Abstract
The purpose of this study was to evaluate peak skin dose received by the patient and scattered dose to the operator during dual‐axis rotational coronary angiography (DARCA), and to compare with those of standard coronary angiography (SA). An anthropomorphic phantom was used to simulate a patient undergoing diagnostic coronary angiography. Cine imaging was applied on the phantom for 2 s, 3 s, and 5 s in SA projections to mimic clinical situations with normal vessels, and uncomplicated and complicated coronary lesions. DARCA was performed in two curved trajectories around the phantom. During both SA and DARCA, peak skin dose was measured with thermoluminescent dosimeter arrays and scattered dose with a dosimeter at predefined height (approximately at the level of left eye) at the operator's location. Compared to SA, DARCA was found lower in both peak skin dose (range: 44%–82%, p < 0.001) and scattered dose (range: 40%–70%, p < 0.001). The maximal reductions were observed in the set mimicking complicated lesion examinations (82% reduction for peak skin dose, p < 0.001; 70% reduction for scattered dose, p < 0.001). DARCA reduces both peak skin dose and scattered dose in comparison to SA. The benefit of radiation dose reduction could be especially significant in complicated lesion examinations due to large reduction in X‐ray exposure time. The use of DARCA could, therefore, be recommended in clinical practice to minimize radiation dose.PACS numbers: 87.53.‐j, 87.53.Bn, 87.59.‐e, 87.59.C‐, 87.59.cf, 87.59.Dj
Highlights
As interventional cardiac procedures become indispensable in the present cardiology practice, concerns arise over potential radiation risk to both patients and operators.[1,2] There are two types of biological effects of radiation: stochastic effects and tissue reactions.(3) Tissue reactions are caused by radiation dose that exceeds specific thresholds
Dual-axis rotational coronary angiography (DARCA) has developed as an innovative adaptation to the standard coronary angiography (SA), which remains the gold standard for assessing coronary stenosis.[8]. During dual-axis rotational coronary angiography (DARCA), the three-dimensional rotation of the gantry around the patient occurs in the left anterior oblique (LAO)/right anterior oblique (RAO) and cranial/caudal orientations during one cine acquisition, to obtain images in a trajectory designed to reduce vessel foreshortening
Compared to SA, this creative technology demonstrates significant potential in reducing patient radiation dose, contrast utilization, and procedure time, while enhancing the number of angiographic projections obtainable with superior imaging results.[8,9,10,11] the above-mentioned dose reductions have been reported with dose area product (DAP), which gives no direct information on peak skin dose (PSD). [12,13,14,15,16] estimating skin dose from DAP has a potential error of at least 30%–40%.(17) The impact of DARCA on patient skin dose, compared with SA, remains unknown
Summary
As interventional cardiac procedures become indispensable in the present cardiology practice, concerns arise over potential radiation risk to both patients and operators.[1,2] There are two types of biological effects of radiation: stochastic effects and tissue reactions (previously called deterministic effects).(3) Tissue reactions are caused by radiation dose that exceeds specific thresholds. Note that data from human populations under radiation exposure suggest that cataract occurs at doses far lower than the previous consensus.[4] there has been an increasing number of case reports on patient skin injuries resulting from interventional procedures.[5,6,7] in order to prevent serious tissue reactions in clinical practice, actions to control radiation dose need to be taken. Compared to SA, this creative technology demonstrates significant potential in reducing patient radiation dose, contrast utilization, and procedure time, while enhancing the number of angiographic projections obtainable with superior imaging results.[8,9,10,11] the above-mentioned dose reductions have been reported with dose area product (DAP), which gives no direct information on peak skin dose (PSD). The purpose of this study was to evaluate patient PSD and scattered dose to the operator in DARCA compared to SA with the use of an anthropomorphic phantom
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