artery and passing posterior and inferior to the aortic root is described. The exact three-dimensional course was not reliably established by coronary angiography but was clearly demonstrated by contrast-enhanced electron beam tomography.

[Personal operator dose in invasive cardiology as a function of body height and tube angulation].

Purpose: To map in an experimental setting of the local personal operator dose for 55 selected tube angulations as a function of body height above ground.

Materials And Methods: On an Alderson-Rando phantom representing the patient, we performed measurements of fluoroscopy scatter radiation ( micro Sv/h) at the operator's position, for the range of 20 - 200 cm body height, for all tube angulations in 30 degrees steps from right anterior oblique (RAO) 90 degrees to left anterior oblique (LAO) 90 degrees position, and for planes angulated cranially (+) and caudally (-) by 10 degrees, 20 degrees, 30 degrees, and 40 degrees, unless rendered unfeasible by geometric circumstances.

Results: Radiation exposure to the operator is lowest between postero-anterior (PA) 0 degrees and RAO 30 degrees angulation, and continuously increases by a factor of approx.

Radiation exposure to patients undergoing percutaneous coronary interventions: are current reference values too high?

Purpose: To determine predictors of patient radiation exposure due to percutaneous coronary interventions (PCI) and to compare our results with the "preliminary reference levels", recently proposed by the European DIMOND research cardiology group: i. e., 75 Gy.

Predialing the number of cinegraphic frames enables an effective patient dose due to coronary angiography of 0.8 mSv.

Purpose: To investigate the effect of a new device for predialing the number of cinegraphic frames before each coronary angiogaphy, with the objective of reducing the patient dose area product (DAP) from coronary angiography, which typically requires 1000 to 2350 cinegraphic frames. That DAP is high and stated to be between 15.6 to 106.

Standardization of occupational dose to patient DAP enables reliable assessment of radiation-protection devices in invasive cardiology.

Purpose: With the aim of assessing the effectiveness of radiation-protection devices in invasive cardiology, the goal of this study was to validate relative parameters for operator occupational exposure, standardized to the patient's primary dose.

Material And Methods: One of these parameters was the local dose, measured in air at the operator's position per dose area product (DAP), applied to a male anthropomorphic Alderson-Rando phantom for simulation of coronary angiography. The second parameter was personal occupational dose to the operator per DAP, measured by thermoluminescence dosimeter stripes during 121 procedures in routine clinical work.

Radiation exposure benefit of a lead cap in invasive cardiology.

Background: Occupational head exposure to radiation in cardiologists may cause radiation induced cataracts and an increased risk of brain cancer.

Objective: To determine the effectiveness of 0.5 mm lead equivalent caps, not previously used in invasive cardiology, in comparison with a 1.