title: Radiation Exposure and Contrast Agent Reduction During Transcatheter Aortic Valve Implantation: An Ongoing Experience.
abstract: OBJECTIVE
  To determine the patient radiation exposure and contrast agent variation during transcatheter aortic valve implantation (TAVI) procedures resulting from technological improvements.
  
  
  METHODS
  TAVI procedures from January 2008 to July 2015 were analyzed in three different time periods: 1st period, when the angiography was equipped with an image intensifier technology; 2nd period, starting with the installation of a new angiography system with flat-panel detector (FPD) technology; and 3rd period, starting with the systematic use of preprocedural multidetector computed tomography (MDCT) to individualize optimal fluoroscopic projections for the aortic prosthesis implantation.
  
  
  RESULTS
  Significant differences were found in contrast volume (198 ± 99 mL vs 139 ± 74 mL; P<.001), kerma area product (211 ± 135 Gy•cm² vs 147 ± 120 Gy•cm²; P<.001) and effective dose (42 ± 27 mSv vs 29 ± 24 mSv; P<.001) between the 1st and 2nd periods, respectively. The reduction continued between the 2nd and 3rd periods for contrast volume (139 ± 74 mL vs 110 ± 61 mL; P<.001), kerma area product (147 ± 120 Gy•cm² vs 111 ± 69 Gy•cm²; P<.001), and effective dose (29 ± 24 mSv vs 22 ± 11 mSv; P<.001), respectively.
  
  
  CONCLUSIONS
  The present study suggests that the appropriate use of FPD technology and preprocedural MDCT to individualize fluoroscopic implant projections for TAVI temporally reduced the amount of radiation and contrast agent administered over time.
authors: San Raffaele Hospital. Via Olgettina 60, 20132 Milan, Italy. maccagni.davide@gmail.com.
authors: Davide
authors: D
authors: Maccagni
authors: Cosmo
authors: C
authors: Godino
authors: Azeem
authors: A
authors: Latib
authors: Morena
authors: M
authors: Mancin
authors: Alaide
authors: A
authors: Chieffo
authors: Alberto
authors: A
authors: Margonato
authors: Antonio
authors: A
authors: Colombo
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007558:Italy; D008297:Male; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D000069079:Radiation Exposure / Q000517:prevention & control*; D011870:Radiologic Health / Q000379:methods / Q000592:standards; D012308:Risk Management / Q000379:methods / Q000458:organization & administration; D013382:Subtraction Technique / Q000009:adverse effects*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods
chemical_list: D003287:Contrast Media