Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR ®

Objectives Identifying the distributions and determinants of fluoroscopy time for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). Background ICA and PCI are significant contributors to radiation exposure from medical imaging in the US. Fluoroscopy time is a potentially modifiable determinant of radiation exposure for these procedures, but has not been well characterized in contemporary practice. Methods We evaluated the distribution of fluoroscopy time in patients undergoing ICA and/or PCI in the CathPCI Registry ® , stratifying patients by numerous clinical scenarios. Hierarchical models were used to determine patient, procedure, operator and hospital‐level factors associated with fluoroscopy time for these procedures. Results Our study included a total of 3,295,348 ICA and PCI procedures performed by 9,600 operators from January 2005 through June 2009. There was wide variation in fluoroscopy times for these procedures with median [IQR] fluoroscopy times of 2.6 [1.7–4.5] minutes for ICA, 6.7 [4.2–10.8] minutes for ICA in patients with prior coronary artery bypass grafting (CABG), 10.1 [6.0–17.4] minutes for PCI, 10.7 [7.0–16.9] minutes for PCI with ICA, and 16.0 [10.6–24.0] minutes for PCI and ICA in patients with prior CABG. Prolonged fluoroscopy times (>30 minutes) were rare for ICA, but occurred in 6.7% of PCIs and 14.7% of PCIs in patients with prior CABG. After accounting for patient characteristics and procedure complexity, operator and hospital‐level factors explained nearly 20% of the variation in fluoroscopy time. Conclusions Fluoroscopy times vary widely during ICA and PCI with operator and hospital‐level factors contributing substantially to these differences. A better understanding of potentially modifiable sources of this variation will elucidate opportunities for enhancing the radiation safety of these procedures. © 2013 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101860/1/ccd24996.pd

Economic and biological costs of cardiac imaging

Medical imaging market consists of several billion tests per year worldwide. Out of these, at least one third are cardiovascular procedures. Keeping in mind that each test represents a cost, often a risk, and a diagnostic hypothesis, we can agree that every unnecessary and unjustifiable test is one test too many. Small individual costs, risks, and wastes multiplied by billions of examinations per year represent an important population, society and environmental burden. Unfortunately, the appropriateness of cardiac imaging is extra-ordinarily low and there is little awareness in patients and physicians of differential costs, radiological doses, and long term risks of different imaging modalities. For a resting cardiac imaging test, being the average cost (not charges) of an echocardiogram equal to 1 (as a cost comparator), the cost of a CT is 3.1x, of a SPECT 3.27x, of a Cardiovascular Magnetic Resonance imaging 5.51x, of a PET 14.03x, and of a right and left heart catheterization 19.96x. For stress cardiac imaging, compared with the treadmill exercise test equal to 1 (as a cost comparator), the cost of stress echocardiography is 2.1x and of a stress SPECT scintigraphy is 5.7x. Biohazards and downstream long-term costs linked to radiation-induced oncogenesis should also be considered. The radiation exposure is absent in echo and magnetic resonance, and corresponds to 500 chest x rays for a sestamibi cardiac stress scan and to 1150 chest x rays for a thallium scan. The corresponding extra-risk in a lifetime of fatal cancer is 1 in 2000 exposed patients for a sestamibi stress and 1 in 1000 for a thallium scan. Increased awareness of economic, biologic, and environmental costs of cardiac imaging will hopefully lead to greater appropriateness, wisdom and prudence from both the prescriber and the practitioner. In this way, the sustainability of cardiac imaging will eventually improve

The Relationship between Subjective and Objective Parameters in CT Phantom Image Evaluation

Objective: To evaluate whether there is a relationship between subjective parameters determined by a reviewer (spatial resolution, low contrast resolution, and artifacts) and objective parameters (the CT number of water, noise, and image uniformity) in CT phantom image evaluations. Materials and Methods: We reviewed the CT results of phantom image evaluations conducted by Korean Institute for Accreditation of Medical Image (KIAMI) from May 2007 to June 2007. We compared the objective parameters against the pass or fail groups for the subjective parameters. We also evaluated whether there is a relationship between the artifact types and the other subjective parameters. Results: The mean noise value was significantly higher in the fail groups for the subjective parameters compared to the pass groups (p = 0.006). Specifically, noise and low contrast resolution were found to have a statistically significant positive correlation (r = 0. 183, p < 0.001). In the fail group for low contrast resolution, the failure due to artifacts was significantly higher than the pass group (p < 0.001). In contrast, no statistically significant differences were found for the mean CT number of water, noise, or image uniformity based on the types of artifacts. Conclusion: Subjective CT image parameters evaluated by a reviewer correlate with objectively measured parameters, especially noise. Therefore, a stricter noise standard might be able to improve the subjective parameters results, such as low contrast resolution.Park HJ, 2008, KOREAN J RADIOL, V9, P354, DOI 10.3348/kjr.2008.9.4.354IM TH, 2007, 1 KIAMI, P1*KIAMI DEP ED, 2006, WORKSH EX QUAL ASS P, P141*FLUK CORP, 2005, NUCL ASS 76 410 4130*KIAMI DEP ED, 2005, WORKSH EX QUAL ASS P, P13McCollough CH, 2004, MED PHYS, V31, P2423, DOI 10.1118/1.1769632MCCOLLOUGH CM, 2000, CATEGORICAL COURSE D, P189WIL R, 1998, CT IMAGE QUALITYEUCLID S, 1994, COMPUT TOMOGR, P174BETHESDA MD, 1988, 99 NCRPJUDY PF, 1977, 1 AAPM*ACR, CT ACCR PROGR REQ

Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields

Breckenkamp J, Berg-Beckhoff G, Muenster E, et al. Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields. Environmental Health. 2009;8(1):23.Background: The aim of this study was to examine the feasibility of performing a cohort study on health risks from occupational exposure to radiofrequency electromagnetic fields (RF-EMF) in Germany. Methods: A set of criteria was developed to evaluate the feasibility of such a cohort study. The criteria aimed at conditions of exposure and exposure assessment (level, duration, preferably on an individual basis), the possibility to assemble a cohort and the feasibility of ascertaining various disease endpoints. Results: Twenty occupational settings with workers potentially exposed to RF-EMF and, in addition, a cohort of amateur radio operators were considered. Based on expert ratings, literature reviews and our set of predefined criteria, three of the cohorts were identified as promising for further evaluation: the personnel (technicians) of medium/short wave broadcasting stations, amateur radio operators, and workers on dielectric heat sealers. After further analyses, the cohort of workers on dielectric heat sealers seems not to be feasible due to the small number of exposed workers available and to the difficulty of assessing exposure (exposure depends heavily on the respective working process and mixture of exposures, e.g. plastic vapours), although exposure was highest in this occupational setting. The advantage of the cohort of amateur radio operators was the large number of persons it includes, while the advantage of the cohort of personnel working at broadcasting stations was the quality of retrospective exposure assessment. However, in the cohort of amateur radio operators the exposure assessment was limited, and the cohort of technicians was hampered by the small number of persons working in this profession. Conclusion: The majority of occupational groups exposed to RF-EMF are not practicable for setting up an occupational cohort study due to the small numbers of exposed subjects or due to exposure levels being only marginally higher than those of the general public

The biological effects of diagnostic cardiac imaging on chronically exposed physicians: the importance of being non-ionizing

Ultrasounds and ionizing radiation are extensively used for diagnostic applications in the cardiology clinical practice. This paper reviewed the available information on occupational risk of the cardiologists who perform, every day, cardiac imaging procedures. At the moment, there are no consistent evidence that exposure to medical ultrasound is capable of inducing genetic effects, and representing a serious health hazard for clinical staff. In contrast, exposure to ionizing radiation may result in adverse health effect on clinical cardiologists. Although the current risk estimates are clouded by approximations and extrapolations, most data from cytogenetic studies have reported a detrimental effect on somatic DNA of professionally exposed personnel to chronic low doses of ionizing radiation. Since interventional cardiologists and electro-physiologists have the highest radiation exposure among health professionals, a major awareness is crucial for improving occupational protection. Furthermore, the use of a biological dosimeter could be a reliable tool for the risk quantification on an individual basis

Estimating radiation effective doses from whole body computed tomography scans based on U.S. soldier patient height and weight

<p>Abstract</p> <p>Background</p> <p>The purpose of this study is to explore how a patient's height and weight can be used to predict the effective dose to a reference phantom with similar height and weight from a chest abdomen pelvis computed tomography scan when machine-based parameters are unknown. Since machine-based scanning parameters can be misplaced or lost, a predictive model will enable the medical professional to quantify a patient's cumulative radiation dose.</p> <p>Methods</p> <p>One hundred mathematical phantoms of varying heights and weights were defined within an x-ray Monte Carlo based software code in order to calculate organ absorbed doses and effective doses from a chest abdomen pelvis scan. Regression analysis was used to develop an effective dose predictive model. The regression model was experimentally verified using anthropomorphic phantoms and validated against a real patient population.</p> <p>Results</p> <p>Estimates of the effective doses as calculated by the predictive model were within 10% of the estimates of the effective doses using experimentally measured absorbed doses within the anthropomorphic phantoms. Comparisons of the patient population effective doses show that the predictive model is within 33% of current methods of estimating effective dose using machine-based parameters.</p> <p>Conclusions</p> <p>A patient's height and weight can be used to estimate the effective dose from a chest abdomen pelvis computed tomography scan. The presented predictive model can be used interchangeably with current effective dose estimating techniques that rely on computed tomography machine-based techniques.</p