Kuon E, Glaser C, Dahm J B
Department of Cardiology, Klinik Fraenkische Schweiz, Feuersteinstr. 2, D-91320 Ebermannstadt, Germany.
Br J Radiol. 2003 Jun;76(906):406-13. doi: 10.1259/bjr/82051842.
The goal of this study was to improve radiation dose reduction techniques in invasive cardiology and after patients' radiation data had approached minimal levels, to evaluate predictors of their radiation exposure resulting from invasive cardiac procedures. Over the course of 1 year (and 1996 procedures) we minimized cinegraphic frames and runs, as well as fluoroscopy time, and trained ourselves to achieve effective fluoroscopy-saving positioning of blinds and filters toward the regions of interest. We were consequently able to reduce the mean dose-area products (DAP) for coronary angiography and angioplasty, combined interventions, high-frequency rotational atherectomy, and excimer laser angioplasty: from levels of 53.9 Gy cm(2), 79.6 Gy cm(2), 112.3 Gy cm(2), 119.4 Gy cm(2), and 168.0 Gy cm(2) as currently reported in the literature, to 12.9 Gy cm(2), 13.3 Gy cm(2), 25.9 Gy cm(2), 33.0 Gy cm(2), and 27.1 Gy cm(2), respectively. The mean DAP due to interventions in acute myocardial infarction was 38.3 Gy cm(2). DAP was influenced by body mass index, complexity of coronary artery disease, tube angulation, documented structure, coronary recanalization, emergency circumstances, and the percutaneous transluminal coronary angioplasty (PTCA) target vessel involved, but not by stent implantation. By favouring radiation-reducing cranial posteroanterior views over standard left anterior oblique views for visualization of the left anterior descending and the diagonal artery, we consequently achieved mean PTCA-DAPs of 10.4 Gy cm(2) and 8.6 Gy cm(2), respectively: levels significantly lower than those for PTCA of the right coronary artery (13.3 Gy cm(2)), left circumflex artery (13.7 Gy cm(2)), and obtuse marginal branch (16.9 Gy cm(2)). In conclusion, enhanced knowledge of radiation dose-reduction techniques significantly reduces patient radiation hazards in invasive cardiology.
本研究的目的是改进侵入性心脏病学中的辐射剂量降低技术，并在患者的辐射数据接近最低水平后，评估侵入性心脏手术导致其辐射暴露的预测因素。在1年的时间里（共进行了1996例手术），我们尽量减少电影造影帧数和次数以及透视时间，并训练自己实现将遮光板和滤光片有效地定位到感兴趣区域以节省透视。因此，我们能够降低冠状动脉造影和血管成形术、联合干预、高频旋切术和准分子激光血管成形术的平均剂量面积乘积（DAP）：从文献中目前报道的53.9 Gy cm²、79.6 Gy cm²、112.3 Gy cm²、119.4 Gy cm²和168.0 Gy cm²，分别降至12.9 Gy cm²、13.3 Gy cm²、25.9 Gy cm²、33.0 Gy cm²和27.1 Gy cm²。急性心肌梗死干预的平均DAP为38.3 Gy cm²。DAP受体重指数、冠状动脉疾病的复杂性、球管角度、记录的结构、冠状动脉再通、紧急情况以及所涉及的经皮腔内冠状动脉成形术（PTCA）目标血管的影响，但不受支架植入的影响。通过在可视化左前降支和对角支动脉时优先采用减少辐射的头位后前位视图而非标准左前斜位视图，我们分别实现了平均PTCA-DAP为10.4 Gy cm²和8.6 Gy cm²：这些水平显著低于右冠状动脉（13.3 Gy cm²）、左旋支动脉（13.7 Gy cm²）和钝缘支（16.9 Gy cm²）的PTCA水平。总之，增强对辐射剂量降低技术的了解可显著降低侵入性心脏病学中患者的辐射危害。
