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Can cardiac procedures be graded in complexity and related with dose?

Can cardiac procedures be graded in complexity and related with dose?. L 8.3. Educational Objectives. Complexity related factors in cardiac interventions Relationship of patient dose with technical and clinical factors Development of complexity index and its utility.

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Can cardiac procedures be graded in complexity and related with dose?

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  1. Can cardiac procedures be graded in complexity and related with dose? L 8.3

  2. Educational Objectives • Complexity related factors in cardiac interventions • Relationship of patient dose with technical and clinical factors • Development of complexity index and its utility Lecture 8.3: Complexity

  3. factors determining patient’s exposure • adequacy of equipment • fluoroscopy time • cine-angiography time operator’s experience procedure complexity Lecture 8.3: Complexity

  4. simple case straightforward right fluoro time: 1 m’ 20 sec total DAP: 102 dGy Lecture 8.3: Complexity

  5. difficult case extreme vessel tortuosity fluoro time: 20 m’ total DAP: 1074 dGy Lecture 8.3: Complexity

  6. complexity related factors • age • number of vessels treated • occluded vessels • previous CABG • poor Ejection Fraction quantification never proposed Lecture 8.3: Complexity

  7. Clinical and technical determinants of the complexity of PTCA procedures. Analysis in relation to fluoroscopy time (Cathet Cardiovasc Intervent 2000; 51:1-9) Lecture 8.3: Complexity

  8. PTCA characteristics n 402, 21/06/96-08/05/98 (50% of tot) mean fluoro time 11,5’ ± 8,6’ 76.3% success 96.5 % 15.4% 8.2% Stenting 49% (x procedure) Lecture 8.3: Complexity

  9. patients’ characteristics n 402, M 72 % age 62±11 31% 34.9% 34.1% 6% previous CABG mean EF 58% ± 10 Lecture 8.3: Complexity

  10. clinical factors tested • age • sex • single or multivessel disease • EF • previous CABG no significant correlation with fluoro time or exposure parameters Lecture 8.3: Complexity

  11. p< 0.001, p<0.01*, p<0.005° Lecture 8.3: Complexity

  12. complexity index/fluoro time correlation most significant & less operator-dependent variables Complexity Index r = 0.576 P < 0.0001 Fluoro time (sec) Lecture 8.3: Complexity

  13. complexity index-based stratification fluoro time P < 0.0001 Fluoro time (sec) 215 119 68 simple medium complex CI = 0 CI  1.5 CI > 1.5 Lecture 8.3: Complexity

  14. complexity index-based stratification cine frames P = 0.001 Cine frames (n) P = ns P = 0.0377 215 119 68 simple medium complex CI = 0 CI  1.5 CI > 1.5 Lecture 8.3: Complexity

  15. complexity index-based stratification total DAP P < 0.0001 Gy * cm2 P = 0.0015 215 119 68 simple medium complex CI = 0 CI  1.5 CI > 1.5 Lecture 8.3: Complexity

  16. procedural success rate (402 cases, 50% of total activity) P = 0.00787 % Lecture 8.3: Complexity

  17. fluoro time in different diagnostic procedures (844) 6.8±7.1 6.1±4.9 6.1±6.0 minutes 65% 2.6±3.4 2.7±2.3 Lecture 8.3: Complexity

  18. conclusions (I) • In our experience, fluoroscopy time and total DAP were directly related to technical and not to clinical factors • The weight of these factors can be quantified in order to anticipate the radiation dose needed to treat patients undergoing complex procedures Lecture 8.3: Complexity

  19. conclusions (II) • Comparison of different centers and operators for quality control assessment, as well as the definition of appropriate fluoroscopy time and DAP doses, should take into account complexity indexes • Further studies in different institutions are warranted to corroborate this data Lecture 8.3: Complexity

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