Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France.
Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France.
Arch Cardiovasc Dis. 2022 Aug-Sep;115(8-9):436-447. doi: 10.1016/j.acvd.2022.04.010. Epub 2022 Jul 5.
X-ray exposure during complex percutaneous coronary intervention is a very important issue.
To reduce patient peak skin dose during percutaneous coronary intervention procedures for chronic total occlusion using on-line estimated peak skin dose software (Dose Map).
Throughout the procedure, Dose Map provided a map of local cumulative peak skin dose. This map was displayed in-room from 1Gy cumulative air kerma, and was updated every 0.5Gy. The operator's actions to minimize deterministic risks following map notification were collected. Skin reaction was evaluated 3 months after the procedure. A comparison with our historical X-ray exposure data (207 patients from January 2013 to July 2014) was performed.
From November 2015 to October 2016, 97 patients (Japanese chronic total occlusion score 2.1±1.1; 100 percutaneous coronary intervention procedures for chronic total occlusion) were prospectively enrolled. Fluoroscopy time was 40.8 (21.6-60.3) minutes, cumulative air kerma 1884 (1144-3231) mGy, estimated peak skin dose 962 (604-1474) mGy and kerma area product 115.8 (71.5-206.7) Gy.cm. Cumulative air kerma was>3Gy in 28% of cases, and>5Gy in 11% of cases. In 68% of cases, at least one action was taken by the operator after map notification to optimize skin dose distribution. Main changes included: gantry angulation (52%); field of view (25%); and collimation (13%). No skin injuries were observed at follow-up. In comparison with our chronic total occlusion historical radiation data, median cumulative air kerma and kerma area product were reduced by 31% and 33%, respectively (P<0.005.
Online skin dose mapping software allows the distribution of patient skin dose during complex percutaneous coronary intervention procedures, and may minimize X-ray exposure.
在复杂经皮冠状动脉介入治疗过程中，X 射线照射是一个非常重要的问题。
使用在线估算峰值皮肤剂量软件（Dose Map）降低慢性完全闭塞经皮冠状动脉介入治疗过程中患者的峰值皮肤剂量。
在整个过程中，Dose Map 提供了局部累积峰值皮肤剂量的地图。该地图从 1Gy 累积空气比释动能开始在室内显示，并每 0.5Gy 更新一次。收集了操作人员根据地图通知采取的最小化确定性风险的操作。术后 3 个月评估皮肤反应。与我们的历史 X 射线照射数据（2013 年 1 月至 2014 年 7 月的 207 例患者）进行了比较。
2015 年 11 月至 2016 年 10 月，前瞻性纳入了 97 例患者（日本慢性完全闭塞评分 2.1±1.1；100 例慢性完全闭塞经皮冠状动脉介入治疗）。透视时间为 40.8（21.6-60.3）分钟，累积空气比释动能为 1884（1144-3231）mGy，估计的峰值皮肤剂量为 962（604-1474）mGy，比释动能面积积分为 115.8（71.5-206.7）Gy·cm。28%的病例累积空气比释动能>3Gy，11%的病例累积空气比释动能>5Gy。在地图通知后，操作人员至少采取了一项行动来优化皮肤剂量分布，占 68%的病例。主要变化包括：机架角度（52%）；视野（25%）；准直（13%）。随访时未观察到皮肤损伤。与我们的慢性完全闭塞历史辐射数据相比，累积空气比释动能和比释动能面积积分中位数分别降低了 31%和 33%（P<0.005）。
在线皮肤剂量映射软件可用于在复杂经皮冠状动脉介入治疗过程中分配患者皮肤剂量，并可能最大限度地减少 X 射线照射。
