Gunja Ateka, Pandey Yagya, Xie Hui, Wolska Beata M, Shroff Adhir R, Ardati Amer K, Vidovich Mladen I
Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL; Faculty of Health Sciences, Simon Fraser University.
Cardiovasc Revasc Med. 2017 Apr-May;18(3):197-201. doi: 10.1016/j.carrev.2016.12.017. Epub 2016 Dec 27.
Transradial coronary angiography (TRA) has been associated with increased radiation doses. We hypothesized that contemporary image noise reduction technology would reduce radiation doses in the cardiac catheterization laboratory in a typical clinical setting.
We performed a single-center, retrospective analysis of 400 consecutive patients who underwent diagnostic and interventional cardiac catheterizations in a predominantly TRA laboratory with traditional fluoroscopy (N=200) and a new image noise reduction fluoroscopy system (N=200). The primary endpoint was radiation dose (mGy cm). Secondary endpoints were contrast dose, fluoroscopy times, number of cineangiograms, and radiation dose by operator between the two study periods. Radiation was reduced by 44.7% between the old and new cardiac catheterization laboratory (75.8mGycm±74.0 vs. 41.9mGycm±40.7, p<0.0001). Radiation was reduced for both diagnostic procedures (45.9%, p<0.0001) and interventional procedures (37.7%, p<0.0001). There was no statistically significant difference in radiation dose between individual operators (p=0.84). In multivariate analysis, radiation dose remained significantly decreased with the use of the new system (p<0.0001) and was associated with weight (p<0.0001), previous coronary artery bypass grafting (p<0.0007) and greater than 3 stents used (p<0.0004). TRA was used in 90% of all cases in both periods. Compared with a transfemoral approach (TFA), TRA was not associated with higher radiation doses (p=0.20).
Image noise reduction technology significantly reduces radiation dose in a contemporary radial-first cardiac catheterization clinical practice.
经桡动脉冠状动脉造影术（TRA）与辐射剂量增加有关。我们推测，当代图像降噪技术将在典型临床环境中降低心导管实验室的辐射剂量。
我们对400例连续接受诊断性和介入性心导管检查的患者进行了单中心回顾性分析，这些患者分别在一个主要采用传统荧光透视的TRA实验室（N = 200）和一个新的图像降噪荧光透视系统实验室（N = 200）进行检查。主要终点是辐射剂量（mGy cm）。次要终点是造影剂剂量、透视时间、电影血管造影数量以及两个研究期间操作者的辐射剂量。新旧心导管实验室之间的辐射剂量降低了44.7%（75.8mGycm±74.0对比41.9mGycm±40.7，p<0.0001）。诊断性操作（45.9%，p<0.0001）和介入性操作（37.7%，p<0.0001）的辐射剂量均有所降低。个体操作者之间的辐射剂量无统计学显著差异（p = 0.84）。多变量分析显示，使用新系统后辐射剂量仍显著降低（p<0.0001），且与体重（p<0.0001）、既往冠状动脉旁路移植术（p<0.0007）以及使用超过3个支架（p<0.0004）有关。两个时期所有病例的90%都采用了TRA。与经股动脉途径（TFA）相比，TRA与更高的辐射剂量无关（p = 0.20）。
图像降噪技术在当代以桡动脉优先的心导管临床实践中显著降低了辐射剂量。
