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Pancholy S - AIMRADIAL 2013 - Radiation exposure
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Pancholy S - AIMRADIAL 2013 - Radiation exposure

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Influence of access-site on radiation exposure in cardiac catheterization

Influence of access-site on radiation exposure in cardiac catheterization

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    Pancholy S - AIMRADIAL 2013 - Radiation exposure Pancholy S - AIMRADIAL 2013 - Radiation exposure Presentation Transcript

    • Influence of Access-site on Radiation Exposure in Cardiac Catheterization Systematic Review and Meta-Analysis of Observational and Randomized Trials Samir Pancholy, MD, Guillaume Plourde, Imdad Ahmed Sunil Rao, Sanjit Jolly, Sripal Bangalore, Tejas Patel, Olivier Bertrand AimRADIAL2013
    • Disclosures Research grants: Cordis, Eli-Lilly, Bristol-MyersSquibb, GE Healthcare, Sanofi-Aventis, Eurocor Consultant: Cordis, Astra-Zeneca, Opsens Research-Scholar from Quebec Fund for Health Research
    • Background Large pool of data comparing TRA vs. TFA radiation exposure However, it remains unclear whether TRA is associated with clinically significant increase in radiation exposure
    • Background Radiation burden a function of many variables Patient substrate Operator experience Operator awareness Equipment Angiographic routine
    • Objectives To perform a systematic review and meta-analysis of ALL studies (observational & randomized) comparing radiation exposure between TRA and TFA for:  Diagnostic coronary angiograms (DCA)  Percutaneous coronary intervention (PCI)
    • Methods Standard PRISMA, QUOROM (randomized) and MOOSE (observational) protocols PubMed, Embase, Cochrane databases using “radial”, “femoral”, “cardiac catheterization”, “radiation exposure”, “fluoroscopy time”, “dose-area-product” Cross-referencing with The Radialist.org Last update: June 26 2013
    • Outcomes Patient’s radiation exposure  Fluoroscopy time (FT) (minutes)  Dose-area-product (DAP) (Gy ・ cm2) Operator’s radiation exposure  Radiation dose (µSv)
    • Meta-Analysis Data summarised as the mean difference of continuous variables with 95% confidence intervals Combined using the DerSimonian and Laird random effects model with inverse variance weighting When SD were missing, or data expressed as medians with IQR, authors were contacted Subgroups were based on intervention type (DCA vs. PCI) Separate analyses for randomized and observational studies, and a third combining both
    • Studies selection Total of 666,765 patients
    • Studies Characteristics 68 studies (666,765 patients), conducted between 1995-2013 18 randomized trials (n=12,051); 50 observational studies (n=654,714) 60 single-center and 8 multi-center studies In randomized trials, 6,193 TRA and 5,858 TFA
    • Impact on FT in diagnostic coronary angiograms Randomized Observational
    • Impact on FT in percutaneous coronary interventions Randomized Observational
    • Impact on DAP in diagnostic coronary angiograms Randomized Observational
    • Impact on DAP in percutaneous coronary interventions Randomized Observational
    • TF vs TR Fluoro time (Diagnostic)
    • LRA vs RRA Fluoro time (PCI)
    • Effect of Training
    • Effect of Training
    • Effect of Training
    • Operator Exposure Sciahbasi A
    • Impact on Operator Dose
    • Relationship Between Years Since 1992 and Fluoroscopy Time PCI Cohort (Non-randomized) TRA TFA
    • Non-randomized trials 80 70 60 Dose-Area Product TR TF 50 Linear (TR) Linear (TF) 40 30 20 18 years later 10 0 10 12 14 16 18 20 Years since first descrip on of TRI 22 24
    • Meta-regression of Fluoroscopy time and Year of Publication since First Description of TRI (1992) (Randomized) 6.00 Difference in means 5.20 P = 0.0001 4.40 3.60 2.80 2.00 1.20 0.40 -0.40 -1.20 -2.00 2.30 4.34 6.38 8.42 10.46 12.50 Years 14.54 16.58 18.62 20.66 22.70
    • Non-randomized Studies Reporting Fluoroscopy Time (PCI) 10.00 P = 0.0001 Difference in means Fluoroscopy Time 8.60 7.20 5.80 4.40 3.00 1.60 0.20 -1.20 -2.60 -4.00 6.70 8.26 9.82 11.38 12.94 14.50 16.06 17.62 Years since TRI Publication 19.18 20.74 22.30
    • Conclusion FT and DAP in TRA continues to decrease over the last years TRA, when compared to TFA in the last 5 years, was associated with <1 minute higher FT for DCA and PCI Radiation exposure is moderately increased when initially adopting TRA (like many other skills), with high likelihood of progressive decrease with increasing experience.