Werner Gerald S, Glaser Peggy, Coenen Anja, Moehlis Hiller, Tischer Karl-Heinz, Koch Matthias, Klingenbeck Reinhold
Medizinische Klinik I (Cardiology and Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
Catheter Cardiovasc Interv. 2017 May;89(6):1005-1012. doi: 10.1002/ccd.26886. Epub 2017 Jan 23.
The increasing complexity of percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) leads to a significant increase of radiation exposure for both patient and operator.
To study the potential of modified settings of the X-ray equipment combined with operator protocols to reduce radiation dose despite increasing procedural complexity.
We analyzed a consecutive cohort of 984 PCIs for CTOs in 863 patients between January 2010 and July 2015. During that period, the X-ray equipment was changed from an analog to a digital detector system, and a subsequent filter and imaging modification was implemented. The fluoroscopy settings were reduced from 15 pulses/s to 7.5, and then to 6. The cine framerate was reduced from 15 to 7.5/s. For the last time period, with optimized settings, procedural, and lesion related factors influencing the radiation exposure were analyzed.
The lesion complexity increased from a J-CTO score of 1.64 to 2.33 with an increase of retrograde procedures from 21.6 to 50.4%. With a similar fluoroscopy time, the dose area product was reduced from period 1 to 2 by 20%, and further by 7% to period 3. There was a significant reduction of Air Kerma from period 2 to 3 from 3.5 to 2.7 Gy. The operator exposure was reduced by more than half. The patient's weight and the complexity of the procedure were the main determinants of radiation exposure.
The radiation exposure for patient and operator was decreased considerably during the three observation periods despite an increase in lesion and procedural complexity. Rigorous implementation of radiation device settings did reduce radiation exposure without impeding procedural success. © 2017 Wiley Periodicals, Inc.
慢性完全冠状动脉闭塞（CTO）的经皮冠状动脉介入治疗（PCI）日益复杂，导致患者和术者的辐射暴露显著增加。
研究在手术复杂性增加的情况下，结合术者操作规范调整X射线设备设置以降低辐射剂量的可能性。
我们分析了2010年1月至2015年7月期间863例患者中连续的984例CTO的PCI手术。在此期间，X射线设备从模拟探测器系统更换为数字探测器系统，并随后进行了滤过和成像调整。透视设置从15脉冲/秒降至7.5，然后降至6。电影帧率从15降至7.5帧/秒。在最后一个时间段，通过优化设置，分析了影响辐射暴露的手术和病变相关因素。
病变复杂性增加，J-CTO评分从1.64升至2.33，逆行手术从21.6%增至50.4%。在透视时间相似的情况下，剂量面积乘积从第1阶段到第2阶段减少了20%，到第3阶段又进一步减少了7%。空气比释动能从第2阶段到第3阶段从3.5 Gy显著降至2.7 Gy。术者的辐射暴露减少了一半以上。患者体重和手术复杂性是辐射暴露的主要决定因素。
在三个观察期内，尽管病变和手术复杂性增加，但患者和术者的辐射暴露仍显著降低。严格实施辐射设备设置确实降低了辐射暴露，且未妨碍手术成功。©2017威利期刊公司。
