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Tag: Fluoro-guided-procedures

radiation-protection-products
RADPAD® Radiation Products Protect Healthcare Providers and Patients

RADPAD® Radiation Products Protect Healthcare Providers and Patients

Posted on March 18, 2019 by in Uncategorized with no comments

RADPAD® Absorbs Scatter Radiation

RADPAD® Radiation Protection Shields are used by physicians and cath lab personnel during fluoro-guided procedures to protect them from the harmful effects of ionizing x-radiation. Placed on the patient in front of the operator, RADPAD® works by absorbing scatter radiation coming from the patient and creating a “shade zone” for the cath lab team to work in during interventional procedures. All RADPAD® Radiation Protection Products are non-lead and PVC-free products. They are procedure specific and designed for single use.

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Physician Protection

Sterile, disposable RADPAD® Radiation Protection Products are placed directly on the patient to protect the operator and cath lab personnel during fluoro-guided procedures from harmful scatter radiation. They are backed by 30 clinical studies and proven in thousands of hospitals on a daily basis worldwide

RADPAD® 5000 series products are comprised of several procedure-specific radiation protection shields designed to provide maximum protection to the operator and cath lab personnel during fluoro-guided procedures

RADPAD® 7000 series are comprised of several procedures specific sterile drape + RADPAD® Radiation Protection Shields, designed to protect operators and cath lab personnel during fluoro-guided procedures

RADPAD® 9000 series of Personal Protection Products are comprised of products worn by the operator and cath lab personnel to for additional protection during fluoro or CT guided procedures. These products include:

  • RADPAD® No Brainer®  is an attenuation material-lined scrub cap worn by the cath lab personnel to protect their brain from scatter radiation during fluoro-guided procedures
  • RADPAD® Thyroid Shield w/ Cover is a RADPAD® thyroid shield worn by the cath lab personnel to protect thyroid glands during fluoro-guided procedures
  • RADPAD® Radiation Protection Sleeve is a full arm-length cover worn the operator during CT guided procedures

Additional Products

RADPAD® Table Skirts w/ Anchor are table skirts that anchor to the table in the cath lab to block scatter radiation coming from below the table

 

Patient Protection

RADPAD® Specialty Shields: Shields of various shapes and sizes used to protect the patient during fluoro guided, interventional radiology, electrophysiology, and cardiac cath examinations

RADPAD® Patient Protection Pads: Pads used underneath the lower or upper body during fluoro-guided procedures

RADPAD® Body Guard Sets: Wraps fitted for adults, children, and infants used to protect the brain, thyroid, upper and lower body during CT examinations

 

Testimony of Clinical Need for Radiation Protection

“72 million CT scans are performed annually in the United States, which is about one scan for every four people in the country…which could account for roughly 29,000 future cancer cases each year!”¹

“In 2013, a scientific consensus was reached that even just one CT scan in childhood is linked to the risk of developing future cancers.”²

“Even 15 or more years after the first exposure to ionizing radiation from CT scan, cancer risks remain elevated by 24%.”³

Sterile, disposable RADPAD® Radiation Protection Products are placed directly on the patient to protect the operator and cath lab personnel during fluoro-guided procedures from harmful scatter radiation. They are backed by 30 clinical studies and proven in thousands of hospitals on a daily basis worldwide.


Contact Us or send inquiries to info@radpad.com for a free No Brainer™ surgical cap sample.

 

The original article appeared on https://www.medalliancegroup.com/product/radpad/.
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RADPAD® Safety News:  Radiation Exposure in Cath Lab Depends on Shield Placement

RADPAD® Safety News: Radiation Exposure in Cath Lab Depends on Shield Placement

Posted on February 19, 2018 by in Safety with no comments

MedPage Today and the American Heart Association collaborated on an insightful article explaining the importance of shield placement in the reduction of scatter radiation exposure:

 

MEDPAGE TODAY ®

Cardiology

Radiation Exposure in Cath Lab Depends on Shield Placement

by Chris Kaiser

Cardiology Editor, MedPage Today October 17, 2011

 

This article is a collaboration between MedPage Today® and:

Screen Shot 2018-02-19 at 2.07.31 PMlife is why

Interventional cardiologists are at greatest risk of scatter radiation exposure compared with other personnel in the cath lab, but their risk can be significantly reduced with the optimal placement of radiation shielding, researchers found.

A ceiling-mounted upper body shield protected best from scatter radiation when it was positioned tight to the patient’s body and just toward the head from the femoral access point, reported Kenneth A. Fetterly, PhD, from the Mayo Clinic in Rochester, Minn., and colleagues.

However, a difference of 5 cm away from the patient’s body and 20 cm closer to the x­ ray tube resulted in a fourfold reduction in protection, according to the study in Oct. 25 Journal of the American College of Cardiology: Cardiovascular Interventions.

“That the most advantageous shield positioning can have a greater than fourfold relative reduction in scatter radiation exposure, supports its use even when inconvenient, and suggests that learning to coordinate multiple shields should be among the fundamental principles taught in every interventional cardiology training program,” wrote Lloyd W. Klein, MD, and Justin Maroney, MD, from Advocate Illinois Masonic Medical Center in Chicago, in an accompanying editorial.

Klein and Maroney noted that the design of the interventional suite has remained stagnant over the past few decades even as innovations in techniques and devices have soared. And because optimal placement of shielding “continues to be operator­ dependent,” it requires a deliberate effort on the part of cath lab personnel to place shield s.

To determine how best to protect against scatter radiation, which occurs when the primary x-ray beam interacts with patient tissue and changes direction, investigators tested four different shielding models individually and in com binat ion:

 

  • A ceiling-mounted upper body shield

 

  • A table side rail-mounted lower body shield

 

  • An accessory vertical shield that mounts as an upper extension of the lower body shield

 

  • A disposable radiation-absorbing pad

 

Researchers used anthropomorphic phantoms through which they directed the x-ray beam in a straight posterior-anterior posit ion.

They measured the scatter radiation from three common physician positions corresponding to standard right femoral art ery, right jugular vein, and left anterior thoracic access point s.

Results showed that maximum protection was provided at the femoral artery access position compared with the other two access points.

When the ceiling-mounted upper body shield was moved away from the patient’s body by 5 cm, and moved more cephalad from the femoral access point by 20 cm, the protective benefit to the middle and upper body went from greater than 80% to less than 20%.

The accessory vertical extension to the lower body shield provided between 25% and 90% additional protection at heights in the range of 100 cm to 150 cm. The disposable pad also provided extra upper body protection, in the range of 55% to 70%.

Researchers found that the combined use of the table apron with vertical extension and the upper body shield resulted in “at least 80% protection at all elevations and 90% protection for elevations below 150 cm” at the femoral access point.

Regarding protection from the right jugular vein and left anterior thoracic access points, testing showed that the lower body shield provided better than 90% reduction in scatter exposure, but no upper body protection, while the disposable pad provided lower body protection and only modest upper body protection (between 40% to 70%).

The upper body shield also interfered with the x-ray receptor and patient access when the right jugular vein access point was used, and it interfered with patient access from the anterior thoracic access point. Patient interference was common with the vertical extension as well.

“A major finding of this work is that the upper body protection provided by the ceiling­ mounted upper body shield is highly dependent on precise positioning,” researchers wrote.

“Note that conventional wisdom is that shields should be placed close to the source of radiation to maximize the size of the protective ‘radiation shadow’ of the shield. Properly positioning the upper body shield requires the opposite mindset,” Fetterly and colleagues said.

Klein and Maroney echoed this sentiment, saying the shield should be used “as one would use an umbrella in wind-driven rain: the closer to the operator’s body the more eff ect ive.”

Limitations of the study included the use of only the posterior-anterior projections, and the lack of an analysis of radiation scatter when involved with the treatment of abdominal and peripheral vessels.

 

The study authors and the editorialists reported relationships relevant to the contents of the study or editorial.

 Reviewed by Zalman S. Agus, MD Em er itus Professor

University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN , BC-ADM, CDE, Nurse Planner 

Primary Source

JACC: Cardiovascular Interventions

Source Reference: Fetterly, KA et al “Effective use of radiation shields to minimize operator dose during invasive cardiology procedures” J Am Coll Cardiol Intv 2011; 4: 1133-1139.

Secondary Source

JACC: Cardiovascular Interventions

Source Reference : Klein LW, et al “Optimizing operator protection by proper radiation shield positioning in the interventional cardiology suite” J Am Coll Cardiol Intv 2011;4:1140-1141.


CONTACT US

Send inquiries to info@radpad.com for a free No Brainer™ sample. The No Brainer™ blocks up to 95% of radiation exposure to the brain. Lightweight, adjustable protection for all O.R. suite and fluoro lab personnel during interventional procedures.

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730 or 1-877-7RADPAD (1-877-772-3723)
Fax: 913-648-0131
Unknown

 

x-ray-radiation-protection-sleeve
Scatter Radiation is Unavoidable, Physician Protection is Not

Scatter Radiation is Unavoidable, Physician Protection is Not

Posted on November 27, 2017 by in Products, Safety with no comments

Protecting Hospital Staff During Fluoro-Guided Procedures

Radiation Therapy is a powerful tool in medicine, especially when used to treat cancer. Radiation works by killing and slowing the growth of cancer cells – but it can also damage healthy cells in the process, which can increase the risk of developing cancer in the future.

In 2017, approximately 80,000 new cases of brain tumors are expected to be diagnosed, with roughly 26,000 of those being malignant cases.^1 This depicts brain and other central nervous system cancer as the 10th leading cause of death in both men and women, and an estimated 16,700 individuals are expected to die from primary brain cancer this year. ^2

 

RADPAD® Radiation protection Products

While healthcare providers are diligent in their efforts to keep patients safe from scatter radiation, it is also important for providers to consider their safety when performing these procedures. Scatter radiation is secondary radiation that deflects from an object, most commonly the patient, during procedures, and can affect the healthcare provider’s brain in the process.

RADPAD® from Worldwide Innovations & Technologies is a full line of radiation protection products that are dedicated to protecting hospital staff during fluoro-guided procedures.

The No Brainer

The No Brainer®

The RADPAD® No Brainer® is an attenuation material-lined scrub cap worn by cath lab personnel that protects the brain from scatter radiation during fluoro-guided procedures.

 

x-ray-protection-thyroid-collar

Thyroid Collar

 

The RADPAD® is also available as a thyroid shield and a full-length protection sleeve to cover the neck and arms of the physician during these procedures.

 

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Table Skirt with Anchor

The RADPAD® Table Skirt anchors to the table in the cath lab to block scatter radiation that flows from below the table, and the RADPAD® Specialty Shields create a shade zone where the physician can work from.

To learn more about how you can protect yourself and your patients with the RADPAD®, contact us:

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730 or 1-877-7RADPAD (1-877-772-3723)
Fax: 913-648-0131

Unknown


1 http://www.abta.org/about-us/news/brain-tumor-statistics/?referrer=https://www.google.com/

2 http://www.cancer.net/cancer-types/brain-tumor/statistics

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RADPAD Presents: Cardiovascular Procedure Volume Growth Report

RADPAD Presents: Cardiovascular Procedure Volume Growth Report

Posted on September 19, 2017 by in Uncategorized with no comments

Here we present an article from MedMarket Diligence that provides information about the growth of cardiovascular procedure volume worldwide.

Based on their report described below, the volume of procedures is predicted to grow by an average of 3.7% per year from 2016 – 2022. The volume of corresponding surgeries and transcatheter interventions is forecast to expand to more than 18.73 million.

 

Cardiovascular procedure volume growth (interventional and surgical)

Cardiovascular surgical and interventional procedures are performed to treat conditions causing inadequate blood flow and supply of oxygen and nutrients to organs and tissues of the body. These conditions include the obstruction or deformation of arterial and venous pathways, distortion in the electrical conducting and pacing activity of the heart, and impaired pumping function of the heart muscle, or some combination of circulatory, cardiac rhythm, and myocardial disorders. Specifically, these procedures are:

  • Coronary artery bypass graft (CABG) surgery;
  • Coronary angioplasty and stenting;
  • Lower extremity arterial bypass surgery;
  • Percutaneous transluminal angioplasty (PTA) with and without bare metal and drug-eluting stenting;
  • Peripheral drug-coated balloon angioplasty;
  • Peripheral atherectomy;
  • Surgical and endovascular aortic aneurysm repair;
  • Vena cava filter placement
  • Endovenous ablation;
  • Mechanical venous thrombectomy;
  • Venous angioplasty and stenting;
  • Carotid endarterectomy;
  • Carotid artery stenting;
  • Cerebral thrombectomy;
  • Cerebral aneurysm and AVM surgical clipping;
  • Cerebral aneurysm and AVM coiling & flow diversion;
  • Left Atrial Appendage closure;
  • Heart valve repair and replacement surgery;
  • Transcatheter valve repair and replacement;
  • Congenital heart defect repair;
  • Percutaneous and surgical placement of temporary and permanent mechanical cardiac support devices;
  • Pacemaker implantation;
  • Implantable cardioverter defibrillator placement;
  • Cardiac resynchronization therapy device placement;
  • Standard SVT & VT ablation; and
  • Transcatheter AFib ablation

For 2016 to 2022, the total worldwide volume of these cardiovascular procedures is forecast to expand on average by 3.7% per year to over 18.73 million corresponding surgeries and transcatheter interventions in the year 2022. The largest absolute gains can be expected in peripheral arterial interventions (thanks to explosive expansion in utilization of drug-coated balloons in all market geographies), followed by coronary revascularization (supported by continued strong growth in Chinese and Indian PCI utilization) and endovascular venous interventions (driven by grossly underserved patient caseloads within the same Chinese and Indian market geography).

Venous indications are also expected to register the fastest (5.1%) relative procedural growth, followed by peripheral revascularization (with 4.0% average annual advances) and aortic aneurysm repair (projected to show a 3.6% average annual expansion).

Source: MedMarket Diligence, LLC; “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022,” (Report #C500).

Geographically, Asian-Pacific (APAC) market geography accounts for slightly larger share of the global CVD procedure volume than the U.S. (29.5% vs 29,3% of the total), followed by the largest Western European states (with 23.9%) and ROW geographies (with 17.3%). Because of the faster growth in all covered categories of CVD procedures, the share of APAC can be expected to increase to 33.5% of the total by the year 2022, mostly at the expense of the U.S. and Western Europe.

However, in relative per capita terms, covered APAC territories (e.g., China and India) are continuing to lag far behind developed Western states in utilization rates of therapeutic CVD interventions with roughly 1.57 procedures per million of population performed in 2015 for APAC region versus about 13.4 and 12.3 CVD interventions done per million of population in the U.S. and largest Western European countries.

Source: MedMarket Diligence, LLC; “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022,” (Report #C500).


Global Cardiovascular Procedures report #C500 details the current and projected surgical and interventional therapeutic procedures commonly used in the management of acute and chronic conditions affecting myocardium and vascular system.

Read the original article:

http://blog.mediligence.com/2017/02/13/cardiovascular-procedure-volume-growth-interventional-and-surgical/


CONTACT US

Send inquiries to info@radpad.com for a free No Brainer™ sample. The No Brainer™ blocks up to 95% of radiation exposure to the brain. Lightweight, adjustable protection for all O.R. suite and fluoro lab personnel during interventional procedures.

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730 or 1-877-7RADPAD (1-877-772-3723)
Fax: 913-648-0131
Unknown
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Low-Volume Contrast CT Angiography Via Pulmonary Artery Injection

Low-Volume Contrast CT Angiography Via Pulmonary Artery Injection

Posted on June 2, 2017 by in Procedures with no comments

The headline is a mouthful to digest, but this is an extremely informative and interesting article centered on reducing the amount of contrast needed in pre-procedure imaging for valve measurement and placement. All TAVR candidates undergo angiographic imaging to ensure that the cardiologist knows exactly what anatomical challenges are waiting ahead. Many of the candidates for the procedure (10-25%) have Chronic Kidney Disease (CKD), and the use of high volumes of contrast in traditional preprocedural imaging increases their risk for post procedure mortality. Dr. Truong and his colleagues demonstrated that use of the pulmonary artery for contrast delivery resulted in significantly lower contrast volumes.

“Low Volume Contrast CT Angiography Via Pulmonary Artery Injection for Measurement of Aortic Annulus in Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR)”

Read the full article below, or visit the Journal of Invasive Cardiology May 2017.

NYM-TAVR-2

Low-Volume Contrast CT Angiography Via Pulmonary Artery Injection for Measurement of Aortic Annulus in Patients Undergoing Transcatheter Aortic Valve Replacement

Author(s):

Vien T. Truong, MD1,2;  Joseph Choo, MD1;  Luke McCoy, MD1;  Adam Mussman, MD1;  Stephanie Ambach3;  Dean Kereiakes, MD1;  Ian Sarembock, MD1;  Wojciech Mazur, MD1

181-186

Abstract: Objectives. To investigate the feasibility and image quality of low-dose contrast computed tomography (CT) angiography with pulmonary artery (PA) protocol. Background. Aortic stenosis is the most common valvular heart disease and transcatheter aortic valve replacement (TAVR) has evolved as an alternative method for surgical valve replacement in intermediate-risk and high-risk surgical patients. CT is essential for measurement of aortic annulus prior to TAVR. Methods. Twenty patients underwent a low-dose contrast study with PA protocol and 20 patients underwent a traditional-dose study (traditional protocol). In PA protocol, the pigtail catheter was advanced in the main pulmonary artery under fluoroscopic guidance, with a second pigtail placed in the abdominal aorta. The pigtail catheter and sheath were secured in position and the patient was taken to the CT scan area for CT angiography of the chest (with injection from the PA catheter), abdomen, and pelvis (with injection from abdominal aortic catheter). Results. The amount of contrast used was significantly lower in the PA protocol vs the traditional protocol (40 mL vs 99.50 ± 6.87 mL; P<.001) at the cost of reduced average signal (265 ± 60 HU vs 371 ± 70 HU; P<.001), but without affecting measurements of the aortic annulus. Furthermore, no statistically significant difference in serum creatinine concentration was observed before and 48 hours after contrast administration in the PA group. Conclusion. Our data provide evidence that the new PA technique can be performed safely with much lower volume of CT contrast without affecting assessment of aortic annulus size.

J INVASIVE CARDIOL 2017;29(5):181-186.

Key words: aortic annulus, aortic valve stenosis, computed tomography


Aortic stenosis (AS) is the most common adult valvular heart disease in developed countries, with a prevalence approaching 12.4% in those who are 75 years of age and older.1 Although aortic valve replacement (AVR) is the treatment of choice for symptomatic AS, as the prognosis is poor for those managed conservatively,2,3 surgical morbidity and mortality can still be problematic in high-risk patients. Transcatheter aortic valve replacement (TAVR) is now indicated for patients with symptomatic AS who have high4 or intermediate estimated surgical risk,5,6 and studies are in progress evaluating lower-risk populations.7 In recent randomized trials, TAVR significantly improved survival and quality of life over standard medical therapy (including percutaneous balloon valvotomy) in patients with inoperable severe symptomatic AS.8-10 In patients considered high surgical risk, 30-day and 1-year mortality rates were similar between balloon-expandable TAVR and surgical AVR.11 Chronic kidney disease (CKD) is a common comorbidity, affecting 10%-25% of patients undergoing TAVR and associated with increased short-term postprocedure mortality.12

Although appropriate sizing of the TAVR valve for implantation initially relied upon measurements of the aortic annulus diameter based upon transthoracic and transesophageal echocardiographic images, the superiority of cardiac computed tomography (CT) imaging in the assessment of aortic root, aortic annulus, and left ventricular outflow tract (LVOT) anatomy and dimensions has been clearly demonstrated. The Society of Cardiovascular Computed Tomography (SCCT) currently recommends CT imaging be performed in all patients under consideration for TAVR unless there is a contraindication.13 A substantial volume of 80 mL to 120 mL of contrast is required for the scan, which can lead to contrast-induced nephropathy (CIN) in patients with preexisting CKD.4,12

In our institution, patients being evaluated for TAVR with CKD and serum creatinine of 1.6 mg/dL or greater are generally excluded from cardiac CT imaging because of the risk of CIN. In these patients, aorto-iliac CT angiography using selective and limited contrast injection (10 mL of contrast) through a pigtail catheter advanced into the infrarenal abdominal aorta has been employed for several years to determine suitability for transfemoral vascular access for TAVR.

We describe a novel technique in which a second pigtail catheter is placed into the pulmonary artery (PA) at the time of pigtail catheter placement in the abdominal aorta (for selective aorto-iliac CT angiography) in the cardiac catheterization laboratory and the patient is then transferred to the CT scanner, where low-dose contrast is injected for CT angiography of the chest, abdomen, and pelvis with and without contrast (PA protocol).

The present study compares CT image quality between traditional intravenous and low-volume contrast PA protocols.

Methods

Patient population. This study is a retrospective analysis of 40 patients who underwent CT angiography with either traditional intravenous or PA protocols using a Philips Brilliance iCT 256-slice CT scanner. Consecutive patients were included, all of whom had adequate study quality. Creatinine levels were obtained at baseline and 48 hours after the procedure. CIN was defined as either a 25% increase in serum creatinine from baseline or 0.5 mg/dL (44 µmol/L) increase in absolute value, at 48-72 hours of intravenous contrast.14,15 A total of 40 mL of contrast was administered to each PA protocol patient. The comparator group comprised patients with serum creatinine <1.6 g/dL who had undergone cardiac and aorto-iliac CT imaging using the standard intravenous contrast injection protocol (80-120 mL of contrast total).4 The study was approved by the institutional review board.

Pulmonary artery (PA) protocol. Patients in the PA protocol were brought to the cardiac catheterization laboratory and were sterilely prepped and draped per our standard cardiac catheterization protocol. Vascular access was obtained in the femoral artery and vein in the standard fashion. A 5 Fr diagnostic pigtail catheter was positioned in the abdominal aorta distal to the renal arteries under fluoroscopic guidance. A PA catheter was then advanced into the PA under fluoroscopic guidance. An exchange-length, 0.25˝ J-tipped wire was advanced through the PA catheter, with removal of the PA catheter over the wire. The exchange-length wire was then used to position a 5 Fr diagnostic pigtail catheter under fluoroscopic guidance in the main PA. The catheters and sheaths were secured in position and the patient was transported for immediate CT angiography of the chest, abdomen, and pelvis using the following sequence: (1) helically acquired non-contrast CT images of the chest, abdomen, and pelvis were obtained and reconstructed at 0.9 mm slice thickness at a 0.45 mm interval with multiplanar reformats; (2) a total of 60 cc of contrast mix (30 cc Omnipaque 350 [iohexol; GE Healthcare] diluted with 30 cc normal saline) at 10 cc/s was administered through the PA catheter; (3) the interventional cardiologist responsible for the procedure removed the pigtail catheters; and (4) the arterial and venous sheaths were removed and manual pressure was applied for hemostasis.

Helically acquired images were obtained with retrospective electrocardiographic gating (without dose modulation) from the mid neck through diaphragm and reconstructed with a slice thickness of 0.9 mm and 0.45 mm spacing. The tube voltage is 120kV, and automatic current modulation is used.

Next, small field of view dedicated cardiac CTA images are reconstructed at 35%, 40%, 45%, and 75% of the R-R interval with a slice thickness of 0.9 mm and 0.45 mm spacing.

All post processing is performed on the Vitrea workstation. Measurements of the annulus are made on the systolic phase reconstruction (35%, 40%, or 45%), which subjectively shows the least motion artifact. Occasionally, measurements from the 75% reconstructed images are necessary in the event of substantial motion artifact on the systolic phase images.

Abdomen and pelvis CTA. A separate contrast injection is performed through the infrarenal aortic pigtail catheter with a total volume of 40 cc contrast mix (10 cc Omnipaque 350 diluted in 30 cc normal saline) at 10 cc/s. Helically acquired images are obtained from the upper abdomen through the pelvis and reconstructed at 0.9 mm slice thickness and 0.45 mm spacing.

Image analysis. Three-dimensional volume-rendered and maximum intensity projection (MIP) reformats were reconstructed at 0.5 mm slice thickness on the Vitrea workstation. The data were loaded into a standard multiplanar cardiac reformat package with images reconstructed in the coronal, sagittal, and transverse (axial) orientations, and then analyzed using a multiplanar oblique tool.

Intravascular CT attenuation (Hounsfield units; HU) and image noise defined as standard deviation (SD) of CT attenuation were measured by using region of interest (ROI) analysis. ROI of approximately 250 mm2 was drawn above and below the aortic valve (to avoid measurement contamination by heavily calcified leaflets). Contrast density was calculated as average of above and below the valve ROI’s end (expressed in HU). Examples of patients who underwent traditional and PA protocol are presented in Figure 1. Signal and signal-to-noise ratio (SNR) is measured below the valve. Contrast-to-noise ratio (CNR) is calculated to assess signal intensity difference between two regions (below the valve and surrounding myocardium). Based on these measurements, SNR and CNR were calculated as:16

SNR = HUbelow the valve / noise

CNR = [HUbelow the valve – HUsurrounding muscle] / noise

Aortic annulus measurement. Aortic annulus, aortic root, and LVOT assessments and measurements for prospective clinical planning for TAVR were obtained from three-dimensional volume-rendered and MIP reformats performed utilizing 3mensio Structural Heart Analysis software, version 7.1 (Pie Medical Imaging). Images from three systolic phases (35%, 40%, and 45% of R-R intervals) were analyzed, and the largest aortic annulus area and perimeter measurements were used for choosing the appropriate TAVR valve size. Rarely, motion artifact in systolic phase required analysis of the aortic annulus and aortic root based upon the 75% R-R interval diastolic phase images.

Analysis of vascular access for the prospective planning of TAVR was performed using the 3mensio Vascular Analysis Package, version 7.1 (Pie Medical Imaging). Two-dimensional and three-dimensional reconstructions of the abdominal aorta, iliac, and femoral arteries were performed to assess suitability for transfemoral artery approach.

Statistical analysis. Continuous variables are expressed as mean ± standard deviation for normal distributions and median (interquartile range [IQR]) for non-normal distributions. Normality was tested using the Shapiro-Wilk test. For the evaluation of qualitative variables, we used the Chi-Squared test. Independent-sample t-test was used to compare age, body mass index (BMI), contrast volume, average signal, signal, SNR, and CNR between two groups. Mann-Whitney U-test was performed to test for significant differences between cardiac index in two groups. Wilcoxon Signed Rank test was used to compare serum creatinine concentration before and after administration of contrast agent. Pearson’s correlation coefficient (R) or Spearman’s rank correlation coefficient (Rs) test were used to test the association of variables with normal distribution or non-normal distribution, respectively. A P-value of <.05 was considered statistically significant. Statistical analysis was performed using the SPSS 22 software program (SPS, Inc).

Results

The study consisted of 40 consecutive patients (20 in the PA group and 20 in the traditional group). The contrast volume was higher in the traditional group than in the PA group (P<.001). There were no differences in age, BMI, body surface area, or cardiac index between groups (Table 1). The average signal (P<.001), SNR (P<.01), and CNR (P=.02) were significantly higher in the traditional group vs the PA group (Table 2). The average signal in the traditional protocol was related to cardiac index (Rs = -0.773; P<.001), but not in the PA group (P=.82). Interestingly, there was a correlation between body surface area and average signal in the PA group (R= -0.528; P=.017), which was not observed in the traditional group (P=.41) (Figure 2). Aortic annulus measurement was feasible in all patients regardless of protocol. TAVR was performed successfully in all patients, with no more than mild perivalvular regurgitation. There were no complications related to the PA protocol. The median serum creatinine value in the patients undergoing PA protocol was 1.68 mg/dL (IQR, 1.58-2.24 mg/dL) before the administration of contrast and 1.81 (IQR, 1.49-2.37 mg/dL) 48 hours after the administration of contrast (difference was not statistically significant; P=.60). Only 1 of the 20 patients (5%) had an increase of at least 0.5 mg/dL in the serum creatinine concentration 48 hours after administration of the contrast agent.

Discussion

This study demonstrates the feasibility of a reduced contrast cardiac CT protocol using selective contrast injection into the PA in the planning for TAVR. The evolution of TAVR has been rapid over the last 5 years, and it is now being performed at many centers with excellent short-term and long-term outcomes.4 CT plays a central role in patient selection and evaluation prior to TAVR. CT provides accurate dimensions of the thoracoabdominal aorta and its iliofemoral branches to optimize vascular access and approach, atherosclerotic burden, anatomy of the ascending aorta, aortic root, and valve annulus, which are of critical importance in valve type and size selection.13,17 However, the use of large volumes of intravenous contrast agent in CT can lead to CIN. CIN can be seen in >10% of patients after contrast-enhanced CT.18 In high-risk patients (including those with diabetes mellitus, CKD, history of congestive heart failure, and older age), CIN has been estimated at 20%-30%.19 In our reduced contrast PA protocol group, only 1 patient (5%) with multiple risk factors developed CIN after exposure to contrast agent. On the other hand, several studies have suggested that intravenous contrast volume is less nephrotoxic than intraarterial administration.20,21PA injection seems more similar to intraarterial and might be worse than a large dose given intravenously.

CIN can be associated with prolonged hospitalization, accelerated onset of end-stage renal disease, the requirement for dialysis, increased costs, and increased mortality.22 The presence of preexisting CKD is known to be a factor predisposing patients to acute kidney injury and is associated with worse outcome following TAVR.12 The most effective means of preventing CIN involves adequate hydration by intravenous saline,23 withholding nephrotoxic medications, and, most critically, the administration of the lowest possible volume of CT contrast.24 In comparison with the traditional technique, the main advantage of our PA protocol was the use of lower contrast volume, which may decrease the incidence of CIN. Some reduction in contrast density was noted, but accurate assessment of the aortic root, aortic annulus, and LVOT for planning TAVR was still achievable. In the low-volume contrast PA protocol patients, attenuation of contrast density did not affect measurements of the ascending aorta and aortic annulus. In addition, PA technique was not sensitive to cardiac index; as such, there was no need to adjust either contrast volume or timing of contrast injection to patient cardiac index. Spagnolo et al reported the results of a study to investigate the feasibility and image quality of 64-slice CT angiography using an ultra-low-dose contrast volume in 162 patients with BMI ≤29 kg/m2 scheduled for TAVR. CT angiography of the entire aorta with a multiphasic, low-iodine dose and BMI-adapted contrast protocol (BMI <22 kg/m2: 40 mL; BMI 22-29 kg/m2: 55 mL) was performed. Image quality of the aortic root and ilio-femoral vessels was evaluated in all patients. Vascular attenuation was >200 HU at any vessel level and measurements at the aortic annulus and iliac arteries were feasible with a substantial reduction of contrast volume.25 However, this study excluded patients with BMI >29 kg/m2, in contrast with our PA protocol, in which patients were not excluded on the basis of BMI.

The principal risk of our PA protocol is its invasive nature compared with peripheral intravenous contrast injection and need for separate injection from a second pigtail catheter placed in the abdominal aorta to visualize the aorto-iliac and femoral arteries. Although the risks from PA catheterization are well described, much of the risk is related to distal PA rupture from aggressive advancement of the catheter and balloon inflation-associated PA rupture. Our technique involves positioning of the catheter over an exchange-length guidewire in the main PA and avoidance of catheter and wire advancement into the distal peripheral PA bed. Meticulous catheter and guidewire manipulation under active fluoroscopic imaging can reduce the risk of serious vascular complications. To reduce the risk of vascular complications from the arterial puncture required for aorto-iliac and femoral artery imaging, we are currently evaluating a modification of our protocol in which peripheral arteries are visualized with a single PA injection: a test bolus of 4.5 cc of contrast (10 cc total, 45% contrast/55% saline) is injected from the PA catheter. The ROI is placed in the descending aorta at the level of the carina; the typical delay is 11-24 s, and the scan starts continuously from neck to pelvis to cover the carotid arteries.

Study limitations. The limitations of our study include its retrospective nature and relatively small sample size. Although only 1 patient (5%) in our PA protocol developed CIN, our study does not address whether the reduced contrast load in the PA protocol reduces CIN when compared with the standard intravenous contrast load. We did not adjust PA contrast dose depending on body surface area, although our data suggest that CT contrast image quality in patients with higher body surface area may benefit from higher contrast volume. In the current study, we used iohexol rather than iodixanol. However, iodixanol has been demonstrated to be less nephrotoxic.26

Conclusion

Our data provide evidence that the new PA technique can be performed safely, with substantially lower volume of CT contrast and with excellent procedural outcomes, without sacrificing image quality and ability to measure aortic annulus.

References

1.    Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013;62:1002-1012.

2.    Martinez-Selles M, Gomez Doblas JJ, Carro Hevia A, et al. Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. J Intern Med. 2014;275:608-620.

3.    Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57-e185.

4.    Holmes DR Jr, Mack MJ, Kaul S, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Thorac Cardiovasc Surg. 2012;144:e29-e84.

5.    Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609-1620.

6.    Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet. 2016;387:2218-2225. Epub 2016 Apr 3.

7.    Thyregod HG, Steinbruchel DA, Ihlemann N, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol. 2015;65:2184-2194.

8.    Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597-1607.

9.    Kapadia SR, Leon MB, Makkar RR, et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015;385:2485-2491.

10.    Kapadia SR, Tuzcu EM, Makkar RR, et al. Long-term outcomes of inoperable patients with aortic stenosis randomly assigned to transcatheter aortic valve replacement or standard therapy. Circulation. 2014;130:1483-1492.

11.    Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366:1686-1695.

12.    Rahman MS, Sharma R, Brecker SJD. Transcatheter aortic valve implantation in patients with pre-existing chronic kidney disease. IJC Heart & Vasculature. 2015;8:9-18.

13.    Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr. 2012;6:366-380.

14.    Golshahi J, Nasri H, Gharipour M. Contrast-induced nephropathy; a literature review. J Nephropathology. 2014;3:51-56.

15.    Feldkamp T, Kribben A. Contrast media induced nephropathy: definition, incidence, outcome, pathophysiology, risk factors and prevention. Minerva Med. 2008;99:177-196.

16.    Geyer LL, De Cecco CN, Schoepf UJ, et al. Low-volume contrast medium protocol for comprehensive cardiac and aortoiliac CT assessment in the context of transcatheter aortic valve replacement. Academic Radiol. 2015;22:1138-1146.

17.    Jurencak T, Turek J, Kietselaer BL, et al. MDCT evaluation of aortic root and aortic valve prior to TAVI. What is the optimal imaging time point in the cardiac cycle? Eur Radiol. 2015;25:1975-1983.

18.    Mitchell AM, Jones AE, Tumlin JA, Kline JA. Incidence of contrast-induced nephropathy after contrast-enhanced computed tomography in the outpatient setting. Clin J Am Soc Nephrol. 2010;5:4-9. Epub 2009 Dec 3.

19.    Tepel M, Aspelin P, Lameire N. Contrast-induced nephropathy: a clinical and evidence-based approach. Circulation. 2006;113:1799-1806.

20.    Solomon R. Contrast-induced acute kidney injury: is there a risk after intravenous contrast? Clin J Am Soc Nephrol. 2008;3:1242-1243.

21.    Dong M, Jiao Z, Liu T, Guo F, Li G. Effect of administration route on the renal safety of contrast agents: a meta-analysis of randomized controlled trials. J Nephrol. 2012;25:290-301.

22.    Jorgensen AL. Contrast-induced nephropathy: pathophysiology and preventive strategies. Crit Care Nurse. 2013;33:37-46.

23.    Weisbord SD, Palevsky PM. Prevention of contrast-induced nephropathy with volume expansion. Clin J Am Soc Nephrol. 2008;3:273-280.

24.    Azzalini L, Spagnoli V, Ly HQ. Contrast-induced nephropathy: from pathophysiology to preventive strategies. Can J Cardiol. 2016;32:247-255.

25.    Spagnolo P, Giglio M, Di Marco D, et al. Feasibility of ultra-low contrast 64-slice computed tomography angiography before transcatheter aortic valve implantation: a real-world experience. Eur Heart J Cardiovasc Imaging. 2016;17:24-33. Epub 2015 Jul 9.

26.    Chalmers N, Jackson RW. Comparison of iodixanol and iohexol in renal impairment. Br J Radiol. 1999;72:701-703.


From 1The Christ Hospital Health Network, Cincinnati, Ohio; 2Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; 3University of Cincinnati, College of Allied Health Sciences, Cincinnati, Ohio. The research was performed at The Christ Hospital Health Network, Cincinnati, Ohio.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript submitted September 15, 2016, provisional acceptance given December 5, 2016, final version accepted February 3, 2017.

Address for correspondence: Wojciech Mazur, MD, The Christ Hospital Health Network, 2139 Auburn Avenue, Cincinnati, OH 45219. Email: mazurw@ohioheart.org


CONTACT US

Send inquiries to info@radpad.com for a free No Brainer™ sample. The No Brainer™ blocks up to 95% of radiation exposure to the brain. Lightweight, adjustable protection for all O.R. suite and fluoro lab personnel during interventional procedures.

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730
or 1-877-7RADPAD (1-877-772-3723)Fax: 913-648-0131Email: info@radpad.com

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Studies Support the Need for Radiation Protection for the Brain

Studies Support the Need for Radiation Protection for the Brain

Posted on May 12, 2017 by in Safety with no comments

Here we present the first of two studies regarding Rad Techs and brain cancer.  This study (3/25/2016) showed a 2.5 times greater incidence of brain cancer due to radiation exposure in the fluoro labs than to those RTs working outside the interventional suite. The study recommended ALARA and more work in this area.

This study and can be used to support the need for radiation protection for the brain.

See the original article publication here.
Read the full article below:
What’s the radiation risk to RTs from fluoro studies?

By Brian Casey, AuntMinnie.com staff writer

April 7, 2017 — Are radiologic technologists (RTs) who assist with interventional studies at higher risk of death from brain cancer? Maybe, but it’s not clear that radiation exposure is the reason why, according to a new study published March 28 in the American Journal of Roentgenology.

Researchers from a variety of institutions studied brain cancer death rates in a group of 110,000 radiologic technologists who participated in a longitudinal survey starting in 1981. While RTs who were involved in fluoroscopy had slightly higher brain cancer death rates than those who weren’t, the researchers found no relationship between the amount of radiation they were exposed to on the job and their risk of brain cancer death.

This led Cari Kitahara, PhD, of the U.S. National Cancer Institute, and colleagues to conclude that there may be other factors behind why interventional RTs have higher brain cancer rates. These could include exposure to developing chemicals used to process film or drugs and iodinated contrast agents used during fluoroscopy-guided procedures (AJR, March 28, 2017).

On-the-job exposure

A number of studies in recent years have examined the link between radiation exposure and cancer death rates in radiologic technologists, particularly interventional procedures due to their higher radiation levels compared to static studies. Researchers have focused on brain cancer mortality because interventional technologists wear lead shielding that protects other parts of the body from radiation, while the head is for the most part unprotected.

A March 2016 study by Rajaraman et al found that interventional technologists had a mortality risk from malignant intracranial neoplasms that was 2.5 times higher compared to RTs who never assisted with fluoroscopy procedures. The current study used the same cohort as the Rajaraman study, but it was designed to assess whether there was a relationship between brain cancer mortality rates and the amount of radiation technologists were exposed to during their work histories.

Kitahara and colleagues analyzed data from the U.S. Radiologic Technologists Study, which began in the 1980s with a cohort of 146,022 technologists who were working in the field at the time, some having started their careers as early as 1926. The technologists received four surveys between 1983 and 2014 that asked various questions regarding work history and practices, medical history, and other issues.

Kitahara’s group used data from technologists who responded to the first or second cohort surveys (or both); this consisted of 83,655 female and 26,642 male technologists. To be included in the study, estimates of annual and cumulative radiation doses to the brain must have been performed for the individuals.

Dose estimates were derived from badge measurements for 72% of the study cohort members between 1960 and 1997, as well as detailed work histories of procedures and protection practices from the first three cohort surveys. The researchers used historical data and dose estimates for the years before 1960 when dosimetry badges weren’t yet available.

Kitahara and colleagues then tracked various demographic characteristics, lifestyle factors, and medical and work histories, including a history of working with fluoroscopy-guided imaging procedures. Finally, they tracked the number of cases of brain cancer that occurred in the subjects.

Over a median follow-up period of 26.7 years, 193 technologists who assisted with fluoroscopically guided procedures died of malignant brain tumors, the researchers found. Individuals in the group had a cumulative mean absorbed brain dose of 12 mGy.

Like Rajaraman et al, Kitahara’s group found a higher relative risk of brain cancer mortality among technologists who assisted with fluoroscopy compared to those who didn’t. But the relationship was not as strong: The new study found that those who were exposed to fluoroscopy procedures had a relative risk of brain cancer mortality of 1.7 compared to technologists who didn’t do fluoroscopy. This compared to a risk of 2.5 in the Rajaraman research. (The Kitahara study followed technologists for an additional four years compared to the previous research.)

Their next question was whether the technologists who received a higher radiation dose experienced a higher rate of brain cancer mortality. The answer was no: Kitahara and colleagues found an excess relative risk for brain cancer mortality of 0.1 per 100 mGy of exposure, just slightly above the rating of 0 that would indicate no association.

“We found no evidence of a dose-response association between cumulative protracted occupational radiation and malignant intracranial tumor mortality,” they wrote.

The researchers noted that the statistical power of their study may have been too limited to identify a positive relationship between radiation dose and mortality, given the relatively small number of cancer deaths and the low range of estimated radiation dose.

But they also postulated that the higher rate of brain tumor deaths found in both the Rajaraman and Kitahara studies could be due to factors other than radiation in the work environment of technologists who assist with interventional radiology

For example, technologists assisting with fluoroscopy-guided procedures continued to perform photographic subtraction angiography in darkrooms through the 1980s, whereas technologists working with static radiographs stopped working with open film tanks in the 1960s, they noted. Film-processing chemicals have been associated with a wide range of health maladies.

Fluoroscopy technologists are also exposed to a variety of drugs and iodinated contrast agents at a higher rate than other RTs, although the authors pointed out that a connection between such chemicals and brain tumor development has not yet been established.

In the end, Kitahara and colleagues noted that their findings are in line with other studies on exposure to low and moderate doses of radiation, which have not established a link between exposure levels and brain cancer mortality in adults.

They advised additional studies in the future, such as examining the association between protracted radiation exposure and benign brain tumor incidence in the same cohort.


CONTACT US

Send inquiries to info@radpad.com for a free No Brainer™ sample. The No Brainer™ blocks up to 95% of radiation exposure to the brain. Lightweight, adjustable protection for all O.R. suite and fluoro lab personnel during interventional procedures.

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730
or 1-877-7RADPAD (1-877-772-3723)

Fax: 913-648-0131

Email: info@radpad.com

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WIT Wins Business Award: 25 Under 25®

Posted on February 10, 2017 by in Other Stories with no comments

Worldwide Innovations & Technologies, Inc. Has Won the 25 Under 25® Award

2016AwardsLookingDown_25U25

“Small businesses are a powerful, but often overlooked force in Kansas City,” said Kelly Scanlon, CEO of Thinking Bigger Business Media and the creator of 25 Under 25®.

“Together, these companies employ thousands upon thousands of people, deliver innovative products and services, and help support our government, schools, nonprofits and other public resources. Of course, most of our winners are too humble and too busy to brag about their contributions. But it’s a story that needs to be told. The 25 Under 25® Awards are proud to celebrate the important service of small businesses.”

 

About the 25 Under 25® Awards

As part of its 10-year anniversary celebration in 2002, Thinking Bigger Business Media Inc. launched the annual 25 Under 25® Awards to recognize 25 outstanding Kansas City businesses with under 25 employees.

Until the 25 Under 25® Awards, no formal recognition program existed in the Kansas City area that specifically targeted businesses with fewer than 25 employees. Yet this segment of business comprises the largest number of companies both locally and nationally, with roughly 83 percent of Kansas City area and 86 percent of businesses nationwide employing 19 or fewer employees.

With the establishment of the 25 Under 25® Awards program, small businesses are being recognized for the significant role they play in the Kansas City economy. The 25 Under 25® Awards program is not just about honoring individual businesses—it’s also about opening the public’s eyes to the economic, social and community impact of small businesses.

 

Honorees

December 7, 2016

Thinking Bigger Business Media is proud to announce the honorees of the 16th annual 25 Under 25® Awards—a group that represents the best of Kansas City’s small business community.

The awards are presented to 25 local businesses with fewer than 25 employees. An independent panel of judges consisting of area business leaders chooses the winning companies. Nearly 1,500 nominations were submitted. This year’s honorees include:

 

More info on the awards and the award reception here: https://ithinkbigger.com/events/25-under-25/

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730
or 1-877-7RADPAD (1-877-772-3723)

Fax: 913-648-0131

Email: info@radpad.com

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RAPDAD Scatter Radiation Shields Protection during Vascular Surgery

Posted on January 20, 2017 by in Products, Safety with no comments

RADPAD-scatter-radiation-protectio

When people go through vascular surgery, scatter radiation occurs. Scatter radiation was inevitable in the past. But with today’s new technology at our disposal, we can protect ourselves from scatter radiation and get results. The most prominent target for scatter radiation are the patients themselves and then the physicians who care for them. Let us look at the different ways we can avoid scatter radiation.

Interventional Peripheral Shields

Interventional Peripheral Shields are used during vascular surgery and cardiothoracic surgery. The shields provide the physician with added length that helps him work on the entire length. The shade is what comes handy and helps in avoiding scatter radiation. There are a lot of fluids used in this process and this is the reason why it is available in absorbent covering.

The shields provide excellent protection during AAA (Abdominal Aortic Aneurysm) and TAVR (Transcatheter Aortic Valve replacement) procedures. During these procedures the physician is required on both sides and thus the protection is also available on two sides.

Why do we need Protection from Scatter Radiation?

Is it inevitable? Why do we need protection against scatter radiation? The simple reason is that all radiation is harmful and there is more than one person present for a surgery. The nurses and the doctors along with the patient are potentially at risk. This is the reason why we need to have protection against scatter radiation.

And this is why RADPAD is inventing and manufacturing better shields that drastically reduce the radiation in every interventional procedure. It is available from 50% to 95% at 90kVp.

Some shields are designed specifically for absorbing radiation in certain zones. This helps in giving the physicians a place where they can safely work where the radiation won’t affect them at all.

Moreover, there are safety regulations for the doctors that state the radiation exposure to the doctors and other personnel should be as low as reasonably achievable (ALARA). This makes the use of RADPAD shields even more important in every operation theater.

So, now you know what kind of RADPAD shields can be used to protect a physician and their team from harmful scatter radiations. When everyone is protected, then surgeons can focus on what’s important; operating on their patients. Get these RADPAD shields for your company today.

TAVR-Radiation-Protection
One-Third of Patients With Low Flow Aortic Stenosis Do Not Improve With TAVR, Research Finds

One-Third of Patients With Low Flow Aortic Stenosis Do Not Improve With TAVR, Research Finds

Posted on October 27, 2016 by in Procedures with no comments

Aortic Stenosis, the narrowing of the aortic valve in the heart, causing restricted blood flow, is one of the most common and serious valve disease problems. A TAVR procedure is the best option for treating this disease, but recent studies have shown that approximately one-third of low flow AS patients continue to suffer with low flow AS after the procedure.

Read the full article on the Radpad blog below, or see the original publication here: http://www.cathlabdigest.com/content/One-Third-Patients-Low-Flow-Aortic-Stenosis-Do-Not-Improve-TAVR-Research-Finds

One-Third of Patients With Low Flow Aortic Stenosis Do Not Improve With TAVR, Research Finds

Patients who do not improve with TAVR are found to have worse clinical outcomes at one year

TAVR-Radiation-Protection

June 16, 2016 – Aortic stenosis (AS), the narrowing of the aortic valve in the heart which causes restricted blood flow, is one of the most common and serious valve disease problems. For patients with one type of AS — low flow — transcatheter aortic valve replacement (TAVR), a minimally invasive procedure which corrects the damaged aortic valve, is often the best option for restoring the heart’s normal pumping function. However, approximately one-third of low flow AS patients treated with TAVR continue to suffer persistent low flow AS even after the procedure, ultimately increasing their risk of death. Now, researchers from the Perelman School of Medicine at the University of Pennsylvania have examined this high-risk patient population to determine the cause of this persistent low flow AS and to evaluate their risk of dying during the year following the procedure. Their findings are detailed in a paper published in the Journal of the American Medical Association – Cardiology.

“There has been a lot of interest in these patients with low flow AS, as their surgical mortality is higher than other patients. TAVR is often a good option, but not all of them will be able to normalize flow following the procedure and these persistently low flow patients have a 60 percent higher rate of mortality at one year,” said Howard C. Herrmann, MD, FACC, MSCAI, John W. Bryfogle Professor of Cardiovascular Medicine and Surgery, and director of Penn Medicine’s Interventional Cardiology Program. “Low flow before TAVR is one of the most important predictors of mortality following TAVR, but it is one of the harder qualities to measure. This presents a challenge to properly treating patients with low flow AS, and can leave some patients at higher risk.”

To better understand the potential benefits of TAVR for low flow AS, researchers conducted an analysis of 984 patients with low flow AS from the PARTNER trial and continued access registry from April 2014 through January 2016. A baseline and follow-up echocardiogram, evaluation of post-TAVR hemodynamics — blood flow — and one year outcomes were assessed.

Through this analysis, researchers identified the large subgroup of patients who, following TAVR, failed to regain normal flow despite a successful procedure. In the first six months following TAVR, flow improved in roughly 66 percent of the patients evaluated. However, those with severe low flow AS had the highest mortality rate — 26 percent — at one year, as compared to approximately 20 percent for those with moderate low flow and even less for those with normal flow.

“Unfortunately, many centers do not routinely measure flow, but rather focus more on a patient’s pressure gradient or valve area when evaluating aortic stenosis pre-and post-TAVR,” said Herrmann. “While low flow is more challenging to monitor, this measurement can better inform the patient’s risk of mortality, and in turn lead to better treatment.”

The researchers noted that the identification of remedial, or treatable, causes of persistent low flow following TAVR, such as severe mitral regurgitation and atrial fibrillation, may represent an opportunity to improve the outcomes of these patients.

Journal Reference:

  1. Venkatesh Y. Anjan, MD; Howard C. Herrmann, MD; Philippe Pibarot, PhD; William J. Stewart, MD; Samir Kapadia, MD; E. Murat Tuzcu, MD; Vasilis Babaliaros, MD; Vinod H. Thourani, MD; Wilson Y. Szeto, MD; Joseph E. Bavaria, MD; Susheel Kodali, MD; Rebecca T. Hahn, MD; Mathew Williams, MD; D. Craig Miller, MD; Pamela S. Douglas, MD; Martin B. Leon, MD. Evaluation of Flow After Transcatheter Aortic Valve Replacement in Patients With Low-Flow Aortic Stenosis: A Secondary Analysis of the PARTNER Randomized Clinical Trial. Journal of the American Medical Association — Cardiology, June 2016 DOI: 10.1001/jamacardio.2016.0759
alternate access for CTOs by RADPAD
RADPAD CLI Perspectives: Alternative Access for CTOs in CLI

RADPAD CLI Perspectives: Alternative Access for CTOs in CLI

Posted on September 12, 2016 by in Procedures with no comments

Last year, Cath Lab Digest published an interview covering alternative access for chronic total occlusions in critical limb ischemia. J.A. Mustapha, MD, interviewed Andrej Schmidt, MD, Department of Angiology, Leipzig Heart Center, Leipzig, Germany. 

Read the full article below or click the link for the original publicaiton:

http://www.cathlabdigest.com/article/CLI-PERSPECTIVES-Alternative-Access-CTOs-CLI

 


CLI PERSPECTIVES: Alternative Access for CTOs in CLI

Author(s):

CLI Perspectives is headed by section editor J.A. Mustapha, MD, 

Metro Health Hospital, Wyoming, Michigan. 

 

Topics:
Access
Critical limb ischemia
Chronic total occlusions (CTO)
Issue Number:
Volume 23 – Issue 2 – February, 2015

 

 

 

J. Mustapha: What is your preferred access method for crossing complex superficial femoral artery (SFA) CTOs, with the exception of ostial SFA disease?

A. Schmidt: Most SFA CTO crossing is performed via ipsilateral antegrade approach.

 

 

J. Mustapha: Why do you prefer an ipsilateral antegrade approach?

A. Schmidt: For multiple beneficial reasons, including shortening the distance from the access site to the CTO, enhancement of pushability, and much better wire and catheter torque.

 

J. Mustapha: Do you ever perform a contralateral access approach for SFA CTOs?

 

A. Schmidt: Yes, mostly in patients who are not good candidates for antegrade access such as obese patients, those with proximal disease, ostial SFA disease, or CTOs. Mostly, I prefer antegrade access for SFA CTOs.

 

J. Mustapha: Many of us have seen you perform live cases and have witnessed your excellent techniques in retrograde popliteal and SFA access in complex CTO crossing. Why do you access these segments?

A. Schmidt: We access distal to the CTO cap of the SFA or popliteal CTO only when we fail to cross from antegrade approach first. The reason we access close to the CTO is similar to the reasoning of the antegrade access, close to the CTO cap, which in turns helps with retrograde pushability and torqueability.

J. Mustapha: What advice would you give practitioners who would like to perform similar retrograde access in the SFA/popliteal?

A. Schmidt: Proceed with caution, as this should only be attempted after an antegrade approach fails.  Be sure to have a balloon across the occluded target lesion and the guidewire across the distal access before taking the access catheter out, so that in case a problem (dissection, occlusion) occurs at the distal entrance, balloon angioplasty can be done to fix it. Hemostasis is principally done by external compression.

 

 

J. Mustapha: What is the average time of your balloon inflation?

A. Schmidt: The time depends on the size of the access catheter or the sheath used. Most of the time, we use the smallest catheter possible, .018-inch to .035-inch.  Therefore, we perform a three-minute balloon inflation followed by an angiogram.

 

J. Mustapha: Is this the same for a stick in a stent vs no stent?

A. Schmidt: Yes.

 

J. Mustapha: Do you worry about harming the stent after getting access in it?

A. Schmidt: No. So far, in our experience, we have not had any issues with stents in these situations. Keep in mind, we only get an access in the stent in extreme cases and place the smallest catheter possible.

J. Mustapha: Moving to retrograde tibial access, which access method do you use to enter the artery, angiogram-guided or ultrasound-guided?

A. Schmidt: We use angiogram-guided access.

 

J. Mustapha: Which is your preferred tibial artery for retrograde access and which part of the artery do you like to enter?

A. Schmidt: My preferred artery is the anterior tibial artery and I prefer to enter it proximally.

 

J. Mustapha: Why proximal versus distal?

A. Schmidt: Proximally, because the vessel diameter is larger and accommodates a 4 French sheath if needed.

 

J. Mustapha: How do you get the access?

A. Schmidt: First we position the foot supine and support it with a rolled-up towel, then perform an angiogram in left oblique 30° view, and enter the needle thru the skin into the artery. If no blood returns, we perform an oblique view with repeat angiogram which helps show the tip of the needle and artery.

 

J. Mustapha: How do you obtain hemostasis after the proximal tibial access?

A. Schmidt: Most of the time, we use an external blood pressure cuff.  Occasionally, we use an intra-arterial balloon.

 

J. Mustapha: If needed, what are your tips and tricks for getting distal tibial access?

A. Schmidt: Starting with the dorsalis pedis access, foot positioning is important. First we position the foot supine and support it with a rolled-up towel, then the C-arm is positioned at about 15° ipsilateral and 10° cranial. We then use the quick access needle holder, followed with an angiogram. Also, we can puncture and perform contrast injection simultaneously, as needed.

 

J. Mustapha: Do you recommend road mapping for tibial access?

A. Schmidt: No, side movements of the artery due to puncture needles are not noticed, which may lead to accidental venous access and failed attempts. Also, I don’t recommend coming in from a lateral approach.

 

J. Mustapha: How do you know your needle is in line with the artery?

A. Schmidt: After angiogram is done, make the needle form one line with the artery (Figure 1A-B).

 

J. Mustapha: What do you do in the setting of no blood return?

A. Schmidt: Obtain oblique orthogonal views at 55-65°, load the guidewire into the needle, and perform contrast injection via the proximal sheath and pull back very slowly. Keep testing if the guidewire makes it through. Another method is to pull back slowly and inject contrast from the needle holder until you see contrast in the artery, then advance the guidewire (Figure 2A-G).

 

J. Mustapha: Any tips on how to get peroneal access?

A. Schmidt: Start with an anterior approach. Place the C-arm at ipsilateral LAO 30° (Figure 3A), perform antegrade angiogram, and position the needle in line with the artery.  If no success, then move the C-arm to right anterior oblique (RAO) 70° (Figure 3B) and repeat angiogram. Redirect the needle toward the artery, puncturing the peroneal artery through the membrana interossea.

 

J. Mustapha: Which puncture site is safer?

A. Schmidt: The distal tibial access approach is safer, as it is not associated with compartment syndrome.

 

J. Mustapha: What needles to you use for proximal and distal tibial access?

A. Schmidt: For proximal anterior tibial, posterior tibial, and peroneal access, we use a 7cm, 21g needle. For distal tibials, we use a 4cm, 21g needle.

 

J. Mustapha: Please advise what NOT to do in infrapopliteal retrograde access.

A. Schmidt: One should not access communication arteries, especially those off of the peroneal artery, as shown in Figure 4.

 

J. Mustapha: How do you minimize radiation exposure?

A. Schmidt: My angiographical approach to retrograde pedal and tibial puncture is quick and precise, minimizing radiation exposure. I attribute this to experience and the right equipment (Figure 5A). I wear a ring dosimeter (Figure 5B) to measure my exposure.

Disclosure: Dr. Mustapha reports he is a consultant to Bard Peripheral Vascular, Covidien, Cordis, CSI, Spectranetics, and Boston Scientific. Dr. Schmidt reports occasional consulting for Bard and Medtronic.

Dr. Andrej Schmidt and Dr. J.A. Mustapha can be contacted at jihad.mustapha@metrogr.org

 

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