Area Product Research Articles

Radiation exposure during cardiac interventions in CHD: German Registry 2012-2020.

Since patients with congenital heart defects (CHD) frequently require life-long medical care and repeat invasive treatment, radiation exposure during interventional procedures is a relevant issue concerning potential radiation related risks. Therefore, an analysis on radiation data from the German Registry for Cardiac Operations and Interventions in patients with CHD was performed. From January 2012 until December 2020 a total of 28,374 cardiac catheter interventions were recorded. 8 specified interventions were selected for evaluation: ASD/PFO, PDA and VSD occlusion, CoA balloon dilatation and stent implantation, aortic valvuloplasty, pulmonary valvuloplasty and transcatheter pulmonary valve implantation. Radiation exposure data included total fluoroscopy time (TFT), dose area product (DAP) and DAP per body weight (DAP/BW). The cohort accounted for 9,350 procedures including 3,426 ASD/PFO occlusions, 2,039 PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations resp. 496 stent implantations for CoA, 168 VSD occlusions and 703 TPVI. 610 ASD/PFO procedures (17.8%) were performed without radiation. Median annual TFT, DAP and DAP/BW showed a continuous decrease while radiation burden correlated with intervention complexity: For ASD/PFO and PDA occlusion, aortic and pulmonary valvuloplasty and balloon dilatation of CoA median DAP/BW was <20.0 µGy*m²/kg, while median values of 26.3 µGy*m²/kg and 31.6 µGy*m²/kg were noted for stenting of CoA and VSD closure. Radiation burden was highest in TPVI with a median DAP/BW of 79.4 µGy*m²/kg. A decrease of radiation exposure was found in 8 cardiac interventions from 1/2012 - 12/2020. Comparison with international registries revealed a good quality of radiation protection.

Evaluating the performance of the EUMETSAT H SAF H35 fractional snow-covered area product over the Tibetan Plateau

Background and aims This study evaluates the performance of the H35 fractional snow-covered area (fSCA) product over the Tibetan Plateau (TP) from May 2019 to December 2021. The H35 product, derived from AVHRR satellite data, provides daily fSCA estimates at a resolution of 0.01°. The aim of this work is to assess the accuracy and reliability of this product in capturing snow cover dynamics over a significant period. Methods Validation of the H35 product uses a high-resolution, cloud-free snow cover dataset derived from long-term MODIS data, ensuring temporal consistency and high accuracy. Statistical metrics, including probability of detection (POD), false alarm ratio (FAR), and accuracy (ACC), were employed to assess the product's performance. Results The results reveal seasonal variations in performance, with POD values reaching a peak of 0.91 during the winter months. The FAR shows an inverse trend, while the overall ACC values remain consistently high, indicating reliable performance across the study period. Conclusions This study contributes to the understanding of snow cover dynamics over the TP and highlights the significance of validating satellite-derived products for hydrological studies. The consistently high accuracy of the H35 product underscores its potential for use in monitoring snow cover in the region.

Establishment of local diagnostic reference levels in terms of dose area product (DAP) in conventional radiology at the Regional Hospital Center of Souss Massa, Morocco

Introduction: The effectiveness of diagnostic reference levels (DRLs) in reducing the doses delivered to patients has been demonstrated. Establishing DRLs in terms of the dose surface product (DSP) is an essential step in the management of radiation doses in conventional radiology. Objective: This retrospective study aimed to assess local diagnostic reference levels (LDRLs) for four types of X-ray examinations in terms of DAP at the Regional Hospital Center of Souss Massa. Materials and methods: Data from 120 adult patients, 30 per location (thorax (PA), pelvis (AP), lumbar spine (AP) and abdomen (AP)) were collected. Patient parameters such as gender, age, BMI, clinical indications, and examination acquisition parameters such as kV, mAs, patient source distance (PSD), and exposure field dimensions were recorded for each patient. The calculation of DRLs is based on a statistical method known as the 75th percentile of the distribution of DAP. The data were statistically analysed by SPSS software V 21.0. Pearson’s parametric test was used to explore the relationship between the different quantitative variables. Results: The mean ESDs for the thorax (PA), lumbar spine (AP), abdomen (AP), and pelvis (AP) were 0.17, 2.55, 2.16, and 2.63 mGy, respectively. The mean DAP values for the thorax (PA), lumbar spine (AP), abdomen (AP), and pelvis (AP) were 16.53, 213.11, 230.55, and 265.19 cGy.cm2, respectively. The DRLs in terms of ESD for the thorax (PA), lumbar spine (AP), abdomen (AP), and pelvis (AP) were 0.17, 2.77, 2.64, 2.87 mGy, respectively. In terms of DAP, they were 16.58, 245, 291.83, and 300.45 cGy.cm², respectively. The results show a significant relationship between DAP and tension, charge, and ESD for all examinations. In addition, there was a significant relationship between DAP and BMI for abdomen X-ray, and no significant relationship for the three other X-ray examinations. Conclusion: It is possible to reduce the dose delivered to patients in the Regional Hospital Center of Souss Massa through the continuous training of radiology workers, implementation of a quality assurance program for equipment, and institutionalization of DRL as an approach to reducing patient doses and health service costs.

The effect of anti-scatter grids on radiation exposure during transcatheter patent ductus arteriosus closure in premature infants.

Radiation exposure and the effect of anti-scatter grids are not well studied in premature infants during transcatheter patent ductus arteriosus closure.This study aimed to investigate whether the use of anti-scatter grids altered the level of radiation exposure to premature infants undergoing transcatheter patent ductus arteriosus closure. Demographic and radiation exposure data for premature infants who underwent transcatheter patent ductus arteriosus closure at the Stead Family Children's Hospital from 10/2019 to 10/2021 were retrospectively reviewed and analyzed. Twenty-four patients (41%) underwent transcatheter patent ductus arteriosus closure with anti-scatter grids, while 34 (59%) underwent the procedure without using anti-scatter grids. At the time of catheterization, the median age, corrected age, and weight were 4.3 weeks (3.4-6), 29 weeks (28.1-30.9), and 1200g (1000-1600), respectively. Total radiation exposures for the dose area product and air kerma were 2.73 µGy.m2 (1.65-4.16), and 1.63 mGy (1.15-2.58), respectively. Radiation doses were higher in the group in whom the anti-scatter grids were utilized with dose area product of 3.33 µGy.m2 (2.39-5.43) and air kerma of 2.27 mGy (1.41-3.06) versus 1.86 µGy.m2 (1.46-3.60) and air kerma of 1.40 mGy (1.08-1.92). When radiation doses were adjusted to the radiation time, no difference in radiation exposure was noticed between the groups. Transcatheter patent ductus arteriosus closure in premature infants can be safely performed with minimal radiation exposure. In the authors' laboratory, the use of anti-scatter grids does not impact radiation exposure in premature infants.

Impact of X-Ray Protective Drapes on Operator and Patient Radiation Exposure During Cardiac Catheterization.

As cardiac catheterization operators are exposed to radiation exposure throughout their careers, optimal radiation protection is crucial. Our study was designed to assess the effects of supplementary protective measures beyond standard radiation protection attire and barriers, measuring their influence on scatter radiation exposure levels for both the operator and the patient. The objective of this trial is to assess the impact of a lead shield on scatter radiation exposure for both the operator and the patient. We conducted a prospective, randomized clinical trial in which procedures were allocated to incorporate the use of a reusable lead apron designed to shield the lower body of the patient. Both operators and patients were outfitted with real-time procedure-specific dosimeters to monitor exposure. All patients undergoing radial access procedures were entered into a randomization process. The study's dual primary outcomes included the relative operator dose above (RODt) and under (RODu) the protective gear, as well as the scatter patient radiation dose (RPD), which was calculated as the measured radiation exposure (µSv) standardized against the dose area product (DAP). Out of 400 procedures that were randomized, data from 346 procedures was complete for analysis. The use of the pelvic shield resulted in a substantial decrease in the RODt and RODu, with reductions of 25% and 40%, respectively (p < 0.0001). There was also a 38% reduction observed in the scatter RPD. In patients with a high BMI, the effectiveness of the pelvic shield varied. Employing an auxiliary pelvic shield significantly diminishes scatter radiation exposure for both the operator and the patient.

Variation in Cone Beam Computed Tomography Utilization and Radiation Exposure Associated with Prostatic Artery Embolization on Two Separate Angiography Systems.

Background: We aimed to compare cone beam computed tomography (CBCT) utilization and radiation exposure during prostatic artery embolization (PAE) procedures on two different angiography systems. Methods: PAEs performed by a single interventionalist between January 2018 and October 2020 on two multivendor angiography systems (AS1 and AS2) at a single center were retrospectively evaluated. Imaging techniques included CBCT acquisition when possible, predominantly from the distal aorta in AS1 and from the bilateral internal iliac arteries in AS2 (Discovery IGS 740, GE HealthCare, Chicago, IL). Baseline demographics, CBCT utilization and radiation doses, and total procedure radiation metrics for each group were collected and compared. Results: One hundred and twenty patients were analyzed in this study, with fifty-three patients (n = 25 in AS1, 28 in AS2) included as embolized bilaterally using CBCT. CBCT was acquired in 31% of the cases in AS1 and in 85% of the cases in AS2. Mean prostate volume was similar in both groups (103.0 mL vs. 130.1 mL, p = 0.23). There was no difference in fluoroscopy time, while the number of DSA series and CBCTs per case did differ in AS1 and AS2 (37.3 min vs. 32.1 min, p = 0.13, 19.8 vs. 8.0, p ≤ 0.001, 1.3 vs. 2.1 p ≤ 0.001). The mean total air kerma, total kerma area product and air kerma per CBCT were higher in AS1 compared to AS2 (2020.4 mGy vs. 490.3 mGy, p ≤ 0.001, 259.3 Gy*cm2 vs. 72.7 Gy*cm2, p ≤ 0.001 and 217.8 mGy vs. 45.8 mGy, p ≤ 0.001 respectively). To prevent confounding from a mean difference in body mass index, the data were adjusted using log outcome means, which corroborated the raw data findings. Conclusions: The mean procedural total kerma area product from AS1 was similar to that reported in other PAE studies, but it was substantially lower in AS2. The angiography system used has a significant impact on the ability to leverage CBCT and on overall patient and thus staff radiation exposure.

Development of a finer-resolution multi-year emission inventory for open biomass burning in Heilongjiang Province, China

Open biomass burning (OBB) is a significant source of air pollutants, profoundly impacting regional air quality and global climate change. However, due to the lack of high-resolution burned area products, limited biomass data resolution, and inappropriate emission factors (EFs), current OBB emission inventories have significant uncertainties. In this study, we integrated the FireCCI51 burned area product (250 m), high-resolution gridded biomass data, localized EFs, and various statistical survey data to compile a finer-resolution (250 m) and long-term (2001–2020) inventory of 11 pollutants for Heilongjiang Province (an important agricultural and forestry region in China). The results indicated that the annual average OBB emissions in Heilongjiang Province were 12.26, 63.70, 931.60, 17,203.35, 16.09, 171.25, 39.83, 71.22, 184.33, 129.16, and 6.35 Gg for BC, CH4, CO, CO2, NH3, NMVOC, NOx, OC, PM10, PM2.5, and SO2, respectively. Taking PM2.5 as an example, emissions from cropland, forest, and grassland burning accounted for 73%, 26%, and 1% respectively. Geographically, emissions were primarily concentrated in the western, southwestern, and northeastern regions of Heilongjiang. The peak PM2.5 emissions exhibited notable seasonal variation, with maxima occurring in April and October. This is primarily due to the extensive burning of straw during the spring and autumn ploughing seasons. The results of this study provide a detailed multi-year inventory crucial for atmospheric transport models and can support the development of effective pollution control strategies and greenhouse gas mitigation measures.

Rota-Tripsy or step-up-approach rotational atherectomy for severe coronary artery calcification treatment: a comparative effectiveness study

Step-up-approach rotational atherectomy has been widely recognized in the treatment of severe calcified plaques. As an alternative, the rota-tripsy procedure is a novel strategy for the modification of calcification lesions. This study aimed to evaluate and compare the efficacy and safety of rota-tripsy and step-up-approach rotational atherectomy, given the limited clinical data available. Clinical data of 3652 patients with coronary calcification were retrospectively collected from February 2021 to February 2024. The cases were divided into two groups based on the technical approach. The primary efficacy endpoint was procedural success (stent expansion rate > 70% and no hospital major adverse cardiac events [MACEs]). The primary safety endpoint was the absence of serious angiographic complications and 30 days MACEs. A total of 37 patients (38 calcified lesions) screened and included in the study, with 18 cases (19 lesions) in group A and 19 cases in group B. The results showed no significant differences in primary efficacy endpoint. However, group A recorded a lower incidence of angiographic complications (P = 0.02) and shorter dose area product and fluoroscopy/interval times compared with group B (P < 0.01). For management of severe coronary calcification, both rota-tripsy and step-up-approach rotational atherectomy had favorable short-term clinical results; however, rota-tripsy provided improved safety and efficiency.

Contrast of Early Phase Amyloid PET

AbstractBackgroundThe method of obtaining pseudo‐cerebral blood flow images from the initial minutes of amyloid PET scans has been proposed. This technique proves to be highly valuable as it not only indicates the presence of amyloid accumulation but also reveals sites of neurodegeneration. However, the obtained early images represent the K1 image rather than cerebral blood flow. Consequently, the contrast in early images from amyloid PET tracers is thought to be compromised when compared to cerebral blood flow images.MethodTo enhance the contrast in early images obtained from amyloid PET tracers and thereby improve diagnostic accuracy, we developed a method for contrast recovery and established a methodology for determining the parameter involved in achieving this contrast recovery, drawing insights from a thorough literature review. Additionally, we conducted a comparative analysis involving PiB’s early images and FDG, investigating their respective contributions.ResultOur study demonstrated a strong correlation between FDG and early images of PiB, with relatively inconspicuous underestimations in high‐blood‐flow regions.ConclusionWhile we theoretically established a method to recover the contrast in early images, our findings suggest that amyloid PET tracers may exhibit a higher permeability‐surface area product than anticipated. This observation raises the possibility that, without correction, these tracers might inherently provide sufficient contrast.

Integration of a lightweight and table-mounted robotic alignment tool with automated patient-to-image registration using robotic cone-beam CT for intracranial biopsies and stereotactic electroencephalography.

Robotics in neurosurgery is becoming increasingly prevalent. The integration of intraoperative imaging for patient registration into workflows of newer robotic systems enhances precision and has further driven their widespread adoption. In this study, the authors report on a lightweight, table-mounted robotic system integrating robotic cone-beam CT (CB-CT) for automated patient registration in cranial biopsies and stereotactic electroencephalography (sEEG). This prospective cohort study included patients who underwent stereotactic biopsy or sEEG with the Cirq system from January 2023 to August 2024. For patient-to-image registration, an external registration matrix was secured near the patient's head before conducting CB-CT with robotic Artis Pheno. CT was then fused with preoperative planning MRI and used as the navigation dataset. Demographic and clinical data were evaluated, and entry and target errors, as well as vector deviation of sEEG electrodes, were assessed and compared with those of patients who underwent biopsies and sEEG with the frameless VarioGuide system. In 26 Cirq-assisted surgical procedures, robotic CB-CT was used for image registration in 20 cases. Of these, 15 were biopsies (mean ± SD 7 ± 1 specimens) and 5 were sEEG with 31 depth electrodes, compared to 29 VarioGuide biopsies and 3 VarioGuide sEEG cases with 25 electrodes. The mean age was 56 ± 19 years, with a male/female ratio of 1.9:1. Lesion size averaged 19 ± 17 cm3 on T1-weighted imaging and 61 ± 53 cm3 on T2-weighted imaging for Cirq and 14 ± 14 cm3 and 68 ± 47 cm3 for VarioGuide. The mean surgical times were 117 ± 34 minutes for biopsy and 269 ± 54 minutes for sEEG in the Cirq group, with skin-to-skin times of 40 ± 23 minutes for biopsy and 208 ± 74 minutes for sEEG; in comparison, surgical times of 78 ± 21 minutes for biopsy and 218 ± 33 minutes for sEEG were reported with VarioGuide, with skin-to-skin times of 34 ± 13 and 158 ± 27 minutes. No complications occurred. The mean dosage area product was 983 ± 351 µGym2 for biopsies and 1772 ± 968 µGym2 for sEEG. Cirq-assisted sEEG electrodes had mean entry and target errors of 1.4 ± 1.2 mm and 2.6 ± 1.6 mm, compared to 5.3 ± 3.3 mm and 6.5 ± 2.8 mm with VarioGuide. Mean vector deviation was 1.6 ± 0.9 mm with Cirq versus 4.9 ± 2.9 mm with VarioGuide. The integration of a lightweight, table-mounted robotic alignment tool with intraoperative CB-CT for automated patient-to-image registration enables high precision and a seamless workflow. This combination is safe, has a manageable learning curve, and holds potential to replace traditional frame-based and frameless procedures. Its efficiency and accuracy are likely to contribute to the increasing adoption of robotics in neurosurgery.

Doses from ionising radiation in paediatric cardiac catheterisations in Norway 1975–2021

Pediatric patients with congenital heart disease often undergo cardiac catheterization procedures and are exposed to considerable ionizing radiation early in life. This study aimed to develop a method for estimating the dose area product (PKA) from pediatric cardiac catheterization procedures (1975-1989) at a national centre for pediatric cardiology and to evaluate trends in PKAand exposure parameters until 2021. Data from 2200 catheterization procedures on 1685 patients (1975-1989) and 4184 procedures on 2139 patients (2000-2021) under 18 years of age were retrospectively collected. PKAvalues were missing for 1975-1989 but available from 2000 onward. The missing PKAwas estimated from air kerma and beam area, based on exposure records and input from clinicians working at that time. PKAtrends were analysed over time and age. There was a 71% reduction in median PKAfrom the period 1975-1989 (median 6.63 Gy cm2) to 2011-2021 (1.91 Gy cm2). The PKAincreases significantly (p=0.0001) with patient age, which was associated with body weight. Approximately 80% of the total PKAwas from cine acquisition in 1975-1989, while 20% was from fluoroscopy. The PKAestimate during 1975-1989 was considerably impacted by the assumptions of missing parameters such as tube filtration, focus-to-heart distance, beam area, and number of cine series. The decreasing trend in PKAvalues was attributed to advancements in both technologies and clinical practices. The high contribution of cine acquisition to the total dose during 1975-1989 was due to factors such as a high frame rate, multiple acquisitions, and high tube current. The estimated PKAvalues for the period 1975-1989 are of importance for the dose reconstruction and risk assessments in the EU epidemiology project Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC).&#xD.

Estimating occupational exposure in interventional radiology through Air Kerma Area Product - calculation of Effective Dose conversion factors

During interventional radiology procedures, interventionists are positioned close to the patient and directly exposed to ionizing radiation. This study presents a methodology to estimate the effective dose of interventionists through Air Kerma Area Product (PKA) in three interventional procedure modalities: coronary, cerebral, and peripheral. Optically stimulated luminescence dosimeters were used in several body regions (thyroid, eye lens, abdomen, feet, and hands) to assess equivalent doses and to convert external to internal doses – leading to effective doses related to each modality. These effective doses were then correlated to the total PKA given by the equipment. Thus, an effective dose estimate factor was calculated to represent the conversion between equipment parameters and the effective dose obtained from dosimeters, resulting in a novel methodology. The agreement between the methods was in the range of ± 0.13 μSv for angiographies and -8.3 to 5.3 μSv for angioplasties. These findings underscore the reliability of PKA as a predictor of effective dose, facilitating a rapid and precise assessment of occupational exposure in IR. This novel approach has the potential to enhance radiation safety protocols and optimize protection strategies for IR professionals, ensuring more accurate monitoring and control of radiation exposure in clinical settings.

Dynamic coronary roadmap in percutaneous coronary intervention: a systematic review and meta-analysis

BackgroundContrast-induced acute kidney injury (CI-AKI) is one of the complications of percutaneous coronary intervention (PCI) with high financial burden and poor outcomes. Dynamic coronary roadmap (DCR) is one of the augmentation tools that can provide a dynamic clear coronary mapping with the potential to reduce contrast use and CI-AKI incidence. Herein, we aim to systematically investigate the studies that have assessed the effect of DCR on PCI outcomes.MethodsFour online databases including PubMed, Scopus, Embase, and the Web of Science were systematically searched for relevant studies. Studies that compared the DCR group with the non-DCR group were included while the outcomes were AKI incidence, contrast volume, fluoroscopy time, dose area product, air kerma, intravascular ultrasonography (IVUS) use, and procedural success. Random-effect meta-analysis was conducted to calculate the standardized mean difference (SMD) or odds ratio (OR) and 95% confidence interval (CI) for comparison of DCR and non-DCR groups.ResultsA total of six studies were included in the final analysis comprised of 447 patients in the DCR group and 527 in the non-DCR group. The mean age was 68.7 ± 10.6 years while 78.9% of the DCR group and 75.6% of the non-DCR group were males. There was no difference between the groups in terms of the rates of hypertension, diabetes, hyperlipidemia, prior myocardial infarction (MI), prior coronary artery bypass grafting (CABG), and atrial fibrillation. Meta-analysis revealed that patients in the DCR group had a significantly lower rate of AKI (OR 0.50, 95% CI 0.27 to 0.93, p-value = 0.028), and contrast volume used (SMD -1.16, 95% CI -2.15 to -0.18, p-value = 0.021). However, there was no difference in fluoroscopy time (SMD -0.64, 95% CI -1.43 to 0.16, p-value = 0.116), air kerma (SMD -1.81, 95% CI -4.61 to 0.99, p-value = 0.206), IVUS use (OR 1.21, 95% CI 0.85 to 1.73, p-value = 0.285), and procedural success (OR 1.05, 95% CI 1.15 to 7.26, p-value = 0.957).ConclusionThese findings show that DCR use is associated with a lower rate of AKI and lower contrast use, compared to conventional PCI. This is of particular importance since many patients undergoing PCI have limited renal function and hence will benefit from the use of DCR. Further studies are needed to confirm these findings and to pave the way for the routine use of DCR in clinical settings.

Initial Real-World Experiences of Pulmonary Vein Isolation and Ablation of Non-Pulmonary Vein Sites Using a Novel Circular Array Pulsed Field Ablation Catheter.

Background and Aims: Various pulsed field ablation (PFA) systems are currently being developed. Recently, a novel CE-approved circular array PFA catheter (PulseSelect™ PFA System, Medtronic, Minneapolis, MN, USA) was introduced. Data on this commercially available system are sparse. The aim was to elucidate real-world data assessing the feasibility, safety, and acute efficacy of pulmonary vein isolation (PVI) and ablation beyond PVI with this novel ablation system. Methods: Consecutive patients with paroxysmal and persistent atrial fibrillation (AF) undergoing first-time ablation with the circular PFA catheter were enrolled in this study. In patients with persistent AF and left atrial (LA) enlargement (LA area > 20 cm2), additional left atrial roof ablation (LARA) was performed. Those with concomitant typical atrial flutter received adjunctive cavo-tricuspid isthmus (CTI) ablation. Results: A total of 100 AF patients were included (29% female, 50% persistent AF). Of these, 33 patients (33%) underwent adjunctive LARA, 1 patient (1%) received posterior wall isolation, and 6 patients (6%) required additional CTI ablation. The skin-to-skin procedural time averaged 66.3 ± 13.8 min, while the fluoroscopy time and dose area product were 13.7 ± 4.7 min and 6.8 ± 4.9 Gycm2, respectively. Acute PVI was achieved in 100% of pulmonary veins. A bidirectional conduction block of the LARA and CTI lines was confirmed in all patients, and no major adverse events were reported. Conclusions: These real-world data demonstrate the feasibility, safety, and acute efficacy of PVI and ablation beyond PVI using a novel circular array PFA catheter in patients with atrial fibrillation and flutter. The system can easily be integrated with standard PVI workflows. Further and larger studies are warranted to assess the clinical long-term effectiveness and safety of this PFA system.

Research on the Current State of Digital Transformation to Develop Smart Agriculture in Hanoi City

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Cerebrovascular Function in Sporadic and Genetic Cerebral Small Vessel Disease

ObjectiveCerebral small vessel diseases (SVDs) are associated with cerebrovascular dysfunction, such as increased blood–brain barrier leakage (permeability surface area product), vascular pulsatility, and decreased cerebrovascular reactivity (CVR). No studies assessed all 3 functions concurrently. We assessed 3 key vascular functions in sporadic and genetic SVD to determine associations with SVD severity, subtype, and interrelations.MethodsIn this prospective, cross‐sectional, multicenter INVESTIGATE‐SVDs study, we acquired brain magnetic resonance imaging in patients with sporadic SVD/cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), including structural, quantitative microstructural, permeability surface area product, blood plasma volume fraction, vascular pulsatility, and CVR (in response to CO2) scans. We determined vascular function and white matter hyperintensity (WMH) associations, using covariate‐adjusted linear regression; normal‐appearing white matter and WMH differences, interrelationships between vascular functions, using linear mixed models; and major sources of variance using principal component analyses.ResultsWe recruited 77 patients (45 sporadic/32 CADASIL) at 3 sites. In adjusted analyses, patients with worse WMH had lower CVR (B = −1.78, 95% CI −3.30, −0.27) and blood plasma volume fraction (B = −0.594, 95% CI −0.987, −0.202). CVR was worse in WMH than normal‐appearing white matter (eg, CVR: B = −0.048, 95% CI −0.079, −0.017). Adjusting for WMH severity, SVD subtype had minimal influence on vascular function (eg, CVR in CADASIL vs sporadic: B = 0.0169, 95% CI −0.0247, 0.0584). Different vascular function mechanisms were not generally interrelated (eg, permeability surface area product~CVR: B = −0.85, 95% CI −4.72, 3.02). Principal component analyses identified WMH volume/quantitative microstructural metrics explained most variance in CADASIL and arterial pulsatility in sporadic SVD, but similar main variance sources.InterpretationVascular function was worse with higher WMH, and in WMH than normal‐appearing white matter. Sporadic SVD‐CADASIL differences largely reflect disease severity. Limited vascular function interrelations may suggest disease stage‐specific differences. ANN NEUROL 2024

Impact of Body Mass Index on the Outcomes of Cryoballoon Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation.

Atrial fibrillation (AF) is prevalent among obese patients, and cryoballoon ablation (CBA) is an effective strategy for the rhythm control of AF. The impact of body mass index (BMI) on the clinical outcomes of CBA for AF is not fully explored. 85 consecutive patients with paroxysmal AF were enrolled and were categorized into three groups as per their BMI: normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2), and obese patients (BMI > 30 kg/m2). The primary study endpoint was a late (12 month) recurrence of AF. Early recurrence of AF, symptom improvement, and procedural outcomes were some key secondary outcomes. 20 patients had normal weight, 35 were overweight, and 30 were obese. Obese patients featured a higher prevalence of diabetes mellitus, heavier exposure to smoking, and worse baseline symptoms (as assessed through EHRA class at admission and 12 months before CBA) compared to overweight and normal weight patients. Both late and early (<3 months) AF recurrence rates were comparable across the three groups. Of note, obese patients showed greater improvement in their symptoms post-CBA, defined as improvement by at least one EHRA class, compared to normal weight patients; this might be explained by improved diastolic function. Total procedure time and dose area product were significantly increased in obese patients. The multivariate logistic regression analysis indicated that early AF recurrence and the duration of hypertension are independent predictors of late AF recurrence. CBA is effective in overweight and obese patients with paroxysmal AF. Procedure time and radiation exposure are increased in obese patients undergoing CBA.

Radiofrequency balloon ablation: 1-year outcomes of the AURORA study.

A novel irrigated radiofrequency balloon (RFB) for pulmonary vein isolation (PVI) integrated into a 3D mapping platform was recently launched. Patients undergoing a first atrial fibrillation (AF) ablation at two German high-volume EP centers were included into the prospective AURORA registry. All patients underwent clinical follow-up (FU) at 90, 180, and 360days following ablation including 48-h Holter ECGs. A total of 99 patients were enrolled (43/99 (43.4%) women, median age 67years (interquartile range [IQR] 59-74), 43/99 (43.4%) persistent AF (Pers-AF), median left ventricular ejection fraction (LVEF) 60% (IQR 62-55)). Eighty-eight patients completed the follow-up. Acute PVI was achieved in 383/383 (100%) PV. Single-shot PVI was achieved in 211/383 (55.1%) PVs. Primary adverse events occurred in 3% of patients (1 postprocedural pharyngeal bleeding, 1 myocardial infarction, 1 non-cardiovascular death); no pericardial effusion, stroke, or phrenic nerve paralysis was observed. Median ablation and procedure times were 23 (IQR 18-32) and 67 (IQR 57-85) min, respectively. Median dose area product was 761 (IQR 509-1534) mGycm2. AF-free survival after a median FU of 361 (IQR 261-375) days was 78.4% for paroxysmal AF (PAF) and 75.4% for Pers-AF (p value = 0.828). Early recurrence of atrial tachyarrhythmia at the 90-day visit was the only independent predictor for AF recurrence at 1year upon multiple regression analysis (hazard ratio [HR] 3.198; 95% confidence interval [95% CI] 1.036-10.32, p value = 0.0433). RFB-based PVI is acutely successful, appears safe, and has comparable rhythm outcomes to other single-shot AF ablation tools. A recurrence of AF at 90days predicts later AF recurrence.

RADIATION PATIENT AND WORKER DOSE APPLICATION (SI PADI)

Medical procedures for diagnostic and therapeutic purposes currently use many sources of ionizing radiation. Monitoring patient and radiation worker doses is needed to keep the radiation dose received to a minimum. The purpose of the patient and radiation worker dose application is to facilitate the task of Medical Physicists in conducting patient and radiation worker dose audits so that they become faster and more effective. The patient and radiation worker dose application is made based on dose audits conducted by Medical Physicists by monitoring patient doses on CT Scan examinations using CT dose index volume (CTDIvol) and dose length product (DLP) parameters on CT Scans and patient doses of the Siemens Somatom 128 slice Cathlab using Dose Area Product (DAP) data on the Philips Azurion 7 C-Arm. Radiation worker dose audits are conducted using evaluation data from TLD badges, TLD eyes, and pocket dosimeters of radiation workers working at Karawang Regional Hospital. Data processing uses a spreadsheet program. The menus on the dashboard are combined with formulas so that the data automatically appears in tables, graphs, or special formats as needed. The radiation patient and worker dose information system (Si Padi) was successfully developed at Karawang Regional Hospital to realize efforts to optimize radiation protection and safety for patients and radiation workers. Keywords: patient dose, radiation worker dose, dose audit, CT dose index (CTDI), dose length product (DLP), dose area product (DAP), Si Padi application.

General anaesthesia and deep sedation for monopolar pulsed field ablation using a lattice-tip catheter combined with a novel three-dimensional mapping system.

A novel three-dimensional mapping platform combined with a lattice-tip catheter that can toggle between monopolar pulsed field ablation (PFA) and radiofrequency energy delivery was recently launched. So far, the system was predominantly applied in general anaesthesia (GA), not in deep sedation. Patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) were enrolled, and pulmonary vein isolation (PVI) and ablation of additional linear lesion sets were performed either in GA or in deep sedation. Pulsed field ablation was applied exclusively to perform ipsilateral PVI. A total of 63 patients (35% female, 75% persistent AF, mean age 64 ± 9 years) were included in the analysis with 23 patients treated in GA and 40 patients in deep sedation. Acute efficacy was comparable in both groups with a PVI rate of 100%. Additional 74 lesion sets were performed in the total cohort. Mean procedure and lab occupancy time in the GA and deep sedation group was 96 ± 24 min vs. 100 ± 23 min (P = 0.52) and 165 ± 40 min vs. 131 ± 35 min (P = 0.0008). Mean dose area product was 489 (216;1093) vs. 452 (272;882) cGycm2 in the GA and the deep sedation group (P = 0.82). There was one conversion from deep sedation to GA. There were no map shifts observed in any group. Pericardial tamponade occurred in one patient of the deep sedation group. The use of a novel ablation platform in conjunction with a lattice-tip catheter in deep sedation is feasible, effective, and associated with significantly shorter lab occupancy time when compared with GA.