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A Cine/Fluoroscopy Mode Ratio-Based Model to Improve Physician Practice During Cardiac Catheterization Procedures for STEMI

V Weir1*, J Zhang2 , (1) Baylor Health Care System, Dallas, Texas, (2) University of Kentucky, Lexington, KY


(Sunday, 7/29/2018) 3:00 PM - 6:00 PM

Room: Exhibit Hall

Purpose: to demonstrate whether patient skin exposure depends on the cine mode and fluoroscopy modes selected by the physician during cardiac procedures. We aim to develop a model to identify an optimal proportion of cine vs. fluoroscopy usage to lower skin exposure.

Methods: A retrospective study of patient dose reports including air kerma, fluoroscopy time, Cine DAP and Fluoroscopy DAP was performed. The data were sorted according to physician who performed the procedure. The cine DAP to fluoroscopy DAP ratio was calculated for each physician. The ratios were categorized as averages from 0.25 to 3.5, with interval of + 0.1 around each category. Air kerma and fluoroscopy time corresponding to each category was normalized to the shortest time and the lowest air kerma. A model was developed to optimize cine to fluoroscopy ratios for cardiac procedures due to STEMI (ST Elevated Myocardial Infarction). An odds ratio was calculated for each physician to estimate the risk of producing high skin exposures.

Results: The proposed model shows that for each ratio category, there is a linear relationship between air kerma (mGy) and fluoroscopy time (min). The model is consistent with the proportion of cine to fluoroscopy mode that physicians used for the procedures. There is a significant difference (p<0.05) between the proportion of cine to fluoroscopy among individual physicians. The odds ratio shows that a patient has a greater chance of receiving higher skin exposures from the practice of certain physicians than others. The model shows that cine to fluoroscopy DAP ratio <1 are optimal compared to cine to fluoroscopy DAP ratios >1.

Conclusion: The choice of cine or fluoroscopy mode plays a significant role in patient skin exposures. The proposed model may be used to improve physician practice to minimize patient exposure during cardiac catheterization procedures for STEMI.


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