Patients' skin dose during percutaneous intervention for chronic total occlusion
The purpose of this research is to assess the patient's entrance skin dose (ESD) during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in six institutions.
Only a few reports are available on the patients' exposure during the procedures.
This study was approved by all of the six institutional review boards, and all patients gave informed consent. This study included consecutive 72 patients who underwent PCI procedures for CTO in the six institutions. They wore jackets that had 100 radiosensitive indicators adhered to the back during the PCI procedures. The patients' ESDs were calculated from the color difference of the indicators. The total fluoroscopic time, total number of cine frames, and maximal ESD were compared among institutions. To check for effects on the skin, clinical follow-up was performed at 1-2 days, 2 weeks, and 3 months after the PCI procedure.
The total fluoroscopic time was 45.0 +/- 24.5 min (range: 10.3-113.0 min) and the total number of cine frames was 4,558 +/- 3,440 (range: 855-22,950). The maximum ESD for each patient was 3.2 +/- 2.1 Gy (range: 0.5-10.2 Gy, median: 2.7 Gy). The average maximum ESDs were significantly different among institutions (P = 0.0006), and they were 1.6-5.3 Gy. Radiation skin injuries were observed in 2 patients.
The maximum ESDs during PCI for CTO exceed the thresholds for radiation skin injuries in many cases, although there are differences in the average maximum ESDs among institutions.
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ABSTRACT: The power spectrum of human heart rate (HR) measured over 24 h exhibits "power-law" 1/f alpha-type spectral behavior with alpha approximately 1. We investigate possible nonstationarity in time of the exponent alpha using maximum likelihood estimation, which allows relatively short data segments to be used. Examination of 24-h HR records from ambulatory normal and congestive heart failure (CHF) subjects indicates that the power-law structure of HR is nonstationary. In addition, alpha varies with time scale and is different for normal (alpha approximately 1) and CHF (alpha approximately 1.5) subjects. Simulations suggest that a possible mechanism underlying the observed power-law spectrum may be a switching between values of alpha near zero (white noise) and near two (Brownian motion). This mechanism generates power-law forms quantitatively similar to CHF subjects when the switching occurs very rapidly and similar to normal subjects when the switching is less rapid.
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ABSTRACT: There is no question that Percutaneous Coronary Intervention has revolutionized the way we
manage coronary artery disease. Over the past two decades we have witnessed maturity in
several techniques and equipment enabling the interventional cardiologist to manage lesions
that have previously been entirely in the domain of the cardiac surgeon. Despite these remarkable
achievements there still remain lesions that are complex enough to create a challenge
in the most experienced hands.The inherent tortuosity in complex vascular anatomies,
branching segments and chronically occluded vessel have been all associated with lower
procedural success and higher complication rates when compared to the “straight forward vessels”. The Magnetic Navigation System (MNS) is a novel and versatile technology that allows
the re-orientation of a wire within the patient’s body. This unique ability means that the “trial
and error” method of externally re-shaping the tip of the wire and re-engaging the vessel can
be effectively eliminated. As such previously “unreachable areas” in the heart or within the
vasculature can now be potentially reached.
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