Plourde G - AIMRADIAL 2013 - Radiation exposure

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Multi- or single-catheter in diagnostic coronary angiogram: effect on patient’s radiation exposure

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Plourde G - AIMRADIAL 2013 - Radiation exposure

  1. 1. Multi- or Single-Catheter in Diagnostic Coronary Angiogram? Effect on Patient’s Radiation Exposure Guillaume Plourde M.D./M.Sc. student, Université Laval Research intern in Dr O.F. Bertrand’s team AimRADIAL2013
  2. 2. Disclosures • No conflicts of interest to disclose.
  3. 3. Background • With transradial approach (TRA), diagnostic coronary angiogram (DCA) is usually performed with routines using single- or multi-catheters. • Is there a difference in radiation exposure?
  4. 4. Objective • To compare fluoroscopy time (FT) and dose-area-product (DAP) during TRA DCA using 4 different routines: • Routine #1 - Judkins L/R • Routine #2 - Amplatz L • Routine #3 - Barbeau • Routine #4 - Multipurpose All patients had an LV angiogram with a Pigtail, a Barbeau or a Multipurpose catheter *Catheters are from Cordis Corporation, Miami Lakes, USA
  5. 5. Study population • All patients who underwent an elective DCA between Nov. 2012 and July 2013 • • • • • 1,384 patients (100% TRA) All had an LV angiogram No PCI, no graft study Radiation data available Intent-to-treat analysis
  6. 6. Factors influencing radiation exposure Patient characteristics - Weight - Height - Gender - Age Radiation delivering/ measuring systems - Rooms (4 different rooms at our hospital) Operators Catheters - 14 different operators (including fellows) - Catheter routine (JL/JR vs. AL vs. Barbeau vs. Multipurpose) - Catheter technique (Single- vs. Multi-catheters)
  7. 7. Factors influencing radiation exposure Patient characteristics - Weight - Height - Gender - Age Radiation delivering/ measuring systems - Rooms (4 different rooms at our hospital) Operators Catheters - 14 different operators (including fellows) - Catheter routine (JL/JR vs. AL vs. Barbeau vs. Multipurpose) - Catheter technique (Single- vs. Multi-catheters)
  8. 8. Baseline characteristics All n = 1,384 Routine #1 (JL/JR) n = 1,193 Routine #2 (AL) n = 56 Routine #3 (Barbeau) n = 90 Routine #4 (Multipurpose) n = 45 P value Males, n (%) 935 (68) 794 (67) 32 (57) 84 (93) 25 (56) < 0.0001 Age (years) 64 ± 11 64 ± 11 65 ± 12 63 ± 11 67 ± 91 0.2714 Weight (kg) 81 ± 18 81 ± 18 80 ± 19 85 ± 16 79 ± 15 0.1346 Height (cm) 168 ± 9 168 ± 9 166 ± 10 172 ± 8 166 ± 10 < 0.0001 BSA (m2) 1.95 ± 0.26 1.95 ± 0.26 1.93 ± 0.28 2.03 ± 0.23 1.92 ± 0.22 0.0293
  9. 9. Factors influencing radiation exposure Patient characteristics - Weight - Height - Gender - Age Radiation delivering/ measuring systems - Rooms (4 different rooms at our hospital) Operators Catheters - 14 different operators (including fellows) - Catheter routine (JL/JR vs. AL vs. Barbeau vs. Multipurpose) - Catheter technique (Single- vs. Multi-catheters)
  10. 10. Radiation data • Radiation exposure was assessed via dose- area-product (Gy・cm2) and fluoroscopy time • DAP values were either estimated by the Xray system or measured by a “Diamentor” DAP-meter integrated to the collimator • X-ray systems: Innova 2000 (GE) and Artis dBc & dFc (Siemens)
  11. 11. Factors influencing radiation exposure Patient characteristics - Weight - Height - Gender - Age Radiation delivering/ measuring systems - Rooms (4 different rooms at our hospital) Operators Catheters - 14 different operators (including fellows) - Catheter routine (JL/JR vs. AL vs. Barbeau vs. Multipurpose) - Catheter technique (Single- vs. Multi-catheters)
  12. 12. Operator effect on radiation exposure 2.6 min
  13. 13. Factors influencing radiation exposure Patient characteristics - Weight - Height - Gender - Age Radiation delivering/ measuring systems - Rooms (4 different rooms at our hospital) Operators Catheters - 14 different operators (including fellows) - Catheter routine (JL/JR vs. AL vs. Barbeau vs. Multipurpose) - Catheter technique (Single- vs. Multi-catheters)
  14. 14. Catheter routine effect on radiation exposure All n = 1,384 Routine #1 (JL/JR) n = 1,193 Routine #2 (AL) n = 56 Routine #3 (Barbeau) n = 90 Routine #4 (Multipurpose) n = 45 P value Fluoroscopy time (min) 2.7 [2.0-3.9] 2.7 [2.0-3.9] 4.0 [3.0-5.7] 3.0 [2.2-4.2] 2.1 [1.6-2.5] <0.0001 Dose-areaproduct (cGy・cm2) 3,099 [2,128-4,408] 3,007 [2,061-4,363] 3,622 [2,592-4,866] 3,874 [2,694-5,503] 3,220 [2,338-4,251] <0.0001 “Intended” routine only n (%) 1,208 (87) 1,070 (90) 44 (79) 51 (57) 44 (98) 0.0004 Crossovers n (%) 175 (13) 123 (10) 12 (21) 39 (43) 1 (2) 0.0004
  15. 15. Catheter routine effect on radiation exposure All n = 1,384 Routine #1 (JL/JR) n = 1,193 Routine #2 (AL) n = 56 Routine #3 (Barbeau) n = 90 Routine #4 (Multipurpose) n = 45 P value Fluoroscopy time (min) 2.7 [2.0-3.9] 2.7 [2.0-3.9] 4.0 [3.0-5.7] 3.0 [2.2-4.2] 2.1 [1.6-2.5] <0.0001 Dose-areaproduct (cGy・cm2) 3,099 [2,128-4,408] 3,007 [2,061-4,363] 3,622 [2,592-4,866] 3,874 [2,694-5,503] 3,220 [2,338-4,251] <0.0001 “Intended” routine only n (%) 1,208 (87) 1,070 (90) 44 (79) 51 (57) 44 (98) 0.0004 Crossovers n (%) 175 (13) 123 (10) 12 (21) 39 (43) 1 (2) 0.0004
  16. 16. Catheter routine effect on radiation exposure Single-catheter technique Single-catheter technique
  17. 17. Catheter technique effect on radiation exposure Routine #2: AL Routine #3: Barbeau Routine #4: Multipurpose Routine #1: JL/JR Routine #2: AL Routine #3: Barbeau Routine #4: Multipurpose Routine #1: JL/JR
  18. 18. Conclusions • Multi-catheters technique (JL/JR) decreases radiation exposure (both DAP and FT) when compared to other single-catheter techniques (AL, Barbeau, Multipurpose). • Further studies with new type of universal catheters (Tiger...) should evaluate the radiation parameters

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