Feature | March 17, 2010

Mayo Clinic Study Looks at How to Minimize Angioplasty Radiation Risks

March 17, 2010 – Body size, gender and the complexity of heart disease significantly influence how much cumulative radiation skin dose patients receive during percutaneous coronary intervention (PCI) therapy, according to a new Mayo Clinic study. The study was undertaken as a quality control initiative to reduce the potential radiation risks of cancer to patients and PCI operators.

Presented at the annual meeting of the American College of Cardiology this week, the review of 14 months worth of radiation data from 1,827 adult patients is an important early step in understanding ways to improve PCI safety and quality while optimizing therapeutic benefits. The Mayo Clinic study identified 20 clinical traits and circumstances that help predict whether a patient likely received higher or lower doses of radiation.

PCI owes its precision, safety and effectiveness to X-ray fluoroscopy imaging. The amount of radiation dose used during procedures is generally much greater than that used for a typical X-ray image, such as a chest X-ray. But because a chest X-ray is usually a screening test and a PCI is a lifesaving procedure, from the clinical perspective, the risk of not performing the PCI is much greater than the predicted radiation risk associated with the procedure.

Mayo study results show:
• Indicators of higher radiation dose included male gender higher body mass index (BMI); more complex disease, such as multiple diseased vessels or complex anatomy and lesions in the vessels; and previous history of coronary artery bypass graft (CABG) surgery.

• The median patient BMI was 29.7, with most patients having a BMI between 21 and 44.6. A BMI less than 30 can fall into normal (20–24.9) or overweight (25–29.9) categories.

• The median cumulative skin radiation dose was 1.5 Gray (Gy), a unit of absorbed radiation, with a range 0.34 Gy to 4.5 Gy. In general, the cancer risk for a typical PCI is likely about 0.05 percent, whereas the “natural cancer rate” from daily exposure to background radiation is about 35 percent, the Mayo team noted.

Implications for Cure

“Radiation risk is a recognized hazard of our specialty that has not been systematically or aggressively addressed,” explains Chet Rihal, M.D., lead cardiovascular physician on the study. “But our commitment to patient safety and quality at Mayo Clinic, and to protecting operators who perform the therapy, makes this a priority issue for us. The next step for us is to follow-up from this initial identification of the problem and lead efforts to formulate specific practice changes clinicians can use to improve safety while maintaining quality.”

Data also showed radiation doses comparable patients received differed depending on which of the 13 physicians treated them. Dr. Rihal says investigating possible causes of this finding is among the goals of the next phase of study.

Context of the Study

Nationwide, concern is growing across medical fields about reducing risks of radiation from all sources, such as X-rays and computed tomography (CT) scans. Recently the FDA has been addressing accidental cases of overexposure to radiation in certain specialties. The Mayo Clinic study cases differ from the FDA efforts. Mayo’s cases do not involve accidents or overexposure, but commonly accepted clinical best practices. “This work is a natural expression of Mayo’s historic commitment to improving patient safety, care and quality of treatment,” Dr. Rihal said. “We aren’t correcting errors, just improving the way things are done for all concerned.”

The Mayo study is the largest to identify clinical conditions that correlate with radiation dose level, and is therefore is an important first step leading to protocols to reduce radiation levels. “There is no standard model of the clinical determinants of radiation skin dose in PCI, so by using clinical data from a large sample of Mayo Clinic adult patients and commonly accepted statistical methods, we identified correlations between clinical variables and radiation dose that we hope will be useful in improving care,” said Kenneth Fetterly, Ph.D., another of the Mayo study authors.

Collaboration and Support

In addition to Dr. Rihal and Fetterly, other Mayo Clinic physicians and scientists who worked on the study were Ryan Lennon, Malcom Bell, M.D. and David Holmes Jr., M.D. Their work was supported by the Mayo Foundation for Medical Education and Research.

For more information: www.mayo.edu, www.mayoclinic.com

Related Content

Toshiba America Medical Systems, Infinix-i Sky + double sliding C-arm, RSNA 2016
Technology | Angiography| October 05, 2016
Interventional labs now have an imaging system that provides clinicians flexibility to perform a wide array of...
Infinix 4D CT

Toshiba's Infinix 4D CT, which combines CT with angiography in the interventional lab.

Feature | Angiography| September 28, 2016 | Tom Watson BS, RCVT, Clinical Analyst, MD Buyline
One of the more significant advancements for interventional X-ray (IXR) in the past few years has been a significantl
atomic bombs, radiation exposure, long-term health effects, Bertrand Jordan, study
News | Radiation Dose Management| August 19, 2016
The detonation of atomic bombs over the Japanese cities of Hiroshima and Nagasaki in August 1945 resulted in horrific...
Cath lab radiation dose, dose reduction, cath lab staff radiation dose
Feature | Radiation Dose Management| August 09, 2016 | Dave Fornell
In the past few years, concern has skyrocketed from interventional cardiologists and cath lab staff over radiation do
Absorb, bioresorbable stent, FDA approval, FDA approves, FDA clears, most popular content, most popular stories, DAIC

The FDA clearance of the first bioresorbable stent, the Abbott Absorb, the first week of July has been the most popular story so far for all of 2016. It is the first fully dissolving stent approved for the U.S. market and many experts say this technology could be a paradigm shift in coronary and peripheral therapies in the coming years as the technology improves. 

Feature | August 05, 2016 | Dave Fornell
Stryker Sustainability Solutions, Angiodynamics Soft Vu Omni Flush Angiographic Catheters, recall
News | Angiographic Catheter| July 25, 2016
Stryker Sustainability Solutions (formerly Ascent Healthcare Solutions) is recalling Angiodynamics Soft Vu Omni Flush...
Siemens Healthineers, Enterprise Services, ES, U.S. launch
Technology | Cardiac Imaging| July 19, 2016
July 19, 2016 — Siemens Healthineers recently introduced an expanded Services portfolio, known as Enterprise Services

A 3-D OCT rendering of a stented vessel segment created on St. Jude Medical's Ilumien Optis OCT system. 

Feature | Angiography| July 15, 2016 | Dave Fornell
While angiographic X-ray fluoroscopy systems are the workhorse for transcatheter cardiovascular interventional proced
Overlay Init