title: Reducing radiation exposure during transcatheter aortic valve implantation (TAVI).
abstract: OBJECTIVE
  To establish radiation dose and determine the effect of changes in cine-fluoroscopic image acquisition settings on radiation dose and procedural outcomes in consecutive patients undergoing transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  The radiation dose during TAVI has not been extensively investigated. Methods to keep doses as low as reasonably achievable should be established for the safety of both the patient and the interventional team involved.
  
  
  METHODS
  Data on radiation exposure was collected for 36 consecutive patients undergoing TAVI using standard image acquisition settings (SS) and 36 consecutive patients using modified image acquisition settings (LS). Radiation dose was recorded using an integrated dosimeter as dose area product (DAP). Data on patient characteristics, screening time, procedure time, contrast volume, and procedural outcomes were recorded prospectively. We also collected radiation dose data on 40 consecutive patients undergoing percutaneous coronary intervention in the same catheterisation laboratory.
  
  
  RESULTS
  The median DAP for the LS group was significantly lower at 74.6 Gy*cm(2) compared to a dose of 102.4 Gy*cm(2) for the SS group (P=0.008). There were no significant differences in the screening times, procedure times, and contrast volume used. Overall, there was no difference in procedural outcomes between the two groups. The radiation dose for TAVI procedures (SS group) was comparable to PCI procedures (102.4 Gy*cm(2) vs. 94.6 Gy*cm(2) ) using the same settings in the same catheterisation laboratory.
  
  
  CONCLUSIONS
  This study demonstrates that the radiation exposure to the patient can be significantly and simply reduced using modified dose acquisition settings for TAVI without affecting procedural outcomes.
authors.affiliation: Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom.
authors.forename: Divyesh
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Altnagelvin Hospital, Londonderry, Northern Ireland, United Kingdom.
authors.forename: Adesh
authors.initials: A
authors.lastname: Ramsewak
authors.affiliation: Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom.
authors.forename: Sean
authors.initials: S
authors.lastname: O'Conaire
authors.affiliation: Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Manoharan
authors.affiliation: Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Spence
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D061214:Patient Safety; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: TAVI; aortic stenosis; radiation dose; transcatheter aortic valve implantation; transfemoral