Determinants of operator and patient radiation exposure during cardiac catheterization: Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial

Georgios Christopoulos, Aristotelis C. Papayannis, Mohammed Alomar, Georgios E. Christakopoulos, Anna Kotsia, Tesfaldet T. Michael, Bavana V. Rangan, Michele Roesle, Deborah Shorrock, Lorenza Makke, Spyros Maragkoudakis, Atif Mohammad, Karan Sarode, Charles E. Chambers, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: In the RadiCure study 505 catheterization procedures were 1:1 randomized to use or no use of real-time radiation monitoring. Use of the Bleeper Sv monitor resulted in a significant reduction in operator radiation exposure. Methods: We examined the association between several baseline and procedural parameters with operator and patient radiation exposure using univariable and multivariable analysis in the 505 patients that were enrolled in RadiCure. All baseline demographic and procedure characteristics recorded were included in the univariable analysis. Results: Median fluoroscopy time was 6.2 (2.5-12.5) minutes, median patient air kerma dose was 0.908 (0.602-1.636) Gray and median first operator exposure was 10 (5-22) μSv. For analysis purposes, the 505 procedures were dichotomized based on the median operator exposure (10 μSv) and median patient radiation dose (0.908 Gray). On multivariable analysis, factors associated with high (above median or >10 μSv) first operator radiation exposure included radial access (odds ratio [OR] 5.44, 95% Confidence Interval [CI] 2.88-10.76), chronic total occlusion (CTO) intervention (OR 12.78, 95% CI 4.42-43.60), real-time radiation monitoring (OR 0.42, 95% CI 0.26-0.66), and use of a radioabsorbent drape (OR 0.53, 95% CI 0.28-0.96). High patient radiation dose (above median or >0.908 Gray) was associated with body mass index>30 kg/m2 (OR 3.22, 95% CI 1.99-5.29), prior MI (OR 2.26, 95% CI 1.29-4.04), prior cerebrovascular disease (OR 0.34, 95% CI 0.15-0.75), hypertension (OR 2.40, 95% CI 1.05-5.82), prior coronary artery bypass graft surgery (OR 2.46, 95% CI 1.40-4.39) and CTO intervention (OR 12.93, 95% CI 3.28-87.31), but was not associated with real-time radiation monitoring and use of a radioabsorbent drape. Conclusions: Several clinical and procedural factors are associated with higher patient and operator radiation exposure. Real-time radiation monitoring and use of disposable radiation shields were associated with lower operator, but not patient, radiation dose.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2015

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Cardiac Catheterization
Odds Ratio
Confidence Intervals
Radiation
Radiation Monitoring
Radiation Exposure
Background Radiation
Cerebrovascular Disorders
Fluoroscopy
Coronary Artery Bypass
Catheterization
Body Mass Index
Air
Demography
Hypertension
Transplants

Keywords

  • Cardiac catheterization
  • Quality improvement
  • Radiation

ASJC Scopus subject areas

  • Medicine(all)
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Determinants of operator and patient radiation exposure during cardiac catheterization : Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial. / Christopoulos, Georgios; Papayannis, Aristotelis C.; Alomar, Mohammed; Christakopoulos, Georgios E.; Kotsia, Anna; Michael, Tesfaldet T.; Rangan, Bavana V.; Roesle, Michele; Shorrock, Deborah; Makke, Lorenza; Maragkoudakis, Spyros; Mohammad, Atif; Sarode, Karan; Chambers, Charles E.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Catheterization and Cardiovascular Interventions, 2015.

Research output: Contribution to journalArticle

Christopoulos, Georgios ; Papayannis, Aristotelis C. ; Alomar, Mohammed ; Christakopoulos, Georgios E. ; Kotsia, Anna ; Michael, Tesfaldet T. ; Rangan, Bavana V. ; Roesle, Michele ; Shorrock, Deborah ; Makke, Lorenza ; Maragkoudakis, Spyros ; Mohammad, Atif ; Sarode, Karan ; Chambers, Charles E. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Determinants of operator and patient radiation exposure during cardiac catheterization : Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial. In: Catheterization and Cardiovascular Interventions. 2015.
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title = "Determinants of operator and patient radiation exposure during cardiac catheterization: Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial",
abstract = "Background: In the RadiCure study 505 catheterization procedures were 1:1 randomized to use or no use of real-time radiation monitoring. Use of the Bleeper Sv monitor resulted in a significant reduction in operator radiation exposure. Methods: We examined the association between several baseline and procedural parameters with operator and patient radiation exposure using univariable and multivariable analysis in the 505 patients that were enrolled in RadiCure. All baseline demographic and procedure characteristics recorded were included in the univariable analysis. Results: Median fluoroscopy time was 6.2 (2.5-12.5) minutes, median patient air kerma dose was 0.908 (0.602-1.636) Gray and median first operator exposure was 10 (5-22) μSv. For analysis purposes, the 505 procedures were dichotomized based on the median operator exposure (10 μSv) and median patient radiation dose (0.908 Gray). On multivariable analysis, factors associated with high (above median or >10 μSv) first operator radiation exposure included radial access (odds ratio [OR] 5.44, 95{\%} Confidence Interval [CI] 2.88-10.76), chronic total occlusion (CTO) intervention (OR 12.78, 95{\%} CI 4.42-43.60), real-time radiation monitoring (OR 0.42, 95{\%} CI 0.26-0.66), and use of a radioabsorbent drape (OR 0.53, 95{\%} CI 0.28-0.96). High patient radiation dose (above median or >0.908 Gray) was associated with body mass index>30 kg/m2 (OR 3.22, 95{\%} CI 1.99-5.29), prior MI (OR 2.26, 95{\%} CI 1.29-4.04), prior cerebrovascular disease (OR 0.34, 95{\%} CI 0.15-0.75), hypertension (OR 2.40, 95{\%} CI 1.05-5.82), prior coronary artery bypass graft surgery (OR 2.46, 95{\%} CI 1.40-4.39) and CTO intervention (OR 12.93, 95{\%} CI 3.28-87.31), but was not associated with real-time radiation monitoring and use of a radioabsorbent drape. Conclusions: Several clinical and procedural factors are associated with higher patient and operator radiation exposure. Real-time radiation monitoring and use of disposable radiation shields were associated with lower operator, but not patient, radiation dose.",
keywords = "Cardiac catheterization, Quality improvement, Radiation",
author = "Georgios Christopoulos and Papayannis, {Aristotelis C.} and Mohammed Alomar and Christakopoulos, {Georgios E.} and Anna Kotsia and Michael, {Tesfaldet T.} and Rangan, {Bavana V.} and Michele Roesle and Deborah Shorrock and Lorenza Makke and Spyros Maragkoudakis and Atif Mohammad and Karan Sarode and Chambers, {Charles E.} and Subhash Banerjee and Brilakis, {Emmanouil S.}",
year = "2015",
doi = "10.1002/ccd.26341",
language = "English (US)",
journal = "Catheterization and Cardiovascular Interventions",
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TY - JOUR

T1 - Determinants of operator and patient radiation exposure during cardiac catheterization

T2 - Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial

AU - Christopoulos, Georgios

AU - Papayannis, Aristotelis C.

AU - Alomar, Mohammed

AU - Christakopoulos, Georgios E.

AU - Kotsia, Anna

AU - Michael, Tesfaldet T.

AU - Rangan, Bavana V.

AU - Roesle, Michele

AU - Shorrock, Deborah

AU - Makke, Lorenza

AU - Maragkoudakis, Spyros

AU - Mohammad, Atif

AU - Sarode, Karan

AU - Chambers, Charles E.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2015

Y1 - 2015

N2 - Background: In the RadiCure study 505 catheterization procedures were 1:1 randomized to use or no use of real-time radiation monitoring. Use of the Bleeper Sv monitor resulted in a significant reduction in operator radiation exposure. Methods: We examined the association between several baseline and procedural parameters with operator and patient radiation exposure using univariable and multivariable analysis in the 505 patients that were enrolled in RadiCure. All baseline demographic and procedure characteristics recorded were included in the univariable analysis. Results: Median fluoroscopy time was 6.2 (2.5-12.5) minutes, median patient air kerma dose was 0.908 (0.602-1.636) Gray and median first operator exposure was 10 (5-22) μSv. For analysis purposes, the 505 procedures were dichotomized based on the median operator exposure (10 μSv) and median patient radiation dose (0.908 Gray). On multivariable analysis, factors associated with high (above median or >10 μSv) first operator radiation exposure included radial access (odds ratio [OR] 5.44, 95% Confidence Interval [CI] 2.88-10.76), chronic total occlusion (CTO) intervention (OR 12.78, 95% CI 4.42-43.60), real-time radiation monitoring (OR 0.42, 95% CI 0.26-0.66), and use of a radioabsorbent drape (OR 0.53, 95% CI 0.28-0.96). High patient radiation dose (above median or >0.908 Gray) was associated with body mass index>30 kg/m2 (OR 3.22, 95% CI 1.99-5.29), prior MI (OR 2.26, 95% CI 1.29-4.04), prior cerebrovascular disease (OR 0.34, 95% CI 0.15-0.75), hypertension (OR 2.40, 95% CI 1.05-5.82), prior coronary artery bypass graft surgery (OR 2.46, 95% CI 1.40-4.39) and CTO intervention (OR 12.93, 95% CI 3.28-87.31), but was not associated with real-time radiation monitoring and use of a radioabsorbent drape. Conclusions: Several clinical and procedural factors are associated with higher patient and operator radiation exposure. Real-time radiation monitoring and use of disposable radiation shields were associated with lower operator, but not patient, radiation dose.

AB - Background: In the RadiCure study 505 catheterization procedures were 1:1 randomized to use or no use of real-time radiation monitoring. Use of the Bleeper Sv monitor resulted in a significant reduction in operator radiation exposure. Methods: We examined the association between several baseline and procedural parameters with operator and patient radiation exposure using univariable and multivariable analysis in the 505 patients that were enrolled in RadiCure. All baseline demographic and procedure characteristics recorded were included in the univariable analysis. Results: Median fluoroscopy time was 6.2 (2.5-12.5) minutes, median patient air kerma dose was 0.908 (0.602-1.636) Gray and median first operator exposure was 10 (5-22) μSv. For analysis purposes, the 505 procedures were dichotomized based on the median operator exposure (10 μSv) and median patient radiation dose (0.908 Gray). On multivariable analysis, factors associated with high (above median or >10 μSv) first operator radiation exposure included radial access (odds ratio [OR] 5.44, 95% Confidence Interval [CI] 2.88-10.76), chronic total occlusion (CTO) intervention (OR 12.78, 95% CI 4.42-43.60), real-time radiation monitoring (OR 0.42, 95% CI 0.26-0.66), and use of a radioabsorbent drape (OR 0.53, 95% CI 0.28-0.96). High patient radiation dose (above median or >0.908 Gray) was associated with body mass index>30 kg/m2 (OR 3.22, 95% CI 1.99-5.29), prior MI (OR 2.26, 95% CI 1.29-4.04), prior cerebrovascular disease (OR 0.34, 95% CI 0.15-0.75), hypertension (OR 2.40, 95% CI 1.05-5.82), prior coronary artery bypass graft surgery (OR 2.46, 95% CI 1.40-4.39) and CTO intervention (OR 12.93, 95% CI 3.28-87.31), but was not associated with real-time radiation monitoring and use of a radioabsorbent drape. Conclusions: Several clinical and procedural factors are associated with higher patient and operator radiation exposure. Real-time radiation monitoring and use of disposable radiation shields were associated with lower operator, but not patient, radiation dose.

KW - Cardiac catheterization

KW - Quality improvement

KW - Radiation

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DO - 10.1002/ccd.26341

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