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Rofo 2003; 175(12): 1706-1710
DOI: 10.1055/s-2003-45341
Dosimetrie
© Georg Thieme Verlag Stuttgart · New York

Predialing the Number of Cinegraphic Frames Enables an Effective Patient Dose Due to Coronary Angiography of 0.8 mSv

Vorwahl der kinematographischen Bilderanzahl reduziert effektive Patientendosis einer Koronarangiographie auf 0,8 mSvE.  Kuon1 , M.  Schmitt1 , C.  Dorn1 , A.  Pfahlberg2 , O.  Gefeller2 , J.  B.  Dahm3
  • 1Department of Cardiology, Klinik Fränkische Schweiz, Ebermannstadt, Germany
  • 2Institute for Computer Sciences, Biometry and Epidemiology, Friedrich Alexander University, Erlangen-Nuremberg, Germany
  • 3Department of Cardiology, Ernst-Moritz-Arndt University, Greifswald, Germany
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Publication History

Publication Date:
08 December 2003 (online)

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Abstract

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 106.3 Gy × cm2. Applying the accepted DAP-to-ED conversion factors, for the thoracic region of approximately 0.20 mSv/Gy × cm2, this corresponds to a mean effective dose (ED) in the range of 3.1 to 21.3 mSv. Material and Methods: For patients undergoing elective coronary angiography, we compared various parameters of radiation exposure obtained with judicious radiation reducing standard techniques (n = 106) and with an additional new rotary switch for predialing the number of cinegraphic frames (n = 106). Results: The patient radiation dose was significantly lower with the new device, with the mean DAP reduced to 5.5 from 9.1 Gy × cm2. The corresponding reducation of the mean DAP for left ventriculography and coronary angiography was 1.3 from 1.7, and 4.2 from 7.4 Gy × cm2, respectively. The number of cinegraphic frames was 98 vs. 184, whereas the number of cinegraphic runs and the fluoroscopy time were comparable. Conclusion: Predialing the cinegraphic frame number before each cinegraphic run enables a reduction of the patients effective dose from coronary angiography to 0.8 mSv, i. e. to 57 % of the baseline value and far below typically reported values.

Zusammenfassung

Ziel: Erprobung einer neuen Vorrichtung zur Vorwählbarkeit der Kinematographie-Serienlänge hinsichtlich der Patientenstrahlenexposition bei Koronarangiographie. Letztere erfordert üblicherweise 1000 - 2350 Kinematographiebilder und verursacht laut Studienlage ein Dosisflächenprodukt (DFP) zwischen 15,6 und 106,3 Gy × cm2. Für in der Thorakalregion anerkannte Konversionsfaktoren von ca 0,2 mSv/Gy × cm2 entspricht dies einer effektiven Patientendosis zwischen 3.1 und 21.3 mSv. Material und Methoden: Im Verlauf von 106 elektiven Koronarangiographien, durchgeführt entsprechend internationalen Strahlenschutzempfehlungen, bestimmten wir verschiedenste strahlendosisrelevante Parameter und verglichen diese mit den Daten von 106 Koronarangiographien unter zusätzlicher Anwendung einer Zeitschaltung, die die Kinematographie-Serienlänge auf eine vorwählbare Bilderanzahl begrenzte. Ergebnisse: Das Patienten-DFP war unter Verwendung der Zeitschaltung signifikant niedriger als im Vergleichskollektiv und betrug 5,5 vs. 9,1 Gy × cm2; die entsprechenden Mittelwerte für Laevokardiographie und Koronarangiographie ergaben 1,3 vs. 1,7 bzw. 4,2 vs. 7,4 Gy × cm2, die Kinematographie-Bilderanzahl betrug 98 vs. 184. Hingegen waren Kinematographie-Serienanzahl und Durchleuchtungszeit vergleichbar. Schlussfolgerung: Eine vorwählbare Kinematographie-Zeitschaltung ermöglicht die Reduktion der effektiven Dosis einer hochauflösenden Koronarangiographie bei Patienten auf 0,8 mSv bzw. 57 % unserer Ausgangswerte. Sie unterschreiten damit erheblich entsprechende Literaturberichte.

Key words

Radiation dose - patient exposure - effective dose - coronary angiography

Literatur

  • 1 Bakalyar D M, Castellani M D, Safian R D. Radiation exposure to patients undergoing diagnostic and interventional cardiac catheterization procedures.  Cathet Cardiovasc Diagn. 1997;  42 121-125
    CrossrefPubMedGoogle Scholar
  • 2 Zorzetto M, Bernardi G, Morocutti G, Fontanelli A. Radiation exposure to patients and operators during diagnostic catheterization and coronary angioplasty.  Cathet Cardiovasc Diagn. 1997;  40 348-351
    CrossrefPubMedGoogle Scholar
  • 3 Betsou S, Efstathopoulos E P, Katritsis D, Faulkner K, Panayiotakis G. Patient radiation doses during cardiac catheterization procedures.  Br J Radiol. 1998;  71 634-639
    CrossrefPubMedGoogle Scholar
  • 4 Clark A L, Brennan A G, Robertson L J, McArthur J D. Factors affecting patient radiation exposure during routine coronary angiography in a tertiary referral centre.  Br J Radiol. 2000;  73 184-189
    PubMedGoogle Scholar
  • 5 Fransson S G, Persliden J. Patient radiation exposure during coronary angiography and intervention.  Acta Radiol. 2000;  41 142-144
    CrossrefPubMedGoogle Scholar
  • 6 Van de Putte S, Verhaegen F, Taeymans Y, Thierens H. Correlation of patient skin doses in cardiac interventional radiology with dose-area product.  Br J Radiol. 2000;  73 504-513
    PubMedGoogle Scholar
  • 7 Lobotessi H, Karoussou A, Neofotistou V, Louisi A, Tsapaki V. Effective dose to a patient undergoing coronary angiography.  Radiat Prot Dosimetry. 2001;  94 173-176
    PubMedGoogle Scholar
  • 8 Arthur W R, Dhawan J, Norell M S, Hunter A J, Clark A L. Does cardiologist- or radiographer-operated fluoroscopy and image acquisition influence optimization of patient radiation exposure during routine coronary angiography?.  Br J Radiol. 2002;  75 748-753
    PubMedGoogle Scholar
  • 9 Delichas M G, Psarrakos K, Molyvda-Athanassopoulou E, Giannoglou G, Hatziioannou K, Papanastassiou E. Radiation doses to patients undergoing coronary angiography and percutaneous transluminal coronary angioplasty.  Radiat Prot Dosimetry. 2003;  103 149-154
    PubMedGoogle Scholar
  • 10 Hart D, Jones D G, Wall B F. Estimation of effective dose in diagnostic radiology from entrance surface dose and dose-area product measurements. NRPB-R 262. National Radiological Protection Board Oxon Ox 11 0RQ; Chilton Didcot 1994: 36
  • 11 Leung K C, Martin C J. Effective doses for coronary angiography.  Br J Radiol. 1996;  69 426-431
    PubMedGoogle Scholar
  • 12 Neofotistou V. Review of patient dosimetry in cardiology.  Radiat Prot Dosimetry. 2001;  94 177-182
    PubMedGoogle Scholar
  • 13 Kuon E, Schmitt M, Dahm J B. Significant reduction of radiation exposure to staff during cardiac interventions by analysis of radiation leakage and improved lead shielding.  Am J Cardiol. 2002;  89 44-49
    CrossrefPubMedGoogle Scholar
  • 14 Kuon E, Dahm J B, Schmitt M, Glaser C, Gefeller O, Pfahlberg A. Time of day influences patient's radiation exposure due to percutaneous cardiac interventions.  Br J Radiol. 2003;  76 189-191
    PubMedGoogle Scholar
  • 15 Kuon E, Dorn C, Schmitt M, Dahm J B. Radiation dose reduction in invasive cardiology by restriction to adequate instead of optimized picture quality.  Health Phys. 2003;  84 626-631
    PubMedGoogle Scholar
  • 16 Kuon E, Glaser C, Dahm J B. Effective techniques to reduce radiation dosage to patients undergoing invasive cardiac procedures.  Br J Radiol. 2003;  76 403-413
    PubMedGoogle Scholar
  • 17 Kuon E, Günther M, Gefeller O, Dahm J B. Standardization of occupational dose to patient's DAP enables reliable assessment of radiation protection devices in invasive cardiology.  Fortschr Röntgenstr. 2003;  175 1545-1550
    PubMedGoogle Scholar
  • 18 Kuon E, Lang E. X-ray exposition in heart catheterism: extent, influencing variables and suggestions to mnimize radiation dose.  Z Kardiol. 1996;  85 543-552
    PubMedGoogle Scholar
  • 19 Recommendations of the International Commission on Radiological Protection .ICRP Publication 60. Oxford; Pergamon Press 1991
  • 20 CEC Council Directive 97/43/Euratom of 30 June 1997 . Article 4: On health protection of individuals against the dangers of ionizing radiation in relation to medical exposure.  Euratom Gazette. 1997;  L180 22-27
    PubMedGoogle Scholar
  • 21 Valentin J. Avoidance of radiation injuries from medical interventional procedures.  Ann ICRP. 2000;  30 7-67
    PubMedGoogle Scholar
  • 22 Wyart P, Dumant D, Gourdier M, Nassar F, Bouthillon J C, Chestier Y. Contribution of self-surveillance of the personnel by electronic radiation dosemeters in invasive cardiology.  Arch Mal Coeur Vaiss. 1997;  90 233-238
    PubMedGoogle Scholar
  • 23 Kalden P, Mohrs O, Kreitner K F, Thelen M, Schreiber W G. Preliminary results of coronary artery examination using a 3D-Navigator sequence on a high performance MR system.  Fortschr Röntgenstr. 2002;  174 183-186
    PubMedGoogle Scholar
  • 24 Achenbach S, Daniel W G. Noninvasive coronary angiography - an acceptable alternative?.  N Engl J Med. 2001;  345 1909-1910
    CrossrefPubMedGoogle Scholar
  • 25 Kim Y, Danias P G, Stuber M, Flamm S D, Plein S, Nagel E, Langerak S E, Weber O M, Pedersen E M, Schmidt M, Botnar R M, Manning W J. Coronary magnetic resonance angiography for the detection of coronary stenoses.  N Engl J Med. 2001;  345 1863-1869
    CrossrefPubMedGoogle Scholar
  • 26 Danias P G, Hauser T H, Katsimaglis G, Botnar R M, Manning W J. Coronary magnetic resonance angiography.  Herz. 2003;  28 90-98
    PubMedGoogle Scholar
  • 27 Herzog C, Ay M, Engelmann K, Abolmaali N, Dogani S, Diebold T, Vogl T J. Visualization techniques for multislice CT datasets of coronary arteries: correlation of axial, multiplanar, three-dimensional, and virtual endoscopic imaging with coronary angiography.  Fortschr Röntgenstr. 2001;  173 341-349
    PubMedGoogle Scholar
  • 28 Achenbach S. Clinical use of multi-slice CT coronary angiography.  Herz. 2003;  28 119-125
    PubMedGoogle Scholar
  • 29 Becker C, Schätzl M, Feist H, Bäuml A, Schöpf U J, Michalski G, Lechel U, Hengge M, Brüning R, Reiser M. Estimation of the effective dose applied by routine investigation of the chest, heart and abdomen with conventional CT, electron beam tomography and coronary angiography.  Fortschr Röntgenstr. 1999;  170 99-104
    PubMedGoogle Scholar
  • 30 Cohnen M, Poll L, Puttmann C, Ewen K, Modder U. Radiation exposure in multi-slice of the heart.  Fortschr Röntgenstr. 2001;  173 295-299
    PubMedGoogle Scholar
  • 31 McCollough C H, Zink F E. Performance evaluation of a multi-slice CT system.  Med Phys. 1999;  26 2223-2230
    CrossrefPubMedGoogle Scholar
  • 32 Golder W, Weiner G. Bodily structures and radiation exposures in static X-ray procedures: A contribution to determine national reference data.  Fortschr Röntgenstr. 2001;  173 563-568
    PubMedGoogle Scholar
  • 33 Announcement to the German Parliament by the German Federal Ministry for Environment, Natural Conversation, and Nuclear Safety. dated 10 September 2001, Letter No. 15/6905:30
  • 34 McCollough C H. Patient dose in cardiac computed tomography.  Herz. 2003;  28 1-6
    PubMedGoogle Scholar
  • 35 Poll L W, Cohnen M, Brachten S, Ewen Modder U. Dose reduction in multi-slice CT of the heart by use of ECG controlled tube current modulation (“ECG pulsing”): phantom measurements.  Fortschr Röntgenstr. 2002;  174 1500-1505
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Morin R L, Gerber T C, McCollough C H. Radiation dose in computed tomography of the Heart.  Circulation. 2003;  107 917-922
    CrossrefPubMedGoogle Scholar
  • 37 Heuschmid M, Küttner A, Flohr T, Wildberger J E, Lell M, Kopp A F, Schröder S, Baum U, Schaller S, Hartung A, Ohnesorge B, Claussen C D. Visualization of coronary arteries in CT as assessed by a new 16 slice technology and reduced gantry rotation time: first experiences.  Fortschr Röntgenstr. 2002;  174 721-724
    PubMedGoogle Scholar
  • 38 Flohr T, Bruder H, Stierstorfer K, Simon J, Schaller S, Ohnesorge B. New technical developments in multislice CT, part 2: submillimeter 16-slice scanning and increased gantry rotation speed for cardiac imaging.  Fortschr Röntgenstr. 2002;  174 1022-1027
    PubMedGoogle Scholar

Dr. med. Eberhard Kuon

Klinik Fränkische Schweiz

Feuersteinstraße 2

91320 Ebermannstadt

Germany

Phone: + 49-9194-55386

Fax: + 49-9194-55387

Email: Eberhard.Kuon@klinik-fraenkische-schweiz.de

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