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Sample records for nuclear cardiology procedures

  1. American Society of Nuclear Cardiology

    MedlinePlus

    ... much more! class="box-li"> Journal of Nuclear Cardiology Official publication of the American Society of Nuclear Cardiology Clinical Guidelines Procedures, Appropriate Use Criteria, Information Statements ...

  2. Nuclear cardiology in China: 2017.

    PubMed

    Tang, Gongshun

    2017-07-10

    This paper provides the current state of nuclear cardiology in China and contrasts it with the state of nuclear cardiology in the United States (US). The West China Hospital and New York-Presbyterian Hospital (NYPH) were used as representative hospitals to contrast nuclear cardiology in China and the US, respectively. In 2015, there were 101 medical cyclotrons, 774 SPECT or SPECT/CT, 240 PET/CT, and 6 PET/MR cameras in China. Most (~90%) of the nuclear cardiology studies are gated SPECT myocardial perfusion imaging (MPI), and ~10% are other types of studies including MUGA, PET/CT MPI, and viability studies. There are differences in nuclear cardiology between the West China Hospital and NYPH and these include those in cardiac stress tests, SPECT/CT acquisition protocols, PET/CT blood flow and viability studies, reimbursement, and fellowship training. In this paper, we aim to present status of nuclear cardiology in China and provide potential solutions.

  3. Update in nuclear cardiology.

    PubMed

    Grambow, D W; Schwaiger, M

    1993-11-01

    Imaging techniques for the noninvasive detection and evaluation of coronary artery disease continue to develop. New techniques for the quantification of myocardial blood flow by positron-emission tomography, new approaches to metabolic imaging, and new gamma camera technology have the potential to expand the scope of cardiac nuclear medicine in many facilities. Determination of the best and most cost-effective method of assessing myocardial viability in patients with advanced coronary artery disease remains of key interest with research directed at alternative 201Tl imaging protocols, fatty acid metabolism, and viability assessment with the new 99mTc-based myocardial perfusion radiopharmaceuticals. The assessment of endothelial function and determination of coronary flow reserve with 13N-ammonia positron-emission tomography may aid in the identification of preclinical atherosclerosis, and in monitoring disease progression and response to therapy. New information in radionuclide perfusion imaging in young and elderly patients and in those with interventricular conduction disturbances may allow for more accurate identification of coronary artery disease. The role of radionuclide imaging in patients with dilated cardiomyopathy continues to evolve with the development of radiolabeled chemicals of the adrenergic nervous system and their analogues, which will be helpful in the stratification of disease severity. These new imaging techniques promise to increase the accuracy of nuclear cardiology for detection of disease, assessment of function, and prognosis.

  4. Nuclear Medicine in Pediatric Cardiology.

    PubMed

    Milanesi, Ornella; Stellin, Giovanni; Zucchetta, Pietro

    2017-03-01

    Accurate cardiovascular imaging is essential for the successful management of patients with congenital heart disease (CHD). Echocardiography and angiography have been for long time the most important imaging modalities in pediatric cardiology, but nuclear medicine has contributed in many situations to the comprehension of physiological consequences of CHD, quantifying pulmonary blood flow symmetry or right-to-left shunting. In recent times, remarkable improvements in imaging equipments, particularly in multidetector computed tomography and magnetic resonance imaging, have led to the progressive integration of high resolution modalities in the clinical workup of children affected by CHD, reducing the role of diagnostic angiography. Technology has seen a parallel evolution in the field of nuclear medicine, with the advent of hybrid machines, as SPECT/CT and PET/CT scanners. Improved detectors, hugely increased computing power, and new reconstruction algorithms allow for a significant reduction of the injected dose, with a parallel relevant decrease in radiation exposure. Nuclear medicine retains its distinctive capability of exploring at the tissue level many functional aspects of CHD in a safe and reproducible way. The lack of invasiveness, the limited need for sedation, the low radiation burden, and the insensitivity to body habitus variations make nuclear medicine an ideal complement of echocardiography. This is particularly true during the follow-up of patients with CHD, whose increasing survival represent a great medical success and a challenge for the health system in the next decades. Metabolic imaging using (18)FDG PET/CT has expanded its role in the management of infection and inflammation in adult patients, particularly in cardiology. The same expansion is observed in pediatric cardiology, with an increasing rate of studies on the use of FDG PET for the evaluation of children with vasculitis, suspected valvular infection or infected prosthetic devices. The

  5. Automated Quantitative Nuclear Cardiology Methods

    PubMed Central

    Motwani, Manish; Berman, Daniel S.; Germano, Guido; Slomka, Piotr J.

    2016-01-01

    Quantitative analysis of SPECT and PET has become a major part of nuclear cardiology practice. Current software tools can automatically segment the left ventricle, quantify function, establish myocardial perfusion maps and estimate global and local measures of stress/rest perfusion – all with minimal user input. State-of-the-art automated techniques have been shown to offer high diagnostic accuracy for detecting coronary artery disease, as well as predict prognostic outcomes. This chapter briefly reviews these techniques, highlights several challenges and discusses the latest developments. PMID:26590779

  6. Nuclear cardiology in a managed care environment.

    PubMed

    Thomas, G S; Wolin, D

    1998-01-01

    Health maintenance organizations (HMO) and nuclear cardiology represent mutual threats and mutual opportunities for each other. On the one hand, nuclear cardiology represents a cost center with HMOs exerting tremendous financial pressure on nuclear cardiology programs. On the other hand, nuclear cardiology can act as a sage gatekeeper to the cardiac catheterization laboratory and help HMOs effectively control the health care of an increasing percentage of the population. Through the process of negotiation, of determining each other's needs, an accommodation can take place between the two. The ability to correlate scan results with coronary angiography provides individual nuclear cardiology programs with the opportunity to demonstrate their accuracy. A Nuclear Cardiology Report Card based on these data can be developed for use, with HMOs creating the opportunity to compete not only on price but also on value. Carved out capitation rates for nuclear cardiology can be estimated on the basis of actual experience with an HMO population and by extrapolation from test frequency of the U.S. population. The financial disincentives of capitation and of managed care challenge the physician-patient relationship. Advocacy of the role of nuclear cardiology and an understanding of negotiation strategies can aid nuclear cardiologists in their attempts to provide quality care with commensurate compensation.

  7. [Methods and clinical applications in nuclear cardiology: a position statement].

    PubMed

    Schäfers, M

    2002-02-01

    Nuclear cardiological procedures have paved the way for non-invasive diagnostics of various partial functions of the heart. Many of these functions cannot be visualised for diagnosis by any other method (e.g. innervation). These techniques supplement morphological diagnosis with regard to treatment planning and monitoring. Furthermore, they possess considerable prognostic relevance, an increasingly important issue in clinical medicine today, not least in view of the cost-benefit ratio. Our current understanding shows that effective, targeted nuclear cardiology diagnosis--in particular for high-risk patients--can contribute toward cost savings while improving the quality of diagnostic and therapeutic measures. In the future, nuclear cardiology will have to withstand mounting competition from other imaging techniques (magnetic resonance imaging, electron beam tomography, multislice computed tomography). The continuing development of these methods increasingly enables measurement of functional aspects of the heart. Nuclear radiology methods will probably develop in the direction of molecular imaging.

  8. Recent Trends in Nuclear Cardiology Practice

    PubMed Central

    Song, Bong-Il

    2013-01-01

    Over the past three decades, radionuclide myocardial perfusion scintigraphy (MPS) has become established as the main functional cardiac imaging technique for ischemic heart disease. It is currently appropriate for all aspects of detecting and managing ischemic heart disease, including diagnosis, risk assessment and stratification, assessment of myocardial viability, and evaluation of left ventricular function. The purpose of this article was to review recent trends in nuclear cardiology practice, excluding positron emission tomography. The past few years have brought several rapid developments that have increased photon sensitivity in nuclear cardiology scanner hardware. Additionally, software applying new methods of single photon emission tomography (SPECT) reconstruction on conventional and dedicated systems has preserved or even improved SPECT image quality with lower count statistics. On the other hand, much interest has been shown in lowering the radiation dose by the stakeholders of MPS. PMID:24010067

  9. Advances in imaging instrumentation for nuclear cardiology.

    PubMed

    Lee, Jae Sung; Kovalski, Gil; Sharir, Tali; Lee, Dong Soo

    2017-07-17

    Advances in imaging instrumentation and technology have greatly contributed to nuclear cardiology. Dedicated cardiac SPECT cameras incorporating novel, highly efficient detector, collimator, and system designs have emerged with the expansion of nuclear cardiology. Solid-state radiation detectors incorporating cadmium zinc telluride, which directly convert radiation to electrical signals and yield improved energy resolution and spatial resolution and enhanced count sensitivity geometries, are increasingly gaining favor as the detector of choice for application in dedicated cardiac SPECT systems. Additionally, hybrid imaging systems in which SPECT and PET are combined with X-ray CT are currently widely used, with PET/MRI hybrid systems having also been recently introduced. The improved quantitative SPECT/CT has the potential to measure the absolute quantification of myocardial blood flow and flow reserve. Rapid development of silicon photomultipliers leads to enhancement in PET image quality and count rates. In addition, the reduction of emission-transmission mismatch artifacts via application of accurate time-of-flight information, and cardiac motion de-blurring aided by anatomical images, are emerging techniques for further improvement of cardiac PET. This article reviews recent advances such as these in nuclear cardiology imaging instrumentation and technology, and the corresponding diagnostic benefits.

  10. Nuclear Cardiology: 2014 Innovations and Developments

    PubMed Central

    Mahmarian, John J.; Chang, SuMin; Nabi, Faisal

    2014-01-01

    Nuclear cardiac imaging is acknowledged as a robust technique for clinically assessing patients with a wide spectrum of cardiac illnesses. Recent technical, radiotracer, and stressor advancements continue to expand the role of nuclear cardiology for the accurate diagnosis and prognostication of patients with known or suspected coronary artery disease. The introduction of I-123 MIBG represents another advance for assessing risk in patients with congestive heart failure and depressed left ventricular (LV) function. Software and hardware innovations and recent shifts in acquisition protocols have greatly improved image quality, reduced cost and radiation exposure, and continue to promote patient and physician satisfaction. The following article will highlight recent achievements in the field that continue to foster a patient-centered imaging approach. PMID:25574344

  11. A survey of nuclear cardiological practice in Great Britain. The British Nuclear Cardiology Group.

    PubMed

    Underwood, R; Gibson, C; Tweddel, A; Flint, J

    1992-03-01

    There is little information on the practice of nuclear cardiology in Great Britain. On behalf of the British Nuclear Cardiology Group in October 1988 we sent a postal questionnaire to 143 hospitals with nuclear medicine facilities (at least 70% of such hospitals). Sixty nine replies were received (48%), of which 23 (33%) were from teaching hospitals and 46 (39%) non-teaching. In these hospitals 147,904 isotope investigations were performed annually (mean 2311 per centre) of which 17,298 (12%) (mean 254 per centre) were cardiac studies. Of these, 59% were equilibrium radionuclide ventriculograms, 14% first pass ventriculograms, and 27% thallium-201 scans. Rest studies were performed more commonly by radiographers or technicians (63%) than by doctors (20%), but doctors were more commonly involved in stress studies (48%). Radiologists reported the studies more often (28%) than they performed them (6%). Methods of acquisition and analysis were varied and, for instance, the lower limit of normal left ventricular ejection fraction ranged from 35% to 75% (mean 49%). For thallium imaging 42% of centres used dipyridamole in some patients and 24% used tomography. These data show that nuclear cardiology techniques are used much less frequently in Great Britain than in countries such as the United States and Germany, that the ratio of blood pool to myocardial perfusion imaging is much higher than elsewhere, and that methods are poorly standardised. They may provide the impetus to improve the service and serve as a baseline for future surveys.

  12. Occupational eye dose in interventional cardiology procedures.

    PubMed

    Haga, Yoshihiro; Chida, Koichi; Kaga, Yuji; Sota, Masahiro; Meguro, Taiichiro; Zuguchi, Masayuki

    2017-04-03

    It is important to measure the radiation dose [3-mm dose equivalent, Hp(3)] in the eye. This study was to determine the current occupational radiation eye dose of staff conducting interventional cardiology procedures, using a novel direct eye dosimeter. We measured the occupational eye dose [Hp(3)] in physicians and nurses in a catheterization laboratory for 6-months. The eye doses [Hp(3)] of 12 physicians (9 with Pb glasses, 3 without), and 11 nurses were recorded using a novel direct eye dosimeter, the DOSIRIS(TM). We placed dosimeters above and under the glasses. We also estimated the eye dose [0.07-mm dose equivalent] using a neck personal dosimeter. The eye doses among interventional staff ranked in the following order: physicians without Pb glasses > physicians with Pb glasses > nurses. The shielding effect of the glasses (0.07-mm Pb) in a clinical setting was approximately 60%. In physicians who do not wear Pb glasses, the eye dose may exceed the new regulatory limit for IR staff. We found good correlations between the neck dosimeter dose and eye dosimeter dose (inside or outside glasses, R(2) = 0.93 and R(2) = 0.86, respectively) in physicians. We recommend that interventional physicians use an eye dosimeter for correct evaluation of the lens dose.

  13. Assessing the need for nuclear cardiology and other advanced cardiac imaging modalities in the developing world.

    PubMed

    Vitola, João V; Shaw, Leslee J; Allam, Adel H; Orellana, Pilar; Peix, Amalia; Ellmann, Annare; Allman, Kevin C; Lee, B N; Siritara, Chanika; Keng, Felix Y J; Sambuceti, Gianmario; Kiess, Marla C; Giubbini, Raffaele; Bouyoucef, Salaheddine E; He, Zuo-Xiang; Thomas, Gregory S; Mut, Fernando; Dondi, Maurizio

    2009-01-01

    In 2005, 80% of cardiovascular disease (CVD) deaths occurred in low- to middle-income countries (i.e., developing nations). Cardiovascular imaging, such as myocardial perfusion SPECT, is one method that may be applied to detect and foster improved detection of at-risk patients. This document will review the availability and utilization for nuclear cardiology procedures worldwide and propose strategies to devise regional centers of excellence to achieve quality imaging around the world. As a means to establish the current state of nuclear cardiology, International Atomic Energy Agency member and non-member states were queried as to annual utilization of nuclear cardiology procedures. Other sources for imaging statistics included data from medical societies (American Society of Nuclear Cardiology, European Society of Cardiology, and the European Association of Nuclear Medicine) and nuclear cardiology working groups within several nations. Utilization was calculated by dividing annual procedural volume by 2007 population statistics (/100,000) and categorized as high (>1,000/100,000), moderate-high (250-999/100,000), moderate (100-249/100,000), low-moderate (50-99/100,000) and low (<50/100,000). High nuclear cardiology utilization was reported in the United States, Canada, and Israel. Most Western European countries, Australia, and Japan reported moderate-high utilization. With the exception of Argentina, Brazil, Colombia and Uruguay, South America had low usage. This was also noted across Eastern Europe, Russia, and Asia. Utilization patterns generally mirrored each country's gross domestic product. However, nuclear cardiology utilization was higher for developing countries neighboring moderate-high "user" countries (e.g., Algeria and Egypt); perhaps the result of accessible high-quality training programs. Worldwide utilization patterns for nuclear cardiology vary substantially and may be influenced by physician access to training and education programs. Development

  14. Clinical and economic outcomes assessment in nuclear cardiology.

    PubMed

    Shaw, L J; Miller, D D; Berman, D S; Hachamovitch, R

    2000-06-01

    The future of nuclear medicine procedures, as understood within our current economic climate, depends upon its ability to provide relevant clinical information at similar or lower comparative costs. With an ever-increasing emphasis on cost containment, outcome assessment forms the basis of preserving the quality of patient care. Today, outcomes assessment encompasses a wide array of subjects including clinical, economic, and humanistic (i.e., quality of life) outcomes. For nuclear cardiology, evidence-based medicine would require a threshold level of evidence in order to justify the added cost of any test in a patient's work-up. This evidence would include large multicenter, observational series as well as randomized trial data in sufficiently large and diverse patient populations. The new movement in evidence-based medicine is also being applied to the introduction of new technologies, in particular when comparative modalities exist. In the past 5 years, we have seen a dramatic shift in the quality of outcomes data published in nuclear cardiology. This includes the use of statistically rigorous risk-adjusted techniques as well as large populations (i.e., > 500 patients) representing multiple diverse medical care settings. This has been the direct result of the development of multiple outcomes databases that have now amassed thousands of patients worth of data. One of the benefits of examining outcomes in large patient datasets is the ability to assess individual endpoints (e.g., cardiac death) as compared with smaller datasets that often assess combined endpoints (e.g., death, myocardial infarction, or unstable angina). New technologies for the diagnosis of coronary artery disease have contributed to the rising costs of care. In the United States and in Europe, costs of care have risen dramatically, consuming an ever-increasing amount of available resources. The overuse of diagnostic angiography often leads to unnecessary revascularization that does not lead to

  15. A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology.

    PubMed

    2017-10-01

    This joint position paper illustrates the role and the correct use of echocardiography, radionuclide imaging with 18F-fluorodeoxyglucose positron emission tomography, radionuclide myocardial perfusion imaging and cardiovascular magnetic resonance imaging for the evaluation and management of patients with known or suspected cardiac sarcoidosis. This position paper will aid in standardizing imaging for cardiac sarcoidosis and may facilitate clinical trials and pooling of multi-centre data on cardiac sarcoidosis. Proposed flow charts for the work up and management of cardiac sarcoidosis are included. Copyright © 2017 European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology.

  16. Cost efficiency of nuclear cardiology services in the modern health care environment.

    PubMed

    Miller, D Douglas

    2004-01-01

    More than a decade of dramatic changes in US and global health care has affected the practice of and payment for nuclear cardiology services. The clear diagnostic and prognostic power of nuclear cardiology procedures to detect coronary artery disease and predict patient outcomes has resulted in the rapid growth of these procedures in clinical practice. This has focused the attention of public and private payers on the high use of medical resources required to carry out nuclear cardiology testing. Two recent, major multicenter trials, one in the United States and another in Europe, have demonstrated the cost effectiveness of stress myocardial perfusion imaging strategies compared with coronary angiography in patients with known or suspected coronary artery disease, across the spectrum of pretest risks and both sexes. These studies, and more extensive data from more than 10 years of decision analysis, have reinforced the value of nuclear cardiology in modern cardiovascular health care. Future challenges will include assurance of provider and laboratory quality in the burgeoning outpatient imaging centers across the country, and wider acceptance by payers and expert panels of the evidence supporting the cost effectiveness of nuclear cardiology in most clinical settings.

  17. Gender Differences in Radiation Dose from Nuclear Cardiology Studies Across the World: Findings from the International Atomic Energy Agency Nuclear Cardiology Protocols Study (INCAPS) Registry

    PubMed Central

    Shi, Lynn; Dorbala, Sharmila; Paez, Diana; Shaw, Leslee J.; Zukotynski, Katherine A.; Pascual, Thomas N. B.; Karthikeyan, Ganesan; Vitola, João V.; Better, Nathan; Bokhari, Nadia; Rehani, Madan M.; Kashyap, Ravi; Dondi, Maurizio; Mercuri, Mathew; Einstein, Andrew J.

    2016-01-01

    OBJECTIVES The aim of this study was to investigate gender-based differences in nuclear cardiology practice, globally, with particular focus on laboratory volume, radiation dose, protocols, and best practices. BACKGROUND It is unclear if gender-based differences exist in radiation exposure for nuclear cardiology procedures. METHODS In a large multicenter observational cross-sectional study encompassing 7911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was utilized to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. We also included the United Nations’ gender inequality and human development indices as covariates in multivariable models. RESULTS The proportion of MPI studies performed in women varied between countries, however there was no significant correlation with gender inequality index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6±4.5 mSv) than in men (10.3±4.5 mSv men, p<0.001), with a difference of only 0.3 mSv in a multivariable model adjusting for patient age and weight. Stress-only imaging was performed more frequently in women (12.5% vs. 8.4%, p<0.001), however camera-based dose-reduction strategies were used less frequently in women (58.6% vs. 65.5%, p<0.001). CONCLUSIONS Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in MPI use and radiation dose offer potential opportunities to address gender-related differences in delivery of nuclear

  18. Molecular imaging. A new approach to nuclear cardiology.

    PubMed

    Dobrucki, L W; Sinusas, A J

    2005-03-01

    Nuclear cardiology has historically played an important role in detection of cardiovascular disease as well as risk stratification. With the growth of molecular biology have come new therapeutic interventions and the requirement for new diagnostic imaging approaches. Noninvasive targeted radiotracer based as well as transporter gene imaging strategies are evolving to meet these new needs, but require the development of an interdisciplinary approach which focuses on molecular processes, as well as the pathogenesis and progression of disease. This progress has been made possible with the availability of transgenic animal models along with many technological advances. Future adaptations of the developing experimental procedures and instrumentation will allow for the smooth translation and application to clinical practice. This review is intended as a brief overview on the subject molecular imaging. Basic concepts and historical perspective of molecular imaging will be reviewed first, followed by description of current technology, and concluding with current applications in cardiology. The emphasis will be on the use of both single photon emission computed tomography (SPECT) and positron emission tomography (PET) radiotracers, although other imaging modalities will be also briefly discussed. The specific approaches presented here will include receptor-based and reporter gene imaging of natural and therapeutic angiogenesis.

  19. [Nuclear cardiology: the present functions and future perspectives].

    PubMed

    Mei, Xiaoli; Fan, Chengzhong

    2013-02-01

    For the past decade, the diagnosis and treatment of coronary artery disease (CAD) has shifted from the traditional model by evaluating coronary artery stenosis with morphological imaging methods to a novel model by focusing on the detection of ischemia for risk stratification. The myocardial perfusion imaging (MPI) using stress single photon emission computed tomography (SPECT) has become the most commonly used stress imaging technique for the diagnosis and treatment of patients with suspected or known CAD. It has got strong supports, including those of the American College of Cardiology, American Heart Association, American Society of Nuclear Cardiology (ACC/AHA/ASNC) and other numerous clinical guidelines. They all stressed that the SPECT MPI is recommended to be used as the "gate keeper" to coronary angiography in order to prevent unnecessary intervention test and save the cost. However, in China the introduction and application of nuclear cardiology was late and highly unbalanced. This leads to the lack of understanding of nuclear cardiology in some clinicians, and there often is misunderstanding on correct selection of coronary angiography, cardiac CT, CT coronary angiography and others for diagnosis and treatment of CAD which results in a trend of over-application of these traditional techniques. In this article, we will focus on the status of nuclear cardiology, including SPECT, positron emission tomography (PET) MPI in the patients with CAD for the diagnosis of ischemia, risk stratification and management decision-making, and also compare it with the traditional morphological imaging techniques. In addition, we will briefly introduce the recent advances in cardiac hybrid imaging and molecular imaging. The aim of this paper is to popularize the knowledge of nuclear cardiology, and promote the rational application of nuclear cardiology in China.

  20. Current status of nuclear cardiology: a limited review

    SciTech Connect

    Botvinick, E.H.; Dae, M.; Hattner, R.S.

    1985-11-01

    To summarize the current status of nuclear cardiology, the authors will focus on areas that the emphasize the specific advantages of nuclear cardiology methods: (a) their benign, noninvasive nature, (b) their pathophysiologic nature, and (c) the ease of their computer manipulation and analysis, permitting quantitative evaluation. The areas covered include: (a) blood pool scintigraphy and parametric imaging, (b) pharmacologic intervention for the diagnosis of ischemic heart disease, (c) scintigraphic studies for the diagnosis and prognosis of coronary artery disease, and (d) considerations of cost effectiveness.

  1. Nuclear cardiology core syllabus of the European Association of Cardiovascular Imaging (EACVI).

    PubMed

    Gimelli, Alessia; Neglia, Danilo; Schindler, Thomas H; Cosyns, Bernard; Lancellotti, Patrizio; Kitsiou, Anastasia

    2015-04-01

    The European Association of Cardiovascular Imaging (EACVI) Core Syllabus for Nuclear Cardiology is now available online. The syllabus lists key elements of knowledge in nuclear cardiology. It represents a framework for the development of training curricula and provides expected knowledge-based learning outcomes to the nuclear cardiology trainees.

  2. Radiation doses in paediatric interventional cardiology procedures.

    PubMed

    Tsapaki, Virginia; Kottou, Sofia; Korniotis, Sarantis; Nikolaki, Niki; Rammos, Spyridon; Apostolopoulou, Sotiria C

    2008-01-01

    The objective was to investigate paediatric doses in coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) in the largest cardiac hospital in Greece. Forty procedures were carried out by two board-certified senior interventional cardiologists. Data collected were: patient weight, height, age, fluoroscopy time (FT), total number of images (N) and kerma-area product (KAP). Median (range) age was 7.5 y (17 d to 17 y). Median FT, N and KAP were 4 min, 655, 2.1 Gy cm2 for CA and 12.1 min, 1296, 14.7 Gy cm2 for PTCA (corresponding adult diagnostic reference levels (DRLs) are: 6.5 min, 700, 45 Gy cm2 for CA and 15.5 min, 1000 and 85 Gy cm2 for PTCA). The highest percentage of cine dose was in newborns (0-1 y) (CA: 92% and PTCA: 100%). As age increased, cine dose percentage decreased, whereas total radiation dose increased. Median paediatric FT and N recorded reached or even exceeded adult DRL and should be optimised. Paediatric DRL should be set.

  3. COMPARING MEASURED AND CALCULATED DOSES IN INTERVENTIONAL CARDIOLOGY PROCEDURES.

    PubMed

    Oliveira da Silva, M W; Canevaro, L V; Hunt, J; Rodrigues, B B D

    2017-03-16

    Interventional cardiology requires complex procedures and can result in high doses and dose rates to the patient and medical staff. The many variables that influence the dose to the patient and staff include the beam position and angle, beam size, kVp, filtration, kerma-area product and focus-skin distance. A number of studies using the Monte Carlo method have been undertaken to obtain prospective dose assessments. In this paper, detailed irradiation scenarios were simulated mathematically and the resulting dose estimates were compared with real measurements made previously under very similar irradiation conditions and geometries. The real measurements and the calculated doses were carried out using or simulating an interventional cardiology system with a flat monoplane detector installed in a dedicated room with an Alderson phantom placed on the procedure table. The X-ray spectra, beam angles, focus-skin distance, measured kerma-area product and filtration were simulated, and the real dose measurements and calculated doses were compared. It was shown that the Monte Carlo method was capable of reproducing the real dose measurements within acceptable levels of uncertainty.

  4. Emerging role of nuclear cardiology in heart failure.

    PubMed

    Flotats, A; Carrió, I

    2010-04-01

    The management of patients with heart failure requires the integration of clinical skills and accurate complementary tests for the correct diagnosis, treatment and estimation of individual prognosis. Identification of those patients most at risk of death, and those most likely to benefit from currently available treatment technologies, remains a challenge. Although the basic characterization of patients with heart failure is supported primarily by the assessment of the left ventricular function, there are several nuclear cardiology techniques and tracers, either available or under development, which can provide important noninvasive imaging insights into the pathophysiology, prognosis and management of patients with heart failure. Nuclear techniques for molecular imaging of the myocardium such as those involved in the processes of myocardial perfusion, metabolism and viability, cellular injury, dyssynchrony, intersticial dysregulation and neurohormonal receptor function may facilitate better clinical outcomes for patients with heart failure. This review mainly focuses on cardiac sympathetic imaging, as other modalities of nuclear cardiology in the assessment of patients with HF are reviewed more extensively in other sections of this issue.

  5. Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries.

    PubMed

    Lindner, Oliver; Pascual, Thomas N B; Mercuri, Mathew; Acampa, Wanda; Burchert, Wolfgang; Flotats, Albert; Kaufmann, Philipp A; Kitsiou, Anastasia; Knuuti, Juhani; Underwood, S Richard; Vitola, João V; Mahmarian, John J; Karthikeyan, Ganesan; Better, Nathan; Rehani, Madan M; Kashyap, Ravi; Dondi, Maurizio; Paez, Diana; Einstein, Andrew J

    2016-04-01

    Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 - 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the

  6. Sample size considerations for clinical research studies in nuclear cardiology.

    PubMed

    Chiuzan, Cody; West, Erin A; Duong, Jimmy; Cheung, Ken Y K; Einstein, Andrew J

    2015-12-01

    Sample size calculation is an important element of research design that investigators need to consider in the planning stage of the study. Funding agencies and research review panels request a power analysis, for example, to determine the minimum number of subjects needed for an experiment to be informative. Calculating the right sample size is crucial to gaining accurate information and ensures that research resources are used efficiently and ethically. The simple question "How many subjects do I need?" does not always have a simple answer. Before calculating the sample size requirements, a researcher must address several aspects, such as purpose of the research (descriptive or comparative), type of samples (one or more groups), and data being collected (continuous or categorical). In this article, we describe some of the most frequent methods for calculating the sample size with examples from nuclear cardiology research, including for t tests, analysis of variance (ANOVA), non-parametric tests, correlation, Chi-squared tests, and survival analysis. For the ease of implementation, several examples are also illustrated via user-friendly free statistical software.

  7. Nuclear Cardiology Practices and Radiation Exposure in the Oceania Region: Results From the IAEA Nuclear Cardiology Protocols Study (INCAPS).

    PubMed

    Biswas, Sinjini; Better, Nathan; Pascual, Thomas N B; Mercuri, Mathew; Vitola, João V; Karthikeyan, Ganesan; Westcott, James; Alexánderson, Erick; Allam, Adel H; Al-Mallah, Mouaz H; Bom, Henry Hee-Seung; Bouyoucef, Salah E; Flotats, Albert; Jerome, Scott; Kaufman, Philip A; Lele, Vikram; Luxenburg, Osnat; Mahmarian, John J; Shaw, Leslee J; Underwood, S Richard; Rehani, Madan; Kashyap, Ravi; Dondi, Maurizio; Paez, Diana; Einstein, Andrew J

    2017-01-01

    There is concern about radiation exposure with radionuclide myocardial perfusion imaging (MPI). This sub-study of the International Atomic Energy Agency (IAEA) Nuclear Cardiology Protocols Study reports radiation doses from MPI, and use of dose-optimisation protocols in Australia and New Zealand (ANZ), and compares them with data from the rest of the world. Data were collected from 7911 MPI studies performed in 308 laboratories worldwide in one week in 2013, including 439 MPI studies from 34 ANZ laboratories. For each laboratory, effective radiation dose (ED) and a quality index (QI) score (out of 8) based on pre-specified "best practices" was determined. In ANZ patients, ED ranged from 0.9-17.9 milliSievert (mSv). Median ED was similar in ANZ compared with the rest of the world (10.0 (IQR: 6.5-11.7) vs. 10.0 (IQR 6.4-12.6, P=0.15), as were mean QI scores (5.5±0.7 vs. 5.4±1.3, P=0.84). Use of stress-only imaging (17.6% vs. 31.8% of labs, P=0.09) and weight-based dosing of technetium-99m (14.7% vs. 30.3%, P=0.07) was lower in ANZ compared with the rest of the world but this difference was not statistically significant. Median ED was significantly lower in metropolitan versus non-metropolitan laboratories (10.1 mSv vs. 11.6 mSv, P<0.01), although mean QI scores were similar (5.4±0.8 vs. 5.5±0.7, P=0.75). Across ANZ, there is variability in ED from MPI, and use of radiation safety practices, particularly between metropolitan and non-metropolitan laboratories. Overall, ANZ laboratories have a similar median ED to laboratories in the rest of the world. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  8. Radiation-Induced Noncancer Risks in Interventional Cardiology: Optimisation of Procedures and Staff and Patient Dose Reduction

    PubMed Central

    Khairuddin Md Yusof, Ahmad

    2013-01-01

    Concerns about ionizing radiation during interventional cardiology have been increased in recent years as a result of rapid growth in interventional procedure volumes and the high radiation doses associated with some procedures. Noncancer radiation risks to cardiologists and medical staff in terms of radiation-induced cataracts and skin injuries for patients appear clear potential consequences of interventional cardiology procedures, while radiation-induced potential risk of developing cardiovascular effects remains less clear. This paper provides an overview of the evidence-based reviews of concerns about noncancer risks of radiation exposure in interventional cardiology. Strategies commonly undertaken to reduce radiation doses to both medical staff and patients during interventional cardiology procedures are discussed; optimisation of interventional cardiology procedures is highlighted. PMID:24027768

  9. Highlights of the 12th International Conference on Nuclear Cardiology and Cardiac CT.

    PubMed

    Kitsiou, Anastasia; Dorbala, Sharmila; Scholte, Arthur J H A

    2015-09-01

    The 12th International Conference on Nuclear Cardiology and Cardiac CT was held from 3 to 5 May 2015 in Madrid, Spain. In this article, the three Congress Program Committee Chairs summarize selected highlights of the presented abstracts. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com. This article is being published concurrently in the Journal of Nuclear Cardiology (10.1007/s12350-015-0260-y) and European Heart Journal – Cardiovascular Imaging (10.1093/ehjci/jev179). The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article.

  10. Advances in image reconstruction software in nuclear cardiology: Is all that glitters gold?

    PubMed

    Marcassa, Claudio; Zoccarato, Orazio

    2017-02-01

    The cornerstone results of nuclear cardiology in the last 25 years were obtained with the Filtered Back Projection as the preferred reconstruction method for tomographic studies. Recently, evolution of the OSEM iterative reconstruction algorithms was implemented by different vendors. The value and limitations of the new methods are briefly addressed.

  11. Reporting nuclear cardiology: a joint position paper by the European Association of Nuclear Medicine (EANM) and the European Association of Cardiovascular Imaging (EACVI).

    PubMed

    Trägårdh, Elin; Hesse, Birger; Knuuti, Juhani; Flotats, Albert; Kaufmann, Philipp A; Kitsiou, Anastasia; Hacker, Marcus; Verberne, Hein J; Edenbrandt, Lars; Delgado, Victoria; Donal, Erwan; Edvardsen, Thor; Galderisi, Maurizio; Habib, Gilbert; Lancellotti, Patrizio; Nieman, Koen; Rosenhek, Raphael; Agostini, Denis; Gimelli, Alessia; Lindner, Oliver; Slart, Riemert; Ubleis, Christopher

    2015-03-01

    The report of an imaging procedure is a critical component of an examination, being the final and often the only communication from the interpreting physician to the referring or treating physician. Very limited evidence and few recommendations or guidelines on reporting imaging studies are available; therefore, an European position statement on how to report nuclear cardiology might be useful. The current paper combines the limited existing evidence with expert consensus, previously published recommendations as well as current clinical practices. For all the applications discussed in this paper (myocardial perfusion, viability, innervation, and function as acquired by single photon emission computed tomography and positron emission tomography or hybrid imaging), headings cover laboratory and patient demographics, clinical indication, tracer administration and image acquisition, findings, and conclusion of the report. The statement also discusses recommended terminology in nuclear cardiology, image display, and preliminary reports. It is hoped that this statement may lead to more attention to create well-written and standardized nuclear cardiology reports and eventually lead to improved clinical outcome.

  12. Subacute radiation dermatitis following an interventional cardiology procedure.

    PubMed

    Cunha, Nélia; Cardoso, Pedro; Cabete, Joana

    2016-11-23

    Although radiation dermatitis is a widely known complication of radiotherapy, its association with fluoroscopy-guided interventional procedures is yet under recognized. We present a case of a 66-year-old man with a left scapular cutaneous lesion, initially diagnosed as a fixed drug eruption. The subsequent knowledge of a previous percutaneous aortic paravalvular leak closure procedure allowed a correct clinicopathological correlation and the final diagnosis of subacute radiodermatitis associated with fluoroscopy. Many of the patients with skin injury associated with fluoroscopic procedures do not associate both and seek physicians other than the one who performed the procedure. Besides interventional physicians, dermatologists and other physicians should be aware of this form of radiation injury and its manifestations. Suspicion and active search for a history of previous fluoroscopic procedures in patients with figurate cutaneous lesions in allusive locations may allow the diagnosis of this potentially serious complication that should have long follow-up due to the possibility of long-term side effects.

  13. Opportunities for improvement on current nuclear cardiology practices and radiation exposure in Latin America: Findings from the 65-country IAEA Nuclear Cardiology Protocols cross-sectional Study (INCAPS).

    PubMed

    Vitola, João V; Mut, Fernando; Alexánderson, Erick; Pascual, Thomas N B; Mercuri, Mathew; Karthikeyan, Ganesan; Better, Nathan; Rehani, Madan M; Kashyap, Ravi; Dondi, Maurizio; Paez, Diana; Einstein, Andrew J

    2017-06-01

    Comparison of Latin American (LA) nuclear cardiology (NC) practice with that in the rest of the world (RoW) will identify areas for improvement and lead to educational activities to reduce radiation exposure from NC. INCAPS collected data on all SPECT and PET procedures performed during a single week in March-April 2013 in 36 laboratories in 10 LA countries (n = 1139), and 272 laboratories in 55 countries in RoW (n = 6772). Eight "best practices" were identified a priori and a radiation-related Quality Index (QI) was devised indicating the number used. Mean radiation effective dose (ED) in LA was higher than in RoW (11.8 vs 9.1 mSv, p < 0.001). Within a populous country like Brazil, a wide variation in laboratory mean ED was found, ranging from 8.4 to 17.8 mSv. Only 11% of LA laboratories achieved median ED <9 mSv, compared to 32% in RoW (p < 0.001). QIs ranged from 2 in a laboratory in Mexico to 7 in a laboratory in Cuba. Three major opportunities to reduce ED for LA patients were identified: (1) more laboratories could implement stress-only imaging, (2) camera-based methods of ED reduction, including prone imaging, could be more frequently used, and (3) injected activity of (99m)Tc could be adjusted reflecting patient weight/habitus. On average, radiation dose from NC is higher in LA compared to RoW, with median laboratory ED <9 mSv achieved only one third as frequently as in RoW. Opportunities to reduce radiation exposure in LA have been identified and guideline-based recommendations made to optimize protocols and adhere to the "as low as reasonably achievable" (ALARA) principle.

  14. [Costing nuclear medicine diagnostic procedures].

    PubMed

    Markou, Pavlos

    2005-01-01

    To the Editor: Referring to a recent special report about the cost analysis of twenty-nine nuclear medicine procedures, I would like to clarify some basic aspects for determining costs of nuclear medicine procedure with various costing methodologies. Activity Based Costing (ABC) method, is a new approach in imaging services costing that can provide the most accurate cost data, but is difficult to perform in nuclear medicine diagnostic procedures. That is because ABC requires determining and analyzing all direct and indirect costs of each procedure, according all its activities. Traditional costing methods, like those for estimating incomes and expenses per procedure or fixed and variable costs per procedure, which are widely used in break-even point analysis and the method of ratio-of-costs-to-charges per procedure may be easily performed in nuclear medicine departments, to evaluate the variability and differences between costs and reimbursement - charges.

  15. Robotic surgery in Cardiology: a safe and effective procedure

    PubMed Central

    Poffo, Robinson; Toschi, Alisson Parrilha; Pope, Renato Bastos; Celullare, Alex Luiz; Benício, Anderson; Fischer, Claudio Henrique; Vieira, Marcelo Luiz Campos; Teruya, Alexandre; Hatanaka, Dina Mie; Rusca, Gabriel Franzin; Makdisse, Marcia

    2013-01-01

    ABSTRACT Objective: To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery. Methods: From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy. Results: The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days. Conclusion: Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies. PMID:24136755

  16. Current status of nuclear cardiology in Japan: Ongoing efforts to improve clinical standards and to establish evidence.

    PubMed

    Yoshinaga, Keiichiro; Tamaki, Nagara

    2015-08-01

    Nuclear cardiology imaging tests are widely performed in Japan as clinical practice. The Japanese nuclear cardiology community has developed new diagnostic imaging tests using (123)I-beta-methyl-p-iodophenyl-pentadecanoic acid, (123)I-metaiodobenzylguanidine, and (18)F-fluorodeoxyglucose PET for detecting cardiac involvement in sarcoidosis. These tests have become popular worldwide. The Japanese Circulation Society and the Japanese Society of Nuclear Cardiology have published clinical imaging guidelines showing indications and standards for the new imaging tests. JSNC is currently striving to improve the standard of clinical practice and is promoting research activities.

  17. Occupational dose constraints in interventional cardiology procedures: the DIMOND approach

    NASA Astrophysics Data System (ADS)

    Tsapaki, Virginia; Kottou, Sophia; Vano, Eliseo; Komppa, Tuomo; Padovani, Renato; Dowling, Annita; Molfetas, Michael; Neofotistou, Vassiliki

    2004-03-01

    Radiation fields involved in angiographic suites are most uneven with intensity and gradient varying widely with projection geometry. The European Commission DIMOND III project addressed among others, the issues regarding optimization of staff doses with an attempt to propose preliminary occupational dose constraints. Two thermoluminescent dosemeters (TLD) were used to assess operators' extremity doses (left shoulder and left foot) during 20 coronary angiographies (CAs) and 20 percutaneous transluminal coronary angioplasties (PTCAs) in five European centres. X-ray equipment, radiation protection measures used and the dose delivered to the patient in terms of dose-area product (DAP) were recorded so as to subsequently associate them with operator's dose. The range of staff doses noted for the same TLD position, centre and procedure type emphasizes the importance of protective measures and technical characteristics of x-ray equipment. Correlation of patient's DAP with staff shoulder dose is moderate whereas correlation of patient's DAP with staff foot dose is poor in both CA and PTCA. Therefore, it is difficult to predict operator's dose from patient's DAP mainly due to the different use of protective measures. A preliminary occupational dose constraint value was defined by calculating cardiologists' annual effective dose and found to be 0.6 mSv.

  18. Improved compliance with reporting standards: A retrospective analysis of Intersocietal Accreditation Commission Nuclear Cardiology Laboratories.

    PubMed

    Maddux, P Tim; Farrell, Mary Beth; Ewing, Joseph A; Tilkemeier, Peter L

    2016-11-09

    In 2011, Tilkemeier et al reported significant nuclear cardiology laboratory noncompliance with reporting standards. The aim of this study was to identify and examine noncompliant reporting elements with the Intersocietal Accreditation Commission Nuclear/PET (IAC) Reporting Standards and to compare compliance between 2008 and 2014. This was a retrospective study of compliance with 18 reporting elements utilizing accreditation findings from all laboratories applying for accreditation in 2008 and 2014. 1816 labs applying for initial or subsequent accreditation were analyzed for compliance. The mean reporting noncompliance per lab decreased from 2008 to 2014 (2.48 ± 2.67 to 1.24 ± 1.79, P < .001). Noncompliance decreased across lab types, labs with Certification Board of Nuclear Cardiology physicians on staff, and by geographic region (P < .001). Overall severity of reporting issues decreased. Facilities with compliant reports increased from 35.0% in 2008 to 57.1% in 2014 (P < .001). Continuing medical education, accreditation, and other instructional activities aimed at improving nuclear cardiology reporting appear to have made a positive impact over time with the number and severity of noncompliance decreased. More labs are now compliant with the IAC Standards and, thus, reporting guidelines. However, the need for continued educational efforts remains.

  19. Skin dosimetry of patients during interventional cardiology procedures in the Czech Republic

    NASA Astrophysics Data System (ADS)

    Sukupova, Lucie; Novak, Leos

    2008-01-01

    The aim of the study is to determine distribution of air kerma-area product, fluoro time and number of frames values for the two most frequent procedures in the interventional cardiology, to reconstruct skin dose distributions for some patients undergoing coronarography and percutaneous transluminal coronary angioplasty procedures. Patient dose data were obtained from X-ray unit dose monitoring software report from one hospital and the reconstructions were performed in MATLAB. Dependence of maximum skin dose on air kerma-area product, fluoro time and number of frames was determined to assess trigger levels of these quantities, which can indicate possible exceeding of the 2 Gy skin dose threshold.

  20. Recent developments of cyclotron produced radionuclides for nuclear cardiology

    NASA Astrophysics Data System (ADS)

    Kulkarni, P. V.; Jansen, D. E.; Corbett, J. R.

    1987-04-01

    For over a decade myocardial perfusion imaging with thallium-201, a cyclotron product, has been routinely used in clinical medicine. Recent advances have allowed the efficient production of very high purity (> 99.8%) iodine-123. New metabolically active 123I labeled radiopharmaceuticals, including alkyl and phenyl fatty acids, and norepinephrine analogs, have been developed and are undergoing clinical trials. Fab' fragments of monoclonal antibodies to cardiac myosin have been labeled with indium-111 ( 111In) and are undergoing clinical evaluation for imaging myocardial infarcts. Monoclonal antibodies to platelets, fibrin, and the thrombolytic agent, tissue plasminogen activator (TPA), have recently been labeled with 111In. Together these developments in radiotracers and instrumentation should have a significant impact on the future of cardiovascular nuclear medicine. This manuscript will discuss developments in single photon emitting radiotracers for myocardial imaging.

  1. Status of radiation protection in various interventional cardiology procedures in the Asia Pacific region

    PubMed Central

    Tsapaki, Virginia; Faruque Ghulam, Mohammed; Lim, Soo Teik; Ngo Minh, Hung; Nwe, Nwe; Sharma, Anil; Sim, Kui-Hian; Srimahachota, Suphot; Rehani, Madan Mohan

    2011-01-01

    Objective Increasing use of interventional procedures in cardiology with unknown levels of radiation protection in many countries of Asia-Pacific region necessitates the need for status assessment. The study was part of an International Atomic Energy Agency (IAEA) project for achieving improved radiation protection in interventional cardiology (IC) in developing countries. Design The survey covers 18 cardiac catheterisation laboratories in seven countries (Bangladesh, India, Malaysia, Myanmar, Singapore, Thailand and Vietnam). An important step was the creation of the ‘Asian network of Cardiologists in Radiation Protection’ and a newsletter. Data were collected on: radiation protection tools, number of IC laboratories, and annual number of various IC paediatric and adult procedures in the hospital and in the country. Patient radiation dose data were collected in terms of Kerma Area Product (KAP) and cumulative dose (CD). Results It is encouraging that protection devices for staff are largely used in the routine practice. Only 39% of the angiographic machines were equipped with a KAP meter. Operators' initial lack of awareness on radiation-protection optimisation improved significantly after participation in IAEA radiation-protection training. Only two out of five countries reporting patient percutaneous coronary intervention radiation-dose data were fully within the international guidance levels. Data from 51 patients who underwent multiple therapeutic procedures (median 2–3) indicated a total KAP reaching 995 Gy.cm2 (range 10.1–995) and CD 15.1 Gy (range 0.4–15.1), stressing the importance of dose monitoring and optimisation. Conclusions There is a need for interventional cardiology societies to play an active role in training actions and implementation of radiation protection. PMID:27325974

  2. Patient safety and outcomes from live case demonstrations of interventional cardiology procedures.

    PubMed

    Eliyahu, Shiran; Roguin, Ariel; Kerner, Arthur; Boulos, Monther; Lorber, Avraham; Halabi, Majdi; Suleiman, Mahmoud; Nikolsky, Eugenia; Rispler, Shmuel; Beyar, Rafael

    2012-02-01

    The goal of this study was to examine the safety and results of interventional procedures performed during the broadcast of live case demonstrations. Professional meetings using live case demonstrations to present cutting-edge technology are considered a valuable educational resource. There is an ongoing discussion on whether patients who are treated during live case demonstrations are exposed to a higher risk. Between 1998 and 2010, 101 patients were treated during live transmissions from a single center in 15 invasive-cardiology conferences. Technical success was defined as the ability to effectively perform the planned procedure without any major complication. The primary endpoint of the study was the composite occurrence of death, myocardial infarction, or stroke. The interventional procedures included coronary (n=66), carotid (n=15), peripheral (n=1), valvular (n=2), congenital heart disease (n=12), and complex electrophysiological mapping and ablation interventions (n=7). In 4 cases, the intended procedure was not done. The procedure was technically successful in 95%. In 5 cases, the procedure was unsuccessful because of the inability to cross a chronic total occlusion. There were no deaths during the hospital stay, and the composite primary endpoint occurred in 2 patients: a minor stroke following an atrial fibrillation ablation and a rise in serum troponin levels after percutaneous coronary intervention. These results were no different from those of 66 matched controls who underwent procedures performed by the same operators but not as live case demonstrations (relative risk: 0.32; 95% confidence interval: 0.02 to 3.62, p=0.62). In this consecutive series of interventional cardiology procedures that were performed by expert operators during live demonstration courses, the procedural and 30-day clinical outcomes were similar to those found in daily practice and to those that have been reported in the contemporary published data. These results suggest that

  3. Gender Differences in Radiation Dose From Nuclear Cardiology Studies Across the World: Findings From the INCAPS Registry.

    PubMed

    Shi, Lynn; Dorbala, Sharmila; Paez, Diana; Shaw, Leslee J; Zukotynski, Katherine A; Pascual, Thomas N B; Karthikeyan, Ganesan; Vitola, João V; Better, Nathan; Bokhari, Nadia; Rehani, Madan M; Kashyap, Ravi; Dondi, Maurizio; Mercuri, Mathew; Einstein, Andrew J

    2016-04-01

    The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models. The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p < 0.001), with a difference of only 0.3 mSv in a multivariable model adjusting for patients' age and weight. Stress-only imaging was performed more frequently in women (12.5% vs. 8.4%; p < 0.001); however, camera-based dose reduction strategies were used less frequently in women (58.6% vs. 65.5%; p < 0.001). Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging use and radiation dose offer potential opportunities to address gender-related differences

  4. Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS).

    PubMed

    Einstein, Andrew J; Pascual, Thomas N B; Mercuri, Mathew; Karthikeyan, Ganesan; Vitola, João V; Mahmarian, John J; Better, Nathan; Bouyoucef, Salah E; Hee-Seung Bom, Henry; Lele, Vikram; Magboo, V Peter C; Alexánderson, Erick; Allam, Adel H; Al-Mallah, Mouaz H; Flotats, Albert; Jerome, Scott; Kaufmann, Philipp A; Luxenburg, Osnat; Shaw, Leslee J; Underwood, S Richard; Rehani, Madan M; Kashyap, Ravi; Paez, Diana; Dondi, Maurizio

    2015-07-07

    To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiation-optimizing 'best practices' worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. We conducted an observational cross-sectional study of protocols used for all 7911 MPI studies performed in 308 nuclear cardiology laboratories in 65 countries for a single week in March-April 2013. Eight 'best practices' relating to radiation exposure were identified a priori by an expert committee, and a radiation-related quality index (QI) devised indicating the number of best practices used by a laboratory. Patient radiation effective dose (ED) ranged between 0.8 and 35.6 mSv (median 10.0 mSv). Average laboratory ED ranged from 2.2 to 24.4 mSv (median 10.4 mSv); only 91 (30%) laboratories achieved the median ED ≤ 9 mSv recommended by guidelines. Laboratory QIs ranged from 2 to 8 (median 5). Both ED and QI differed significantly between laboratories, countries, and world regions. The lowest median ED (8.0 mSv), in Europe, coincided with high best-practice adherence (mean laboratory QI 6.2). The highest doses (median 12.1 mSv) and low QI (4.9) occurred in Latin America. In hierarchical regression modelling, patients undergoing MPI at laboratories following more 'best practices' had lower EDs. Marked worldwide variation exists in radiation safety practices pertaining to MPI, with targeted EDs currently achieved in a minority of laboratories. The significant relationship between best-practice implementation and lower doses indicates numerous opportunities to reduce radiation exposure from MPI globally. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  5. Current status of nuclear cardiology practice in Latin America and the Caribbean.

    PubMed

    Paez, Diana; Peix, Amalia; Orellana, Pilar; Vitola, Joao; Mut, Fernando; Gutiérrez, Claudia; Plaza, Crosby; Becic, Tarik; Dondi, Maurizio; Estrada, Enrique

    2017-02-01

    The burden of cardiovascular diseases (CVDs) in the world is ever growing. They represent the first cause of death worldwide and in Latin America. Nuclear cardiology has a well-established role in the management of patient with CVDs and is being increasingly integrated into the healthcare systems in the region. However, there remains variability as to the infrastructure available across the countries, in terms of existing technology, radiopharmaceuticals, and human resources. The approximate number of gamma (γ) cameras in the region is 1348, with an average of 2.25 per million population; Argentina and Brazil having the largest number. Nearly 80% of the existing cameras are single-photon emission tomography (SPECT), of which 8% are hybrid SPECT-CT systems. Positron emission tomography technology is steadily increasing, and currently, there is an average of 0.25 scanners per million inhabitants, indicating that there is a potential to expand the capacities in order to cover the needs. Four countries have nuclear reactors for research purposes, which allow the production of technetium-99 m (Argentina, Chile, Mexico and Peru), while four (Argentina, Brazil, Cuba, and Mexico) assemble (99)Mo-(99m)Tc generators. As for the nuclear cardiology studies, about 80% of studies performed are gated SPECT myocardial perfusion imaging; less than 10% are multi-gated acquisition (mainly for evaluation of cardiac toxicity in cancer patients), and the other 10% correspond to other types of studies, such as viability detection, and adrenergic innervation studies with (123)I-MIBG. Physical stress is preferred, when possible, based on the clinical condition of the patient. Regarding human resources, there is an average of 1.1 physicians and 1.3 technologists per γ camera, with 0.1 medical physicists and 0.1 radiopharmacists per center in the region. The future of nuclear cardiology in Latin America and the Caribbean is encouraging, with great potential and possibilities for growth

  6. [The clinical management guidelines of the Sociedad Española de Cardiología. Nuclear cardiology: the technical bases and clinical applications].

    PubMed

    Candell Riera, J; Castell Conesa, J; Jurado López, J A; López de Sá, E; Nuño de la Rosa, J A; Ortigosa Aso, F J; Valle Tudela, V

    1999-11-01

    Although the role of nuclear cardiology is currently well consolidated, the addition of new radiotracers and modern techniques prompt us to permanently update the requirements, equipment and clinical applications of these isotopic tests. Radioisotopic drugs, instrumentation and characteristics of radionuclide tests that are presently used are explained in the first part of this text. In the second part, diagnostic and prognostic indications of these tests are presented in detail.

  7. Overall measurements of dose to patients in common interventional cardiology procedures.

    PubMed

    Wang, Weipeng; Zhang, Menglong; Zhang, Yi

    2013-12-01

    This study was designed to measure peak skin dose (PSD), dose-area product (DAP), cumulative dose (CD) and fluoroscopy time (FT) for interventional cardiology procedures and to evaluate whether patient doses were higher than that in other published data. Three cardiac procedure types, including coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA) and radio frequency (RF) ablation, were entered into the study. Data of four special metrics (PSD, DAP, CD and FT) for these procedures were collected and measured. A total of 238 patients who underwent interventional radiology procedures participated in this study. For every procedure, data about PSD were resulted from six TLD arrays and DAP, CD and FT were collected from the displayed monitor. The mean, standard deviation (SD), range and third quartile of the distribution of PSD, DAP, CD and FT recorded and measured on spot were calculated for all procedures. High-dose cases were specifically recorded. There was wide variation in the doses observed for different instances of the same procedure. PSD for PTCA and RF ablation ranged from 0.1 Gy to more than 3 Gy. Of 238 instances, there were 22 (9.2 %) with PSDs greater than 2 Gy and 4 (1.7 %) than 3 Gy. The third quartile of the distribution for PTCA had exceeded the DIMOND preliminary reference levels by 41.1 % in DAP and 25.0 % in FT. Mean DAP was in the range of reported values for CAG procedure, but higher than all data obtained in literatures for PTCA. Data from this study are in the range of most reported values for CAG and RF ablation procedure, while higher than that obtained in some literatures for PTCA. In case of a constant delivering of high doses to patient and physician himself, thorough training of interventionalists and staff is necessary, and the legislation has to be revised and set dose constrains especially for the interventional high-dose procedures.

  8. Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS)

    PubMed Central

    Einstein, Andrew J.; Pascual, Thomas N. B.; Mercuri, Mathew; Karthikeyan, Ganesan; Vitola, João V.; Mahmarian, John J.; Better, Nathan; Bouyoucef, Salah E.; Hee-Seung Bom, Henry; Lele, Vikram; Magboo, V. Peter C.; Alexánderson, Erick; Allam, Adel H.; Al-Mallah, Mouaz H.; Flotats, Albert; Jerome, Scott; Kaufmann, Philipp A.; Luxenburg, Osnat; Shaw, Leslee J.; Underwood, S. Richard; Rehani, Madan M.; Kashyap, Ravi; Paez, Diana; Dondi, Maurizio

    2015-01-01

    Aims To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiation-optimizing ‘best practices’ worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. Methods and results We conducted an observational cross-sectional study of protocols used for all 7911 MPI studies performed in 308 nuclear cardiology laboratories in 65 countries for a single week in March–April 2013. Eight ‘best practices’ relating to radiation exposure were identified a priori by an expert committee, and a radiation-related quality index (QI) devised indicating the number of best practices used by a laboratory. Patient radiation effective dose (ED) ranged between 0.8 and 35.6 mSv (median 10.0 mSv). Average laboratory ED ranged from 2.2 to 24.4 mSv (median 10.4 mSv); only 91 (30%) laboratories achieved the median ED ≤ 9 mSv recommended by guidelines. Laboratory QIs ranged from 2 to 8 (median 5). Both ED and QI differed significantly between laboratories, countries, and world regions. The lowest median ED (8.0 mSv), in Europe, coincided with high best-practice adherence (mean laboratory QI 6.2). The highest doses (median 12.1 mSv) and low QI (4.9) occurred in Latin America. In hierarchical regression modelling, patients undergoing MPI at laboratories following more ‘best practices’ had lower EDs. Conclusion Marked worldwide variation exists in radiation safety practices pertaining to MPI, with targeted EDs currently achieved in a minority of laboratories. The significant relationship between best-practice implementation and lower doses indicates numerous opportunities to reduce radiation exposure from MPI globally. PMID:25898845

  9. Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology.

    PubMed

    Vano, E; Sanchez, R M; Fernandez, J M

    2015-07-01

    The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 µSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm(2), respectively. The median ratios for dosemeters worn over the apron by operators (protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 µSv Gy(-1) cm(-2), respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y(-1) and per operator were necessary to reach the new lens dose limit for the three interventional specialties.

  10. Radiation Safety in Nuclear Medicine Procedures.

    PubMed

    Cho, Sang-Geon; Kim, Jahae; Song, Ho-Chun

    2017-03-01

    Since the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant in 2011, radiation safety has become an important issue in nuclear medicine. Many structured guidelines or recommendations of various academic societies or international campaigns demonstrate important issues of radiation safety in nuclear medicine procedures. There are ongoing efforts to fulfill the basic principles of radiation protection in daily nuclear medicine practice. This article reviews important principles of radiation protection in nuclear medicine procedures. Useful references, important issues, future perspectives of the optimization of nuclear medicine procedures, and diagnostic reference level are also discussed.

  11. Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

    PubMed Central

    Journy, N; Sinno-Tellier, S; Maccia, C; Le Tertre, A; Pirard, P; Pagès, P; Eilstein, D; Donadieu, J; Bar, O

    2012-01-01

    Objective The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. Methods We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. Results The mean MSD and DAP were respectively 389 mGy and 65 Gy cm−2 for CAs, and 916 mGy and 69 Gy cm−2 for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r=0.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. Conclusion Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions. PMID:22457404

  12. Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity: cardiovascular magnetic resonance and nuclear cardiology.

    PubMed

    Pepe, Alessia; Pizzino, Fausto; Gargiulo, Paola; Perrone-Filardi, Pasquale; Cadeddu, Christian; Mele, Donato; Monte, Ines; Novo, Giuseppina; Zito, Concetta; Di Bella, Gianluca

    2016-05-01

    Chemotherapy-induced cardiotoxicity (CTX) is a determining factor for the quality of life and mortality of patients administered potentially cardiotoxic drugs and in long-term cancer survivors. Therefore, prevention and early detection of CTX are highly desirable, as is the exploration of alternative therapeutic strategies and/or the proposal of potentially cardioprotective treatments. In recent years, cardiovascular imaging has acquired a pivotal role in this setting. Although echocardiography remains the diagnostic method most used to monitor cancer patients, the need for more reliable, reproducible and accurate detection of early chemotherapy-induced CTX has encouraged the introduction of second-line advanced imaging modalities, such as cardiac magnetic resonance (CMR) and nuclear techniques, into the clinical setting. This review of the Working Group on Drug Cardiotoxicity and Cardioprotection of the Italian Society of Cardiology aims to afford an overview of the most important findings from the literature about the role of CMR and nuclear techniques in the management of chemotherapy-treated patients, describe conventional and new parameters for detecting CTX from both diagnostic and prognostic perspectives and provide integrated insight into the role of CMR and nuclear techniques compared with other imaging tools and versus the positions of the most important international societies.

  13. Can diagnostic and procedural skills required to practice cardiology as a specialist be mastered in 3 years?

    PubMed

    Yu, Eric H C; Nair, Parvathy; Sibbald, Matthew G; Lee, Douglas S; Dorian, Paul

    2015-01-01

    Cognitive and procedural skills required of cardiologists have increased in the past 10 years. What is unknown is whether residents consistently meet recommended volumes during training and what their own subjective assessments of their competency are after training. The purpose of this study was to (1) determine whether current training provides residents with opportunities to develop skills to function independently and (2) identify whether residents perceive gaps in their skills. We surveyed current and recent graduates of adult cardiology programs in Canada. One hundred ten responses from 425 surveys were received. Procedural and diagnostic test interpretation volumes were recorded, as were the optimum number the respondents believed were important to complete to function independently. These volumes were compared with the 2008 American College of Cardiology Core Cardiology Training Symposium (COCATS 3) and the Canadian Cardiovascular Society (CCS) recommendations for training. The proportion of residents meeting recommended volumes for diagnostic test interpretation ranged from 7% (Holter monitors) to 91% (echocardiograms). For procedures, the range was from 71% (echocardiography) to 100% (cardioversion). The ratio of residents' perceived minimum numbers believed to be required for proficiency for diagnostic test interpretation to those recommended ranged from 14% (electrocardiograms) to 116% (echocardiograms), and for procedures, the ratio was 66% (temporary pacemaker placement) to 116% (echocardiography). Recent graduates' perception of minimum required numbers to achieve competency is underestimated compared with COCATS 3 and CCS recommendations. Few graduates achieved the recommended volume targets suggested for diagnostic test interpretation. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  14. Simulation-based training for cardiology procedures: Are we any further forward in evidencing real-world benefits?

    PubMed

    Harrison, Christopher M; Gosai, Jivendra N

    2017-04-01

    Simulation-based training as an educational tool for healthcare professionals continues to grow in sophistication, scope, and usage. There have been a number of studies demonstrating the utility of the technique, and it is gaining traction as part of the training curricula for the next generation of cardiologists. In this review, we focus on the recent literature for the efficacy of simulation for practical procedures specific to cardiology, focusing on transesophageal echocardiography, cardiac catheterization, coronary angioplasty, and electrophysiology. A number of studies demonstrated improved performance by those trained using SBT when compared to other methods, although evidence of this leading to an improvement in patient outcomes remains scarce. We discuss this evidence, and the implications for practice for training in cardiology.

  15. The treatment of carotid artery bifurcation stenoses with systematic stenting: experience of first 100 consecutive cardiological procedures.

    PubMed

    Sganzerla, Paolo; Bocciarelli, Monica; Savasta, Carlo; Bonin, Monica; Tavasci, Emanuela; Fini, Matteo; Perlasca, Elena; Alioto, Giusy; Colombo, Francesca; Passaretti, Bruno

    2004-10-01

    Carotid endarterectomy still represents the gold standard treatment of carotid artery bifurcation stenosis but percutaneous angioplasty with stenting is rapidly growing as a non-invasive alternative. In this paper we report the results of systematic application of carotid stenting performed in a cardiological setting, particularly as regards clinical management of patients and technical approach. One-hundred (100) procedures of carotid artery stenting (CAS) on 94 consecutive patients, both symptomatic and asymptomatic, with a carotid stenosis > 70%, were performed over a period of 30 months. The technical approach was directly derived from coronary angioplasty with use of large lumen guiding catheters, 0.014 in. intravascular guidewires and distal protection devices usually employed in coronary interventions. In 3 cases, a post-carotid endarterectomy restenosis and in 97 cases, a de-novo lesion, were treated respectively; in 71 cases, the degree of stenosis was 71-89% and in 29 cases, 90-99%. Cerebral protection was obtained with a distal to the lesion endovascular filter in 63 cases. Immediate technical success, i.e. residual stenosis of the treated vessel < 30% and no significant pathologic acceleration of blood flow (< 1.5 m/sec) at the Doppler ultrasound evaluation, was achieved in all procedures (100%). Ninety-six (96) procedures were totally uncomplicated; in-hospital cerebral complications were 1 TIA, 2 minor and 1 major strokes; at 30-day follow-up one additional major stroke occurred. Despite a particularly high incidence of comorbidities, neither unfavorable cardiological complications nor neurologic deaths were reported. Systematic CAS is a feasible treatment of the carotid artery bifurcation stenosis with high procedural success and low perioperative and short term complications. Its performance in a cardiological setting can combine satisfying procedural results and potentially successful handling of cardiovascular complications.

  16. Obstructive Thebesian valve: anatomical study and implications for invasive cardiologic procedures.

    PubMed

    Ghosh, Sanjib Kumar; Raheja, Shashi; Tuli, Anita

    2014-03-01

    Thebesian valve is the embryological remnant of the right sinoatrial valve, guarding the coronary sinus (CS) ostium. Advanced invasive and interventional cardiac diagnostic and management tools involve cannulation of the CS ostium. The presence of obstructive Thebesian valves has been reported to lead to unsuccessful cannulation of the CS. We studied the morphology of the Thebesian valve and CS ostium to assess the possible impact of these structures on invasive cardiological procedures. One hundred fifty randomly selected human cadaveric heart specimens fixed in 10% formalin were dissected in the customary routine manner. The Thebesian valves were classified according to their shape as semilunar/fenestrated/biconcave band like and according to their composition as membranous/fibromuscular/fibrous/muscular, and the extent to which the valve covered the CS ostium was also noted. An obstructive Thebesian valve that could interfere with the cannulation of the CS was defined as non-fenestrated (semilunar/biconcave band like) and non-membranous (fibromuscular/fibrous/muscular) valves covering >75% of the CS ostium. Thebesian valves were present in 118 (79%) heart specimens, of which 27 (18%) met the criteria of being obstructive. Semilunar was the most common type of Thebesian valve in terms of shape and was observed in 65 (65/118; 55%) hearts. This type was associated with the least mean craniocaudal (7.9±0.6 mm) and mean transverse (6.25±0.6 mm) diameters of the CS ostium. The mean craniocaudal diameter of the CS ostium (9.4±2.1 mm) was significantly larger (p=0.004) than the mean transverse diameter (7.15±1.5 mm) in specimens with Thebesian valves, and the cranial margin of the CS ostium was free from any attachment of the Thebesian valve in all the types observed (in terms of shape). Hence, attempts to direct the tip of the catheter toward the cranial margin of the CS ostium under direct vision may lead to successful cannulation of the same when conventional

  17. [Glycaemic management in type 1 and 2 diabetes patients undergoing interventional cardiology procedures. Heart and Diabetes Working Group. Sociedad Espan˜ola de Cardiologı´a. Sociedad Espan˜ola de Diabetes].

    PubMed

    Alonso-García, Angeles; Moreno Gómez, Raúl; Miranda Guardiola, Faustino; Artola-Menéndez, Sara; Lisbona-Gil, Arturo

    2012-03-03

    Despite the growing number of therapeutic alternatives available as well as general reviews and treatment guidelines for the treatment of diabetes, physicians are often left without a clear pathway of therapy to follow in specific clinical contexts such as interventional cardiology. The present document proposes a consensus treatment algorithm, based both on a critical appraisal of evidence from recent clinical trials and on value judgements supported by the authors' collective clinical knowledge and experience, in an attempt to guide practitioners when choosing the most appropriate alternatives in the context of glycemic management in type 1 and 2 diabetic patients scheduled to undergo interventional cardiology procedures in a haemodynamic laboratory.

  18. An overview of nuclear medicine imaging procedures.

    PubMed

    Hogg, Peter; Lawson, Richard

    2015-11-25

    Nuclear medicine imaging is not generally well understood by nurses who work outside this area. Consequently, nurses can find themselves unable to answer patients' questions about nuclear medicine imaging procedures or give them proper information before they attend for a test. This article aims to explain what is involved in some common diagnostic nuclear medicine imaging procedures so that nurses are able to discuss this with patients. It also addresses some common issues about radiation protection that nurses might encounter in their usual working routine. The article includes links to videos showing some typical nuclear medicine imaging procedures from a patient's point of view and links to an e-Learning for Healthcare online resource that provides detailed information for nurses.

  19. Review of cardiovascular imaging in the journal of nuclear cardiology in 2016: Part 2 of 2-myocardial perfusion imaging.

    PubMed

    Hage, Fadi G; AlJaroudi, Wael A

    2017-04-06

    In 2016, the Journal of Nuclear Cardiology published many high-quality articles. Similar to previous years, we will summarize here a selection of the articles that were published in the Journal in 2016 to provide a concise review of the main advancements that have recently occurred in the field. In the first article of this two-part series we focused on publications dealing with positron emission tomography, computed tomography, and magnetic resonance. This review will place emphasis on myocardial perfusion imaging using single-photon emission-computed tomography summarizing advances in the field including in diagnosis, prognosis, and appropriate use.

  20. Does Simulation-Based Training Improve Procedural Skills of Beginners in Interventional Cardiology?--A Stratified Randomized Study.

    PubMed

    Voelker, Wolfram; Petri, Nils; Tönissen, Christoph; Störk, Stefan; Birkemeyer, Ralf; Kaiser, Erhard; Oberhoff, Martin

    2016-02-01

    To assess whether mentored simulation-based-training can improve the procedural skills of beginners in coronary interventional procedures. Simulation based-catheter training is a valuable tool to practice interventional procedures. Whether this type of training enhances the procedural skills of fellows learning percutaneous coronary interventions has never been studied. Eighteen cardiology fellows were randomized either into the simulation-based training (n = 9) or the control group (n = 9). The simulation group received 7.5 hours of virtual reality (VR) simulation training, whereas the control group attended 4.5 hours of lectures. Each participant had to perform a simple (pre-evaluation) and a more complex (post-evaluation) catheter intervention on a pulsatile coronary flow model in a catheterization laboratory. All procedures were videotaped, analyzed, and rated by 3 expert interventionalists, who were blinded to the randomization. To assess the individual performance level, a "skills score" was determined, comprising 14 performance characteristics (5-level Likert scale, maximum score of 70 points). The "skills score" increased by 5.8 ± 6.1 points in the VR simulation group and decreased by 6.7 ± 8.4 in the control group (P = 0.003) from the simple stenosis at pre- to the more complex lesion at post-evaluation demonstrating the effectiveness of simulation-based training. This pilot study suggests that curriculum-based mentored VR simulation training improves the performance level of cardiology fellows in coronary interventions. Further investigation to evaluate the effect on clinical outcomes is warranted. © 2015, Wiley Periodicals, Inc.

  1. Journey in evolution of nuclear cardiology: will there be another quantum leap with the F-18-labeled myocardial perfusion tracers?

    PubMed

    Dilsizian, Vasken; Taillefer, Raymond

    2012-12-01

    The field of nuclear cardiac imaging has evolved from being rather subjective, more "art than a science," to a more objective, digital-based quantitative technique, providing insight into the physiological processes of cardiovascular disorders and predicting patient outcome. In a mere 4 decades of its clinical use, the technology used to image myocardial perfusion has made quantum leaps from planar to single-photon emission computed tomography (SPECT) and now to a more contemporary rapid SPECT, positron emission tomography (PET), and hybrid SPECT-computed tomography (CT) and PET-CT techniques. Meanwhile, radiotracers have flourished from potassium-43 and red blood cell-tagged blood pool imaging to thallium-201 and technetium-99m-labeled SPECT perfusion tracers along with rubidium-82, ammonia N-13, and more recently F-18 fluorine-labeled PET perfusion tracers. Concurrent with this expansion is the introduction of new quantitative methods and software for image processing, evaluation, and data interpretation. Technical advances, particularly in obtaining quantitative data, have led to a better understanding of the physiological mechanisms underlying cardiovascular diseases beyond discrete epicardial coronary artery disease to coronary vasomotor function in the early stages of the development of coronary atherosclerosis, hypertrophic cardiomyopathy, and dilated nonischemic cardiomyopathy. Progress in the areas of molecular and hybrid imaging are equally important areas of growth in nuclear cardiology. However, this paper focuses on the past and future of nuclear myocardial perfusion imaging and particularly perfusion tracers. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. The contribution of interventional cardiology procedures to the population radiation dose in a 'health-care level I' representative region.

    PubMed

    Peruzzo Cornetto, Andrea; Aimonetto, Stefania; Pisano, Francesco; Giudice, Marcello; Sicuro, Marco; Meloni, Teodoro; Tofani, Santi

    2016-02-01

    This study evaluates per-procedure, collective and per capita effective dose to the population by interventional cardiology (IC) procedures performed during 2002-11 at the main hospital of Aosta Valley Region that can be considered as representative of the health-care level I countries, as defined by the UNSCEAR, based on its socio-demographic characteristics. IC procedures investigated were often multiple procedures in patients older than 60 y. The median extreme dose-area product values of 300 and 22 908 cGycm(2) were found for standard pacemaker implantation and coronary angioplasty, respectively, while the relative mean per-procedure effective dose ranged from 0.7 to 47 mSv. A 3-fold increase in frequency has been observed together with a correlated increase in the delivered per capita dose (0.05-0.27 mSv y(-1)) and the collective dose (5.8-35 man Sv y(-1)). Doses increased particularly from 2008 onwards mainly because of the introduction of coronary angioplasty procedures in the authors' institution. IC practice contributed remarkably in terms of effective dose to the population, delivering ∼10% of the total dose by medical ionising radiation examination categories.

  3. Changing from image intensifier to flat detector technology for interventional cardiology procedures: a practical point of view.

    PubMed

    Bokou, C; Schreiner-Karoussou, A; Breisch, R; Beissel, J

    2008-01-01

    A small-scale internal audit has been used to evaluate the impact of the use of a dynamic flat panel detector in the clinical routine in the National Interventional Cardiology Centre in Luxembourg. The parameters tested during commissioning and constancy control of an X-ray system, the introduction of new clinical protocols, the patient and the personal staff dosimetry were considered. The technical parameters tested by the hospital physicist stay the same as for the image intensifier. No innovative protocols have been adopted due to the existence of the flat panel detector. A reduction in dose was noted after the installation of a flat detector, due mostly to the continuing education of the interventional cardiologists as well as the initial calibration of the radiological system. The understanding of the X-ray system and its possibilities is vital for the optimisation of clinical procedures in patient and staff exposure.

  4. Impact of Pre-operative Cardiology Consultation Prior to Intermediate-risk Surgical Procedures.

    PubMed

    Dogan, Volkan; Biteker, Murat; Özlek, Eda; Özlek, Bülent; Başaran, Özcan; Yıldırım, Birdal; Kayataş, Kadir; Çelik, Oğuzhan; Doğan, Marwa Mouline

    2017-08-07

    Patients undergoing noncardiac, nonvascular surgery (NCNVS) are at risk of perioperative cardiovascular events. However, benefits of cardiology consultation (CC) in patients with known or suspected cardiac disease undergoing intermediate-risk NCNVS is unknown. The study group included 700 consecutive patients referred for CC before intermediate-risk NCNVS in a tertiary-care teaching hospital. The control group included 1200 age-matched and sex-matched consecutive patients proceeded to the intermediate-risk surgery without preoperative CC during the same period. Patients older than 18 yr who underwent an elective, NCNVS were enrolled. Requests for consultation were made either by surgeon or an attending anesthesiologist. All patients underwent a complete preoperative clinical evaluation. Of the 700 patients who were referred for CC in the study group, 530 patients (75.7%) had no additional recommendations, and 170 patients (24.3%) underwent additional preoperative tests or had a change in preoperative therapy. Only 20 (2.8%) patients' NCNVS were delayed based on the cardiologists' recommendation and 680 patients eventually had their surgeries. Major cardiovascular and noncardiovascular complication rates were similar in the study and in the control groups (12.9% vs 13.6%, p=0.273 and 25.2% vs 26%, p=0.432 respectively). Preoperative CC in patients who underwent intermediate-risk NCNVS does not affect either perioperative management or outcome of surgery. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  5. Comparison of a conventional and a flat-panel digital system in interventional cardiology procedures.

    PubMed

    Tsapaki, V; Kottou, S; Kollaros, N; Dafnomili, P; Koutelou, M; Vano, E; Neofotistou, V

    2004-07-01

    The purpose of the study was to analyse the technical characteristics of a newly installed flat-panel fluoroscopy (FPF) system in an interventional cardiology (IC) department and compare it with an older conventional system. A patient survey was performed to investigate the radiation doses delivered by the X-ray systems. Finally, methods of technique optimization regarding the new digital system were investigated. Dose rates in all fluoroscopic and cine modes were measured and image quality assessed using a dedicated test tool. 200 patients were investigated, half using the conventional and half using the digital FPF system. Patient data collected were: sex, age, weight, height, dose-area product (DAP), fluoroscopy time (T) and total number of frames (F). Our results are: (1) Digital FPF system: high contrast resolution (HCR) is not affected by fluoroscopic mode, whereas low contrast resolution (LCR) is slightly decreased in the low mode. (2) The digital FPF system has 2.5 times better HCR than the conventional system, with 5 times lower dose in the fluoroscopy mode. (3) Median values of DAP, T and F, respectively, in coronary angiography (CA) are: 27.7 Gycm(2), 4.1 min and 876 for the digital and 39.3 Gycm(2), 5.3 min and 1600 for the conventional system. Median values for percutaneous transluminal coronary angioplasty (PTCA) are: 51.1 Gycm(2), 12.7 min and 1184 for the digital and 44.3 Gycm(2), 7.4 min and 1936 for the conventional system. Digital DAP in CA is reduced by 30%, suggesting that a dose reduction in the FPF system is possible. The results of the study concerning the FPF system lead to the conclusion that the lowest fluoroscopic mode and the lowest frame rate should be used in routine practice.

  6. Review of cardiovascular imaging in The Journal of Nuclear Cardiology in 2014: Part 1 of 2: Positron emission tomography, computed tomography, and neuronal imaging.

    PubMed

    AlJaroudi, Wael A; Hage, Fadi G

    2015-06-01

    The year 2014 has been an exciting year for the cardiovascular imaging community with significant advances in the realm of nuclear and multimodality cardiac imaging. In this new feature of the Journal of Nuclear Cardiology, we will summarize some of the breakthroughs that were published in the Journal in 2014 in 2 sister articles. This first article will concentrate on publications dealing with cardiac positron emission tomography (PET), computed tomography (CT), and neuronal imaging.

  7. CHARACTERIZATION AND EXPERIMENTAL MEASUREMENTS OF SCATTER DOSE AT CARDIOLOGIST'S EYES DURING PAEDIATRIC INTERVENTIONAL CARDIOLOGY PROCEDURES IN COSTA RICA.

    PubMed

    Ubeda, Carlos; Salazar, Luisa; Retana, Viviana; Santos, Freddy; Salvador, Lourdes; Sáenz, Carlos; Quesada, Cristhian; Gavarrete, Manuel; Picado, Marcela; Arce, Luis

    2017-03-21

    This paper presents the results of the first characterization and experimental measurements of scatter dose at cardiologist's eyes for the only X-ray system that performs all paediatric Interventional cardiology procedures in Costa Rica. Entrance surface air kerma (ESAK) and the scatter dose values were measured on phantoms of 4-20 cm thicknesses of polymethyl methacrylate slabs. Image quality was evaluated using DICOM images of a test object Leeds TOR 18-FG, through the numerical parameters signal-to-noise ratio (SNR), high-contrast spatial resolution (HCSR) and figure of merit (FOM). When PMMA thickness is increased and during a move from low fluoroscopy to cine modes, ESAK, SNR, HCSR and FOM values range from 0.44 to 391.0 μGy fr-1; 2.8 to 14.89; 3.17 to 15.54 and 0.51 to 79.94, respectively. The highest scattered dose rates recorded during the simulations were 1.79 and 8.04 mSv h-1 for the high fluoroscopy and cine modes, respectively.

  8. [Upper gastrointestinal bleeding after cardiac surgery and invasive cardiology procedures--prophylaxis and therapy].

    PubMed

    Davidkov, L; Evstatiev, I; Chirkov, A

    2005-01-01

    The abdominal complications after cardiac surgery prolong the hospitalization and increase the cost. The operative treatment of these complications is having high mortality rate--up to 85%. In this study we investigated the upper gastrointestinal bleeding: the causes, the diagnostic and therapeutic approaches, and the difficulties of the treatment. From January to December 2003, 724 cardiac operations were performed in University Hospital "Saint Ekaterina", Sofia 2771 angiographies, 594 angioplasties, and 874 stent implantations were done as well. 380 upper GI endoscopies were performed for this period. Upper GI bleeding was found in 27 cases. We used Somatostatin and Omeprasol treatment protocol in the cases of acute upper GI bleeding and for bleeding prophylaxis in patients with previously diagnosed stomach or duodenal erosions and ulcers. Endoscopic sclerotherapy was performed in 9 cases to achieve control of the bleeding. We had no relapses of the bleeding. No open surgical procedures were necessary, and we had no mortalities due to upper GI bleeding during the study period.

  9. Review of cardiovascular imaging in the journal of nuclear cardiology in 2015. Part 1 of 2: Plaque imaging, positron emission tomography, computed tomography, and magnetic resonance.

    PubMed

    AlJaroudi, Wael A; Hage, Fadi G

    2016-02-01

    In 2015, many original articles pertaining to cardiovascular imaging with impressive quality were published in the Journal of Nuclear Cardiology. In a set of 2 articles, we provide an overview of these contributions to facilitate for the interested reader a quick review of the advancements that occurred in the field over this year. In this first article, we focus on arterial plaque imaging, cardiac positron emission tomography, computed tomography, and magnetic resonance imaging.

  10. [Cardiology 2001].

    PubMed

    Jerie, P

    2002-09-01

    A review of the most important topics published during 2001 is presented. The Writing Committee of the American College of Cardiology and the American Heart Association decided to take a new approach to the classification of heart failure that emphasizes both the evolution and the progression of the disease, using potential risk factors and structural disorders as criteria to identify the severity of a heart failure syndrome. Similarly, an ACC/AHA Clinical Competence Statement on electrocardiography and ambulatory electrocardiography was published with a special emphasis on the computer interpretation of the electrocardiogram. Since various drugs were shown to induce electrocardiographic abnormalities as e.g. QT prolongation associated with ventricular tachycardias, the FDA decided to introduce higher regulatory requirements on the cardiac safety of novel drugs. In cardiovascular surgery Octopus off-pump bypass was demonstrated to be a safe procedure for carefully selected patients with multivessel coronary heart disease. Because of the extensive progress made in cardiovascular surgery, the management of severe heart failure has to be improved and early effective preventive measures have to be introduced to reduce the risk of intractable heart failure. The "New guidelines for evaluating acute coronary syndrome" stress the importance of early identifying and early treatment, including invasive strategy as PTCA with stenting.

  11. Reducing radiation to patients and improving image quality in a real-world nuclear cardiology laboratory.

    PubMed

    Bloom, Stephen A; Meyers, Karen

    2017-03-22

    In part because of aging equipment and reduced reimbursement for imaging services in the last several years, nuclear cardiologists who remain in private practice face challenges in maintaining high quality and in reducing radiation exposure to patients. We review patient-centered approaches and affordable software solutions employed in our practice combined with supine-prone myocardial perfusion imaging to achieve increased interpretive confidence with reduced radiation exposure to patients.

  12. Radiopharmaceuticals in cardiology.

    PubMed

    Mikołajczak, Renata; Garnuszek, Piotr

    2012-04-24

    Myocardial perfusion studies are among the most often performed investigations in Nuclear Medicine. However, the development of radiopharmaceuticals for cardiology is an emerging discipline and several other radiotracers have been proven to be useful. Although the myocardial perfusion studies have a well established role in the management of cardiac disorders, still a number of radiopharmaceuticals are under development for a variety of specific cardiac indications and their eventual clinical role remains to be seen. The paper provides a short overview of currently used radiopharmaceuticals and potential molecular imaging radiotracers applicable in cardiology.

  13. Nuclear Weapon Accident Response Procedures (NARP)

    DTIC Science & Technology

    2005-02-22

    Fast, reliable, and accurate communications are essential for nuclear weapon accident response operations. Moreover, securing adequate internal ...activities near the scene of a nuclear weapon accident to speed the flow of information to the public and the internal audience. Although it is 183...Departments and Agencies in a nuclear weapon accident. Inherent in this event are the relationships between international , national, State, and

  14. Normal values and standardization of parameters in nuclear cardiology: Japanese Society of Nuclear Medicine working group database.

    PubMed

    Nakajima, Kenichi; Matsumoto, Naoya; Kasai, Tokuo; Matsuo, Shinro; Kiso, Keisuke; Okuda, Koichi

    2016-04-01

    As a 2-year project of the Japanese Society of Nuclear Medicine working group activity, normal myocardial imaging databases were accumulated and summarized. Stress-rest with gated and non-gated image sets were accumulated for myocardial perfusion imaging and could be used for perfusion defect scoring and normal left ventricular (LV) function analysis. For single-photon emission computed tomography (SPECT) with multi-focal collimator design, databases of supine and prone positions and computed tomography (CT)-based attenuation correction were created. The CT-based correction provided similar perfusion patterns between genders. In phase analysis of gated myocardial perfusion SPECT, a new approach for analyzing dyssynchrony, normal ranges of parameters for phase bandwidth, standard deviation and entropy were determined in four software programs. Although the results were not interchangeable, dependency on gender, ejection fraction and volumes were common characteristics of these parameters. Standardization of (123)I-MIBG sympathetic imaging was performed regarding heart-to-mediastinum ratio (HMR) using a calibration phantom method. The HMRs from any collimator types could be converted to the value with medium-energy comparable collimators. Appropriate quantification based on common normal databases and standard technology could play a pivotal role for clinical practice and researches.

  15. Avian cardiology.

    PubMed

    Strunk, Anneliese; Wilson, G Heather

    2003-01-01

    The field of avian cardiology is continually expanding. Although a great deal of the current knowledge base has been derived from poultry data, research and clinical reports involving companion avian species have been published. This article will present avian cardiovascular anatomy and physiology, history and physical examination considerations in the avian cardiac disease patient, specific diagnostic tools, cardiovascular disease processes, and current therapeutic modalities.

  16. Nuclear cardiology and CVD in the developing world: Are we applying our scarce resources appropriately? Why is our mortality rate so high?

    PubMed

    Vitola, João V

    2016-10-01

    While mortality rates from cardiovascular diseases have progressively decreased in developed nations, this has not been observed to the same extent in the developing world. Nuclear Cardiology utilization remains low or non-existent for most of those living in the low-to-middle-income countries. How much of the decline in mortality observed in the developed world has to do with advanced cardiac imaging? Are we applying our scarce resources appropriately for myocardial perfusion imaging? Are myocardial revascularizations being guided by appropriate use criteria? Is more imaging necessary to reduce the mortality rates further in the developing world?

  17. Review of Cardiovascular Imaging in the Journal of Nuclear Cardiology in 2016. Part 1 of 2: Positron Emission Tomography, Computed Tomography and Magnetic Resonance.

    PubMed

    AlJaroudi, Wael; Hage, Fadi G

    2017-02-13

    Several original articles and editorials have been published in the Journal of Nuclear Cardiology last year. It has become a tradition at the beginning of each year to summarize some of these key articles (AlJaroudi and Hage in J Nucl Cardiol 22:507-512, 2015, 23:122-130, 2016; Hage and AlJaroudi in J Nucl Cardiol 22:714-719, 2015; 23:493-498, 2016). In this part one, we will discuss some of the progress made in patients with infiltrative disease, cardiomyopathies (non-ischemic, ischemic, and diabetic), hybrid and molecular imaging, using advancement in positron emission tomography, computed tomography, and magnetic resonance imaging.

  18. Nuclear ventriculography

    MedlinePlus

    ... ventriculography (RNV); Multiple gate acquisition scan (MUGA); Nuclear cardiology; Cardiomyopathy - nuclear ventriculography ... 56. Udelson JE, Dilsizian V, Bonow RO. Nuclear cardiology. In: Bonow RO, Mann DL, Zipes DP, Libby ...

  19. Invasive Cardiologists Are Exposed to Greater Left Sided Cranial Radiation: The BRAIN Study (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures).

    PubMed

    Reeves, Ryan R; Ang, Lawrence; Bahadorani, John; Naghi, Jesse; Dominguez, Arturo; Palakodeti, Vachaspathi; Tsimikas, Sotirios; Patel, Mitul P; Mahmud, Ehtisham

    2015-08-17

    This study sought to determine radiation exposure across the cranium of cardiologists and the protective ability of a nonlead, XPF (barium sulfate/bismuth oxide) layered cap (BLOXR, Salt Lake City, Utah) during fluoroscopically guided, invasive cardiovascular (CV) procedures. Cranial radiation exposure and potential for protection during contemporary invasive CV procedures is unclear. Invasive cardiologists wore an XPF cap with radiation attenuation ability. Six dosimeters were fixed across the outside and inside of the cap (left, center, and right), and 3 dosimeters were placed outside the catheterization lab to measure ambient exposure. Seven cardiology fellows and 4 attending physicians (38.4 ± 7.2 years of age; all male) performed diagnostic and interventional CV procedures (n = 66.2 ± 27 cases/operator; fluoroscopy time: 14.9 ± 5.0 min). There was significantly greater total radiation exposure at the outside left and outside center (106.1 ± 33.6 mrad and 83.1 ± 18.9 mrad) versus outside right (50.2 ± 16.2 mrad; p < 0.001 for both) locations of the cranium. The XPF cap attenuated radiation exposure (42.3 ± 3.5 mrad, 42.0 ± 3.0 mrad, and 41.8 ± 2.9 mrad at the inside left, inside center, and inside right locations, respectively) to a level slightly higher than that of the ambient control (38.3 ± 1.2 mrad, p = 0.046). After subtracting ambient radiation, exposure at the outside left was 16 times higher than the inside left (p < 0.001) and 4.7 times higher than the outside right (p < 0.001). Exposure at the outside center location was 11 times higher than the inside center (p < 0.001), whereas no difference was observed on the right side. Radiation exposure to invasive cardiologists is significantly higher on the left and center compared with the right side of the cranium. Exposure may be reduced similar to an ambient control level by wearing a nonlead XPF cap. (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures [BRAIN]; NCT

  20. Cardiology Mannequin

    NASA Technical Reports Server (NTRS)

    1979-01-01

    Education of medical students in cardiology requires access to patients having a variety of different forms of heart disease. But bringing together student, instructor and patient is a difficult and expensive process that does not benefit the patient. An alternate approach is substitution of a lifelike mannequin capable of simulating many conditions of heart disease. The mannequin pictured below, together with a related information display, is an advanced medical training system whose development benefited from NASA visual display technology and consultative input from NASA's Kennedy Space Center. The mannequin system represents more than 10 years of development effort by Dr. Michael S. Gordon, professor of cardiology at the University of Miami (Florida) School of Medicine.

  1. The contribution of interventional cardiology procedures to the population radiation dose in a ‘health-care level I’ representative region

    PubMed Central

    Peruzzo Cornetto, Andrea; Aimonetto, Stefania; Pisano, Francesco; Giudice, Marcello; Sicuro, Marco; Meloni, Teodoro; Tofani, Santi

    2016-01-01

    This study evaluates per-procedure, collective and per capita effective dose to the population by interventional cardiology (IC) procedures performed during 2002–11 at the main hospital of Aosta Valley Region that can be considered as representative of the health-care level I countries, as defined by the UNSCEAR, based on its socio-demographic characteristics. IC procedures investigated were often multiple procedures in patients older than 60 y. The median extreme dose-area product values of 300 and 22 908 cGycm2 were found for standard pacemaker implantation and coronary angioplasty, respectively, while the relative mean per-procedure effective dose ranged from 0.7 to 47 mSv. A 3-fold increase in frequency has been observed together with a correlated increase in the delivered per capita dose (0.05–0.27 mSv y−1) and the collective dose (5.8–35 man Sv y−1). Doses increased particularly from 2008 onwards mainly because of the introduction of coronary angioplasty procedures in the authors’ institution. IC practice contributed remarkably in terms of effective dose to the population, delivering ∼10 % of the total dose by medical ionising radiation examination categories. PMID:26012484

  2. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association.

    PubMed

    Raatikainen, M J Pekka; Arnar, David O; Zeppenfeld, Katja; Merino, Jose Luis; Levya, Francisco; Hindriks, Gerhardt; Kuck, Karl-Heinz

    2015-01-01

    There has been large variations in the use of invasive electrophysiological therapies in the member countries of the European Society of Cardiology (ESC). The aim of this analysis was to provide comprehensive information on cardiac implantable electronic device (CIED) and catheter ablation therapy trends in the ESC countries over the last five years. The European Heart Rhythm Association (EHRA) has collected data on CIED and catheter ablation therapy since 2008. Last year 49 of the 56 ESC member countries provided data for the EHRA White Book. This analysis is based on the current and previous editions of the EHRA White Book. Data on procedure rates together with information on economic aspects, local reimbursement systems and training activities are presented for each ESC country and the five geographical ESC regions. In 2013, the electrophysiological procedure rates per million population were highest in Western Europe followed by the Southern and Northern European countries. The CIED implantation and catheter ablation rate was lowest in the Eastern European and in the non-European ESC countries, respectively. However, in some Eastern European countries with relative low gross domestic product procedure rates exceeded those of some wealthier Western countries, suggesting that economic resources are not the only driver for utilization of arrhythmia therapies. These statistics indicate that despite significant improvements, there still is considerable heterogeneity in the availability of arrhythmia therapies across the ESC area. Hopefully, these data will help identify areas for improvement and guide future activities in cardiac arrhythmia management. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  3. Nuclear Medicine Procedures in Children: Special Considerations.

    PubMed

    Gelfand, Michael J; Clements, Crysta; MacLean, Joseph R

    2017-03-01

    Nuclear medicine imaging in children is best accomplished when a child-friendly environment is provided for patients and parents. An approach that minimizes patient anxiety and fear is described. International guidelines for administered activity should be used to minimize absorbed radiation doses from radiopharmaceuticals. CT exposure parameters may be reduced to pediatric best practice for diagnostic CT and further reduced when CT images are needed only for localization purposes.

  4. Determination of efficacy of nuclear medicine procedures

    SciTech Connect

    Saenger, E.L.; Buncher, C.R.; Specker, B.; McDevitt, R.A.

    1984-01-01

    Nuclear medicine, a high technology field, is evaluated as to its usefulness. This paper describes the SNM study of 2023 patients comparing two methods evaluating efficacy for lung scanning (LS). Only the referring physicians determined the probabilities of the most important (MI) and most likely (ML) diagnoses and management before and after lung scanning. A logistic regression model was developed for probability of a signout diagnosis of PE. Equal patient groups tested the validity of the regression equations for the probability of PE as MI or ML. The models developed on Group I (G-I) and used on Group II (G-II) gave similar results. This shows that LS classifies PE and NOT PE categories where PE was considered both MI and ML. Entropy minimax pattern detection (EMPD) attempts prediction of signout diagnosis and management from prior patient attributes. In 2023 cases, attributes alone could not eliminate the use of LS for all patients. Comparing the two methods, the predictive values, sensitivity and specificity of each method are similar. EMPD predicts on a relatively small percent (40% before LS, 71% post LS) while the logistic equation predicts on 100% of the cases. An advantage of EMPD is that it does not require estimates of prior probability. However, LR, uses this estimate, thus incorporating intuitive knowledge not evaluated by EMPD. These methods are unique in showing that LS can direct the referring physician toward or away from anticoagulant therapy based on findings of the lung scan.

  5. Osteoporosis: radiologic and nuclear medicine procedures.

    PubMed Central

    Weissman, B N

    1987-01-01

    A number of radiographic and nuclear medicine techniques are available for the assessment of patients suspected of having osteoporosis or at risk for the development of osteoporosis. Spinal radiographs are insensitive indicators of osteoporosis. They can document the presence of metastatic tumors or other lesions that may produce compression fracture. The Singh index assesses the trabecular pattern of the proximal femur. As bone loss occurs, the trabeculae disappear in a definite sequence. Radiogrammetry refers to the measurement of bone and cortical widths in the peripheral skeleton, usually the second metacarpal. The method is low cost and most useful for population studies. It does not reflect early osteoporosis. Photodensitometry entails radiography of a part of a bone with inclusion of a standard reference wedge on the radiograph. The density of the bone is compared with the wedge. In some laboratories, precision is good (1.5 percent) and the radiation dose is low. Peripheral cortical bone is measured primarily, which is a disadvantage. Single photon absorptiometry uses the transmission of 27.5 keV photons emitted from an iodine-125 source to assess bone density. In most instances, measurements of the radial shaft are made, which reflect primarily cortical bone rather than the more reactive trabecular bone. The distal end of the radius and the calcaneus may also be measured; these areas contain primarily trabecular bone. Radiation dose is low (less than 10 mrad), but when cortical bone is evaluated, the results correlate poorly with spinal bone mineral. Thus, the test is an insensitive indicator of spinal osteoporosis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3120210

  6. Current practice of transradial approach for coronary procedures: A survey by the Italian Society of Interventional Cardiology (SICI-GISE) and the Italian Radial Club.

    PubMed

    Rigattieri, Stefano; Valsecchi, Orazio; Sciahbasi, Alessandro; Tomassini, Francesco; Limbruno, Ugo; Marchese, Alfredo; La Manna, Alessio; Mauro, Ciro; Varbella, Ferdinando; Berti, Segio; Tarantino, Fabio F; Musumeci, Giuseppe

    Transradial approach (TRA) for percutaneous coronary procedures is associated with improved patient outcome and is being increasingly adopted worldwide. We surveyed Italian interventional cardiologists in order to take a snapshot of the current practice of TRA. A web-based questionnaire was emailed to all members of the Italian Society of Interventional Cardiology. The survey was taken by 508 respondents. Cardiogenic shock and chronic total occlusions represented the principal limitations to TRA. Right TRA was the default approach for 81% of respondents. Both diagnostic and interventional procedures were routinely performed through 6 Fr sheaths (83% and 93%, respectively); dedicated TRA curves were used in 11% of diagnostic and in about 3% of interventional procedures. Almost 70% of the operators did not assess dual hand circulation. In case of crossover, the contralateral radial artery was the preferred site (57%). Radial artery hemostasis was mostly achieved by pneumatic bracelet (64%) and patency of the radial artery during hemostasis was ensured in 60% of cases. Pre-discharge patency of the radial artery was routinely assessed by almost 60% of respondents. For diagnostic procedures, adequate heparin anticoagulation (5000IU) was only given by 45% of operators. Most respondents believed that TRA is associated with greater radiation exposure for both the patient (82%) and the operator (98%) as compared to transfemoral approach. This survey provides contemporary data about the adoption of TRA in Italy and gives interesting insights about several technical and clinical issues related to the practice of this vascular approach for coronary procedures. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Procedures manual for the Evaluated Nuclear Structure Data File

    SciTech Connect

    Bhat, M.R.

    1987-10-01

    This manual is a collection of various notes, memoranda and instructions on procedures for the evaluation of data in the Evaluated Nuclear Structure Data File (ENSDF). They were distributed at different times over the past few years to the evaluators of nuclear structure data and some of them were not readily avaialble. Hence, they have been collected in this manual for ease of reference by the evaluators of the international Nuclear Structure and Decay Data (NSDD) network contribute mass-chains to the ENSDF. Some new articles were written specifically for this manual and others are reivsions of earlier versions.

  8. University cardiology clinic.

    PubMed

    Borozanov, V

    2013-01-01

    In distant 1972, within framework of the Internal Clinic, a cardiologic department was organized which was soon, on 29.XII.1974, transformed into the Cardiology Clinic, later the Institute for Heart Diseases, and in 2008 was renamed the University Cardiology Clinic. The greater part of its foundation was possible owing to Prof. Dimitar Arsov and Prof. Radovan Percinkovski, who was the clinic's first director in the period from 1974 to 1984. In 1985, the Clinic moved into its own new building, and in that way was physically detached from the Internal Clinics. Until its move to the new building, the Clinic functioned in the Internal Clinics building, organized as an outpatient polyclinic and inpatient infirmary department with clinical beds, a coronary intensive care unit and a haemodynamics laboratory equipped with the most modern equipment of that time. Today the Clinic functions through two integral divisions: an inpatient infirmary department which comprises an intensive coronary care unit and fourteen wards which altogether have 139 clinical beds, and the diagnostic centre which comprises an emergency clinic and day hospital, a communal and consultative outpatients' clinic functioning on a daily basis, through which some 300-350 patients pass every day, and diagnostic laboratories with a capacity of nearly 100 non-invasive and 20-30 invasive diagnostic procedures daily. The Clinic is a teaching base, and its doctors are educators of students at the Medical, Dental and Pharmacy Faculties, and also of students at the High School for Nurses and X-ray technicians, but also for those in Internal Medicine and especially Cardiology. The Clinic is also a base for scientific Masters' and post-doctoral studies, and such higher degrees are achieved not only by doctors who work here, but also by doctors from Medical Centres both in the country and abroad. Doctors working in this institution publish widely, not only a great number of books and monographs, but also original

  9. Tele-cardiology.

    PubMed

    Molefi, M; Fortuin, J; Wynchank, S

    2006-01-01

    After defining tele-medicine, we describe its situation in the public health service of South Africa and its application to cardiology. Methods of communication relevant to tele-cardiology are outlined, together with their bearing on primary healthcare. The range of tele-cardiological applications to electrocardiology, echocardiology, auscultation, imaging and pathology are indicated. Tele-cardiology's contributions to a range of cardiological problems and types of management are described briefly. Finally, a mention is made of the relevance of tele-medicine to education and the costs related to cardiology, with an indication of some future needs for tele-cardiology.

  10. Automating Nuclear-Safety-Related SQA Procedures with Custom Applications

    SciTech Connect

    Freels, James D.

    2016-01-01

    Nuclear safety-related procedures are rigorous for good reason. Small design mistakes can quickly turn into unwanted failures. Researchers at Oak Ridge National Laboratory worked with COMSOL to define a simulation app that automates the software quality assurance (SQA) verification process and provides results in less than 24 hours.

  11. Automating Nuclear-Safety-Related SQA Procedures with Custom Applications

    DOE PAGES

    Freels, James D.

    2016-01-01

    Nuclear safety-related procedures are rigorous for good reason. Small design mistakes can quickly turn into unwanted failures. Researchers at Oak Ridge National Laboratory worked with COMSOL to define a simulation app that automates the software quality assurance (SQA) verification process and provides results in less than 24 hours.

  12. Llama cardiology.

    PubMed

    Boon, J A; Knight, A P; Moore, D H

    1994-07-01

    Auscultatory, ECG, and echocardiographic data have been presented for healthy llamas. The literature, however, contains little information on the incidence of congenital and acquired heart disease in the llama. Data compiled from the medical records at CSU-VTH and the VMDB provide an indication of the types of cardiac disease to be found in llamas in North America. A wide variety of congenital cardiac defects are found in llamas, the most prevalent defect of which is VSD. Llamas tend to do well with this defect but are unlikely to be useful pack animals. Acquired heart disease primarily involved inflammatory processes of the pericardium, endocardium, epicardium, and myocardium, and pericardial effusion without documented inflammatory disease. Although not every cardiac murmur necessitates a complete cardiac work-up, every effort should be made to compile accurate medical histories and physical findings related to the cardiac disease in llamas in order to advance our knowledge of these disorders. There also is a need to use available technologies to better define cardiac abnormalities in the llama and accurately report these findings in the literature before cardiology of llamas is fully understood.

  13. [Use of radionuclide isotopes by cardiologists. Results of a French survey. Study group: "Nuclear Cardiology" of the French Society of Cardiology and the Society of Nuclear Medicine and Biophysics].

    PubMed

    Pézard, P; Karcher, G

    1995-03-01

    The authors report the results of an enquiry carried out amongst French cardiologists to determine their opinion about radionuclide investigations in cardiological practice. Of the 5,050 cardiologists contacted, 1,431 (28.3%) replied. The cardiologists were attracted by the non-invasive nature (84%) of radionuclide techniques and their complementarity with other methods of investigation (74%) but regretted their cost (55%), their lick of availability in emergencies (35%) and, in general, their difficult of access (30%). Only 38% of the cardiologists who replied used radionuclide investigation on an everyday basis, this being impossible for some because of the distance to the nearest centre with these facilities (on average 32 km but exceeding 50 km in 29% of cases, and the delay before obtaining an appointment (average 13 days) which was often excessive, especially for myocardial scintigraphy (thallium or equivalent). Each cardiologist prescribed an average of 5 myocardial scintigraphies, 3 pulmonary scintigraphies and 2 radioisotopic ventriculography per month. These results seem to be an overestimation; in fact, radionuclide investigations are relatively underemployed, probably more because of the factors cited above than because of lack interest or quality, these latter two points being generally judged positively by the majority of cardiologists. Cardiologists require more from the conclusions of the investigation than a simple description of the images obtained. As with all other investigations that they perform themselves, the interpretation of the results must take the clinical context into consideration and form part of the diagnostic and therapeutic management of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Assessing Competence in Pediatric Cardiology

    ERIC Educational Resources Information Center

    Johnson, Apul E.; And Others

    1976-01-01

    In response to the need to assure physician competence, a rating scale was developed at the University of Minnesota Medical School for use in evaluating clinical competence in pediatric cardiology. It was tested on first- and second-year specialists. Development and testing procedures are described. (JT)

  15. Assessing Competence in Pediatric Cardiology

    ERIC Educational Resources Information Center

    Johnson, Apul E.; And Others

    1976-01-01

    In response to the need to assure physician competence, a rating scale was developed at the University of Minnesota Medical School for use in evaluating clinical competence in pediatric cardiology. It was tested on first- and second-year specialists. Development and testing procedures are described. (JT)

  16. Supporting the future nuclear workforce with computer-based procedures

    DOE PAGES

    Oxstrand, Johanna; Le Blanc, Katya

    2016-05-01

    Here we see that computer-based tools have dramatically increased ease and efficiency of everyday tasks. Gone are the days of paging through a paper catalog, transcribing product numbers, and calculating totals. Today, a consumer can find a product online with a simple search engine, and then purchase it in a matter of a few clicks. Paper catalogs have their place, but it is hard to imagine life without on-line shopping sites. All tasks conducted in a nuclear power plant are guided by procedures, which helps ensure safe and reliable operation of the plants. One prominent goal of the nuclear industrymore » is to minimize the risk of human errors. To achieve this goal one has to ensure tasks are correctly and consistently executed. This is partly achieved by training and by a structured approach to task execution, which is provided by procedures and work instructions. Procedures are used in the nuclear industry to direct workers' actions in a proper sequence. The governing idea is to minimize the reliance on memory and choices made in the field. However, the procedure document may not contain sufficient information to successfully complete the task. Therefore, the worker might have to carry additional documents such as turnover sheets, operation experience, drawings, and other procedures to the work site. The nuclear industry is operated with paper procedures like paper catalogs of the past. A field worker may carry a large stack of documents needed to complete a task to the field. Even though the paper process has helped keep the industry safe for decades, there are limitations to using paper. Paper procedures are static (i.e., the content does not change after the document is printed), difficult to search, and rely heavily on the field worker’s situational awareness and ability to consistently meet the high expectation of human performance excellence. With computer-based procedures (CBPs) that stack of papers may be reduced to the size of a small tablet or even

  17. Supporting the future nuclear workforce with computer-based procedures

    SciTech Connect

    Oxstrand, Johanna; Le Blanc, Katya

    2016-05-01

    Here we see that computer-based tools have dramatically increased ease and efficiency of everyday tasks. Gone are the days of paging through a paper catalog, transcribing product numbers, and calculating totals. Today, a consumer can find a product online with a simple search engine, and then purchase it in a matter of a few clicks. Paper catalogs have their place, but it is hard to imagine life without on-line shopping sites. All tasks conducted in a nuclear power plant are guided by procedures, which helps ensure safe and reliable operation of the plants. One prominent goal of the nuclear industry is to minimize the risk of human errors. To achieve this goal one has to ensure tasks are correctly and consistently executed. This is partly achieved by training and by a structured approach to task execution, which is provided by procedures and work instructions. Procedures are used in the nuclear industry to direct workers' actions in a proper sequence. The governing idea is to minimize the reliance on memory and choices made in the field. However, the procedure document may not contain sufficient information to successfully complete the task. Therefore, the worker might have to carry additional documents such as turnover sheets, operation experience, drawings, and other procedures to the work site. The nuclear industry is operated with paper procedures like paper catalogs of the past. A field worker may carry a large stack of documents needed to complete a task to the field. Even though the paper process has helped keep the industry safe for decades, there are limitations to using paper. Paper procedures are static (i.e., the content does not change after the document is printed), difficult to search, and rely heavily on the field worker’s situational awareness and ability to consistently meet the high expectation of human performance excellence. With computer-based procedures (CBPs) that stack of papers may be reduced to the size of a small tablet or even a smart

  18. Supporting the future nuclear workforce with computer-based procedures

    SciTech Connect

    Oxstrand, Johanna; Le Blanc, Katya

    2016-05-01

    Here we see that computer-based tools have dramatically increased ease and efficiency of everyday tasks. Gone are the days of paging through a paper catalog, transcribing product numbers, and calculating totals. Today, a consumer can find a product online with a simple search engine, and then purchase it in a matter of a few clicks. Paper catalogs have their place, but it is hard to imagine life without on-line shopping sites. All tasks conducted in a nuclear power plant are guided by procedures, which helps ensure safe and reliable operation of the plants. One prominent goal of the nuclear industry is to minimize the risk of human errors. To achieve this goal one has to ensure tasks are correctly and consistently executed. This is partly achieved by training and by a structured approach to task execution, which is provided by procedures and work instructions. Procedures are used in the nuclear industry to direct workers' actions in a proper sequence. The governing idea is to minimize the reliance on memory and choices made in the field. However, the procedure document may not contain sufficient information to successfully complete the task. Therefore, the worker might have to carry additional documents such as turnover sheets, operation experience, drawings, and other procedures to the work site. The nuclear industry is operated with paper procedures like paper catalogs of the past. A field worker may carry a large stack of documents needed to complete a task to the field. Even though the paper process has helped keep the industry safe for decades, there are limitations to using paper. Paper procedures are static (i.e., the content does not change after the document is printed), difficult to search, and rely heavily on the field worker’s situational awareness and ability to consistently meet the high expectation of human performance excellence. With computer-based procedures (CBPs) that stack of papers may be reduced to the size of a small tablet or even a smart

  19. Significance of worsening renal function and nuclear cardiology for predicting cardiac death in patients with known or suspected coronary artery disease.

    PubMed

    Yoda, Shunichi; Nakanishi, Kanae; Tano, Ayako; Hori, Yusuke; Suzuki, Yasuyuki; Matsumoto, Naoya; Hirayama, Atsushi

    2015-11-01

    Estimated glomerular filtration rates (eGFRs) at baseline are useful to determine the severity of renal function and to predict cardiac events. However, no studies aimed to demonstrate significance of eGFRs measured during follow-up and usefulness of combination with nuclear cardiology for prediction of cardiac death in patients with coronary artery disease (CAD). We retrospectively investigated 1739 patients with known/suspected CAD who underwent myocardial perfusion single photon emission computed tomography (SPECT), who had eGFRs measured at baseline and after one year and who underwent a three-year follow-up. The SPECT images were analyzed with the visual scoring model to estimate summed defect scores. Reduction in eGFRs (ΔeGFR) was defined as the difference between eGFRs measured after one year and at baseline. The endpoint of the follow-up was cardiac deaths within three years after the SPECT, which were identified with medical records or responses to posted questionnaires. Cardiac death was observed in 54 of 1739 patients during the follow-up period (45.6±9.1 months). The multivariate Cox regression analysis showed baseline eGFRs, ΔeGFR, and summed stress scores to be significant independent variables for prediction of cardiac death. The area under receiver operating characteristic curves for detection of cardiac death was 0.677 for the baseline eGFR and 0.802 for the follow-up eGFR. Sensitivity of detection of cardiac death was significantly higher in the follow-up eGFR than in the baseline eGFR (p=0.0002). Combination of the best cut-off values, i.e. 9 for the summed stress scores and 10 for the ΔeGFR, which were suggested by receiver operating characteristic analysis, was useful for risk stratification of cardiac death both in patients with and without chronic kidney disease. Baseline and follow-up eGFRs as well as nuclear variables are useful to predict cardiac death in patients with known/suspected CAD. Copyright © 2015 Japanese College of

  20. COMPUTERIZATION OF NUCLEAR POWER PLANT EMERGENCY OPERATING PROCEDURES.

    SciTech Connect

    OHARA,J.M.; HIGGINS,J.; STUBLER,W.

    2000-07-30

    Emergency operating procedures (EOPs) in nuclear plants guide operators in handling significant process disturbances. Historically these procedures have been paper-based. More recently, computer-based procedure (CBP) systems have been developed to improve the usability of EOPs. The objective of this study was to establish human factors review guidance for CBP systems based on a technically valid methodology. First, a characterization of CBPs was developed for describing their key design features, including both procedure representation and functionality. Then, the research on CBPs and related areas was reviewed. This information provided the technical basis on which the guidelines were developed. For some aspects of CBPs the technical basis was insufficient to develop guidance; these aspects were identified as issues to be addressed in future research.

  1. Angioseal VIP® vs. StarClose SE® closure devices: a comparative analysis in non-cardiological procedures.

    PubMed

    Lucatelli, Pierleone; Fanelli, Fabrizio; Cannavale, Alessandro; Corona, Mario; Cirelli, Carlo; D'Adamo, Alessandro; Salvatori, Filippo M; Catalano, Carlo

    2017-02-01

    The aim of this paper was to compare the use of two different commercially available vascular closure devices (VCD), Angioseal VIP® (St. Jude Medical, St. Paul, MN, USA) and StarClose SE (Abbott Laboratories, Abbott Park, IL, USA). From January 2010 to January 2012, 347 patient underwent retrograde femoral arterial puncture for different interventional procedures (angioplasty, stenting, embolization for bleeding, fibrinolysis for ischemia and chemoembolization). Hemostasis was achieved by deployment of an Angioseal VIP® (N.=184) or StarClose SE® (N.=163). In 94 cases, the retrograde femoral access was bilateral and managed with two StarClose SE devices (N.=53) or an Angioseal VIP® plus a StarClose SE® (N.=41). Technical success was obtained in 95.1% (330/347) of patients. Overall time to hemostasis (TTH) and time to ambulation (TTA) were 5,5±1,5 min (range 3-8 min) and 6±2.5 hr (range 2-9 hours) respectively. No statistical significative difference (P>0.05) were appreciable between to groups for both TTH and TTA: Angioseal VIP® TTH was 5.3±1.4 min and StarClose SE® TTH was 5.6±1.6 min; Angioseal VIP® TTA was 5.9±1.8 hr and StarClose SE® TTA was 6.1±1.9 hr. VAS scores result underline a mild difference between two devices. Angioseal VIP® patients experience a mild to moderate pain within the first 3 minutes from the deployment. Whereas StarClose SE® patients still experience pain at 5 minutes from deployment. The device failure rate was 4.9% (17 cases) and included 13 minor complications and 4 major complications. Minor complications (3.75%) occurred during the initial phase and consisted in recurrent wound bleeding (N.=5 StarClose SE®; N.=4 Angioseal VIP®) treated with manual compression, and hematoma (N.=2 StarClose SE®; N.=2 Angioseal VIP®) that solved spontaneously. The 4 major complications (1,15%) were: 1 Angioseal-related common femoral artery (CFA) obstruction treated with surgical bypass from the CFA to the superficial femoral artery; 1

  2. Computer diagnosis in cardiology

    PubMed Central

    Ewing, Graham Wilfred; Ewing, Elena Nikolayevna

    2009-01-01

    This article reports upon the emergence of a novel cognitive, computer-based technology which may lead to significantly improved methods of cardiological diagnosis and a rapid and inexpensive method of cardiological screening. The technology ‘Virtual Scanning’ illustrates how, in blood, the reaction of proteins and their reactive substrates releases light; that the colour and intensity of this bioluminescence is unique to each reaction and it's rate; and that the development of pathologies influence cognition and visual perception. This illustrates that the function of the autonomic nervous system is linked to that of the physiological systems and that the rate of biochemical reactions, and the progression of disease, can be measured by a cognitive test procedure and used as an indication of the disease(s) affecting heart function. The article discusses the limitations of the conventional biomarker technique, and the potential value of non-invasive cognitive techniques, such as Virtual Scanning, to the medical practitioner. Finally, it discusses how the ability of Virtual Scanning to diagnose disease from its presymptomatic origins may lead to improved diagnostic accuracy and significantly reduced costs. PMID:22666689

  3. [Over diagnostic imaging in cardiology].

    PubMed

    Carpeggiani, Clara

    2014-03-01

    Medical imaging is one of the major cause of rising health care costs. Diagnostic imaging has increased more rapidly than any other component of medical care. About 5 billion imaging tests are performed worldwide each year. According to recent estimates, at least one-third of all examinations are partially or totally inappropriate. Two out of 3 imaging tests employ ionizing radiations with radiology or nuclear medicine. The medical use of radiation is the largest man-made source of radiation exposure. Medical X-rays and γ-rays are a proven human carcinogen. The attributable long-term extra-risk of cancer due to diagnostic testing is around 10% in industrialized countries. Cardiologists prescribe and/or directly perform >50% of all imaging examinations, accounting for about two-thirds of the total effective dose given to patients. The dose of common cardiological examinations may be significant: 500 chest X-rays= a stress scintigraphy with sestamibi, 750 chest X-rays= a Multislice Computed Tomography, 1,000 chest X-rays= a coronary angiography and stenting. Unfortunately, few doctors are aware of the level of radiation their patients are exposed to during radiological tests and more intensive use of ionizing testing was not associated with greater awareness. Also as a consequence of unawareness, the rate of inappropriate examinations is unacceptably high in cardiology, even for procedures with high radiation load. Higher exposure doses correspond to higher long-term risks; there are no safe doses, and all doses add up in determining the cumulative risks over a lifetime. Doctors should make every effort so that «each patient should get the right imaging exam, at the right time, with the right radiation dose», as suggested by US Food and Drug Administration in the 2010 initiative to reduce unnecessary radiation exposure from medical imaging. This is best obtained through a systematic implementation of the "3 A's strategy" proposed by the International Atomic Energy

  4. Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC).

    PubMed

    Flotats, Albert; Knuuti, Juhani; Gutberlet, Matthias; Marcassa, Claudio; Bengel, Frank M; Kaufmann, Philippe A; Rees, Michael R; Hesse, Birger

    2011-01-01

    Improvements in software and hardware have enabled the integration of dual imaging modalities into hybrid systems, which allow combined acquisition of the different data sets. Integration of positron emission tomography (PET) and computed tomography (CT) scanners into PET/CT systems has shown improvement in the management of patients with cancer over stand-alone acquired CT and PET images. Hybrid cardiac imaging either with single photon emission computed tomography (SPECT) or PET combined with CT depicts cardiac and vascular anatomical abnormalities and their physiologic consequences in a single setting and appears to offer superior information compared with either stand-alone or side-by-side interpretation of the data sets in patients with known or suspected coronary artery disease (CAD). Hybrid systems are also advantageous for the patient because of the single short dual data acquisition. However, hybrid cardiac imaging has also generated controversy with regard to which patients should undergo such integrated examination for clinical effectiveness and minimization of costs and radiation dose, and if software-based fusion of images obtained separately would be a useful alternative. The European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC) in this paper want to present a position statement of the institutions on the current roles of SPECT/CT and PET/CT hybrid cardiac imaging in patients with known or suspected CAD.

  5. [Radiation protection in interventional cardiology].

    PubMed

    Durán, Ariel

    2015-01-01

    INTERVENTIONAL: cardiology progress makes each year a greater number of procedures and increasing complexity with a very good success rate. The problem is that this progress brings greater dose of radiation not only for the patient but to occupationally exposed workers as well. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability and use of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  6. The value of CT cardiac angiography and CT calcium score testing in a modern cardiology service in New Zealand: a report of a single centre eight-year experience from 5,237 outpatient procedures.

    PubMed

    Ellis, Chris; Gamble, Greg; Edwards, Colin; van Pelt, Niels; Gabriel, Ruvin; Lowe, Boris; Christiansen, Jonathan; To, Andrew; Winch, Helen; Osborne, Mark; Ormiston, John; Legget, Malcolm

    2016-12-02

    Computed tomographic (CT) cardiac angiography is of increasing value in several areas of patient management in cardiology. We assessed the ability of CT cardiac angiography to effectively 'rule out' severe coronary stenoses in patients presenting with 'atypical' symptoms and/or an equivocal stress test, which offers a new approach to the management of coronary artery disease. We also examined the use of the CT calcium score test in cardiovascular (CVS) risk assessment. From a large single centre (Mercy Hospital) in Auckland, using a prospectively acquired, comprehensive database, we audited the entire eight-year experience of 5,169 patients (7/8/06 to 31/1/14) who underwent 5,237 64-slice computed tomographic (CT) cardiac angiogram or CT calcium score tests (GE Lightspeed scanner). From 5,169 patients there were 5,237 CT procedures. The mean patient age was 57 (SD 10) years; 42% patients were female. Of the 3,603 (69%) full CT cardiac angiogram scans, 3,509 (67%) included a calcium score test. One thousand four hundred and eighty-three (28%) of scans were a calcium score test only. Of the 3,603 (69%) full CT cardiac angiogram scans, it was possible to 'rule out' significant coronary atheroma (stenosis ≥50%) in 2,947 (82%) of these procedures. Of the 4,903 (94%) patients who had a CT calcium score test, in whom we could calculate the NZ Framingham-based CVS risk, it was possible to reassign 532 (22%) of these patients who were previously thought to be at 'low risk' to be at a higher CVS risk. CT cardiac angiography has become established in the modern management of cardiology patients. It has particular value as a tool to 'rule out' severe coronary stenoses, and as a tool to give a more accurate assessment of CVS risk. It adds significant value to the care of many patients within an established cardiology practice.

  7. Hammersmith cardiology workshop series. Volume 3

    SciTech Connect

    Maseri, A.; Sobel, B.E.; Chierchia, S.

    1987-01-01

    This book contains over 40 selections. Some of the titles are: Nuclear Cardiology: A Decade of Clinical Use for the Detection of Coronary Artery Disease; Characterization of Ischemic Myocardium with Positron Emission Tomography; Postmortem Findings in Acute Myocardial Infarction; Mechanisms of Coronary Obstructions; and Correlation Between Exercise Stress Testing and Coronary Angiography.

  8. [Differential diagnostics of Parkinson's disease with nuclear medicine procedures].

    PubMed

    Meyer, P T; Amtage, F; Hellwig, S

    2014-06-01

    Early differential diagnosis of parkinsonism is of paramount therapeutic and prognostic importance. In the present review, the diagnostic value of routinely used nuclear medicine procedures is presented and critically discussed. The [(123)I]FP-CIT single-photon emission computed tomography (SPECT) is the method of choice for differentiation between neurodegenerative and non-neurodegenerative parkinsonism. The [(18)F]fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) method provides a very high diagnostic accuracy for differentiating between Parkinson's disease (PD) and atypical Parkinsonian syndromes (APS), which is clearly superior to the accuracy of [(123)I]FP-CIT SPECT, [(123)I]IBZM SPECT and [(123)I]MIBG scintigraphy. Furthermore, [(18)F]FDG-PET is the only of the aforementioned techniques that also allows a reliable differentiation between APS subgroups (e.g., multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration). Current studies are investigating the probable value of [(18)F]FDG-PET for risk stratification of dementia in PD.

  9. Current trends in the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology member countries: 2015 report from the European Heart Rhythm Association.

    PubMed

    Raatikainen, M J Pekka; Arnar, David O; Zeppenfeld, Katja; Merino, Jose Luis; Kuck, Karl-Heinz; Hindricks, Gerhardt

    2015-08-01

    The aim was to provide comprehensive information on the use of cardiac implantable electronic device (CIED) and catheter ablation therapy in the European Society of Cardiology (ESC) area. The European Heart Rhythm Association (EHRA) has collected data on use of invasive arrhythmia managements since 2008. Fifty-one of the 56 ESC member countries provided data for the EHRA White Book 2015. This analysis is based on the current and previous editions of the EHRA White Book. Up-to-date information on procedure rates for the last 5 years together with information on economic resources, reimbursement systems, and training requirements are presented for each country and the five geographical ESC regions. In 2014, the CIED implantation rates per million population were highest in the Western followed by the Southern and Northern European countries. The catheter ablation activity was largest in the Western followed by the Northern and Southern areas. Altogether the procedure rates were lowest in the Eastern European and in the non-European ESC countries. In the European ESC countries, the procedure rates were 3-10 times higher than in the non-European ESC countries. However, in some countries with a relatively low gross domestic product the procedure rates exceeded the average values indicating that utilization of arrhythmia therapies was not driven merely by the economic factors. This analysis indicates that considerable heterogeneity in the availability and utilization of arrhythmia therapies still exist across the ESC area. The data will hopefully aid in directing future activities and promote harmonization of cardiac arrhythmia care in the ESC countries. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  10. [Perspectives in cardiological research].

    PubMed

    Kübler, W

    2004-08-01

    German cardiological research is confronted with increasing difficulties. Clinical research is restricted by regulations, such as the working hours protecting law, the revised version of the legal articles against corruption and acceptance of advantage as well as by many parts of law for the general frame of the university structures. In addition more and more administrative duties are tranferred to doctors engaged in research. Furthermore cardiology is at a disadvantage as only part of the net profits for cardiological services are tranferred to the responsible clinic. Likewise the facilities for cooperation are increasingly restricted, as basic science institutions originally allocated to cardiological research, are now devoted to other subjects and as many pharmaceutical firms have left the country. Cardiology in our country is practically not supported by private research organizations. Research projects are, therefore, predominantly financed by grants from the Bundeministerium für Bildung und Forschung and by the Deutsche Forschungsgemeinschaft. The financial resources for research in our country are declining and much smaller compared, e. g., to the USA. As a consequence of the shortage of resources not only are the weak projects turned down; it is feared that also the very innovative projects are likewise excluded for entering unknown territory. In periods of financial restrictions the central office and the experts evaluating the projects have a special responsibility, which cannot be met by technical objections, such as e. g., an "unsufficient impact factor". In order to improve the conditions for cardiological research the net profits for cardiological services should be transferred unrestricted to the responsible clinic. The acceptance rate of cardiologcal projects may be increased by more intensive cooperation. At the end, the principle of help by self-help also applies to cardiological research; the British Heart Foundation has developed into an

  11. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The CO...

  12. 48 CFR 1850.403 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Special procedures for unusually hazardous or nuclear risks. 1850.403 Section 1850.403 Federal Acquisition Regulations System... Residual Powers 1850.403 Special procedures for unusually hazardous or nuclear risks. ...

  13. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The CO...

  14. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The CO...

  15. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The CO...

  16. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The...

  17. 48 CFR 1850.403 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Special procedures for unusually hazardous or nuclear risks. 1850.403 Section 1850.403 Federal Acquisition Regulations System... Residual Powers 1850.403 Special procedures for unusually hazardous or nuclear risks....

  18. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following information...

  19. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following information...

  20. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following information...

  1. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following information...

  2. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following...

  3. Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association.

    PubMed

    Raatikainen, M J Pekka; Arnar, David O; Merkely, Bela; Camm, A John; Hindricks, Gerhardt

    2016-08-01

    The aim of this analysis was to provide comprehensive information on the access to and use of cardiac implantable electronic device (CIED) and catheter ablation therapy in the European Society of Cardiology (ESC) area. The European Heart Rhythm Association (EHRA) has been collecting descriptive and quantitative data on invasive arrhythmia therapies since 2008. This year 50 of the 56 ESC member countries provided data for the EHRA White Book. Up-to-date information on procedure rates for the last 5 years together with information on demographics, economy, vital statistics, local healthcare systems, and training activities is presented for each country and the 5 geographical ESC regions. Our analysis indicated that considerable heterogeneity in the access to arrhythmia therapies still exists across the ESC area. In 2015, the CIED implantation rates per million population were highest in the Western followed by the Southern and Northern European countries. The catheter ablation activity was largest in the Western followed by the Northern and Southern areas. Overall, the procedure rates were 3-10 times higher in the European than in the non-European ESC countries. Economic resources were not the only driver for utilization of arrhythmia therapies as in some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. These data will help the healthcare professionals and stakeholders to identify and to understand in more depth the trends, disparities, and gaps in cardiac arrhythmia care and thereby promote harmonization of cardiac arrhythmias therapies in the ESC area. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  4. 2014 update on interventional cardiology.

    PubMed

    Hernández Hernández, Felipe; de la Torre Hernández, José M; Rumoroso Cuevas, José R; García del Blanco, Bruno; Martínez-Sellés, Manuel; Trillo Nouche, Ramiro

    2015-04-01

    This article reviews the most relevant publications and studies in the field of interventional cardiology in 2014. In the area of coronary interventional procedures, integrated treatment of acute coronary syndrome continues to be the subject of numerous studies that evaluate different devices and pharmacological and mechanical strategies that can be used without increasing the risk of hemorrhage or the need for reintervention. Certain anatomical substrates continue to generate a considerable number of publications, both on the outcomes with different stents and on the use of specific techniques. Bioabsorbable drug-eluting stents are used in increasingly complex lesions with promising results. The development of interventional procedures for structural heart disease continues to advance, with new evidence on percutaneously placed aortic valve prostheses, the outcome of percutaneous mitral valve repair, and the safety and efficacy of left atrial appendage occlusion. Finally, renal denervation has generated one of the major debates of the year. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Update on interventional cardiology 2013.

    PubMed

    Hernández Hernández, Felipe; Rumoroso Cuevas, José Ramón; García Del Blanco, Bruno; Trillo Nouche, Ramiro

    2014-04-01

    The present article reviews the most important publications and studies in the field of interventional cardiology in 2013. Coronary interventions for ST-segment elevation myocardial infarction are among the most important, with studies that assess different devices and pharmacologic and mechanical strategies in primary angioplasty. Increasingly large groups of patients (with diabetes, of advanced age) and the best coronary revascularization strategy are also the focus of exhaustive research. Percutaneous procedures in the left main coronary artery continue to give rise to a significant number of publications, both because of the results of using different types of stent and because of the intravascular imaging techniques used to guide procedures and the results of their use. New bioabsorbable polymer-coated drug-eluting stents or bioresorbable drug-eluting scaffolds are being compared with second-generation drug-eluting stents to show their efficacy in preventing restenosis and reducing incidence of late thrombosis. Percutaneous treatment of structural heart disease continues to produce many publications, especially regarding percutaneous aortic prostheses, but also on closure of foramen ovale and of left atrial appendage. Finally, renal denervation continues to arouse much interest in the medical literature. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  6. Artificial intelligence in cardiology.

    PubMed

    Bonderman, Diana

    2017-10-04

    Decision-making is complex in modern medicine and should ideally be based on available data, structured knowledge and proper interpretation in the context of an individual patient. Automated algorithms, also termed artificial intelligence that are able to extract meaningful patterns from data collections and build decisions upon identified patterns may be useful assistants in clinical decision-making processes. In this article, artificial intelligence-based studies in clinical cardiology are reviewed. The text also touches on the ethical issues and speculates on the future roles of automated algorithms versus clinicians in cardiology and medicine in general.

  7. [Quality assurance in interventional cardiology].

    PubMed

    Gülker, H

    2009-10-01

    Quality assurance in clinical studies aiming at approval of pharmaceutical products is submitted to strict rules, controls and auditing regulations. Comparative instruments to ensure quality in diagnostic and therapeutic procedures are not available in interventional cardiology, likewise in other fields of cardiovascular medicine. Quality assurance simply consists of "quality registers" with basic data not externally controlled. Based on the experiences of clinical studies and their long history of standardization it is assumed that these data may be severely flawed thus being inappropriate to set standards for diagnostic and therapeutic strategies. The precondition for quality assurance are quality data. In invasive coronary angiography and intervention medical indications, the decision making process interventional versus surgical revascularization, technical performance and after - care are essential aspects affecting quality of diagnostics and therapy. Quality data are externally controlled data. To collect quality data an appropriate infrastructure is a necessary precondition which is not existent. For an appropriate infrastructure investments have to be done both to build up as well as to sustain the necessary preconditions. As long as there are no infrastructure and no investments there will be no "quality data". There exist simply registers of data which are not proved to be a basis for significant assurance and enhancement in quality in interventional coronary cardiology. Georg Thieme Verlag KG Stuttgart, New York.

  8. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks. ...

  9. 48 CFR 1850.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Special procedures for unusually hazardous or nuclear risks. 1850.104-3 Section 1850.104-3 Federal Acquisition Regulations System... nuclear risks. (a) Indemnification requests. (1) Contractor indemnification requests must be submitted to...

  10. 48 CFR 1850.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Special procedures for unusually hazardous or nuclear risks. 1850.104-3 Section 1850.104-3 Federal Acquisition Regulations System... nuclear risks. (a) Indemnification requests. (1) Contractor indemnification requests must be submitted to...

  11. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks. ...

  12. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks. ...

  13. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks. ...

  14. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks....

  15. Trends in radiation exposure from clinical nuclear medicine procedures in Shanghai, China.

    PubMed

    Yi, Yanling; Zheng, Junzheng; Zhuo, Weihai; Gao, Linfeng

    2012-03-01

    This study was designed to assess the trends in the frequencies of nuclear medicine procedures in Shanghai, China, and to determine their contributions to the per capita effective dose to the Shanghai population. The mean activities of radionuclides administered by nuclear medicine departments were compared with the Chinese national guidelines on diagnostic reference levels. On the basis of the three surveys carried out by Shanghai Municipal Center for Disease Control and Prevention in 1996, 1998, and 2008, the typically administered radiopharmaceuticals, levels of activity, the number of procedures, and population were systematically analyzed to assess the frequencies of nuclear medicine procedures and the per capita effective dose. The frequencies were approximately 2.77, 3.46, and 6.63 per 1000 people in 1996, 1998, and 2008, respectively. The annual per capita doses from diagnostic nuclear medicine were estimated to be 0.016, 0.022, and 0.032 mSv in 1996, 1998, and 2008, respectively. The annual frequency of therapeutic nuclear medicine procedures increased from 0.131 to 0.430 per 1000 people in the intervening 12 years. In the 12 years before 2008, diagnostic and therapeutic procedures in nuclear medicine in Shanghai increased continuously, and the annual per capita dose doubled. Increases in PET imaging and bone scans were the major contributors to the increasing frequency and magnitude of radiation exposure to the population. The activities administered for most diagnostic procedures were generally consistent with the designated reference levels.

  16. A Decade of Information on the Use of Cardiac Implantable Electronic Devices and Interventional Electrophysiological Procedures in the European Society of Cardiology Countries: 2017 Report from the European Heart Rhythm Association.

    PubMed

    Raatikainen, M J Pekka; Arnar, David O; Merkely, Bela; Nielsen, Jens Cosedis; Hindricks, Gerhard; Heidbuchel, Hein; Camm, John

    2017-08-01

    The aim of this analysis was to provide comprehensive information on invasive cardiac arrhythmia therapies in the European Society of Cardiology (ESC) area over the past 10 years. The European Heart Rhythm Association (EHRA) has collected data on invasive arrhythmia therapies since 2008. This year 53 of the 56 ESC member countries provided data for the EHRA White Book. Here we present updated data on procedure rates together with information on demographics, economy, vital statistics, local healthcare systems and training activities. Considerable heterogeneity in the access to invasive arrhythmia therapies still exists across the five geographical ESC regions. In 2016, the device implantation rates per million population were 3-6 times higher in the Western region than in the non-European and Eastern ESC member countries. Catheter ablation activity was highest in the Western countries followed by the Northern and Southern areas. In the non-European countries, atrial fibrillation ablation rate was more than tenfold lower than in the European countries. On the other hand, the growth rate over the past ten years was highest in the non-European and Eastern countries. In some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. It was encouraging to note that during the past decade the growth in invasive arrhythmia therapies was greatest in the areas historically with relatively low activity. Nevertheless, there is substantial disparity and continued efforts are needed to improve harmonization of cardiac arrhythmia therapies in the ESC area.

  17. Japanese consensus guidelines for pediatric nuclear medicine. Part 1: Pediatric radiopharmaceutical administered doses (JSNM pediatric dosage card). Part 2: Technical considerations for pediatric nuclear medicine imaging procedures.

    PubMed

    Koizumi, Kiyoshi; Masaki, Hidekazu; Matsuda, Hiroshi; Uchiyama, Mayuki; Okuno, Mitsuo; Oguma, Eiji; Onuma, Hiroshi; Kanegawa, Kimio; Kanaya, Shinichi; Kamiyama, Hiroshi; Karasawa, Kensuke; Kitamura, Masayuki; Kida, Tetsuo; Kono, Tatsuo; Kondo, Chisato; Sasaki, Masayuki; Terada, Hitoshi; Nakanishi, Atsushi; Hashimoto, Teisuke; Hataya, Hiroshi; Hamano, Shin-ichiro; Hirono, Keishi; Fujita, Yukihiko; Hoshino, Ken; Yano, Masayuki; Watanabe, Seiichi

    2014-06-01

    The Japanese Society of Nuclear Medicine has recently published the consensus guidelines for pediatric nuclear medicine. This article is the English version of the guidelines. Part 1 proposes the dose optimization in pediatric nuclear medicine studies. Part 2 comprehensively discusses imaging techniques for the appropriate conduct of pediatric nuclear medicine procedures, considering the characteristics of imaging in children.

  18. Building a cardiology practice.

    PubMed

    Greenberg, David I; Blonder, Ronald D; Eastburn, Ted E; Smith, G Scott; Schwartz, David J; Miller, James B; Glass, James M; Lee, Joseph R; Ascarelli, E David; Rosenbaum, David A; Harris, Nita G; Mantia, William; Keledjian, Laura M

    2004-01-01

    This study was designed to quantify the clinical and marketing effectiveness of the Pocket EKG Clinical Based Marketing Program by measuring its impact on new patient visits, patient satisfaction, payor negotiations, and patient management at Pikes Peak Cardiology (PPC), Colorado Springs, Colorado. New patient visits were found to increase by 22% for 6.5 consecutive years. Ninety-two percent of patients surveyed found that the Pocket EKG Card promoted loyalty to the cardiology practice. The Pocket EKG Patient Satisfaction Survey was proven to satisfy Health Plan Employer Data and Information Set (HEDIS) guidelines as required in payor contracting. Finally, access to a baseline electrocardiogram contributed to a 54% reduction in unnecessary hospitalization. The Pocket EKG Clinical Based Marketing Program proved to successfully market PPC to its three customers: patients, payors, and primary care physicians.

  19. Hanford spent nuclear fuel hot conditioning system test procedure

    SciTech Connect

    Cleveland, K.J.

    1997-09-16

    This document provides the test procedures for cold testing of the prototype Hot Conditioning System (HCS) at the 306E Facility. The primary objective of this testing is to confirm design choices and provide data for the detailed design package prior to procurement of the process equipment. The current scope of testing in this document includes a fabricability study of the HCS, equipment performance testing of the HCS components, heat-up and cool-down cycle simulation, and robotic arm testing.

  20. [Gender differences in cardiology].

    PubMed

    Hochleitner, Margarethe; Bader, Angelika

    2003-01-01

    Frequent reports of gender differences in cardiology prompted us to study the cardiological situation in Tyrol, Austria, from 1995 to 2000. Mortality statistics for heart deaths 1995: women 1008 (53.5%), men 875 (46.5%); 2000: women 1104 (58.2%), men 792 (41.8%). Coronary heart deaths 1995: women 572 (50.0%), men 571 (50.0%); 2000: women 634 (54.4%), men 531 (45.6%). Angiograms 1995: women 332 (33.9%), men 646 (66.1%); 2000: women 688 (32.5%), men 1429 (67.5%). Bypass surgery 1995: women 54 (33.0%), men 156 (67.0%); 2000: women 42 (27.5%), men 157 (72.5%). Heart deaths 1995-2000: women +9.5%, men -9.5%; coronary heart deaths 1995-2000: women +10.8%, men -7.0%. By (welcome) contrast, coronary angiograms 1995-2000: women +107.2%, men +121.2%. Bypass operations 1995-2000: women -22.2%, men +0.6%. Life expectancy 1995-2000: women +0.6%, men +0.6%. Patient age at heart death 1995-2000: women +1.8%, men +2.5%. In aggregate, we see that for decades more women than men have died a heart death, but that cardiac mortalities remain a typically "male bastion" with persistent gender differences in access to clinical cardiology. The worsening trend for women begs for awareness programs and corresponding preventive measures.

  1. Routine Quality Control of Clinical Nuclear Medicine Instrumentation: A Brief Review*

    PubMed Central

    Zanzonico, Pat

    2009-01-01

    This article reviews routine quality-control (QC) procedures for current nuclear medicine instrumentation, including the survey meter, dose calibrator, well counter, intraoperative probe, organ (“thyroid”) uptake probe, γ-camera, SPECT and SPECT/CT scanner, and PET and PET/CT scanner. It should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. The procedures described and their respective frequencies are presented only as general guidelines. PMID:18587088

  2. Routine quality control of clinical nuclear medicine instrumentation: a brief review.

    PubMed

    Zanzonico, Pat

    2008-07-01

    This article reviews routine quality-control (QC) procedures for current nuclear medicine instrumentation, including the survey meter, dose calibrator, well counter, intraoperative probe, organ ("thyroid") uptake probe, gamma-camera, SPECT and SPECT/CT scanner, and PET and PET/CT scanner. It should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. The procedures described and their respective frequencies are presented only as general guidelines.

  3. Radiation monitoring in interventional cardiology: a requirement

    NASA Astrophysics Data System (ADS)

    Rivera, T.; Uruchurtu, E. S.

    2017-01-01

    The increasing of procedures using fluoroscopy in interventional cardiology procedures may increase medical and patients to levels of radiation that manifest in unintended outcomes. Such outcomes may include skin injury and cancer. The cardiologists and other staff members in interventional cardiology are usually working close to the area under examination and they receive the dose primarily from scattered radiation from the patient. Mexico does not have a formal policy for monitoring and recording the radiation dose delivered in hemodynamic establishments. Deterministic risk management can be improved by monitoring the radiation delivered from X-ray devices. The objective of this paper is to provide cardiologist, techniques, nurses, and all medical staff an information on DR levels, about X-ray risks and a simple a reliable method to control cumulative dose.

  4. Women in interventional cardiology: Is there a problem?

    PubMed

    Safian, Robert D

    2016-03-01

    In the United States, women account for 4% of interventional cardiologists and perform 3% of interventional procedures. Male and female cardiology fellows share concerns that dissuade them from careers in interventional cardiology; unique issues for women include professional isolation and childbearing. Interventional fellowships should enhance female mentorship and develop friendly policies regarding maternity leave; other issues require comprehensive solutions to medical school debt, duration of training, and balancing professional goals with lifestyle.

  5. [Technique and humanization in invasive cardiology].

    PubMed

    Tambone, V; Fagioli, V; Ragusa, V

    2001-01-01

    The technique used in invasive cardiology, in special way in the PTCA, is here considered technique of first and second order (Donati's classification). This kind of technique is a chance to improve the physician-nurse relationship with patient and the knowledge of the patient on his/her own body. We must use this technique in order to get better the relation with the patient trough an excellent information during all the procedure.

  6. Improvement of canine somatic cell nuclear transfer procedure.

    PubMed

    Jang, G; Oh, H J; Kim, M K; Fibrianto, Y H; Hossein, M S; Kim, H J; Kim, J J; Hong, S G; Park, J E; Kang, S K; Lee, B C

    2008-01-15

    The purpose of the present study on canine somatic cell nuclear transfer (SCNT) was to evaluate the effects of fusion strength, type of activation, culture media and site of transfer on developmental potential of SCNT embryos. We also examined the potential of enucleated bovine oocytes to serve as cytoplast recipients of canine somatic cells. Firstly, we evaluated the morphological characteristics of in vivo-matured canine oocytes collected by retrograde flushing of the oviducts 72 h after ovulation. Secondly, the effectiveness of three electrical strengths (1.8, 2.3 and 3.3 kV/cm), used twice for 20 micros, on fusion of canine cytoplasts with somatic cells were compared. Then, we compared: (1) chemical versus electrical activation (a) after parthenogenetic activation or (b) after reconstruction of canine oocytes with somatic cells; (2) culture of resulting intergeneric (IG) embryos in either (a) mSOF or (b) TCM-199. The exposure time to 6-DMAP was standardized by using bovine oocytes reconstructed with canine somatic cells. Bovine oocytes were used for SCNT after a 22 h in vitro maturation interval. The fusion rate was significantly higher in the 3.3 kV/cm group than in the 1.8 and 2.3 kV/cm treatment groups. After parthenogenesis or SCNT with chemical activation, 3.4 and 5.8%, respectively, of the embryos developed to the morula stage, as compared to none of the embryos produced using electrical activation. Later developmental stages (8-16 cells) were transferred to the uterine horn of eight recipients, but no pregnancy was detected. However, IG cloned embryos (bovine cytoplast/canine somatic cell) were capable of in vitro blastocyst development. In vitro developmental competence of IG cloned embryos was improved after exposure to 6-DMAP for 4 h as compared to 0, 2 or 6h exposure, although the increase was not significantly different among culture media. In summary, for production of canine SCNT embryos, we recommend fusion at 3.3 kV/cm, chemical activation

  7. [Epistemology in cardiology].

    PubMed

    de Micheli, A

    1988-01-01

    The probabilistic character of several scientific laws, is emphasized. Some considerations are formulated about epistemology: the critical study of the principles, hypotheses and results of sciences. The evolution of medical epistemology and its implications in the field of cardiology is also described from the hippocratic treatises to the present. In former works the oldest use of the word hypothesis with the sense of supposition, is found. Finally remains to be established the relationship between the individual and general field i.e. between a patient, the isolated object of study, and the disease as an abstraction of the human mind.

  8. Cardiology Still a Man's Field, Survey Finds

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_162700.html Cardiology Still a Man's Field, Survey Finds Women less ... Dr. Claire Duvernoy, chair of the Women in Cardiology Council at the American College of Cardiology (ACC). ...

  9. Guidelines and procedures for design of Class 1 elevated temperature nuclear system components

    SciTech Connect

    Not Available

    1986-09-01

    This standard provides guidelines and procedures which may be used by the manufacturer in satisfying the requirements given for design of class 1 elevated temperature nuclear system components. Guidance is given regarding planning and control of design analysis. A sequence for calculations is recommended. Methods of analysis, including procedures to account for environmental effects, are given which are acceptable in principle to the owner. A format is provided for use in documentation of design analyses.

  10. Computer-Based Procedures for Field Workers in Nuclear Power Plants: Development of a Model of Procedure Usage and Identification of Requirements

    SciTech Connect

    Katya Le Blanc; Johanna Oxstrand

    2012-04-01

    The nuclear industry is constantly trying to find ways to decrease the human error rate, especially the human errors associated with procedure use. As a step toward the goal of improving procedure use performance, researchers, together with the nuclear industry, have been looking at replacing the current paper-based procedures with computer-based procedure systems. The concept of computer-based procedures is not new by any means; however most research has focused on procedures used in the main control room. Procedures reviewed in these efforts are mainly emergency operating procedures and normal operating procedures. Based on lessons learned for these previous efforts we are now exploring a more unknown application for computer based procedures - field procedures, i.e. procedures used by nuclear equipment operators and maintenance technicians. The Idaho National Laboratory and participants from the U.S. commercial nuclear industry are collaborating in an applied research effort with the objective of developing requirements and specifications for a computer-based procedure system to be used by field workers. The goal is to identify the types of human errors that can be mitigated by using computer-based procedures and how to best design the computer-based procedures to do so. This paper describes the development of a Model of Procedure Use and the qualitative study on which the model is based. The study was conducted in collaboration with four nuclear utilities and five research institutes. During the qualitative study and the model development requirements and for computer-based procedures were identified.

  11. 48 CFR 1850.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Special procedures for unusually hazardous or nuclear risks. 1850.104-3 Section 1850.104-3 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CONTRACT MANAGEMENT EXTRAORDINARY CONTRACTUAL ACTIONS AND THE SAFETY ACT Extraordinary Contractual...

  12. Nuclear cardiac

    SciTech Connect

    Slutsky, R.; Ashburn, W.L.

    1982-01-01

    The relationship between nuclear medicine and cardiology has continued to produce a surfeit of interesting, illuminating, and important reports involving the analysis of cardiac function, perfusion, and metabolism. To simplify the presentation, this review is broken down into three major subheadings: analysis of myocardial perfusion; imaging of the recent myocardial infarction; and the evaluation of myocardial function. There appears to be an increasingly important relationship between cardiology, particularly cardiac physiology, and nuclear imaging techniques. (KRM)

  13. Triggering radiation alarm at security checks. Patients should be informed even after diagnostic nuclear medicine procedures.

    PubMed

    Palumbo, Barbara; Neumann, Irmgard; Havlik, Ernst; Palumbo, Renato; Sinzinger, Helmut

    2009-01-01

    During the last few years an increasing number of nuclear medicine patients in various countries evoked a radiation alarm after therapeutic or diagnostic procedures, and even after passive exposure. A prospective calculation of activity retention in the patient's body is difficult due to extremely high variation of uptake and kinetics. Furthermore, different sensitivities and distances of the detectors make a prospective calculation even more difficult. In this article a number of cases are being reported, related problems are discussed and the surprisingly very limited literature reviewed. In order to minimize problems after eventually triggering alarms, we strongly recommend that each patient receives a certificate providing personal data, tracer, dose, half-life of the radionuclide, type and date of procedure applied as well as the nuclear medicine unit to contact for further information. Furthermore, a closer cooperation and exchange of information between the authorities and local nuclear medicine societies, would be welcome.

  14. Trends of population radiation adsorbed dose from diagnostic nuclear medicine procedures in Iran: 1985-1989

    SciTech Connect

    Mohammadi, H.; Tabeie, F.; Saghari, M.

    1995-04-01

    In view of the rapid expansion of diagnostic nuclear medicine procedures in Iran, this study was undertaken to examine trends of nuclear medicine practice in the country and to determine the mean effective dose equivalent per patient and per capita. Comprehensive national data covering 93% of all nuclear medicine centers in 1985-1989 were obtained. The total number of nuclear medicine examinations inc teased by 42% during these years. The relative frequency of thyroid investigations was 84% followed by liver/spleen and bone procedures (7% and 6%, respectively). {sup 99m}Tc was the radionuclide of choice for 86% of investigation while {sup 131}I alone accounted for 59% of collective effective dose equivalent. The annual average number of nuclear medicine procedures per 1,000 people was 1.9. For the thyroid, the highest number (48%) of patients investigated was in the 15-29 y age group and the lowest (3%) was in the >64 y age group. The male to female ratio of thyroid and cardiac patient was 0.18 and 3.64, respectively. The numbers of males and females studied for the remaining eight procedures were less frequent and about the same. The mean effective dose equivalent per patient and per capita was about 4.3 mSv and 8 {mu}Sv, respectively. {sup 131}I was responsible for most of collective effective dose equivalent produced by nuclear medicine. Therefore, future efforts should be concentrated on dose reduction for diagnostic {sup 131}I tests.

  15. [Fetus radiation doses from nuclear medicine and radiology diagnostic procedures. Potential risks and radiation protection instructions].

    PubMed

    Markou, Pavlos

    2007-01-01

    Although in pregnancy it is strongly recommended to avoid diagnostic nuclear medicine and radiology procedures, in cases of clinical necessity or when pregnancy is not known to the physician, these diagnostic procedures are to be applied. In such cases, counseling based on accurate information and comprehensive discussion about the risks of radiation exposure to the fetus should follow. In this article, estimations of the absorbed radiation doses due to nuclear medicine and radiology diagnostic procedures during the pregnancy and their possible risk effects to the fetus are examined and then discussed. Stochastic and detrimental effects are evaluated with respect to other risk factors and related to the fetus absorbed radiation dose and to the post-conception age. The possible termination of a pregnancy, due to radiation exposure is discussed. Special radiation protection instructions are given for radiation exposures in cases of possible, confirmed or unknown pregnancies. It is concluded that nuclear medicine and radiology diagnostic procedures, if not repeated during the pregnancy, are rarely an indication for the termination of pregnancy, because the dose received by the fetus is expected to be less than 100 mSv, which indicates the threshold dose for having deterministic effects. Therefore, the risk for the fetus due to these diagnostic procedures is low. However, stochastic effects are still possible but will be minimized if the radiation absorbed dose to the fetus is kept as low as possible.

  16. A probabilistic seismic risk assessment procedure for nuclear power plants: (I) Methodology

    USGS Publications Warehouse

    Huang, Y.-N.; Whittaker, A.S.; Luco, N.

    2011-01-01

    A new procedure for probabilistic seismic risk assessment of nuclear power plants (NPPs) is proposed. This procedure modifies the current procedures using tools developed recently for performance-based earthquake engineering of buildings. The proposed procedure uses (a) response-based fragility curves to represent the capacity of structural and nonstructural components of NPPs, (b) nonlinear response-history analysis to characterize the demands on those components, and (c) Monte Carlo simulations to determine the damage state of the components. The use of response-rather than ground-motion-based fragility curves enables the curves to be independent of seismic hazard and closely related to component capacity. The use of Monte Carlo procedure enables the correlation in the responses of components to be directly included in the risk assessment. An example of the methodology is presented in a companion paper to demonstrate its use and provide the technical basis for aspects of the methodology. ?? 2011 Published by Elsevier B.V.

  17. Avicenna's contribution to cardiology.

    PubMed

    Chamsi-Pasha, Mohammed A R; Chamsi-Pasha, Hassan

    2014-01-01

    Ibn Sina, known in the West as Avicenna, was the most famous and influential of all the Islamic philosopher-scientists. His most important medical works are the Canon of Medicine medical encyclopedia and a treatise on cardiac drugs. His Canon of Medicine remained the standard text in both the East and West until the 16(th) century. Avicenna's description of cardiac diseases was logically presented perhaps for the first time in the history of medicine. Avicenna was the first to describe carotid sinus hypersensitivity, which presents with vasovagal syncope. He was a pioneer in pulsology and the first correct explanation of pulsation was given by Avicenna, after he refined Galen's theory of the pulse. Besides, he discussed the action of available drugs on the heart in details and mentioned their indications and contraindications. In conclusion, Avicenna made important contributions to cardiology. This article describes some of his contributions in this field.

  18. Methods in molecular cardiology

    PubMed Central

    de Theije, C.C.; de Windt, L.J.; Doevendans, P.A.

    2002-01-01

    Sequencing is one the major breakthroughs in molecular cardiology. The development of this technique has made it possible to determine the exact order of the nucleotides in DNA. The exact order is relevant for the formation of proteins, through the genetic code. Sequencing is even more important for the identification of genetic variation and disease-causing mutations. The elucidation of the human genome is based on the continuous improvement of this technique, reducing the cost and increasing efficiency. Initially, complex chemical reactions were performed using isotopes to unravel the base sequence in genes. Nowadays, fluorescent capillary-based techniques are available to determine the genetic information. Here, the historical development of the technique is described. In addition, examples are provided on how sequencing is used in clinical medicine. ImagesFigure 2Figure 3Figure 8Figure 9 PMID:25696079

  19. Sources and magnitude of occupational and public exposures from nuclear medicine procedures

    SciTech Connect

    1996-03-11

    This Report addresses the sources of exposures incurred in the practice of nuclear medicine and provides the necessary data to evaluate the magnitude of exposures to those directly associated with that practice and to those who provide nursing care to the patients containing radiopharmaceuticals. Exposure to members of the public are also addressed. The primary emphasis of this Report is on these individuals and not on the patient, since the patient receives the direct benefit from the nuclear medicine procedure. It is recognized that the patient also receives the bulk of any potential radiation decrement.

  20. Optimized procedure of extraction, purification and proteomic analysis of nuclear proteins from mouse brain.

    PubMed

    Jankowska, Urszula; Latosinska, Agnieszka; Skupien-Rabian, Bozena; Swiderska, Bianka; Dziedzicka-Wasylewska, Marta; Kedracka-Krok, Sylwia

    2016-03-01

    The cell nucleus is a highly dynamic subcellular compartment performing crucial processes for functioning and administration of the cell. Proteomic analysis of isolated nuclear fraction enables in-depth insight into these processes leading to better understanding of physiological and pathological state of the brain. There is no universal method for nuclear proteome investigation and each biological material needs individual optimization. An additional difficulty is the large amount of nucleic acids, which impairs isoelectrofocusing of proteins and shotgun mass spectrometry analysis of complex peptide samples. We performed the first comprehensive optimization of intact nuclei isolation from mouse brain in combination with nuclear protein purification prior to two-dimensional gel electrophoresis (2DE) and gel-free proteomic analysis. Application of sonication, digestion with nuclease and protein precipitation with acetone allowed to obtain high quality 2DE gels. Shotgun mass spectrometry analysis of isolated proteins proved an enrichment in nuclear proteins. The 66.4% of 265 identified proteins had assigned nucleus localization in UniProt database. Gene Ontology analysis using DAVID platform revealed the highest fold enrichment in spliceosome (24.5), nuclear periphery (12.4) and nuclear matrix (11.3). The proposed procedure is tailored to mouse brain tissue nuclear subproteome investigation. The quality of isolated nuclei, the effectiveness of the protein purification, efficiency of protein recovery after precipitation and overall method reproducibility was taken into detailed consideration. The elaborated procedure could be further applied for in-depth proteomic analysis of molecular processes occurring in the mouse brain nucleus. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Roles of nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance: Noninvasive risk stratification and a conceptual framework for the selection of noninvasive imaging tests in patients with known or suspected coronary artery disease.

    PubMed

    Berman, Daniel S; Hachamovitch, Rory; Shaw, Leslee J; Friedman, John D; Hayes, Sean W; Thomson, Louise E J; Fieno, David S; Germano, Guido; Wong, Nathan D; Kang, Xingping; Rozanski, Alan

    2006-07-01

    This review deals with noninvasive imaging for risk stratification and with a conceptual approach to the selection of noninvasive tests in patients with suspected or known chronic coronary artery disease (CAD). Already widely acknowledged with SPECT, there is an increasing body of literature data demonstrating that CT coronary calcium assessment is also of prognostic value. The amount of coronary atherosclerosis, as can be extrapolated from CT coronary calcium score, has been shown to be highly predictive of cardiac events. The principal difference between myocardial perfusion SPECT (MPS) and CT coronary calcium for prognostic application appears to be that the former is an excellent tool for assessing short-term risk, thus effectively guiding decisions regarding revascularization. In contrast, the atherosclerosis imaging methods are likely to provide greater long-term risk assessment and, thus, are more useful in determination of the need for aggressive medical prevention measures. Although the more recent development of CT coronary angiography is promising for diagnosis, there has been no information to date regarding the prognostic value of the CT angiographic data. Similarly, cardiac MRI has not yet been adequately studied for its prognostic content. The selection of the most appropriate test for a given patient depends on the specific question being asked. In patients with a very low likelihood of CAD, no imaging test may be required. In screening the remaining asymptomatic patients, atherosclerosis imaging may be beneficial. In symptomatic patients, MPS, CT coronary angiography, and cardiac MRI play important roles. We consider it likely that, with an increased emphasis on prevention and a concomitant aging of the population, many forms of noninvasive cardiac imaging will continue to grow, with nuclear cardiology continuing to grow.

  2. Computer–Based Procedures for Nuclear Power Plant Field Workers: Preliminary Results from Two Evaluation Studies

    SciTech Connect

    Katya L Le Blanc; Johanna H Oxstrand

    2013-10-01

    The Idaho National Laboratory and participants from the U.S. nuclear industry are collaborating on a research effort aimed to augment the existing guidance on computer-based procedure (CBP) design with specific guidance on how to design CBP user interfaces such that they support procedure execution in ways that exceed the capabilities of paper-based procedures (PBPs) without introducing new errors. Researchers are employing an iterative process where the human factors issues and interface design principles related to CBP usage are systematically addressed and evaluated in realistic settings. This paper describes the process of developing a CBP prototype and the two studies conducted to evaluate the prototype. The results indicate that CBPs may improve performance by reducing errors, but may increase the time it takes to complete procedural tasks.

  3. Procedure for conducting a human-reliability analysis for nuclear power plants. Final report

    SciTech Connect

    Bell, B.J.; Swain, A.D.

    1983-05-01

    This document describes in detail a procedure to be followed in conducting a human reliability analysis as part of a probabilistic risk assessment when such an analysis is performed according to the methods described in NUREG/CR-1278, Handbook for Human Reliability Analysis with Emphasis on Nuclear Power Plant Applications. An overview of the procedure describing the major elements of a human reliability analysis is presented along with a detailed description of each element and an example of an actual analysis. An appendix consists of some sample human reliability analysis problems for further study.

  4. Using cost/risk procedures to establish recovery criteria following a nuclear reactor accident.

    PubMed

    Tawil, J J; Strenge, D L

    1987-02-01

    In the event of a major accidental release of radionuclides at a nuclear power plant, large populated areas could become seriously contaminated. Local officials would be responsible for establishing radiation recovery criteria that would permit the evacuated population to return safely to their jobs and homes. The range of acceptable criteria could imply variations in property losses in the billions of dollars. Given the likely public concern over the health consequences and the enormity of the potential property losses, a cost/risk analysis can provide important input to establishing the recovery criteria. This paper describes procedures for conducting a cost/risk analysis of a site radiologically contaminated by a nuclear power plant accident. The procedures are illustrated by analyzing a hypothetically contaminated site, using software developed for determining the property and health effects of major reactor accidents.

  5. Nuclear Hardness Evaluation Procedures for the Preliminary Assessment of the FLEETSATCOM Attitude and Velocity Control Subsystem.

    DTIC Science & Technology

    1979-12-01

    attitude and velocity control subsystem of the FLSATCOM satellite to various nuclear weapon effects. DD1473 E ITION OF INOV 6 IS OBSOLETE...thermomechanical damage and material degradation. These procedures are presented in Section 3. 3) the so-called top-level screen of the AVCS assessment which ETI...bays with cat-a-lac paint, a low Z material , to minimize cavity field coupling. 44 0 use of terminal protection, mostly in the form of zener diodes or

  6. Computer-based procedure for field activities: Results from three evaluations at nuclear power plants

    SciTech Connect

    Oxstrand, Johanna; bly, Aaron; LeBlanc, Katya

    2014-09-01

    Nearly all activities that involve human interaction with the systems of a nuclear power plant are guided by procedures. The paper-based procedures (PBPs) currently used by industry have a demonstrated history of ensuring safety; however, improving procedure use could yield tremendous savings in increased efficiency and safety. One potential way to improve procedure-based activities is through the use of computer-based procedures (CBPs). Computer-based procedures provide the opportunity to incorporate context driven job aids, such as drawings, photos, just-in-time training, etc into CBP system. One obvious advantage of this capability is reducing the time spent tracking down the applicable documentation. Additionally, human performance tools can be integrated in the CBP system in such way that helps the worker focus on the task rather than the tools. Some tools can be completely incorporated into the CBP system, such as pre-job briefs, placekeeping, correct component verification, and peer checks. Other tools can be partly integrated in a fashion that reduces the time and labor required, such as concurrent and independent verification. Another benefit of CBPs compared to PBPs is dynamic procedure presentation. PBPs are static documents which limits the degree to which the information presented can be tailored to the task and conditions when the procedure is executed. The CBP system could be configured to display only the relevant steps based on operating mode, plant status, and the task at hand. A dynamic presentation of the procedure (also known as context-sensitive procedures) will guide the user down the path of relevant steps based on the current conditions. This feature will reduce the user’s workload and inherently reduce the risk of incorrectly marking a step as not applicable and the risk of incorrectly performing a step that should be marked as not applicable. As part of the Department of Energy’s (DOE) Light Water Reactors Sustainability Program

  7. Stochastic online appointment scheduling of multi-step sequential procedures in nuclear medicine.

    PubMed

    Pérez, Eduardo; Ntaimo, Lewis; Malavé, César O; Bailey, Carla; McCormack, Peter

    2013-12-01

    The increased demand for medical diagnosis procedures has been recognized as one of the contributors to the rise of health care costs in the U.S. in the last few years. Nuclear medicine is a subspecialty of radiology that uses advanced technology and radiopharmaceuticals for the diagnosis and treatment of medical conditions. Procedures in nuclear medicine require the use of radiopharmaceuticals, are multi-step, and have to be performed under strict time window constraints. These characteristics make the scheduling of patients and resources in nuclear medicine challenging. In this work, we derive a stochastic online scheduling algorithm for patient and resource scheduling in nuclear medicine departments which take into account the time constraints imposed by the decay of the radiopharmaceuticals and the stochastic nature of the system when scheduling patients. We report on a computational study of the new methodology applied to a real clinic. We use both patient and clinic performance measures in our study. The results show that the new method schedules about 600 more patients per year on average than a scheduling policy that was used in practice by improving the way limited resources are managed at the clinic. The new methodology finds the best start time and resources to be used for each appointment. Furthermore, the new method decreases patient waiting time for an appointment by about two days on average.

  8. Lack of radiological awareness among physicians working in a tertiary-care cardiological centre.

    PubMed

    Correia, Maria Joao; Hellies, Arianna; Andreassi, Maria Grazia; Ghelarducci, Bruno; Picano, Eugenio

    2005-09-01

    Medical irradiation is the most important artificial source of exposure to ionising radiations in Europe and implies biorisks. To assess the level of radiological awareness in a tertiary-care referral centre of adult-pediatric cardiological excellence. One hundred physicians (31 women, age=41+/-8 years) were polled with a simple, one-page, multiple choice questionnaire. Twenty-five physicians worked in a pediatric, 75 in an adult cardiology centre. Eighty-nine of the polled physicians wrongly estimated the contribution of nuclear and radiological tests in overall radiation exposure of average US inhabitant as <0.01% (36% of physicians) or <1% (31%) or <10% (22%) (correct answer given by 11% of physicians: >10%). Ninety-five physicians wrongly estimated the risk of fatal cancer associated with a stress myocardial perfusion scintigraphy procedure as "zero" (48%) or "<1 in 10 million"(19%) or "<1 in 1 million" (28%) (correct answer given by 5%: >1 in 10,000 tests). Seventy-one wrongly estimated the dose exposure of a myocardial stress perfusion scintigraphy as equal to one (13%), or one-half (9%), or three times (49%) that of a chest X-ray (correct answer given by 29%: 500 times). The average level of radiological awareness was not correlated to the number of radiological-nuclear exams performed/prescribed per year and to the type of (adult or pediatric) working environment. Physicians working in an adult and pediatric cardiological environment of excellence are largely unaware of environmental impact, biorisks and dose exposure of the ionising exams they prescribe and/or perform daily.

  9. A Procedure to Obtain the Effective Nuclear Charge from the Atomic Spectrum of Sodium

    NASA Astrophysics Data System (ADS)

    Sala*, O.; Araki, Koiti; Noda, L. K.

    1999-09-01

    The penetration of the valence electron orbitals of the alkali metals into their inner shells and its effect on the energy levels can be considered through two methods that take into account modifications of the hydrogen formula (one-electron system). One of them considers the quantum defect, modifying the quantum number n; the other considers the effective nuclear charge Z* replacing the nuclear charge Z. The method using the quantum defect is widely used because this quantity is practically constant for a given angular momentum quantum number l. However, the method using effective nuclear charge is more realistic because it explains many atomic and molecular properties - but the effective nuclear charge depends on l as well as on the principal quantum number n. This article describes a relatively simple graphical procedure to calculate the effective nuclear charges experienced by the sodium valence electron from its atomic spectrum. A relation of Z* with n for a given l is obtained and the Z* values for all states of the valence electron are found; the energy terms can also be determined. The calculations can be performed by using common spreadsheet software.

  10. Current global and Korean issues in radiation safety of nuclear medicine procedures.

    PubMed

    Song, H C

    2016-06-01

    In recent years, the management of patient doses in medical imaging has evolved as concern about radiation exposure has increased. Efforts and techniques to reduce radiation doses are focussed not only on the basis of patient safety, but also on the fundamentals of justification and optimisation in cooperation with international organisations such as the International Commission on Radiological Protection, the International Atomic Energy Agency, and the World Health Organization. The Image Gently campaign in children and Image Wisely campaign in adults to lower radiation doses have been initiated in the USA. The European Association of Nuclear Medicine paediatric dosage card, North American consensus guidelines, and Nuclear Medicine Global Initiative have recommended the activities of radiopharmaceuticals that should be administered in children. Diagnostic reference levels (DRLs), developed predominantly in Europe, may be an important tool to manage patient doses. In Korea, overexposure to radiation, even from the use of medical imaging, has become a public issue, particularly since the accident at the Fukushima nuclear power plant. As a result, the Korean Nuclear Safety and Security Commission revised the technical standards for radiation safety management in medical fields. In parallel, DRLs for nuclear medicine procedures have been collected on a nationwide scale. Notice of total effective dose from positron emission tomography-computed tomography for cancer screening has been mandatory since mid-November 2014. © The International Society for Prosthetics and Orthotics.

  11. Procedure and information displays in advanced nuclear control rooms: experimental evaluation of an integrated design.

    PubMed

    Chen, Yue; Gao, Qin; Song, Fei; Li, Zhizhong; Wang, Yufan

    2017-02-13

    In the main control rooms of nuclear power plants, operators frequently have to switch between procedure displays and system information displays. In this study, we proposed an operation-unit-based integrated design, which combines the two displays to facilitate the synthesis of information. We grouped actions that complete a single goal into operation units and showed these operation units on the displays of system states. In addition, we used different levels of visual salience to highlight the current unit and provided a list of execution history records. A laboratory experiment, with 42 students performing a simulated procedure to deal with unexpected high pressuriser level, was conducted to compare this design against an action-based integrated design and the existing separated-displays design. The results indicate that our operation-unit-based integrated design yields the best performance in terms of time and completion rate and helped more participants to detect unexpected system failures. Practitioner Summary: In current nuclear control rooms, operators frequently have to switch between procedure and system information displays. We developed an integrated design that incorporates procedure information into system displays. A laboratory study showed that the proposed design significantly improved participants' performance and increased the probability of detecting unexpected system failures.

  12. Radiation dose produced by patients during radiopharmaceutical incorporation in nuclear medicine diagnostic procedures.

    PubMed

    Morán, V; Prieto, E; García-García, B; Barbés, B; Ribelles, M J; Richter, J Á; Martí-Climent, J M

    2016-01-01

    The aim of this study was to assess the dose received by members of the public due to close contact with patients undergoing nuclear medicine procedures during radiopharmaceutical incorporation, and comparing it with the emitted radiation dose when the test was complete, in order to establish recommendations. A prospective study was conducted on 194 patients. H*(10) dose rates were measured at 0.1, 0.5, and 1.0m after the radiopharmaceutical administration, before the image acquisition, and at the end of the nuclear medicine procedure. Effective dose for different close contact scenarios were calculated, according to 95th percentile value (bone scans) and the maximum value (remaining tests). During the radiopharmaceutical incorporation, a person who stays with another injected patient in the same waiting room may receive up to 0.59 mSv. If the patient had a medical appointment, or went to a restaurant or a coffee shop, members of the public could receive 23, 43, and 22 μSv, respectively. After finishing the procedure, these doses are reduced by a factor 3. In most of the studies, the use of private instead of public transport may reduce the dose by more than a factor 6. It is recommended to increase the distance between the patients during the radiopharmaceutical incorporation and to distribute them according to the diagnostic procedure. Patients should be encouraged to use private instead of public transport. Depending on the number of nuclear medicine outpatients per year attended by a physician, it could be necessary to apply restrictions. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  13. Geriatric Cardiology: An Emerging Discipline

    PubMed Central

    Dodson, John A.; Matlock, Daniel D.; Forman, Daniel E.

    2017-01-01

    Given changing demographics, patients with cardiovascular (CV) disease in developed countries are now older and more complex than even a decade ago. This trend is expected to continue into the foreseeable future; accordingly, cardiologists in practice are encountering patients with a greater number of comorbid illnesses as well as “geriatric conditions” such as cognitive impairment and frailty which complicate management and influence outcomes. Simultaneously, technological advances have widened the therapeutic options available for patients, including those with the most advanced CV disease. In the setting of these changes, geriatric cardiology has recently emerged as a discipline that aims to adapt principles from geriatric medicine into everyday cardiology practice. Accordingly, the tasks of a “geriatric cardiologist” may include both traditional evidence-based CV management plus comprehensive geriatric assessment, medication reduction, team-based coordination of care, and explicit incorporation of patient goals into management. Given that the field is still in its relative infancy, the training pathways and structure of clinical programs in geriatric cardiology are still being delineated. In this review we highlight the rationale behind geriatric cardiology as a discipline, several current approaches by geriatric cardiology programs, and future directions for the field. PMID:27476988

  14. Geriatric Cardiology: An Emerging Discipline.

    PubMed

    Dodson, John A; Matlock, Daniel D; Forman, Daniel E

    2016-09-01

    Given changing demographics, patients with cardiovascular (CV) disease in developed countries are now older and more complex than even a decade ago. This trend is expected to continue into the foreseeable future; accordingly, cardiologists are encountering patients with a greater number of comorbid illnesses as well as "geriatric conditions," such as cognitive impairment and frailty, which complicate management and influence outcomes. Simultaneously, technological advances have widened the therapeutic options available for patients, including those with the most advanced CV disease. In the setting of these changes, geriatric cardiology has recently emerged as a discipline that aims to adapt principles from geriatric medicine to everyday cardiology practice. Accordingly, the tasks of a "geriatric cardiologist" may include both traditional evidence-based CV management plus comprehensive geriatric assessment, medication reduction, team-based coordination of care, and explicit incorporation of patient goals into management. Given that the field is still in its relative infancy, the training pathways and structure of clinical programs in geriatric cardiology are still being delineated. In this review, we highlight the rationale behind geriatric cardiology as a discipline, several current approaches by geriatric cardiology programs, and future directions for the field. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  15. How to Practice Sports Cardiology: A Cardiology Perspective.

    PubMed

    Lawless, Christine E

    2015-07-01

    The rigorous cardiovascular (CV) demands of sport, combined with training-related cardiac adaptations, render the athlete a truly unique CV patient and sports cardiology a truly unique discipline. Cardiologists are advised to adopt a systematic approach to the CV evaluation of athletes, taking into consideration the individual sports culture, sports-specific CV demands, CV adaptations and their appearance on cardiac testing, any existing or potential interaction of the heart with the internal and external sports environment, short- and long-term CV risks, and potential effect of performance-enhancing agents and antidoping regulations. This article outlines the systematic approach, provides a detailed example, and outlines contemporary sports cardiology core competencies.

  16. Pediatric Cardiology in India: Onset of a New Era.

    PubMed

    Kumar, Dinesh; Bagri, Narendra

    2015-07-01

    Pediatric cardiology is outgrowing from the shadows of adult cardiology and cardiac surgery departments in India. It promises to be an attractive and sought-after subspeciality of Pediatrics, dealing with not only congenital cardiac diseases but also metabolic, rheumatic and host of other cardiac diseases. The new government policy shall provide more training avenues for the budding pediatric cardiologists, pediatric cardiac surgeons, pediatric anesthetists, pediatric cardiac intensivists, neonatologists and a host of supportive workforce. The proactive role of Indian Academy of Pediatrics and Pediatric Cardiac Society of India, towards creating a political will at the highest level for framing policies towards building infrastructure, training of workforce and subsidies for pediatric cardiac surgeries and procedures shall fuel the development of multiple tertiary cardiac centers in the country, making pediatric cardiology services accessible to the needy population.

  17. Mental workload measurement for emergency operating procedures in digital nuclear power plants.

    PubMed

    Gao, Qin; Wang, Yang; Song, Fei; Li, Zhizhong; Dong, Xiaolu

    2013-01-01

    Mental workload is a major consideration for the design of emergency operation procedures (EOPs) in nuclear power plants. Continuous and objective measures are desired. This paper compares seven mental workload measurement methods (pupil size, blink rate, blink duration, heart rate variability, parasympathetic/sympathetic ratio, total power and (Goals, Operations, Methods, and Section Rules)-(Keystroke Level Model) GOMS-KLM-based workload index) with regard to sensitivity, validity and intrusiveness. Eighteen participants performed two computerised EOPs of different complexity levels, and mental workload measures were collected during the experiment. The results show that the blink rate is sensitive to both the difference in the overall task complexity and changes in peak complexity within EOPs, that the error rate is sensitive to the level of arousal and correlate to the step error rate and that blink duration increases over the task period in both low and high complexity EOPs. Cardiac measures were able to distinguish tasks with different overall complexity. The intrusiveness of the physiological instruments is acceptable. Finally, the six physiological measures were integrated using group method of data handling to predict perceived overall mental workload. The study compared seven measures for evaluating the mental workload with emergency operation procedure in nuclear power plants. An experiment with simulated procedures was carried out, and the results show that eye response measures are useful for assessing temporal changes of workload whereas cardiac measures are useful for evaluating the overall workload.

  18. REVIEW Of COMPUTERIZED PROCEDURE GUIDELINES FOR NUCLEAR POWER PLANT CONTROL ROOMS

    SciTech Connect

    David I Gertman; Katya Le Blanc; Ronald L Boring

    2011-09-01

    Computerized procedures (CPs) are recognized as an emerging alternative to paper-based procedures for supporting control room operators in nuclear power plants undergoing life extension and in the concept of operations for advanced reactor designs. CPs potentially reduce operator workload, yield increases in efficiency, and provide for greater resilience. Yet, CPs may also adversely impact human and plant performance if not designed and implemented properly. Therefore, it is important to ensure that existing guidance is sufficient to provide for proper implementation and monitoring of CPs. In this paper, human performance issues were identified based on a review of the behavioral science literature, research on computerized procedures in nuclear and other industries, and a review of industry experience with CPs. The review of human performance issues led to the identification of a number of technical gaps in available guidance sources. To address some of the gaps, we developed 13 supplemental guidelines to support design and safety. This paper presents these guidelines and the case for further research.

  19. Final report on repair procedure of strong ground motion data from underground nuclear tests

    SciTech Connect

    Tunnell, T.W.

    1995-04-01

    Certain difficulties arise when recording close-in around motion from underground nuclear explosions. Data quality can be compromised by a variety of factors, including electromagnetic pulse, noise spikes, direct current effect, and gauge clipping and gauge tilt. From March 1988 through September 1994, EG&G Energy Measurements repaired strong round-motion data (acceleration data) from underground nuclear tests for the Los Alamos National Laboratory using, an automated repair procedure. The automated repair determined and implemented the required repairs based on user input and a consistent set of criteria. A log was kept of each repair so that the repair procedure could be duplicated. This relaxed the requirement to save the repaired data. Developed for the VAX system, the procedure allowed the user to stack up a large number of repairs, plot the repaired data, and obtain hard copies. The plotted data could then be reviewed for a given test to determine the consistency of repair for a given underground test. This feature released the user to perform other tasks while the data were being repaired.

  20. Collective effective dose in Europe from X-ray and nuclear medicine procedures.

    PubMed

    Bly, R; Jahnen, A; Järvinen, H; Olerud, H; Vassileva, J; Vogiatzi, S

    2015-07-01

    Population doses from radiodiagnostic (X-ray and nuclear medicine) procedures in Europe were estimated based on data collected from 36 European countries. For X-ray procedures in EU and EFTA countries (except Liechtenstein) the collective effective dose is 547,500 man Sv, resulting in a mean effective dose of 1.06 mSv per caput. For all European countries included in the survey the collective effective dose is 605,000 man Sv, resulting in a mean effective dose of 1.05 mSv per caput. For nuclear medicine procedures in EU countries and EFTA (except Liechtenstein) countries the collective effective dose is 30,700 man Sv, resulting in a mean effective dose of 0.06 mSv per caput. For all European countries included in the survey the collective effective dose is 31,100 man Sv, resulting in a mean effective dose of 0.05 mSv per caput. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital.

    PubMed

    Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

    2014-10-01

    Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments.

  2. Improving Performance in a Nuclear Cardiology Department

    ERIC Educational Resources Information Center

    LaFleur, Doug; Smalley, Karolyn; Austin, John

    2005-01-01

    Improving performance in the medical industry is an area that is ideally suited for the tools advocated by the International Society of Performance Improvement (ISPI). This paper describes an application of the tools that have been developed by Dale Brethower and Geary Rummler, two pillars of the performance improvement industry. It allows the…

  3. Nuclear cardiology: Myocardial perfusion and function

    SciTech Connect

    Seldin, D.W. )

    1991-08-01

    Myocardial perfusion studies continue to be a major focus of research, with new investigations of the relationship of exercise-redistribution thallium imaging to diagnosis, prognosis, and case management. The redistribution phenomenon, which seemed to be fairly well understood a few years ago, is now recognized to be much more complex than originally thought, and various strategies have been proposed to clarify the meaning of persistent defects. Pharmacologic intervention with dipyridamole and adenosine has become available as an alternative to exercise, and comparisons with exercise imaging and catheterization results have been described. Thallium itself is no longer the sole single-photon perfusion radiopharmaceutical; two new technetium agents are now widely available. In addition to perfusion studies, advances in the study of ventricular function have been made, including reports of studies performed in conjunction with technetium perfusion studies, new insights into cardiac physiology, and the prognostic and case-management information that function studies provide. Finally, work has continued with monoclonal antibodies for the identification of areas of myocyte necrosis. 41 references.

  4. Improving Performance in a Nuclear Cardiology Department

    ERIC Educational Resources Information Center

    LaFleur, Doug; Smalley, Karolyn; Austin, John

    2005-01-01

    Improving performance in the medical industry is an area that is ideally suited for the tools advocated by the International Society of Performance Improvement (ISPI). This paper describes an application of the tools that have been developed by Dale Brethower and Geary Rummler, two pillars of the performance improvement industry. It allows the…

  5. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false What procedures are to be used to transfer real property at defense nuclear facilities for economic development? 770.7 Section 770.7 Energy DEPARTMENT OF ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7 What procedures are to be used to transfer real property...

  6. Recent Advances in Invasive Cardiology

    PubMed Central

    Garbe, George J.

    1987-01-01

    This paper describes recent advances in invasive cardiology that enable the primary-care physician to offer his/her patient a wider range of effective treatments. Major developments in the investigation and management of the acute coronary syndromes, unstable angina and myocardial infarction, have revolutionized the care of patients with these conditions. The primary-care physician must be aware of the treatment modalities, the lines of referral, and strategies for management available in his/her clinical setting to allow prompt application of these modalities. A sampling of exciting advances in other areas of invasive cardiology are also described. PMID:21263906

  7. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false What procedures are to be used to transfer real property at defense nuclear facilities for economic development? 770.7 Section 770.7 Energy DEPARTMENT OF ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7...

  8. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false What procedures are to be used to transfer real property at defense nuclear facilities for economic development? 770.7 Section 770.7 Energy DEPARTMENT OF ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7...

  9. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false What procedures are to be used to transfer real property at defense nuclear facilities for economic development? 770.7 Section 770.7 Energy DEPARTMENT OF ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7...

  10. ICTS, an interventional cardiology training system.

    PubMed

    Cotin, S; Dawson, S L; Meglan, D; Shaffer, D W; Ferrell, M A; Bardsley, R S; Morgan, F M; Nagano, T; Nikom, J; Sherman, P; Walterman, M T; Wendlandt, J

    2000-01-01

    In this article, we present an Interventional Cardiology Training System developed by the Medical Application Group at Mitsubishi Electric in collaboration with the Center for Innovative Minimally Invasive Therapy. The core of the ICTS is a computer simulation of interventional cardiology catheterization. This simulation integrates clinical expertise, research in learning, and technical innovations to create a realistic simulated environment. The goal of this training system is to augment the training of new cardiology fellows as well as to introduce cardiologists to new devices and procedures. To achieve this goal, both the technical components and the educational content of the ICTS bring new and unique features: a simulated fluoroscope, a physics model of a catheter, a haptic interface, a fluid flow simulation combined with a hemodynamic model and a learning system integrated in a user interface. The simulator is currently able to generate--in real-time--high quality x-ray images from a 3D anatomical model of the thorax, including a beating heart and animated lungs. The heart and lung motion is controlled by the hemodynamic model, which also computes blood pressure and EKG. The blood flow is then calculated according to the blood pressure and blood vessel characteristics. Any vascular tool, such as a catheter, guide wire or angioplasty balloon can be represented and accurately deformed by the flexible tool physics model. The haptics device controls the tool and provides appropriate feedback when contact with a vessel wall is detected. When the catheter is in place, a contrast agent can be injected into the coronary arteries; blood and contrast mixing is computed and a visual representation of the angiogram is displayed by the x-ray renderer. By bringing key advances in the area of medical simulation--with the real-time x-ray renderer for instance--and by integrating in a single system both high quality simulation and learning tools, the ICTS opens new

  11. Graphic user interface-based nuclear medicine reporting system.

    PubMed

    Sanger, J J

    1993-03-01

    A graphically based, computerized report generation program has been developed and deployed at a dozen nuclear medicine facilities. The system is based on the Macintosh graphical user interface (GUI) and has been designed to be easy to learn and use. The system allows the nuclear medicine practitioner to generate reports for any nuclear medicine or nuclear cardiology procedure without transcriptionist support, dramatically decreasing report turnaround time. The system includes a relational database engine that allows cost-effective storage and rapid retrieval of final reports and also supports facsimile transmission of reports directly to referring clinicians' offices.

  12. An integrated computer-based procedure for teamwork in digital nuclear power plants.

    PubMed

    Gao, Qin; Yu, Wenzhu; Jiang, Xiang; Song, Fei; Pan, Jiajie; Li, Zhizhong

    2015-01-01

    Computer-based procedures (CBPs) are expected to improve operator performance in nuclear power plants (NPPs), but they may reduce the openness of interaction between team members and harm teamwork consequently. To support teamwork in the main control room of an NPP, this study proposed a team-level integrated CBP that presents team members' operation status and execution histories to one another. Through a laboratory experiment, we compared the new integrated design and the existing individual CBP design. Sixty participants, randomly divided into twenty teams of three people each, were assigned to the two conditions to perform simulated emergency operating procedures. The results showed that compared with the existing CBP design, the integrated CBP reduced the effort of team communication and improved team transparency. The results suggest that this novel design is effective to optim team process, but its impact on the behavioural outcomes may be moderated by more factors, such as task duration. The study proposed and evaluated a team-level integrated computer-based procedure, which present team members' operation status and execution history to one another. The experimental results show that compared with the traditional procedure design, the integrated design reduces the effort of team communication and improves team transparency.

  13. Physician Requirements-1990. For Cardiology.

    ERIC Educational Resources Information Center

    Tracy, Octavious; Birchette-Pierce, Cheryl

    Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…

  14. Sedation practice for paediatric nuclear medicine procedures in Denmark related to EANM guidelines.

    PubMed

    Andersson, Linda; Andersen, Trine Borup; Petersen, Lars J

    2015-01-01

    The objective of this study was to examine sedation practices for paediatric nuclear medicine examinations. A questionnaire was sent to all nuclear medicine departments in Denmark about sedation practices during 2012. The response rate was 100% (18 departments). Three departments did not examine children at all. The total number of paediatric examinations among the remaining 15 sites varied from 20 to 1,583 (median 191). Sedation practice showed that approximately 50% of the sites regularly (>50% of the patients) used pharmacological sedation for renography in children aged 6-12 months and 1-3 years. A minority of centres (∼15%) regularly used sedation in children aged 0-6 months, and no sites regularly used sedation in children aged and 4-6 years. Similar findings were found for renal scintigraphy. However, one large site used no sedation in children aged 1-3 years for renography but approximately 50% of patients used it in the same age group receiving renal scintigraphy with SPET. There was a trend for reduced use of sedation with increasing total number of paediatric medicine procedures. The most frequently used agents were benzodiazepines and barbiturates. The most common route of administration was rectal, oral, and intravenous. The sedation practices varied considerably among Danish nuclear medicine departments. The sedation of children in clinical practice seemed to be more prevalent than is recommended by guidelines.

  15. Mobile Apps in Cardiology: Review

    PubMed Central

    2013-01-01

    Background Cardiovascular diseases are the deadliest diseases worldwide, with 17.3 million deaths in 2008 alone. Among them, heart-related deaths are of the utmost relevance; a fact easily proven by the 7.25 million deaths caused by ischemic heart disease alone in that year. The latest advances in smartphones and mHealth have been used in the creation of thousands of medical apps related to cardiology, which can help to reduce these mortality rates. Objective The aim of this paper is to study the literature on mobile systems and applications currently available, as well as the existing apps related to cardiology from the leading app stores and to then classify the results to see what is available and what is missing, focusing particularly on commercial apps. Methods Two reviews have been developed. One is a literature review of mobile systems and applications, retrieved from several databases and systems such as Scopus, PubMed, IEEE Xplore, and Web of Knowledge. The other is a review of mobile apps in the leading app stores, Google play for Android and Apple’s App Store for iOS. Results Search queries up to May 2013 located 406 papers and 710 apps related to cardiology and heart disease. The most researched section in the literature associated with cardiology is related to mobile heart (and vital signs) monitoring systems and the methods involved in the classification of heart signs in order to detect abnormal functions. Other systems with a significant number of papers are mobile cardiac rehabilitation systems, blood pressure measurement, and systems for the detection of heart failure. The majority of apps for cardiology are heart monitors and medical calculators. Other categories with a high number of apps are those for ECG education and interpretation, cardiology news and journals, blood pressure tracking, heart rate monitoring using an external device, and CPR instruction. There are very few guides on cardiac rehabilitation and apps for the management of the

  16. Mobile apps in cardiology: review.

    PubMed

    Martínez-Pérez, Borja; de la Torre-Díez, Isabel; López-Coronado, Miguel; Herreros-González, Jesús

    2013-07-24

    Cardiovascular diseases are the deadliest diseases worldwide, with 17.3 million deaths in 2008 alone. Among them, heart-related deaths are of the utmost relevance; a fact easily proven by the 7.25 million deaths caused by ischemic heart disease alone in that year. The latest advances in smartphones and mHealth have been used in the creation of thousands of medical apps related to cardiology, which can help to reduce these mortality rates. The aim of this paper is to study the literature on mobile systems and applications currently available, as well as the existing apps related to cardiology from the leading app stores and to then classify the results to see what is available and what is missing, focusing particularly on commercial apps. Two reviews have been developed. One is a literature review of mobile systems and applications, retrieved from several databases and systems such as Scopus, PubMed, IEEE Xplore, and Web of Knowledge. The other is a review of mobile apps in the leading app stores, Google play for Android and Apple's App Store for iOS. Search queries up to May 2013 located 406 papers and 710 apps related to cardiology and heart disease. The most researched section in the literature associated with cardiology is related to mobile heart (and vital signs) monitoring systems and the methods involved in the classification of heart signs in order to detect abnormal functions. Other systems with a significant number of papers are mobile cardiac rehabilitation systems, blood pressure measurement, and systems for the detection of heart failure. The majority of apps for cardiology are heart monitors and medical calculators. Other categories with a high number of apps are those for ECG education and interpretation, cardiology news and journals, blood pressure tracking, heart rate monitoring using an external device, and CPR instruction. There are very few guides on cardiac rehabilitation and apps for the management of the cardiac condition, and there were no

  17. History of German pediatric cardiology.

    PubMed

    Heintzen, P

    2002-01-01

    Due to the isolation of German medicine in World War II accompanied by the destruction of many hospitals, German pediatricians did not show any serious interest in the treatment of children with congenital heart diseases, nor did they take notice of the progress achieved by Helen Taussig, Alfred Blalock and other cardiologists and surgeons in the western world. This problem was even worse in East Germany. Only a few German internists and forward-looking surgeons were able and ready to take care of this group of principally operable children in places like Bonn/Düsseldorf, Marburg/Munich, Berlin, and Hamburg. However, in the early 1950s some directors of pediatrics at university hospitals--largely motivated by the cardiac surgeons--allowed or even encouraged younger colleagues to concentrate on pediatric cardiology and to begin application of heart catheterization and angiocardiography. In 1960 a group of colleagues interested in pediatric cardiology met for the first time in Frankfurt and became the nucleus of the future "working group" (1969) and finally the "German Society of Pediatric Cardiology" (1974). By 1972 pediatric cardiology had been approved as an independent (sub)specialty. Colleagues and friends from surrounding countries (Austria, Great Britain, Sweden, Switzerland, and the Netherlands) and also from the US and some eastern countries were either members or regular guests during or between the meetings. Pediatric cardiology is now represented in Germany by specialized practitioners, trainees and assistants who work in both community and university hospitals, and in specialized departments. Due to the foresightedness of the Chief of Pediatrics, Prof. G. Joppich, the first Chair of Pediatric Cardiology was founded in Göttingen in 1960 under the direction of A. Beuren. Another model of interdisciplinary cooperation between pediatric cardiologists, bioengineers, mathematicians and computer scientists was established in Kiel in 1966. In other places

  18. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital

    PubMed Central

    Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

    2014-01-01

    Context: Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. Aim: The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. Materials and Methods: A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. Results: The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. Conclusion: ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments. PMID:25400363

  19. [Problems in cardiology specialty training in Turkey].

    PubMed

    Altun, Armağan

    2012-04-01

    Cardiology Specialty Training in our country should be made in accordance with the law numbered 1219 on the Practice of Medicine and Related Arts, and according to the Medical and Dental Specialist Training Regulation which is published according to the 9th article of this law. The duration of Cardiology Specialist Training has been defined as 4 years in our country. The European Society of Cardiology (ESC), European Union of Medical Specialists (UEMS), and the European Cardiology Section Foundation (ECSF) define the duration of Cardiology Specialist Training as 6 years. Therefore, insufficient Cardiology residency training occurs in our country due to the shortened length of time. In this report, the problems of the Cardiology Specialist Training in Turkey will be addressed under different headings.

  20. A probabilistic seismic risk assessment procedure for nuclear power plants: (II) Application

    USGS Publications Warehouse

    Huang, Y.-N.; Whittaker, A.S.; Luco, N.

    2011-01-01

    This paper presents the procedures and results of intensity- and time-based seismic risk assessments of a sample nuclear power plant (NPP) to demonstrate the risk-assessment methodology proposed in its companion paper. The intensity-based assessments include three sets of sensitivity studies to identify the impact of the following factors on the seismic vulnerability of the sample NPP, namely: (1) the description of fragility curves for primary and secondary components of NPPs, (2) the number of simulations of NPP response required for risk assessment, and (3) the correlation in responses between NPP components. The time-based assessment is performed as a series of intensity-based assessments. The studies illustrate the utility of the response-based fragility curves and the inclusion of the correlation in the responses of NPP components directly in the risk computation. ?? 2011 Published by Elsevier B.V.

  1. [What's new in pediatric cardiology?].

    PubMed

    Bonnet, D; Sidi, D

    1999-07-01

    In recent years, close collaborations have been established between pediatric cardiology, medical and molecular genetics, fetal cardiology and pediatric radiology. As a consequence, several congenital heart defects and syndromes including cardiovascular malformations have been related to microdeletions such as 22q11 in Di George syndrome and 7q in Williams syndrome. Prenatal detection of heart malformations has become a crucial part of the management of life-threatening malformations of the neonate such as the transposition of the great arteries or the coarctation of the aorta. We are at the dawn of a new era of the development of preventive cardiovascular medicine starting from childhood thanks to new techniques of echo-tracking. Finally, three-dimensional reconstruction of heart defects by using ultrasound, X-ray or MRI have dramatically improved the diagnosis and the therapeutic strategies of cardiac diseases.

  2. Cataract Risk in a Cohort of U.S. Radiologic Technologists Performing Nuclear Medicine Procedures.

    PubMed

    Bernier, Marie-Odile; Journy, Neige; Villoing, Daphnee; Doody, Michele M; Alexander, Bruce H; Linet, Martha S; Kitahara, Cari M

    2017-10-11

    Purpose To estimate the risk of cataract in a cohort of nuclear medicine (NM) radiologic technologists on the basis of their work histories and radiation protection practices. Materials and Methods In the years 2003-2005 and 2012-2013, 42 545 radiologic technologists from a U.S. prospective study completed questionnaires in which they provided information regarding their work histories and cataract histories. Cox proportional hazards models, stratified according to birth-year cohort (born before 1940 or born in 1940 or later) and adjusted for age, sex, and race, were used to estimate hazard ratios (HRs) for the risk of cataract in radiologic technologists according to NM work history practices according to decade. Results During the follow-up period (mean follow-up, 7½ years), 7137 incident cataracts were reported. A significantly increased risk of cataract (HR, 1.08; 95% confidence interval [CI]: 1.03, 1.14) was observed among workers who performed an NM procedure at least once-as opposed to never. Risks of cataract were increased in the group who had performed a diagnostic (HR, 1.07; 95% CI: 1.01, 1.12) or therapeutic (HR, 1.10; 95% CI: 1.04, 1.17) NM procedure. Risks were higher for those who had first performed diagnostic NM procedures in the 1980s to early 2000s (HR, 1.30; 95% CI: 1.08, 1.58) and those who had performed therapeutic NM procedures in the 1970s (HR, 1.11; 95% CI: 1.01, 1.23) and in the 1980s to early 2000s (HR, 1.14; 95% CI: 1.02, 1.29). With the exception of a significantly increased risk associated with performing therapeutic NM procedures without shielding the radiation source in the 1980s (HR, 1.32; 95% CI: 1.04, 1.67), analyses revealed no association between cataract risk and specific radiation protection technique used. Conclusion An increased risk of cataract was observed among U.S. radiologic technologists who had performed an NM procedure at least once. This association should be examined in future studies incorporating estimated lens

  3. Processes and Procedures for Application of CFD to Nuclear Reactor Safety Analysis

    SciTech Connect

    Richard W. Johnson; Richard R. Schultz; Patrick J. Roache; Ismail B. Celik; William D. Pointer; Yassin A. Hassan

    2006-09-01

    Traditionally, nuclear reactor safety analysis has been performed using systems analysis codes such as RELAP5, which was developed at the INL. However, goals established by the Generation IV program, especially the desire to increase efficiency, has lead to an increase in operating temperatures for the reactors. This increase pushes reactor materials to operate towards their upper temperature limits relative to structural integrity. Because there will be some finite variation of the power density in the reactor core, there will be a potential for local hot spots to occur in the reactor vessel. Hence, it has become apparent that detailed analysis will be required to ensure that local ‘hot spots’ do not exceed safety limits. It is generally accepted that computational fluid dynamics (CFD) codes are intrinsically capable of simulating fluid dynamics and heat transport locally because they are based on ‘first principles.’ Indeed, CFD analysis has reached a fairly mature level of development, including the commercial level. However, CFD experts are aware that even though commercial codes are capable of simulating local fluid and thermal physics, great care must be taken in their application to avoid errors caused by such things as inappropriate grid meshing, low-order discretization schemes, lack of iterative convergence and inaccurate time-stepping. Just as important is the choice of a turbulence model for turbulent flow simulation. Turbulence models model the effects of turbulent transport of mass, momentum and energy, but are not necessarily applicable for wide ranges of flow types. Therefore, there is a well-recognized need to establish practices and procedures for the proper application of CFD to simulate flow physics accurately and establish the level of uncertainty of such computations. The present document represents contributions of CFD experts on what the basic practices, procedures and guidelines should be to aid CFD analysts to obtain accurate

  4. Diagnostic reference level: an important tool for reducing radiation doses in adult and pediatric nuclear medicine procedures in Brazil.

    PubMed

    Willegaignon, José; Braga, Luis F E F; Sapienza, Marcelo T; Coura-Filho, George B; Cardona, Marissa A R; Alves, Carlos E R; Gutterres, Ricardo F; Buchpiguel, Carlos A

    2016-05-01

    This study aimed to establish a concise method for determining a diagnostic reference level (DRL) for adult and pediatric nuclear medicine patients on the basis of diagnostic procedures and administered radioisotope as a means of controlling medical exposure. A screening was carried out in all Brazilian Nuclear Medicine Service (NMS) establishments to support this study by collecting the average activities administered during adult diagnostic procedures and the rules applied to adjust these according to the patient's age and body mass. Percentile 75 was used in all the activities administered as a means of establishing DRL for adult patients, with additional correction factors for pediatric patients. Radiation doses from nuclear medicine procedures on the basis of average administered activity were calculated for all diagnostic exams. A total of 107 NMSs in Brazil agreed to participate in the project. From the 64 nuclear medicine procedures studied, bone, kidney, and parathyroid scans were found to be used in more than 85% of all the NMSs analyzed. There was a large disparity among the activities administered, when applying the same procedures, this reaching, in some cases, more than 20 times between the lowest and the highest. Diagnostic exams based on Ga, Tl, and I radioisotopes proved to be the major exams administering radiation doses to patients. On introducing the DRL concept into clinical routine, the minimum reduction in radiation doses received by patients was about 15%, the maximum was 95%, and the average was 50% compared with the previously reported administered activities. Variability in the available diagnostic procedures as well as in the amount of activities administered within the same procedure was appreciable not only in Brazil, but worldwide. Global efforts are needed to establish a concise DRL that can be applied in adult and pediatric nuclear medicine procedures as the application of DRL in clinical routine has been proven to be an important

  5. [Preventive cardiology and cardiac rehabilitation].

    PubMed

    Grima-Serrano, Alberto; García-Porrero, Esteban; Luengo-Fernández, Emilio; León Latre, Montserrat

    2011-01-01

    The Preventive Cardiology and Rehabilitation Section of the Spanish Society of Cardiology provides the principal national reference point for scientific knowledge about cardiovascular risk factors in the Spanish population, about the incidence and prevalence of cardiovascular disease in Spain, and about disease prevention and the use of cardiac rehabilitation to improve the quality of life and prolong the survival of individuals already affected by the disease. By necessity, research into cardiovascular prevention involves sponsoring the implementation of studies into cardiovascular risk factors and disease occurrence. The MESYAS study is a good example. It is the fruit of the combined efforts of members of the metabolic syndrome working group belonging to our Section of the Spanish Society of Cardiology and its aim was to answer a number of unresolved questions that had arisen about the incidence, prevalence and consequences of cardiovascular disease in the Spanish population. Today, after this cohort has been followed up for more than 5 years, the first analysis of the cardiovascular events that occurred in the cohort and their relationship with individual risk factors observed many years previously has become available. Here, the metabolic syndrome working group reports some interesting findings. With the aim of communicating up-to-date information that has undergone expert review, the coordinator of the cardiac rehabilitation working group has the responsibility of summarizing, evaluating and updating the scientific data available on the important subject of the secondary prevention of cardiovascular disease. Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  6. History of Cardiology in India

    PubMed Central

    Das, Mrinal Kanti; Kumar, Soumitra; Deb, Pradip Kumar; Mishra, Sundeep

    2015-01-01

    History as a science revolves around memories, travellers' tales, fables and chroniclers' stories, gossip and trans-telephonic conversations. Medicine itself as per the puritan's definition is a non-exact science because of the probability-predictability-sensitivity-specificity factors. Howsoever, the chronicles of Cardiology in India is quite interesting and intriguing. Heart and circulation was known to humankind from pre-Vedic era. Various therapeutics measures including the role of Yoga and transcendental meditation in curing cardiovascular diseases were known in India. Only recently there has been resurgence of the same globally. There have been very few innovations in Cardiology in India. The cause of this paucity possibly lie in the limited resources. This has a vicious effect on the research mentality of the population who are busy in meeting their daily requirements. This socio-scientific aspect needs a thorough study and is beyond the scope of the present documentation. Present is the future of past and so one must not forget the history which is essentially past that give the present generation the necessary fulcrum to stand in good stead. The present article essentially aims to pay tribute to all the workers and pioneers in the field of Cardiology in India, who in spite of limited resources ventured in an unchartered arena. PMID:26071301

  7. History of Cardiology in India.

    PubMed

    Das, Mrinal Kanti; Kumar, Soumitra; Deb, Pradip Kumar; Mishra, Sundeep

    2015-01-01

    History as a science revolves around memories, travellers' tales, fables and chroniclers' stories, gossip and trans-telephonic conversations. Medicine itself as per the puritan's definition is a non-exact science because of the probability-predictability-sensitivity-specificity factors. Howsoever, the chronicles of Cardiology in India is quite interesting and intriguing. Heart and circulation was known to humankind from pre-Vedic era. Various therapeutics measures including the role of Yoga and transcendental meditation in curing cardiovascular diseases were known in India. Only recently there has been resurgence of the same globally. There have been very few innovations in Cardiology in India. The cause of this paucity possibly lie in the limited resources. This has a vicious effect on the research mentality of the population who are busy in meeting their daily requirements. This socio-scientific aspect needs a thorough study and is beyond the scope of the present documentation. Present is the future of past and so one must not forget the history which is essentially past that give the present generation the necessary fulcrum to stand in good stead. The present article essentially aims to pay tribute to all the workers and pioneers in the field of Cardiology in India, who in spite of limited resources ventured in an unchartered arena.

  8. Indications, Utility and Appropriateness of Echocardiography in Outpatient Cardiology

    PubMed Central

    Orsini, Enrico; Antoncecchi, Ettore; Carbone, Vincenzo; Dato, Achille; Monducci, Igor; Nistri, Stefano; Zito, Giovanni Battista

    2013-01-01

    Objective: Respect of “appropriateness” is considered an essential requirement, both on the clinical and the economic profile, and also as it helps to shorten the waiting list. However, only a few studies have dealt with the control of appropriateness in clinical practice, and most of them have focused only on hospital admissions and invasive procedures. Materials and Methods: INDICARD-out is a prospective, multicenter study carried out by A.R.C.A. (Associazioni Regionali Cardiologi Ambulatoriali) cardiologists from 13 Italian Regions, providing information on indications, utility and appropriateness of echocardiography in outpatient cardiology. Results: A total of 2110 prescriptions for echocardiogram were evaluated. Hypertension (23%) and the screening of asymptomatic subjects (17%) by far were the most frequent indications to echocardiography. Overall, 54% of the tests resulted appropriate, 30% were of uncertain appropriateness and 16% were inappropriate. Besides, 31% of the echocardiograms were not useful, and 28% were non pertinent for patient management. The vast majority of prescriptions (72%) came from non-cardiologist physicians (54% from general practitioners). The echocardiograms prescribed by cardiologists were significantly more appropriate, more useful and more pertinent than the tests prescribed by non-cardiologists. Conclusions: The appropriateness, utility and pertinence of the echocardiography are still suboptimal in practice cardiology, especially when indicated by non-cardiologists. The cardiologist, from mere executor of tests prescribed and managed by other physicians, should gain the role of the clinician who takes care of all the cardiologic needs of the patient community. PMID:28465880

  9. The study of material accountancy procedures for uranium in a whole nuclear fuel cycle

    SciTech Connect

    Nakano, Hiromasa; Akiba, Mitsunori

    1995-07-01

    Material accountancy procedures for uranium under a whole nuclear fuel cycle were studied by taking into consideration the material accountancy capability associated with realistic measurement uncertainties. The significant quantity used by the International Atomic Energy Agency (IAEA) for low-enriched uranium is 75 kg U-235 contained. A loss of U-235 contained in uranium can be detected by either of the following two procedures: one is a traditional U-235 isotope balance, and the other is a total uranium element balance. Facility types studied in this paper were UF6 conversion, gas centrifuge uranium enrichment, fuel fabrication, reprocessing, plutonium conversion, and MOX fuel production in Japan, where recycled uranium is processed in addition to natural uranium. It was found that the material accountancy capability of a total uranium element balance was almost always higher than that of a U-235 isotope balance under normal accuracy of weight, concentration, and enrichment measurements. Changing from the traditional U-235 isotope balance to the total uranium element balance for these facilities would lead to a gain of U-235 loss detection capability through material accountancy and to a reduction in the required resources of both the IAEA and operators.

  10. [Sustainability of medical imaging in cardiology].

    PubMed

    Picano, Eugenio; Lombardi, Massimo; Neglia, Danilo; Lazzeri, Mauro

    2006-11-01

    Every year, 5 billion imaging testing are performed worldwide, and about 1 out of 2 are cardiovascular examinations. According to recent estimates, 30 to 50% of all examinations are partially or totally inappropriate. This represents a potential damage for patient undergoing imaging (who takes the acute risks of a stress procedure and/or a contrast study without a commensurable benefit), an exorbitant cost for the society and an excessive delay in the waiting lists for other patients needing the examination. Economic induction, medico-legal concern, and specialist guidelines, which do not quantitate the potential benefits against the risks of a given procedure, boost inappropriateness of all imaging techniques. In case of ionizing tests, the reduction of useless imaging testing would improve the quality of care also through abatement of long-term risks, which are linked to the dose employed. The radiation dose equivalent of common cardiological imaging examinations corresponds to more than 1000 chest x rays for a thallium scan and to more than 500 chest x-rays for a multislice computed tomography. Although a direct evaluation of incidence of cancer in patients submitted to these procedures is not available, the estimated risk (often ignored by cardiologists) of cancer according to the latest 2005 Biological Effects of Ionizing Radiation Committee VII is about one in 500 exposed patients for a Thallium scintigraphy scan, and one in 750 for a CT scan. Such a risk is probably not acceptable when a scintigraphic or radiological procedure is applied for mass screening (when the risk side of the risk-benefit balance is not considered) or when a similar information can be obtained by other means. By contrast, it is fully acceptable in appropriately selected groups as a filter to more invasive, risky and costly procedures (for instance, coronary angiography and anatomy-driven revascularization). At this point, the cardiological community, that faces the reality of limited

  11. Big Data for cardiology: novel discovery?

    PubMed

    Mayer-Schönberger, Viktor

    2016-03-21

    Big Data promises to change cardiology through a massive increase in the data gathered and analysed; but its impact goes beyond improving incrementally existing methods. The potential of comprehensive data sets for scientific discovery is examined, and its impact on the scientific method generally and cardiology in particular is posited, together with likely consequences for research and practice. Big Data in cardiology changes how new insights are being discovered. For it to flourish, significant modifications in the methods, structures, and institutions of the profession are necessary. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  12. Comparison of abomasal emptying in neonatal calves with a nuclear scintigraphic procedure.

    PubMed

    Nappert, G; Lattimer, J C

    2001-01-01

    The purpose of the present study was to demonstrate that nuclear medicine technology allows observation of the effect that milk clotting has on abomasal emptying in the living neonatal calf. Scintigraphic evaluation of abomasal emptying was carried out in 6 healthy male Holstein calves. The calves were fed 10% of their body weight daily as whole cow's milk that was divided equally and consumed as 2 feedings via a nipple bottle. One day before the nuclear scintigraphic procedure, the calves were randomly fed whole cow's milk, or an oral rehydration solution (ORS) containing bicarbonate and high levels of soluble fibre was fed for 3 consecutive feedings an hour before the portion of milk. For each calf, both feeding programs were repeated twice at a one-week interval. Immediately following administration of the 99mTC-sulfur-colloid-containing milk, the calves were imaged with the gamma camera positioned lateral and ventral to the abomasum. Additional right lateral and ventral views of the abomasum were collected at 15, 30, 45, 60, 90, 120, 150, 180, 210, and 240 min after administration of the radionuclide. Blood glucose determination were performed at one-hour intervals for 7 h after feeding milk to evaluate milk digestibility in both feeding programs. No significant differences in the results of the glucose absorption test or in the radionuclide counts of the abomasum were found between both feeding programs. Scintigraphic evaluation of abomasal emptying was found to be a useful technique for visualization of milk clotting and to test the effect of an ORS on milk digestibility.

  13. Statistics for nuclear medicine. Part 6: normal values, evaluating a new diagnostic procedure, sequential methods, and conclusion

    SciTech Connect

    O'Brien, P.C.; Shampo, M.A.; Robertson, J.S.

    1983-06-01

    This paper discusses the significance of a laboratory measurement as it relates to a set of values from a healthy reference population. To do this, the distribution of the variable in the healthy population must be found. The evaluation of new diagnostic procedures in nuclear medicine is used as an example. (KRM)

  14. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false What procedures are to be used to transfer real property... ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7 What... congressional defense committees through the Secretary of Energy. (d) Transfer. After the congressional...

  15. Potential Uses, Limitations, and Basic Procedures of Micronuclei and Nuclear Abnormalities in Buccal Cells

    PubMed Central

    Torres-Bugarín, Olivia; Zavala-Cerna, María Guadalupe; Nava, Arnulfo; Flores-García, Aurelio; Ramos-Ibarra, María Luisa

    2014-01-01

    The use of biomarkers as tools to evaluate genotoxicity is increasing recently. Methods that have been used previously to evaluate genomic instability are frequently expensive, complicated, and invasive. The micronuclei (MN) and nuclear abnormalities (NA) technique in buccal cells offers a great opportunity to evaluate in a clear and precise way the appearance of genetic damage whether it is present as a consequence of occupational or environmental risk. This technique is reliable, fast, relatively simple, cheap, and minimally invasive and causes no pain. So, it is well accepted by patients; it can also be used to assess the genotoxic effect derived from drug use or as a result of having a chronic disease. Furthermore the beneficial effects derived from changes in life style or taking additional supplements can also be evaluated. In the present paper, we aim to focus on the explanation of MN test and its usefulness as a biomarker; we further give details about procedures to perform and interpret the results of the test and review some factors that could have an influence on the results of the technique. PMID:24778463

  16. Simulation of beta radiator handling procedures in nuclear medicine by means of a movable hand phantom.

    PubMed

    Blunck, Ch; Becker, F; Urban, M

    2011-03-01

    In nuclear medicine therapies, people working with beta radiators such as (90)Y may be exposed to non-negligible partial body doses. For radiation protection, it is important to know the characteristics of the radiation field and possible dose exposures at relevant positions in the working area. Besides extensive measurements, simulations can provide these data. For this purpose, a movable hand phantom for Monte Carlo simulations was developed. Specific beta radiator handling scenarios can be modelled interactively with forward kinematics or automatically with an inverse kinematics procedure. As a first investigation, the dose distribution on a medical doctor's hand injecting a (90)Y solution was measured and simulated with the phantom. Modelling was done with the interactive method based on five consecutive frames from a video recorded during the injection. Owing to the use of only one camera, not each detail of the radiation scenario is visible in the video. In spite of systematic uncertainties, the measured and simulated dose values are in good agreement.

  17. An overview of radioactive waste disposal procedures of a nuclear medicine department.

    PubMed

    Ravichandran, R; Binukumar, J P; Sreeram, Rajan; Arunkumar, L S

    2011-04-01

    Radioactive wastes from hospitals form one of the various types of urban wastes, which are managed in developed countries in a safe and organized way. In countries where growth of nuclear medicine services are envisaged, implementations of existing regulatory policies and guidelines in hospitals in terms of handling of radioactive materials used in the treatment of patients need a good model. To address this issue, a brief description of the methods is presented. A designed prototype waste storage trolley is found to be of great help in decaying the I-131 solid wastes from wards before releasing to waste treatment plant of the city. Two delay tanks with collection time of about 2 months and delay time of 2 months alternately result in 6 releases of urine toilet effluents to the sewage treatment plant (STP) of the hospital annually. Samples of effluents collected at releasing time documented radioactive releases of I-131 much below recommended levels of bi-monthly release. External counting of samples showed good statistical correlation with calculated values. An overview of safe procedures for radioactive waste disposal is presented.

  18. An overview of radioactive waste disposal procedures of a nuclear medicine department

    PubMed Central

    Ravichandran, R.; Binukumar, J. P.; Sreeram, Rajan; Arunkumar, L. S.

    2011-01-01

    Radioactive wastes from hospitals form one of the various types of urban wastes, which are managed in developed countries in a safe and organized way. In countries where growth of nuclear medicine services are envisaged, implementations of existing regulatory policies and guidelines in hospitals in terms of handling of radioactive materials used in the treatment of patients need a good model. To address this issue, a brief description of the methods is presented. A designed prototype waste storage trolley is found to be of great help in decaying the I-131 solid wastes from wards before releasing to waste treatment plant of the city. Two delay tanks with collection time of about 2 months and delay time of 2 months alternately result in 6 releases of urine toilet effluents to the sewage treatment plant (STP) of the hospital annually. Samples of effluents collected at releasing time documented radioactive releases of I-131 much below recommended levels of bi-monthly release. External counting of samples showed good statistical correlation with calculated values. An overview of safe procedures for radioactive waste disposal is presented. PMID:21731225

  19. Individual monitoring in nuclear medicine therapeutic procedures using extremity dosemeters LiF(Mg, Cu, P).

    PubMed

    Sarti, G; Del Dottore, F; Fabbri, C; Tassinari, L; Pagan, S; Rustignoli, M; Motta, P

    2011-03-01

    Unsealed beta-gamma-emitting sources are used (15 GBq (90)Y each session) in nuclear medicine therapeutic procedures. Inside the manipulation cell and while giving the injection to the patient, the skin exposure is very high; electron radiation field is not homogeneous and thus the exposure of the extremities is not uniform. Particular individual monitoring is adopted: single thermoluminescence dosemeter, wrapped in polyethylene film and placed on an adhesive tape, is positioned on the tip of the fingers; 6-10 dosemeters are assigned to each operator per session. The energy and angle response is studied for X-ray spectra, (90)Sr/Y and (204)Tl--a unique mean calibration factor is calculated in order to estimate H(p)(0.07). Performance of dosemeter is analysed according to ISO 62387-1(2007) and the combined uncertainty (calculated using the Monte Carlo method) results lie in the order of 11 %. This method reveals the critical step of manipulation and administration and ensures that dose limits are not exceeded.

  20. Potential uses, limitations, and basic procedures of micronuclei and nuclear abnormalities in buccal cells.

    PubMed

    Torres-Bugarín, Olivia; Zavala-Cerna, María Guadalupe; Nava, Arnulfo; Flores-García, Aurelio; Ramos-Ibarra, María Luisa

    2014-01-01

    The use of biomarkers as tools to evaluate genotoxicity is increasing recently. Methods that have been used previously to evaluate genomic instability are frequently expensive, complicated, and invasive. The micronuclei (MN) and nuclear abnormalities (NA) technique in buccal cells offers a great opportunity to evaluate in a clear and precise way the appearance of genetic damage whether it is present as a consequence of occupational or environmental risk. This technique is reliable, fast, relatively simple, cheap, and minimally invasive and causes no pain. So, it is well accepted by patients; it can also be used to assess the genotoxic effect derived from drug use or as a result of having a chronic disease. Furthermore the beneficial effects derived from changes in life style or taking additional supplements can also be evaluated. In the present paper, we aim to focus on the explanation of MN test and its usefulness as a biomarker; we further give details about procedures to perform and interpret the results of the test and review some factors that could have an influence on the results of the technique.

  1. Nobel prizes: contributions to cardiology.

    PubMed

    Mesquita, Evandro Tinoco; Marchese, Luana de Decco; Dias, Danielle Warol; Barbeito, Andressa Brasil; Gomes, Jonathan Costa; Muradas, Maria Clara Soares; Lanzieri, Pedro Gemal; Gismondi, Ronaldo Altenburg

    2015-08-01

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize's history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.

  2. The history of veterinary cardiology.

    PubMed

    Buchanan, James W

    2013-03-01

    Throughout civilization, animals have played a pivotal role in the advancement of science and medicine. From as early as 400 BC when Hippocrates recognized that diseases had natural causes, the steadfast advances made by biologists, scientists, physicians and scholars were fueled by timely and important facts and information- much of it gained through animal observations that contributed importantly to understanding anatomy, physiology, and pathology. There have been many breakthroughs and historic developments. For example, William Harvey in the 16th and 17th centuries clarified the importance of the circulatory system, aided by observations in dogs and pigs, which helped to clarify and confirm his concepts. The nineteenth century witnessed advances in physical examination techniques including auscultation and percussion. These helped create the basis for enhanced proficiency in clinical cardiology. An explosion of technologic advances that followed in the 20th century have made possible sophisticated, accurate, and non-invasive diagnostics. This permitted rapid patient assessment, effective monitoring, the development of new cardiotonic drugs, clinical trials to assess efficacy, and multi-therapy strategies. The latter 20th century has marshaled a dizzying array of advances in medical genetics and molecular science, expanding the frontiers of etiologies and disease mechanisms in man, with important implications for animal health. Veterinary medicine has evolved during the last half century, from a trade designed to serve agrarian cultures, to a diverse profession supporting an array of career opportunities ranging from private, specialty practice, to highly organized, specialized medicine and subspecialty academic training programs in cardiology and allied disciplines.

  3. Nobel Prizes: Contributions to Cardiology

    PubMed Central

    Mesquita, Evandro Tinoco; Marchese, Luana de Decco; Dias, Danielle Warol; Barbeito, Andressa Brasil; Gomes, Jonathan Costa; Muradas, Maria Clara Soares; Lanzieri, Pedro Gemal; Gismondi, Ronaldo Altenburg

    2015-01-01

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male. PMID:25945466

  4. [Circulatory assist devices in cardiology].

    PubMed

    Ferrari, M; Figulla, H R

    2005-03-24

    One out of 13 patients with an acute myocardial infarction is endangered of cardiogenic shock. In addition, acute valvular leakage, shunt vitiae, and acute myocarditis can lead to acute myocardial failure. As a therapeutic option, mechanical assist devices offer cardiac support and hemodynamic stabilization under these circumstances. The following minimal-invasive devices are used in cardiology and intensive care medicine: intra-aortic balloon pulsation (IABP), intra-vascular axial screw pumps, extra-corporal centrifugal pumps with and without additional membrane oxygenator. The IABP improves left ventricular function by a systolic reduction of the after-load, and an increase of diastolic blood pressure dependent on myocardial function. In contrast, axial screw pumps and centrifugal pumps can provide circulatory support independently of myocardial function. Mechanical assist devices can prevent irreversible damage not only by offering a reduction of myocardial work load, but also by improving organ perfusion in cardiogenic shock situations. Another indication for mechanical circulatory support depicts high-risk coronary angioplasty if the left ventricular ejection fraction is severely reduced or the target vessel supplies more than 50 % of vital myocardium. In case of irreversible heart failure, turbine pumps or centrifugal pumps offer a stabilization for the patient's transfer to a cardiac surgery center. They can also be used for bridging to heart transplantation in acute situations. Technical improvements will enhance the use of mechanical assist devices in the near future. Especially the development of portable emergency devices will enrich therapeutic possibilities in cardiology and intensive care medicine.

  5. Integrating sleep medicine into a cardiology practice.

    PubMed

    Lee, Joseph R

    2005-01-01

    The sequelae of sleep-disordered breathing is encountered on a daily basis by the general cardiology practitioner. This includes arterial and pulmonary hypertension, congestive heart failure, atrial arrhythmias, and possibly vascular disease. Recognition, diagnosis, and treatment of sleep-disordered breathing is relatively straightforward and can be smoothly incorporated into an existing cardiology practice.

  6. The history of paediatric cardiology on stamps.

    PubMed

    Gursu, Hazım A; Cetin, Ibrahim I

    2017-08-14

    Paediatric cardiology is arguably the sub-specialty in which the greatest advances have been made in both disease diagnosis and treatment over the past half a century. Paediatric cardiology emerged as a discipline in the 1930s. Since then, advances in imaging techniques such as echocardiography, angiography, CT, or magnetic resonance and extracorporeal circulation have provided excellent diagnosis and treatment of CHD. The pioneers of paediatric cardiology are more than eponyms, for each used in new and original ways the tools and concepts available in his or her era. This brief overview of the history of paediatric cardiology on stamps begins from William Harvey up to our own time, and includes the milestones in paediatric cardiology.

  7. A summary of recommendations for occupational radiation protection in interventional cardiology.

    PubMed

    Durán, Ariel; Hian, Sim Kui; Miller, Donald L; Le Heron, John; Padovani, Renato; Vano, Eliseo

    2013-02-01

    The radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures, and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational radiation protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational radiation dose include minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance program; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. These recommendations for occupational radiation protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.

  8. Historical Patterns in the Types of Procedures Performed and Radiation Safety Practices Used in Nuclear Medicine From 1945-2009.

    PubMed

    Van Dyke, Miriam E; Drozdovitch, Vladimir; Doody, Michele M; Lim, Hyeyeun; Bolus, Norman E; Simon, Steven L; Alexander, Bruce H; Kitahara, Cari M

    2016-07-01

    The authors evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945-2009 in a sample of U.S. radiologic technologists. In 2013-2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945-1964, 1965-1979, 1980-1989, 1990-1999, and 2000-2009. An overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures was observed across the five time periods. Between 1945-1964 and 2000-2009, the median frequency of diagnostic procedures performed substantially increased (from 5 wk to 30 wk), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 mo to 3 mo). Also a notable increase was observed in the use of most radiation safety practices from 1945-1964 to 2000-2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks for nuclear medicine technologists.

  9. Light Water Reactor Sustainability Program: Computer-Based Procedures for Field Activities: Results from Three Evaluations at Nuclear Power Plants

    SciTech Connect

    Oxstrand, Johanna; Le Blanc, Katya; Bly, Aaron

    2014-09-01

    The Computer-Based Procedure (CBP) research effort is a part of the Light-Water Reactor Sustainability (LWRS) Program, which is a research and development (R&D) program sponsored by Department of Energy (DOE) and performed in close collaboration with industry R&D programs that provides the technical foundations for licensing and managing the long-term, safe, and economical operation of current nuclear power plants. One of the primary missions of the LWRS program is to help the U.S. nuclear industry adopt new technologies and engineering solutions that facilitate the continued safe operation of the plants and extension of the current operating licenses. One area that could yield tremendous savings in increased efficiency and safety is in improving procedure use. Nearly all activities in the nuclear power industry are guided by procedures, which today are printed and executed on paper. This paper-based procedure process has proven to ensure safety; however, there are improvements to be gained. Due to its inherent dynamic nature, a CBP provides the opportunity to incorporate context driven job aids, such as drawings, photos, and just-in-time training. Compared to the static state of paper-based procedures (PBPs), the presentation of information in CBPs can be much more flexible and tailored to the task, actual plant condition, and operation mode. The dynamic presentation of the procedure will guide the user down the path of relevant steps, thus minimizing time spent by the field worker to evaluate plant conditions and decisions related to the applicability of each step. This dynamic presentation of the procedure also minimizes the risk of conducting steps out of order and/or incorrectly assessed applicability of steps.

  10. Procedures for using expert judgment to estimate human-error probabilities in nuclear power plant operations. [PWR; BWR

    SciTech Connect

    Seaver, D.A.; Stillwell, W.G.

    1983-03-01

    This report describes and evaluates several procedures for using expert judgment to estimate human-error probabilities (HEPs) in nuclear power plant operations. These HEPs are currently needed for several purposes, particularly for probabilistic risk assessments. Data do not exist for estimating these HEPs, so expert judgment can provide these estimates in a timely manner. Five judgmental procedures are described here: paired comparisons, ranking and rating, direct numerical estimation, indirect numerical estimation and multiattribute utility measurement. These procedures are evaluated in terms of several criteria: quality of judgments, difficulty of data collection, empirical support, acceptability, theoretical justification, and data processing. Situational constraints such as the number of experts available, the number of HEPs to be estimated, the time available, the location of the experts, and the resources available are discussed in regard to their implications for selecting a procedure for use.

  11. [Integrated Health Care in cardiology].

    PubMed

    Graf, C

    2006-01-01

    Integrated Health Care forces rethinking of all partners. Health care providers need to cooperate and have to face an emerging competition among themselves. Health insurance companies are no longer the common enemy, but a business partner on an individual basis. Rethinking has already commenced. The Barmer insurance company has initiated a considerable number of similar contracts with respect to Integrated Health Care in cardiology. One of the first contracts was agreed upon at Recklinghausen (it is reported later in this volume) and a couple of them have been concluded in the Berlin/Brandenburg region (which are also reported in this volume).A special feature is the support for the general disease management programs that have been initiated in light of the new laws beginning in 2000. The Barmer company will enroll some 500,000 patients with coronary artery disease in these programs.

  12. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A; Masoudi, Frederick A; Dehmer, Gregory J; Patel, Manesh R; Smith, Peter K; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian C; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Russo, Andrea M; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Bailey, Steven R; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Shaw, Leslee; Stainback, Raymond F; Allen, Joseph M

    2012-04-01

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD

  13. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A

    2012-02-28

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD

  14. Study of on-line computerized procedures system of nuclear power plants

    SciTech Connect

    Liu Fei; Zhang Zhijian; Peng Minjun

    2006-07-01

    An on-line computerized procedures system (OCPS) for normal operation is developed. The system makes use of the advantages of computerized procedures system and provides the detailed and comprehensible procedures. The configuration is introduced. OCPS has been built on Embedded real-time operation system VxWorks using C language. Computerized procedures are described exampled with cold start-up in this paper, helping operators to know about the state of plants during the complex operating course. After adopting the computerized procedures, the labor intensity and mental pressure of operators will be reduced. (authors)

  15. Experience with ALARA and ALARA procedures in a nuclear power plant

    SciTech Connect

    Abrahamse, J.C.

    1995-03-01

    The nuclear power plant Borssele is a Siemens two-loop Pressurized Water Reactor having a capacity of 480 MWe and in operation since 1973. The nuclear power plant Borssle is located in the southwest of the Netherlands, near the Westerschelde River. In the first nine years of operation the radiation level in the primary system increased, reaching a maximum in 1983. The most important reason for this high radiation level was the cobalt content of the grid assemblies of the fuel elements. After resolving this problem, the radiation level decreased to a level comparable with that of other nuclear power plants.

  16. [Management of sleep-related abnormal breathing by cardiologists and hospital departments of cardiology].

    PubMed

    Fietze, I; Penzel, T; Baumann, G; Bönner, G; Kamke, W; Podszus, T

    2010-02-01

    In the general population there is a high prevalence of sleep-related disorders of breathing (sleep apnea). In addition to being leading symptom of excessive day-time sleepiness they are also important predictors are cardiovascular disease such as arterial hypertension, heart failure, cardiac arrhythmias and stroke. Are the cardiologists the specialists who recognize such patients and refer them to diagnostic procedures and treatment? We sent out a questionnaires to cardiologists in private practice, to hospitals with cardiology departments and to cardiology rehabilitation units in Germany in order to assess the knowledge about sleep apnea and of the current diagnostic and therapeutic procedures in patients with suspected sleep apnea. All cardiology rehabilitation units and every other practice and cardiology department listed in the reference book 'Medführer' were approached. 98% of 388 cardiologists with private practice were found to know about the disorder sleep apnea. 94.3% routinely asked their patients about any sleep disorder and specifically about excessive day-time sleepiness. More than half of the cardiologists (59.3%) questioned patients about possible sleep apnea as part of their interview, but only 32.7% carried out tests with a portable sleep apnea monitor. Most patients were referred to a sleep center. In 60% of the cardiology departments a portable sleep apnea monitor was used. Further diagnostic investigation followed in collaborating sleep centers (66.4%), because only 22.4% of the departments had a sleep laboratories. The main focus was on the diagnosis of abnormal sleep due to central or obstructive disorders of breathing. More than two thirds of the cardiology departments initiate nocturnal ventilation treatment. Cardiologists in private practice and cardiologists in hospital departments know about sleep-related abnormal breathing. The use of portable sleep apnea monitors and of polysomnography in special as parts of sleep centers within

  17. Eye lens dose in interventional cardiology.

    PubMed

    Principi, S; Delgado Soler, C; Ginjaume, M; Beltran Vilagrasa, M; Rovira Escutia, J J; Duch, M A

    2015-07-01

    The ICRP has recently recommended reducing the occupational exposure dose limit for the lens of the eye to 20 mSv y(-1), averaged over a period of 5 y, with no year exceeding 50 mSv, instead of the current 150 mSv y(-1). This reduction will have important implications for interventional cardiology and radiology (IC/IR) personnel. In this work, lens dose received by a staff working in IC is studied in order to determine whether eye lens dose monitoring or/and additional radiological protection measures are required. Eye lens dose exposure was monitored in 10 physicians and 6 nurses. The major IC procedures performed were coronary angiography and percutaneous transluminal coronary angioplasty. The personnel were provided with two thermoluminescent dosemeters (TLDs): one calibrated in terms of Hp(3) located close to the left ear of the operator and a whole-body dosemeter calibrated in terms of Hp(10) and Hp(0.07) positioned on the lead apron. The estimated annual eye lens dose for physicians ranged between 8 and 60 mSv, for a workload of 200 procedures y(-1). Lower doses were collected for nurses, with estimated annual Hp(3) between 2 and 4 mSv y(-1). It was observed that for nurses the Hp(0.07) measurement on the lead apron is a good estimate of eye lens dose. This is not the case for physicians, where the influence of both the position and use of protective devices such as the ceiling shield is very important and produces large differences among doses both at the eyes and on the thorax. For physicians, a good correlation between Hp(3) and dose area product is shown. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. The Paediatric Cardiology Hall of Fame – Donald Nixon Ross.

    PubMed

    Somerville, Jane

    2015-10-01

    Donald Nixon Ross, FRCS (4 October 1922 to 7 July 2014) was a South African-born British cardiothoracic surgeon, who developed the pulmonary autograft, known as the Ross procedure, for the treatment of aortic valve disease, and also performed the first heart transplant in the United Kingdom in 1968. This paper, written by Jane Somerville, Professor of Cardiology [Retired], Imperial College London, London, United Kingdom, provides the personal recollections about Donald Ross from Jane Somerville, and thus provides a unique snapshot of cardiac surgical history.

  19. Current status of preventive cardiology training among United States cardiology fellowships and comparison to training guidelines.

    PubMed

    Pack, Quinn R; Keteyian, Steven J; McBride, Patrick E; Weaver, W Douglas; Kim, Henry E

    2012-07-01

    We evaluated preventive cardiology education in United States cardiology fellowship programs and their adherence to Core Cardiovascular Training Symposium training guidelines, which recommend 1 month of training, faculty with expertise, and clinical experience in cardiac rehabilitation, lipid disorder management, and diabetes management as a part of the prevention curricula. We sent an anonymous survey to United States cardiology program directors and their chief fellow. The survey assessed the program curricula, rotation structure, faculty expertise, obstacles, and recommended improvements. The results revealed that 24% of surveyed programs met the Core Cardiovascular Training Symposium guidelines with a dedicated 1-month rotation in preventive cardiology, 24% had no formalized training in preventive cardiology, and 30% had no faculty with expertise in preventive cardiology, which correlated with fewer rotations in prevention than those with specialized faculty (p = 0.009). Fellows rotated though the following experiences (% of programs): cardiac rehabilitation, 71%; lipid management, 37%; hypertension, 15%; diabetes, 7%; weight management/obesity, 6%; cardiac nutrition, 6%; and smoking cessation, 5%. The program directors cited "lack of time" as the greatest obstacle to providing preventive cardiology training and the chief fellows reported "lack of a developed curriculum" (p = 0.01). The most recommended improvement was for the American College of Cardiology to develop a web-based curriculum/module. In conclusion, most surveyed United States cardiology training programs currently do not adhere to basic preventive cardiovascular medicine Core Cardiovascular Training Symposium recommendations. Additional attention to developing curricular content and structure, including the creation of an American College of Cardiology on-line knowledge module might improve fellowship training in preventive cardiology.

  20. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Ronan, Grace; Wolk, Michael J; Bailey, Steven R; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Rosenbaum, Lisa; Shaw, Leslee J; Stainback, Raymond F; Allen, Joseph M; Brindis, Ralph G; Kramer, Christopher M; Shaw, Leslee J; Cerqueira, Manuel D; Chen, Jersey; Dean, Larry S; Fazel, Reza; Hundley, W Gregory; Itchhaporia, Dipti; Kligfield, Paul; Lockwood, Richard; Marine, Joseph Edward; McCully, Robert Benjamin; Messer, Joseph V; O'Gara, Patrick T; Shemin, Richard J; Wann, L Samuel; Wong, John B; Patel, Manesh R; Kramer, Christopher M; Bailey, Steven R; Brown, Alan S; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Lindsay, Bruce D; Min, James K; Shaw, Leslee J; Stainback, Raymond F; Wann, L Samuel; Wolk, Michael J; Allen, Joseph M

    2014-02-01

    The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1-9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram (ECG

  1. Advanced Pipe Replacement Procedure for a Defective CRDM Housing Nozzle Enables Continued Normal Operation of a Nuclear Power Plant

    SciTech Connect

    Gilmore, Geoff; Becker, Andrew

    2006-07-01

    During the 2003 outage at the Ringhals Nuclear Plant in Sweden, a leak was found in the vicinity of a Control Rod Drive Mechanism (CRDM) housing nozzle at Unit 1. Based on the ALARA principle for radioactive contamination, a unique repair process was developed. The repair system includes utilization of custom, remotely controlled GTAW-robots, a CNC cutting and finishing machine, snake-arm robots and NDE equipment. The success of the repair solution was based on performing the machining and welding operations from the inside of the SCRAM pipe through the CRDM housing since accessibility from the outside was extremely limited. Before the actual pipe replacement procedure was performed, comprehensive training programs were conducted. Training was followed by certification of equipment, staff and procedures during qualification tests in a full scale mock-up of the housing nozzle. Due to the ingenuity of the overall repair solution and training programs, the actual pipe replacement procedure was completed in less than half the anticipated time. As a result of the successful pipe replacement, the nuclear power plant was returned to normal operation. (authors)

  2. Requirements for Computer Based-Procedures for Nuclear Power Plant Field Operators Results from a Qualitative Study

    SciTech Connect

    Katya Le Blanc; Johanna Oxstrand

    2012-05-01

    Although computer-based procedures (CBPs) have been investigated as a way to enhance operator performance on procedural tasks in the nuclear industry for almost thirty years, they are not currently widely deployed at United States utilities. One of the barriers to the wide scale deployment of CBPs is the lack of operational experience with CBPs that could serve as a sound basis for justifying the use of CBPs for nuclear utilities. Utilities are hesitant to adopt CBPs because of concern over potential costs of implementation, and concern over regulatory approval. Regulators require a sound technical basis for the use of any procedure at the utilities; without operating experience to support the use CBPs, it is difficult to establish such a technical basis. In an effort to begin the process of developing a technical basis for CBPs, researchers at Idaho National Laboratory are partnering with industry to explore CBPs with the objective of defining requirements for CBPs and developing an industry-wide vision and path forward for the use of CBPs. This paper describes the results from a qualitative study aimed at defining requirements for CBPs to be used by field operators and maintenance technicians.

  3. Quality control for invasive cardiology: Holland.

    PubMed

    Plokker, H W

    1996-10-01

    Although no official registration of indications, treatments and results in patients with coronary heart disease has taken place in Holland, the following authorities and commissions have introduced guidelines for quality control: the Dutch government, the Dutch Society of Cardiology, the Working Group on Interventional Cardiology and the health insurers. Until 1991, the right to perform coronary interventions was tied to a license issued by the Ministry of Health. New recommendations were delineated 5 years ago: at least 500 interventions must be annually performed by 5 interventional cardiologists, i.e. ca. 100 interventions annually per cardiologist. No interventional cardiology may be performed without an in-house cardiac surgery and vice versa. In a survey by the Dutch Society of Cardiology on the quality of the Dutch centers, PTCA-mortality was ca. 0.3%, infarction rate was ca. 2%. An emergency bypass operation was necessary in 1.0 to 1.6% of the cases; the surgical team was on immediate alert for 11% of the patients. Selection of patients without risk was deemed impossible. Despite objections by some members the Dutch Society of Cardiology, it was recommended that cardiac surgery and interventions should not be separated. Data from health insurers showed no inappropriate indications for PTCA. The DUCAT-study, which used the RAND criteria, showed PTCA indications to be correct in more than 90% of the cases. The Dutch government wants to control the expansion of PTCA centers, so it is no wonder that waiting lists are becoming longer.

  4. [Assessment of multivariate logistic regression analysis in articles published in Turkish cardiology journals].

    PubMed

    Tanboğa, Ibrahim Halil; Kurt, Mustafa; Işik, Turgay; Kaya, Ahmet; Ekinci, Mehmet; Aksakal, Enbiya; Sevimli, Serdar; Cayli, Murat

    2012-03-01

    We aimed to assess the use and reporting-quality of multivariate logistic regression analysis (MVLRA) in articles published in two Turkish cardiology journals. We reviewed all original articles published in two Turkish cardiology journals (The Anatolian Journal of Cardiology and Archives of the Turkish Society of Cardiology) between January 2010 and August 2011. The articles that used MVLRA were analyzed comprehensively based on 10 predefined criteria. A total of 212 articles were reviewed, of which MVLRA was used in 33 (15.6%). Twenty-nine articles (87.9%) properly included the main components of the MVRLA, namely, odds ratios, 95% confidence intervals, and p values. However, none of the articles reported MVRLA-related data such as the modeling type, validation, goodness-fit, multicollinearity and interaction tests. There were severe reporting flaws and faults as to the ratio of the total number of events or sample size to the number of independent variables included into the MVLRA model, the use of fitness procedures, and how the independent variables were selected. Our results indicate that MVLRA has become a standard statistical method in the Turkish cardiology literature. However, overall reporting of MVLRA data still has seriously inadequate and inaccurate aspects.

  5. Interventional cardiology in Europe 1993. Working Group on Coronary Circulation of the European Society of Cardiology.

    PubMed

    Meyer, B J; Meier, B; Bonzel, T; Fabian, J; Heyndrickx, G; Morice, M C; Mühlberger, V; Piscione, F; Rothman, M; Wijns, W; van den Brand, M

    1996-09-01

    An annual survey on cardiac interventions in Europe is performed by the working group on Coronary Circulation of the European Society of Cardiology with the help of the national societies of cardiology. A questionnaire about cardiac interventions in 1993 was mailed to a representative of the national societies of 35 members of the European Society of Cardiology. The data collection of coronary interventions was delayed by slow backreporting and from 10 of the 35 national members data were missing or grossly incomplete. They were excluded from the analysis. A total of 756,822 coronary angiograms were reported resulting in an incidence of 1146 +/- 1024 per 10(6) inhabitants, ranging from 24 (Romania) to 3499 (Germany). This represents an increase of 12% compared to 1992. Germany (279,882 cases), France (157,237), the United Kingdom (77,000), Italy (44,934) and Spain (37,591) registered 79% of all the coronary angiograms performed. A total of 183,728 percutaneous transluminal coronary angioplasty cases were reported in 1993, 24% more than in 1992. On average, they accounted for 18 +/- 7% (range 8 (Romania) to 35% (Sweden) of the coronary angiograms. Most of these percutaneous transluminal coronary angioplasties (82%) were confined to a single vessel. In 13% only, percutaneous transluminal coronary angioplasty took place immediately after the diagnostic study. Adjusted per capita. Germany ranks first with 873 percutaneous transluminal coronary angioplasties per 10(6) inhabitants, followed by France (737), Holland (725), Belgium (713), and Switzerland (665). The European mean of percutaneous transluminal coronary angioplasties per 10(6) inhabitants was 270 +/- 279, representing an increase of 14% compared with 1992. A major in-hospital complication was reported in 3.8% of the patients undergoing percutaneous transluminal coronary angioplasty: 0.6% hospital deaths, 1.5% emergency coronary artery bypass grafting, and 1.7% myocardial infarctions. In 1993 stents were

  6. Introduction to methods in molecular cardiology.

    PubMed

    Sun, Zhongjie

    2005-01-01

    Molecular cardiology is a new area of cardiovascular medicine that aims to apply molecular biological techniques for the mechanistic investigation, diagnosis, prevention, and treatment of cardiovascular disease. As an emerging discipline, it has changed our conceptual thinking of cardiovascular development, disease etiology, and pathophysiology. Although molecular cardiology is still at a very early stage, it has opened a promising avenue for understanding and controlling cardiovascular disease. With the rapid development and application of molecular biological techniques, scientists and clinicians are closer to curing heart diseases that were thought to be incurable 20 yr ago. There clearly is a need for a more thorough understanding of the molecular mechanisms of cardiovascular diseases to promote the advancement of cell and gene therapy for heart diseases. This chapter briefly reviews state-of-the-art techniques in the area of molecular cardiology.

  7. [Sports cardiology - a general practice oriented update].

    PubMed

    Schmied, Christian

    2014-08-06

    As a sub-speciality, Sports Cardiology focuses on sport and physical training interacting with cardiac issues. Particularly, Sports Cardiology deals with the so-called "Sports Paradox", which implicates the fact the on one side regular physical training leads to a multitude of relevant health benefits. But on the other hand, exercise can also be a trigger for sudden cardiac death, particularly in case of an underlying cardiac disease. However, health benefits by regular training outweigh potential risks by far, but only if an adequate cardiac screening and individual recommendations for sports participation have been provided. This review highlights various aspects of Sports Cardiology like strategies to prevent sudden cardiac death in sports and training recommendations in patients with an underlying cardiovascular disease.

  8. Diagnostic cardiology: Noninvasive imaging techniques

    SciTech Connect

    Come, P.C.

    1985-01-01

    This book contains 23 chapters. Some of the chapter titles are: The chest x-ray and cardiac series; Computed tomographic scanning of the heart, coronary arteries, and great vessels; Digital subtraction angiography in the assessment of cardiovascular disease; Magnetic resonance: technique and cardiac applications; Basics of radiation physics and instrumentation; and Nuclear imaging: the assessment of cardiac performance.

  9. Hippocrates, cardiology, Confucius and the Yellow Emperor.

    PubMed

    Cheng, T O

    2001-12-01

    Although Hippocrates (460-c.375 BC) has been traditionally recognized as the Father of Medicine, the fact that he was seminal in the development of cardiology is much less well known. Evidence is presented to support the notion that Hippocrates could also be considered the Father of Cardiology. Hippocrates also had many of the teachings and practices in common with Confucius (c.551-c.479 BC) and the Yellow Emperor of China (2695-2589 BC). Whereas Confucius was not a physician, the Yellow Emperor was an ancient Chinese physician whose Huang Di Neijing, the Yellow Emperor's Canon of Internal Medicine, is the oldest known treatise of medicine in existence.

  10. Nuclear medicine procedures in the diagnosis of NET: a historical perspective.

    PubMed

    Maffione, Anna Margherita; Karunanithi, Sellam; Kumar, Rakesh; Rubello, Domenico; Alavi, Abass

    2014-01-01

    Novel diagnostic tools and therapies have emerged as a result of the continuous endeavors relating to neuroendocrine tumors (NETs). Nuclear medicine plays a pivotal role in the imaging and treatment of NETs. Somatostatin receptor analogues and metaiodobenzylguanidine remain front-line single-photon emission computed tomography (SPECT) radiotracers in the imaging of NET; their utility has been augmented by the increasing availability of SPECT/CT. Positron emission tomography has been growing rapidly in the imaging of NETs, paralleled by great efforts toward the development of new tracers. Hybrid imaging will play an important role in the future of NETs. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Unfractionated heparin in cardiology: redefining the standard of practice.

    PubMed

    Rihn, Thomas L; Díez, José

    2004-08-01

    Acute coronary syndromes (ACS) consist of unstable angina (UA), non-ST-segment myocardial infarction (NSTEMI) and ST-segment myocardial infarction (STEMI). Timely intervention with effective, predictable antithrombin therapy is critically important in the early management of these conditions. Platelet aggregation is also an important component of thrombus formation in arterial thrombosis. Historically, unfractionated heparin (UFH) has been combined with aspirin to suppress thrombin propagation and fibrin formation; however, its effectiveness has been questioned in this setting. Unlike newer anticoagulant alternatives, UFH paradoxically stimulates platelet aggregation, which may further promote clot formation. In addition, obtaining a valid therapeutic activated partial thromboplastin time (aPTT) in cardiology patients is a major challenge, and dosing is complex. Due to substantial variation in reagents and instruments, target aPTT ranges for UFH in ACS clinical trials cannot be extrapolated to individual institutions. Further, the risk of ischemic events is greater shortly after abrupt discontinuation of UFH compared with alternative agents with longer half-lives and less stimulation of platelet aggregation. Key UA-NSTEMI clinical trials have demonstrated that UFH is inferior to newer agents, such as the low-molecular-weight heparins (LMWHs). Consistent with this evidence, the most recent practice guidelines of the American College of Cardiology and the American Heart Association in UA-NSTEMI identify the LMWH enoxaparin as the agent of choice. In patients with STEMI receiving the fibrinolytic tenecteplase as reperfusion therapy, enoxaparin has also been superior to UFH in combination. In percutaneous procedures, newer indirect (enoxaparin) and direct (bivalirudin) antithrombins have demonstrated safety and efficacy. There is little doubt that as we move forward in optimizing adjunctive anticoagulation in the cardiology setting, UFH will largely be replaced by

  12. Measures of Knowledge and Attitude Toward Preventive Cardiology.

    ERIC Educational Resources Information Center

    Allred, Charlene A.; And Others

    1985-01-01

    The development and validation of an inventory of preventive cardiology at the University of Virginia is described. The inventory contains two instruments designed to measure medical students' preinstructional and postinstructional knowledge of and attitude toward preventive cardiology. (Author/MLW)

  13. The National Cardiac Societies of the European Society of Cardiology.

    PubMed

    Atar, Dan

    2015-06-01

    The National Cardiac Societies are one of the Constituent Bodies of the European Society of Cardiology (ESC). They are the backbone of the ESC and together form the "Cardiology of Europe" in 56 European and Mediterranean countries.

  14. Measures of Knowledge and Attitude Toward Preventive Cardiology.

    ERIC Educational Resources Information Center

    Allred, Charlene A.; And Others

    1985-01-01

    The development and validation of an inventory of preventive cardiology at the University of Virginia is described. The inventory contains two instruments designed to measure medical students' preinstructional and postinstructional knowledge of and attitude toward preventive cardiology. (Author/MLW)

  15. ENDF-102 DATA FORMATS AND PROCEDURES FOR THE EVALUATION NUCLEAR DATA FILE ENDF-6.

    SciTech Connect

    MCLANE,V.

    2001-05-15

    The Evaluated Nuclear Data File (ENDF) formats and libraries are decided by the Cross Section Evaluation Working Group (CSEWG), a cooperative effort of national laboratories, industry, and universities in the U.S. and Canada, and are maintained by the National Nuclear Data Center (NNDC). Earlier versions of the ENDF format provided representations for neutron cross sections and distributions, photon production from neutron reactions, a limited amount of charged-particle production from neutron reactions, photo-atomic interaction data, thermal neutron scattering data, and radionuclide production and decay data (including fission products). Version 6 (ENDF-6) allows higher incident energies, adds more complete descriptions of the distributions of emitted particles, and provides for incident charged particles and photonuclear data by partitioning the ENDF library into sub-libraries. Decay data, fission product yield data, thermal scattering data, and photo-atomic data have also been formally placed in sub-libraries. In addition, this rewrite represents an extensive update to the Version V manual.

  16. Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania.

    PubMed

    Valuckiene, Zivile; Jurenas, Martynas; Cibulskaite, Inga

    2016-09-01

    Ionizing radiation management is among the most important safety issues in interventional cardiology. Multiple radiation protection measures allow the minimization of x-ray exposure during interventional procedures. Our purpose was to assess the utilization and effectiveness of radiation protection and optimization techniques among interventional cardiologists in Lithuania. Interventional cardiologists of five cardiac centres were interviewed by anonymized questionnaire, addressing personal use of protective garments, shielding, table/detector positioning, frame rate (FR), resolution, field of view adjustment and collimation. Effective patient doses were compared between operators who work with and without x-ray optimization. Thirty one (68.9%) out of 45 Lithuanian interventional cardiologists participated in the survey. Protective aprons were universally used, but not the thyroid collars; 35.5% (n  =  11) operators use protective eyewear and 12.9% (n  =  4) wear radio-protective caps; 83.9% (n  =  26) use overhanging shields, 58.1% (n  =  18)-portable barriers; 12.9% (n  =  4)-abdominal patient's shielding; 35.5% (n  =  11) work at a high table position; 87.1% (n  =  27) keep an image intensifier/receiver close to the patient; 58.1% (n  =  18) reduce the fluoroscopy FR; 6.5% (n  =  2) reduce the fluoro image detail resolution; 83.9% (n  =  26) use a 'store fluoro' option; 41.9% (N  =  13) reduce magnification for catheter transit; 51.6% (n  =  16) limit image magnification; and 35.5% (n  =  11) use image collimation. Median effective patient doses were significantly lower with x-ray optimization techniques in both diagnostic and therapeutic interventions. Many of the ionizing radiation exposure reduction tools and techniques are underused by a considerable proportion of interventional cardiology operators. The application of basic radiation protection tools and

  17. A Pediatric Cardiology Fellowship Boot Camp improves trainee confidence.

    PubMed

    Allan, Catherine K; Tannous, Paul; DeWitt, Elizabeth; Farias, Michael; Mansfield, Laura; Ronai, Christina; Schidlow, David; Sanders, Stephen P; Lock, James E; Newburger, Jane W; Brown, David W

    2016-12-01

    Introduction New paediatric cardiology trainees are required to rapidly assimilate knowledge and gain clinical skills to which they have limited or no exposure during residency. The Pediatric Cardiology Fellowship Boot Camp (PCBC) at Boston Children's Hospital was designed to provide incoming fellows with an intensive exposure to congenital cardiac pathology and a broad overview of major areas of paediatric cardiology practice.

  18. Update for 2014 on clinical cardiology, geriatric cardiology, and heart failure and transplantation.

    PubMed

    Barón-Esquivias, Gonzalo; Manito, Nicolás; López Díaz, Javier; Martín Santana, Antonio; García Pinilla, José Manuel; Gómez Doblas, Juan José; Gómez Bueno, Manuel; Barrios Alonso, Vivencio; Lambert, José Luis

    2015-04-01

    In the present article, we review publications from the previous year in the following 3 areas: clinical cardiology, geriatric cardiology, and heart failure and transplantation. Among the new developments in clinical cardiology are several contributions from Spanish groups on tricuspid and aortic regurgitation, developments in atrial fibrillation, syncope, and the clinical characteristics of heart disease, as well as various studies on familial heart disease and chronic ischemic heart disease. In geriatric cardiology, the most relevant studies published in 2014 involve heart failure, degenerative aortic stenosis, and data on atrial fibrillation in the geriatric population. In heart failure and transplantation, the most noteworthy developments concern the importance of multidisciplinary units and patients with preserved systolic function. Other notable publications were those related to iron deficiency, new drugs, and new devices and biomarkers. Finally, we review studies on acute heart failure and transplantation, such as inotropic drugs and ventricular assist devices.

  19. Design and evaluation of computerized operating procedures in nuclear power plants.

    PubMed

    Hwang, Fei-Hui; Hwang, Sheue-Ling

    2003-01-15

    A small-scale virtual system has been developed in this study to enhance operators' understanding and operating performance. For this, a computerized graphical interface based on Dynamic Work Causality Equation (DWCE) has been designed to transform the operating procedure into a flowchart. Furthermore, the Programmable Logic Controller (PLC) was installed to connect the signboard (proposed system) with the computerized graphical interface. An experiment was conducted to verify the effect of computerized graphic interface, indicating that the computerized system significantly decreases learning time and improves operational performance.

  20. Hanford spent nuclear fuel cold vacuum drying proof of performance test procedure

    SciTech Connect

    McCracken, K.J.

    1998-06-10

    This document provides the test procedure for cold testing of the first article skids for the Cold Vacuum Drying (CVD) process at the Facility. The primary objective of this testing is to confirm design choices and provide data for the initial start-up parameters for the process. The current scope of testing in this document includes design verification, drying cycle determination equipment performance testing of the CVD process and MCC components, heat up and cool-down cycle determination, and thermal model validation.

  1. [The best of interventional cardiology in 2006].

    PubMed

    Blanchard, D; Eltchaninoff, H; Berland, J; Carrie, D; Dupouy, P; Funck, F; Gilard, M; Louvard, Y

    2007-01-01

    The year 2006 was a landmark in interventional cardiology. Confirmations of results of large-scale trials and meta analyses, the commercialisation of new drug-elution stents, discussions about well established methods, questions about long-term outcomes of dilated patients, have made 2006 a particularly rich year in controversy, especially during its last three months.

  2. Evaluation of Cardiology Training and Manpower Requirements.

    ERIC Educational Resources Information Center

    Adams, Forrest H., Ed.; Mendenhall, Robert C., Ed.

    Begun in June, 1971 and completed in October 1973, the study had the following specific goals: to define the cardiologist's role; to determine cardiology training program objectives; to determine manpower needs for cardiologists; and to determine the educational needs of cardiologists. The major information was sought from all active cardiologists…

  3. [Usefulness of Cochrane Collaboration for pediatric cardiology].

    PubMed

    González-de Dios, Javier; Balaguer-Santamaría, Albert; Ochoa-Sangrador, Carlos

    2005-09-01

    The Cochrane Collaboration provides growing and readily accessible resources to help ensure that medical decision-making is based on detailed, methodical, and up-to-date reviews of the best available evidence. We analyzed systematic reviews in the field of pediatric cardiology published by the Cochrane Collaboration's 50 Collaborative Review Groups. We found a total of 20 systematic reviews: 13 published by the Cochrane Neonatal Group, 6 by the Cochrane Heart Group, and 1 by the Cochrane Peripheral Vascular Disease Group. Systematic reviews in pediatric cardiology appear infrequently. They only concern evidence-based decision-making in the therapeutic management of patent ductus arteriosus and arterial hypotension in preterm infants, and in the management of children with Kawasaki disease. The quality of the clinical trials contained in the systematic reviews of acute rheumatic fever or obesity in children is limited. Consequently, the reviewers' conclusions provide an inadequate basis for inferring probable effects in clinical practice. In pediatric cardiology, many therapies continue to be used without supportive evidence. We found no systematic reviews of important cardiologic topics in childhood such as heart failure, shock, hypertension, congenital cardiopathy, and arrhythmia. Clinical practice guidelines complement systematic reviews, which can recommend only strategies that are supported by strong evidence or suggest further research when scientific evidence is inadequate.

  4. An Evaluation of a Clerkship In Cardiology

    ERIC Educational Resources Information Center

    Edson, John N.; and others

    1969-01-01

    Evaluation of the clinical clerkship in Cardiology for general practitioners proves there is an urgent need for continuing post graduate medical education for general practitioners. Clerkship was offered jointly by the Long Island College Hospital and the State University of New York Downstate Medical Center, Brooklyn, New York. (IR)

  5. [Update on preventive cardiology and rehabilitation].

    PubMed

    Fernández de Bobadilla Osorio, Jaime; Fernández-Bobadilla, Esteban; García-Porrero, Esteban; Luengo-Fernández, Emilio; Casasnovas-Lenguas, José Antonio

    2012-01-01

    The aim of the Preventive Cardiology and Rehabilitation Section of the Spanish Society of Cardiology is to promote knowledge about and adoption of the lifestyle, therapy and rehabilitation program guidelines that are best able to improve cardiovascular health in the Spanish population. To achieve this aim, a number of working groups have carried out research into and provided education about the latest developments in cardiovascular prevention, and have provided information about these developments to all those affected, including physicians, healthcare workers, healthcare administrators and the general public. This year, the working group on smoking produced an key document that was presented to cardiologists in our Society; its intention was to provide a simple algorithm to help patients give up smoking that could be applied in only 3 minutes. The working group on cardiac rehabilitation gave a presentation on the true impact of rehabilitation on survival after percutaneous coronary intervention and heart failure. Also this year, the European Society of Cardiology published a major revision of guidelines on the treatment of dyslipidemia, which was welcomed by many but criticized by others. Our correspondent at the European Society reflects on the role and usefulness of these guidelines in practice. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  6. An Evaluation of a Clerkship In Cardiology

    ERIC Educational Resources Information Center

    Edson, John N.; and others

    1969-01-01

    Evaluation of the clinical clerkship in Cardiology for general practitioners proves there is an urgent need for continuing post graduate medical education for general practitioners. Clerkship was offered jointly by the Long Island College Hospital and the State University of New York Downstate Medical Center, Brooklyn, New York. (IR)

  7. [Aquapheresis, an innovative technique in cardiology].

    PubMed

    Armand, Patricia; Boutarin, David; Gerbaaï, Raphaëlle

    2015-03-01

    Used in France for the last two years, aquapheresis is a technique to remove excess water from patients with heart failure resistant to diuretics. The therapy is delivered during the patient's hospitalisation in a cardiology intensive care unit to ensure optimal monitoring and the prevention of potential complications. A team from Grenoble shares its experience.

  8. The increasing impact of laboratory medicine on clinical cardiology.

    PubMed

    Clerico, Aldo

    2003-07-01

    The practice of cardiology continues to evolve along with a better understanding of the pathophysiology of cardiovascular disease and the development of new therapeutic procedures. Consequently, new demands are being made on the in vitro diagnostics industry to improve the performance of existing cardiac markers and to develop novel markers for new cardiac disease indications. Indeed, in the last 20 years there has been a progressive increase in new laboratory tests for markers of cardiac diseases. Several highly sensitive and/or specific assays for the detection of myocardial ischemic damage as well as some immunoassays for cardiac natriuretic hormones, now considered a reliable marker of myocardial function, have become commercially available. In parallel, a growing number of some novel risk factors, which can be assessed and monitored by laboratory methods, have been added to the classical risk factors for cardiovascular disease. Finally, the recent explosion of genetic analysis may soon place at the clinical cardiologist's disposal many laboratory tests for defining the diagnosis at the molecular level, assessing new risk factors, and better targeting the pharmaceutical approaches in patients with cardiovascular disease. In the present article, after a brief description of the analytical tests included in these four groups, each group's impact on clinical cardiology is discussed in detail.

  9. Business process re-engineering a cardiology department.

    PubMed

    Bakshi, Syed Murtuza Hussain

    2014-01-01

    The health care sector is the world's third largest industry and is facing several problems such as excessive waiting times for patients, lack of access to information, high costs of delivery and medical errors. Health care managers seek the help of process re-engineering methods to discover the best processes and to re-engineer existing processes to optimize productivity without compromising on quality. Business process re-engineering refers to the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical, contemporary measures of performance, such as cost, quality and speed. The present study is carried out at a tertiary care corporate hospital with 1000-plus-bed facility. A descriptive study and case study method is used with intensive, careful and complete observation of patient flow, delays, short comings in patient movement and workflow. Data is collected through observations, informal interviews and analyzed by matrix analysis. Flowcharts were drawn for the various work activities of the cardiology department including workflow of the admission process, workflow in the ward and ICCU, workflow of the patient for catheterization laboratory procedure, and in the billing and discharge process. The problems of the existing system were studied and necessary suggestions were recommended to cardiology department module with an illustrated flowchart.

  10. Optimization and surgical design for applications in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison; Bernstein, Adam; Taylor, Charles; Feinstein, Jeffrey

    2007-11-01

    The coupling of shape optimization to cardiovascular blood flow simulations has potential to improve the design of current surgeries and to eventually allow for optimization of surgical designs for individual patients. This is particularly true in pediatric cardiology, where geometries vary dramatically between patients, and unusual geometries can lead to unfavorable hemodynamic conditions. Interfacing shape optimization to three-dimensional, time-dependent fluid mechanics problems is particularly challenging because of the large computational cost and the difficulty in computing objective function gradients. In this work a derivative-free optimization algorithm is coupled to a three-dimensional Navier-Stokes solver that has been tailored for cardiovascular applications. The optimization code employs mesh adaptive direct search in conjunction with a Kriging surrogate. This framework is successfully demonstrated on several geometries representative of cardiovascular surgical applications. We will discuss issues of cost function choice for surgical applications, including energy loss and wall shear stress distribution. In particular, we will discuss the creation of new designs for the Fontan procedure, a surgery done in pediatric cardiology to treat single ventricle heart defects.

  11. Ionizing Radiation-Induced Cataract in Interventional Cardiology Staff

    PubMed Central

    Bitarafan Rajabi, Ahmad; Noohi, Feridoun; Hashemi, Hassan; Haghjoo, Majid; Miraftab, Mohammad; Yaghoobi, Nahid; Rastgou, Fereydon; Malek, Hadi; Faghihi, Hoshang; Firouzabadi, Hassan; Asgari, Soheila; Rezvan, Farhad; Khosravi, Hamidreza; Soroush, Sara; Khabazkhoob, Mehdi

    2015-01-01

    Background: The use of ionizing radiation has led to advances in medical diagnosis and treatment. Objectives: The purpose of this study was to determine the risk of radiation cataractogenesis in the interventionists and staff performing various procedures in different interventional laboratories. Patients and Methods: This cohort study included 81 interventional cardiology staff. According to the working site, they were classified into 5 groups. The control group comprised 14 professional nurses who did not work in the interventional sites. Participants were assigned for lens assessment by two independent trained ophthalmologists blinded to the study. Results: The electrophysiology laboratory staff received higher doses of ionizing radiation (17.2 ± 11.9 mSv; P < 0.001). There was a significant positive correlation between the years of working experience and effective dose in the lens (P < 0.001). In general, our findings showed that the incidence of lens opacity was 79% (95% CI, 69.9-88.1) in participants with exposure (the case group) and our findings showed that the incidence of lenses opacity was 7.1% (95% CI:2.3-22.6) with the relative risk (RR) of 11.06 (P < 0.001). Conclusions: We believe that the risk of radiation-induced cataract in cardiology interventionists and staff depends on their work site. As the radiation dose increases, the prevalence of posterior eye changes increases. PMID:25789258

  12. Outpatient radioiodine therapy for thyroid cancer: a safe nuclear medicine procedure.

    PubMed

    Willegaignon, José; Sapienza, Marcelo; Ono, Carla; Watanabe, Tomoco; Guimarães, Maria Inês; Gutterres, Ricardo; Marechal, Maria Helena; Buchpiguel, Carlos

    2011-06-01

    To evaluate the dosimetric effect of outpatient radioiodine therapy for thyroid cancer in members of a patient's family and their living environment, when using iodine-131 doses reaching 7.4 GBq. The following parameters were thus defined: (a) whole-body radiation doses to caregivers, (b) the production of contaminated solid waste, and (c) radiation potential and surface contamination within patients' living quarters. In total, 100 patients were treated on an outpatient basis, taking into consideration their acceptable living conditions, interests, and willingness to comply with medical and radiation safety guidelines. Both the caregivers and the radiation dose potentiality inside patients' residences were monitored by using thermoluminescent dosimeters. Surface contamination and contaminated solid wastes were identified and measured with a Geiger-Müller detector. A total of 90 monitored individuals received a mean dose of 0.27 (±0.28) mSv, and the maximum dose registered was 1.6 mSv. The mean value for the potential dose within all living quarters was 0.31 (±0.34) mSv, and the mean value per monitored surface was 5.58 Bq/cm(2) for all the 1659 points measured. The overall production of contaminated solid wastes was at a low level, being about 3 times less than the exemption level indicated by the International Atomic Energy Agency. This study indicates that the treatment of thyroid cancer by applying radioiodine activities up to 7.4 GBq, on an outpatient basis, is a safe procedure, especially when supervised by qualified professionals. This alternative therapy should be a topic for careful discussion considering the high potential for reducing costs in healthcare and improving patient acceptance.

  13. Nuclear medicine practices in the 1950s through the mid-1970s and occupational radiation doses to technologists from diagnostic radioisotope procedures.

    PubMed

    Drozdovitch, Vladimir; Brill, Aaron B; Mettler, Fred A; Beckner, William M; Goldsmith, Stanley J; Gross, Milton D; Hays, Marguerite T; Kirchner, Peter T; Langan, James K; Reba, Richard C; Smith, Gary T; Bouville, André; Linet, Martha S; Melo, Dunstana R; Lee, Choonsik; Simon, Steven L

    2014-10-01

    Data on occupational radiation exposure from nuclear medicine procedures for the time period of the 1950s through the 1970s is important for retrospective health risk studies of medical personnel who conducted those activities. However, limited information is available on occupational exposure received by physicians and technologists who performed nuclear medicine procedures during those years. To better understand and characterize historical radiation exposures to technologists, the authors collected information on nuclear medicine practices in the 1950s, 1960s, and 1970s. To collect historical data needed to reconstruct doses to technologists, a focus group interview was held with experts who began using radioisotopes in medicine in the 1950s and the 1960s. Typical protocols and descriptions of clinical practices of diagnostic radioisotope procedures were defined by the focus group and were used to estimate occupational doses received by personnel, per nuclear medicine procedure, conducted in the 1950s to 1960s using radiopharmaceuticals available at that time. The radionuclide activities in the organs of the reference patient were calculated using the biokinetic models described in ICRP Publication 53. Air kerma rates as a function of distance from a reference patient were calculated by Monte Carlo radiation transport calculations using a hybrid computational phantom. Estimates of occupational doses to nuclear medicine technologists per procedure were found to vary from less than 0.01 μSv (thyroid scan with 1.85 MBq of administered I-iodide) to 0.4 μSv (brain scan with 26 MBq of Hg-chlormerodin). Occupational doses for the same diagnostic procedures starting in the mid-1960s but using Tc were also estimated. The doses estimated in this study show that the introduction of Tc resulted in an increase in occupational doses per procedure.

  14. NUCLEAR MEDICINE PRACTICES IN THE 1950s THROUGH THE mid-1970s AND OCCUPATIONAL RADIATION DOSES TO TECHNOLOGISTS FROM DIAGNOSTIC RADIOISOTOPE PROCEDURES

    PubMed Central

    Drozdovitch, Vladimir; Brill, Aaron B.; Mettler, Fred A.; Beckner, William M.; Goldsmith, Stanley J.; Gross, Milton D.; Hays, Marguerite T.; Kirchner, Peter T.; Langan, James K.; Reba, Richard C.; Smith, Gary T.; Bouville, André; Linet, Martha S.; Melo, Dunstana R.; Lee, Choonsik; Simon, Steven L.

    2014-01-01

    Data on occupational radiation exposure from nuclear medicine procedures for the time period of the 1950s through the 1970s is important for retrospective health risk studies of medical personnel who conducted those activities. However, limited information is available on occupational exposure received by physicians and technologists who performed nuclear medicine procedures during those years. To better understand and characterize historical radiation exposures to technologists, we collected information on nuclear medicine practices in the 1950s, 1960s, and 1970s. To collect historical data needed to reconstruct doses to technologists, a focus group interview was held with experts who began using radioisotopes in medicine in the 1950s and the 1960s. Typical protocols and descriptions of clinical practices of diagnostic radioisotope procedures were defined by the focus group and were used to estimate occupational doses received by personnel, per nuclear medicine procedure, conducted in the 1950s-1960s using radiopharmaceuticals available at that time. The radionuclide activities in the organs of the reference patient were calculated using the biokinetic models described in ICRP Publication 53. Air kerma rates as a function of distance from a reference patient were calculated by Monte Carlo radiation transport calculations using a hybrid computational phantom. Estimates of occupational doses to nuclear medicine technologists per procedure were found to vary from less than 0.01 μSv (thyroid scan with 1.85 MBq of administered 131I-iodide) to 0.4 μSv (brain scan with 26 MBq of 203Hg-chlormerodin). Occupational doses for the same diagnostic procedures starting in the mid-1960s but using 99mTc were also estimated. The doses estimated in this study show that the introduction of 99mTc resulted in an increase in occupational doses per procedure. PMID:25162420

  15. Behavioral cardiology: current advances and future directions.

    PubMed

    Rozanski, Alan

    2014-07-08

    Growing epidemiological evidence identifies key domains relevant to behavioral cardiology, including health behaviors, emotions, mental mindsets, stress management, social connectedness, and a sense of purpose. Each of these domains exists along a continuum, ranging from positive factors that promote health, to negative factors, which are pathophysiological. To date, there has been relatively little translation of this growing knowledge base into cardiology practice. Four initiatives are proposed to meet this challenge: 1) promulgating greater awareness of the potency of psychosocial risks factors; 2) overcoming a current "artificial divide" between conventional and psychosocial risk factors; 3) developing novel cost-effective interventions using Internet and mobile health applications, group-based counseling, and development of tiered-care behavioral management; and 4) in recognition that "one size does not fit all" with respect to behavioral interventions, developing specialists who can counsel patients in multidisciplinary fashion and use evidence-based approaches for promoting patient motivation and execution of health goals.

  16. Use of smartphone technology in cardiology.

    PubMed

    Nguyen, Hoang H; Silva, Jennifer N A

    2016-05-01

    Smartphone-based technologies along with broadband connectivity are changing the way modern cardiology is practiced. The ever broadening connectivity and increasing capabilities of smartphone-based technologies can better monitor, diagnose, and prevent cardiovascular diseases. Researchers can leverage the ubiquitous use of smartphone-based technologies and their constant stream of biometric data to establish large community-based clinical research studies. Patient engagement is enhanced with constant and on-demand access to physicians, daily self-monitoring, and expanding social networks. On the other hand, the exponential growth of smartphone-based technologies invariably disrupts the traditional healthcare model and leaves a vacuum in the infrastructure, medico-legal apparatus, and reimbursement systems that need to be addressed. In this review, we present a comprehensive discussion of the various applications utilizing smartphone-based technologies in cardiology.

  17. [Sports cardiology : Overview of relevant clinical topics].

    PubMed

    Laszlo, R; Scharhag, J; Burgstahler, C; Striegel, H; Steinacker, J M

    2017-01-23

    Physical activity is nowadays an established therapeutic principle concerning primary and secondary prevention of cardiovascular diseases; therefore, in internal sports medicine various aspects go beyond basic cardiological knowledge and require special medical expertise (sports cardiology). Acute cardiac risk is increased during physical activity; therefore, physical activity should be individually phased under consideration of the whole clinical situation. Physical training results in a functional adaptation of the cardiovascular system. Moreover, a structural adaptation can also be observed in competitive athletes but a differentiation between athlete's heart and cardiomyopathy is sometimes challenging. Preparticipation screening verifiably reduces the incidence of sudden cardiac death in athletes. Respective recommendations for the required diagnostics have been published and statutory health insurances are increasingly more willing to bear the incurred costs. Statistically, doping is more frequent in performance-orientated leisure time sports than in competitive sports. Drugs which are relevant for doping have partially irreversible cardiac side effects.

  18. [Management control of cardiology: the experience of a departmental unit].

    PubMed

    Boccanelli, A; Spandonaro, F

    2000-01-01

    In most Italian hospitals, sanitary reform is being applied, while at the same time a new organization of the National Health System is being planned. The director of the medical hospital (head doctor) is becoming more and more involved in management and this aspect has modified his professional attributes. Cardiology is a branch of medicine that, through its scientific preparatory work consisting in debates, management courses, ethics, and production of managerial software, is closer to applying the reform without risking improper administrative aspects. This, obviously, comes about after thoroughly reviewing past work methods and the need to have an administrative organization, which allocates efficient use of manpower and materials, helping to eliminate any sources of inefficiency. The logical procedure foresees an actual analysis in terms of sanitary needs and availability of resources, and so attempting to better balance and harmonize both aspects of the problem. Certainly, the acquisition of theoretical norms and practices, which today are present because of the upsurge in training courses for doctors, is not enough to guarantee the achievement of optimal results. Furthermore, we find that theoretical models need to be validated and adapted to real work situations in the public hospital sector. This paper proposes, therefore, to explain the managerial experiences achieved in actual work situations at the Cardiology Department Unit of the San Giovanni Addolorata Hospital in Rome. In particular, it shows that in order to reach its clinical and economical objectives, it is essential to make available correct informative support for strategic and operational decisions. We can observe that there is a continuing lack of computer support systems being integrated into the present organization of most cardiology units. The use of software distributed to cardiology units from the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) has enabled us to partially

  19. Women in interventional cardiology: The French experience.

    PubMed

    Vautrin, E; Marlière, S; Bellemain-Appaix, A; Gilard, M; Manzo-Silberman, S

    2016-12-01

    Exploring the discrepancy in sex-ratio among interventional cardiologists by analysing the population of the female interventionalist. Despite an increase number of women who graduate from medical school in France during the last generation today, women represent only 24% of all cardiologists and 3% are interventional cardiologists. To face this international gender-based issue of interventional cardiology, committees were established in US (WIN) and recently within the EAPCI: the Women EAPCI chaired by Drs Mehilli and Mauri. In France, the Intervention'Elles committee emerged in order to participate in this concern. As a first initiative, the Intervention'Elles group launched an e-survey to obtain information on the population of French female interventional cardiologists, focused on demography, work patterns, maternity and radiation exposure. Mean age is 40 years old (±7,4), 68% are working in large volume center, 28% have also structural interventional activity. Only 40% have left arm coverage. Despite 80% of French female interventional cardiologists wear personal dosimeters only 45% of them have a dosimetry feedback. Interestingly, even if 54% of women have children (mean: 1.9±1) 28% of them report that childbearing had interfered with their career plan. This questionnaire identifies for the first time the women population in interventional cardiology in France and highlights some of the issues encountered in more detail. This first descriptive step would help to develop strategies for attaining gender equality in interventional cardiology. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. Evaluation of drug information for cardiology patients.

    PubMed Central

    Baker, D; Roberts, D E; Newcombe, R G; Fox, K A

    1991-01-01

    1. Cardiologists and pharmacists at the University Hospital of Wales collaborated to write 20 individual leaflets incorporating guidelines for a range of drugs used in the treatment of cardiology patients. The Plain English Campaign advised on the intelligibility and presentation of the information. 2. One hundred and twenty-five patients from the Regional Cardiology Unit, University Hospital of Wales were randomly allocated to receive usual verbal counselling about their drug treatment with or without an individualised drug information wallet. Two weeks after discharge from hospital patients completed a postal questionnaire to determine their satisfaction with the information about their drug treatment and their understanding of it. Forty-nine questionnaires were returned from the leaflet group and 52 from the control group. 3. The provision of written guidelines resulted in significant improvements in patients' satisfaction with their drug treatment (chi 2 = 33.3, P less than 0.001) and their understanding of it (P less than 0.001, Mann-Whitney test). Overall, patients who received leaflets were more likely to be aware of the potential side effects of their drugs but less likely to be apprehensive about them. Succinct guidelines concerning drug therapy can be assimilated by cardiology patients and provide them with a permanent record for future reference. PMID:1888619

  1. Trends in percutaneous coronary intervention from 2004 to 2013 according to the Portuguese National Registry of Interventional Cardiology.

    PubMed

    Pereira, Hélder; Teles, Rui Campante; Costa, Marco; da Silva, Pedro Canas; Ferreira, Rui Cruz; da Gama Ribeiro, Vasco; Santos, Ricardo; e Abreu, Pedro Farto; de Carvalho, Henrique Cyrne; Marques, Jorge; Fernandes, Renato; Brandão, Vítor; Martins, Dinis; Drummond, António; Pipa, João Luís; Seca, Luís; Calisto, João; Baptista, José; Matias, Fernando; Ramos, José Sousa; Pereira-Machado, Francisco; Silva, João Carlos; Almeida, Manuel

    2015-11-01

    The aim of the present paper is to report trends in Portuguese interventional cardiology from 2004 to 2013 and to compare them with other European countries. Based on the Portuguese National Registry of Interventional Cardiology and on official data from the Directorate-General of Health, we give an overview of developments in coronary interventions from 2004 to 2013. In 2013, 36 810 diagnostic catheterization procedures were performed, representing an increase of 34% compared to 2007 and a rate of 3529 coronary angiograms per million population. Coronary interventions increased by 65% in the decade from 2004 to 2013, with a total of 13 897 procedures and a rate of 1333 coronary interventions per million population in 2013. Primary percutaneous coronary intervention (PCI) increased by 265% from 2004 to 2013 (1328 vs. 3524), an adjusted rate of 338 primary PCIs per million, representing 25% of total angioplasties. Stents were the most frequently used devices, drug-eluting stents being used in 73% in 2013. Radial access increased from 4.1% in 2004 to 57.9% in 2013. Interventional cardiology in Portugal has been expanding since 2004. We would emphasize the fact that in 2013 all Portuguese interventional cardiology centers were participating in the National Registry of Interventional Cardiology, as well as the growth in primary PCI and increased use of radial access.

  2. Nuclear cardiograph and scintigraphy

    NASA Technical Reports Server (NTRS)

    Mclaughlin, P.

    1975-01-01

    Extensive advances in the technology of detectors, data analysis systems, and tracers used have resulted in greatly expanded applications of radioisotopes to the assessment of cardiac function and disease. The development of nuclear cardiology has proceeded along four lines: (1) radionuclide angiography, (2) myocardial perfusion imaging, (3) intracoronary microsphere imaging, and (4) regional myocardial blood flow determination using inert gases.

  3. Radiation exposure to nuclear medicine staffs during 18F-FDG PET/CT procedures at Ramathibodi Hospital

    NASA Astrophysics Data System (ADS)

    Donmoon, T.; Chamroonrat, W.; Tuntawiroon, M.

    2016-03-01

    The aim of this study is to estimate the whole body and finger radiation doses per study received by nuclear medicine staff involved in dispensing, administration of 18F-FDG and interacting with radioactive patients during PET/CT imaging procedures in a PET/CT facility. The whole-body doses received by radiopharmacists, technologists and nurses were measured by electronic dosimeter and the finger doses by ring dosimeter during a period of 4 months. In 70 PET/CT studies, the mean whole-body dose per study to radiopharmacist, technologist, and nurse were 1.07±0.09, 1.77±0.46, μSv, and not detectable respectively. The mean finger doses per study received by radiopharmacist, technologist, and nurse were 265.65±107.55, 4.84±1.08 and 19.22±2.59 μSv, respectively. The average time in contact with 18F-FDG was 5.88±0.03, 39.06±1.89 and 1.21±0.02 minutes per study for radiopharmacist, technologist and nurse respectively. Technologists received highest mean effective whole- body dose per study and radiopharmacist received the highest finger dose per study. When compared with the ICRP dose limit, each individual worker can work with many more 18F- FDG PET/CT studies for a whole year without exceeding the occupational dose limits. This study confirmed that low levels of radiation does are received by our medical personnel involved in 18F-FDG PET/CT procedures.

  4. A rapid dissolution procedure to aid initial nuclear forensics investigations of chemically refractory compounds and particles prior to gamma spectrometry.

    PubMed

    Reading, David G; Croudace, Ian W; Warwick, Phillip E; Britton, Richard

    2015-11-05

    A rapid and effective preparative procedure has been evaluated for the accurate determination of low-energy (40-200 keV) gamma-emitting radionuclides ((210)Pb, (234)Th, (226)Ra, (235)U) in uranium ores and uranium ore concentrates (UOCs) using high-resolution gamma ray spectrometry. The measurement of low-energy gamma photons is complicated in heterogeneous samples containing high-density mineral phases and in such situations activity concentrations will be underestimated. This is because attenuation corrections, calculated based on sample mean density, do not properly correct where dense grains are dispersed within a less dense matrix (analogous to a nugget effect). The current method overcomes these problems using a lithium tetraborate fusion that readily dissolves all components including high-density, self-attenuating minerals/compounds. This is the ideal method for dissolving complex, non-volatile components in soils, rocks, mineral concentrates, and other materials where density reduction is required. Lithium borate fusion avoids the need for theoretical efficiency corrections or measurement of matrix matched calibration standards. The resulting homogeneous quenched glass produced can be quickly dissolved in nitric acid producing low-density solutions that can be counted by gamma spectrometry. The effectiveness of the technique is demonstrated using uranium-bearing Certified Reference Materials and provides accurate activity concentration determinations compared to the underestimated activity concentrations derived from direct measurements of a bulk sample. The procedure offers an effective solution for initial nuclear forensic studies where complex refractory minerals or matrices exist. It is also significantly faster, safer and simpler than alternative approaches. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons.

    PubMed

    Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

    2017-03-06

    The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes (ACS) and stable ischemic heart disease were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and in an effort to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing ACS and stable ischemic heart disease individually. This document presents the AUC for ACS. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, presence of clinical instability or ongoing ischemic symptoms, prior reperfusion therapy, risk level as assessed by noninvasive testing, fractional flow reserve testing, and coronary anatomy. This update provides a reassessment of clinical scenarios that the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization. A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range (4 to 6

  6. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons.

    PubMed

    Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

    2017-06-12

    The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that

  7. Function Allocation in Complex Socio-Technical Systems: Procedure usage in nuclear power and the Context Analysis Method for Identifying Design Solutions (CAMIDS) Model

    NASA Astrophysics Data System (ADS)

    Schmitt, Kara Anne

    This research aims to prove that strict adherence to procedures and rigid compliance to process in the US Nuclear Industry may not prevent incidents or increase safety. According to the Institute of Nuclear Power Operations, the nuclear power industry has seen a recent rise in events, and this research claims that a contributing factor to this rise is organizational, cultural, and based on peoples overreliance on procedures and policy. Understanding the proper balance of function allocation, automation and human decision-making is imperative to creating a nuclear power plant that is safe, efficient, and reliable. This research claims that new generations of operators are less engaged and thinking because they have been instructed to follow procedures to a fault. According to operators, they were once to know the plant and its interrelations, but organizationally more importance is now put on following procedure and policy. Literature reviews were performed, experts were questioned, and a model for context analysis was developed. The Context Analysis Method for Identifying Design Solutions (CAMIDS) Model was created, verified and validated through both peer review and application in real world scenarios in active nuclear power plant simulators. These experiments supported the claim that strict adherence and rigid compliance to procedures may not increase safety by studying the industry's propensity for following incorrect procedures, and when it directly affects the outcome of safety or security of the plant. The findings of this research indicate that the younger generations of operators rely highly on procedures, and the organizational pressures of required compliance to procedures may lead to incidents within the plant because operators feel pressured into following the rules and policy above performing the correct actions in a timely manner. The findings support computer based procedures, efficient alarm systems, and skill of the craft matrices. The solution to

  8. Spanish cardiac catheterization and coronary intervention registry. 22nd official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2012).

    PubMed

    García Del Blanco, Bruno; Rumoroso Cuevas, Jose Ramón; Hernández Hernández, Felipe; Trillo Nouche, Ramiro

    2013-11-01

    The Working Group on Cardiac Catheterization and Interventional Cardiology presents the yearly report on the data collected for the Spanish registry. Institutions provided their data voluntarily (online) and the information was analyzed by the Working Group's Steering Committee. Data were provided by 109 hospitals (71 public and 38 private) that mainly treat adults. There were 136,912 diagnostic procedures, 120, 441 of which were coronary angiograms, slightly fewer than the year before, with a rate of 2979 diagnostic studies per million population. Percutaneous coronary interventions increased slightly to 65,909 procedures, for a rate of 1434 interventions per million population. Of the 99,110 stents implanted, 62% were drug-eluting stents. In all, 17,125 coronary interventions were carried out during the acute phase of myocardial infarction, 10.5% more than in 2011, representing 25.9% of the total number of coronary interventions. The most frequently performed intervention for adult congenital heart disease was atrial septal defect closure (292 procedures). The use of percutaneous mitral valvuloplasty continued to decline (258 procedures) and percutaneous aortic valve implantations increased by only 10% in 2012. In 2012, the only increase in hemodynamic activity occurred in the field of ST-elevation myocardial infarction, and the increasing trend had slowed for percutaneous aortic valve implantation and other procedures affecting structure. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  9. Three-dimensional printing in cardiac surgery and interventional cardiology: a single-centre experience.

    PubMed

    Schmauss, Daniel; Haeberle, Sandra; Hagl, Christian; Sodian, Ralf

    2015-06-01

    In individual cases, routine preoperative imaging might not be sufficient for optimal planning of cardiovascular procedures. Three-dimensional printing (3D), a widely used technique to build life-like replicas of anatomical structures that has proven value in different medical disciplines, might overcome these shortcomings. However, data on 3D printing in cardiovascular medicine are limited to single reports. This stimulated us to present our single-centre experience with 3D printing models in cardiac surgery and interventional cardiology. Between the years 2006 and 2013, we fabricated 3D printing models using preoperative computed tomography or magnetic resonance imaging data in paediatric and adult cardiac surgery, as well as interventional cardiology. We present the 8 most representative cases. The models were very helpful for perioperative planning and orientation, as well as simulation of procedures due to the exact and life-like illustration of the cardiovascular anatomy. The fabrication of 3D printing models is feasible for perioperative planning and simulation in a variety of complex cases in paediatric and adult cardiac surgery, as well as in interventional cardiology. Further studies including more patients and providing more data are expected to demonstrate that the use of 3D printing may decrease morbidity and mortality of complex, non-routine procedures in cardiovascular medicine. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  10. Training residents/fellows in paediatric cardiology: the Emory experience.

    PubMed

    Campbell, Robert M

    2016-12-01

    Pediatric cardiology fellowship is a very busy time, with new responsibilities, new knowledge, new technology and fast pace. Above and beyond the science and art of pediatric cardiology, we emphasize that our cardiology fellows are in the middle of the "people business", with additional roles and responsibilities as they serve their patients and communities. This manuscript provides insight into these opportunities for our pediatric cardiac professionals.

  11. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-01-01

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research.

  12. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-11-23

    The American College of Cardiology Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research.

  13. ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine.

    PubMed

    Douglas, Pamela S; Khandheria, Bijoy; Stainback, Raymond F; Weissman, Neil J; Peterson, Eric D; Hendel, Robert C; Stainback, Raymond F; Blaivas, Michael; Des Prez, Roger D; Gillam, Linda D; Golash, Terry; Hiratzka, Loren F; Kussmaul, William G; Labovitz, Arthur J; Lindenfeld, JoAnn; Masoudi, Frederick A; Mayo, Paul H; Porembka, David; Spertus, John A; Wann, L Samuel; Wiegers, Susan E; Brindis, Ralph G; Douglas, Pamela S; Hendel, Robert C; Patel, Manesh R; Peterson, Eric D; Wolk, Michael J; Allen, Joseph M

    2008-03-18

    The American College of Cardiology Foundation (ACCF) and the American Society of Echocardiography (ASE) together with key specialty and subspecialty societies, conducted an appropriateness review for stress echocardiography. The review assessed the risks and benefits of stress echocardiography for several indications or clinical scenarios and scored them on a scale of 1 to 9 (based upon methodology developed by the ACCF to assess imaging appropriateness). The upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The midrange (4 to 6) indicates a clinical scenario for which the indication for a stress echocardiogram is uncertain. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Use of stress echocardiography for risk assessment in patients with coronary artery disease (CAD) was viewed favorably, while routine repeat testing and general screening in certain clinical scenarios were viewed less favorably. It is anticipated that these results will have a significant impact on physician decision making and performance, reimbursement policy, and will help guide future research.

  14. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D; Kramer, Christopher M; Berman, Daniel; Brown, Alan; Chaudhry, Farooq A; Cury, Ricardo C; Desai, Milind Y; Einstein, Andrew J; Gomes, Antoinette S; Harrington, Robert; Hoffmann, Udo; Khare, Rahul; Lesser, John; McGann, Christopher; Rosenberg, Alan; Schwartz, Robert; Shelton, Marc; Smetana, Gerald W; Smith, Sidney C

    2010-11-23

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research.

  15. Comparison between Cystatin C- and Creatinine-Estimated Glomerular Filtration Rate in Cardiology Patients

    PubMed Central

    Åkerblom, Axel; Helmersson-Karlqvist, Johanna; Flodin, Mats; Larsson, Anders

    2015-01-01

    Objective Estimation of the glomerular filtration rate (GFR) is essential for identification, evaluation and risk prediction in patients with kidney disease. Estimated GFR (eGFR) is also needed for the correct dosing of drugs eliminated by the kidneys and to identify high-risk individuals in whom coronary angiography or other procedures may lead to kidney failure. Both cystatin C and creatinine are used for the determination of GFR, and we aimed to investigate if eGFR by the two methods differ in cardiology patients. Methods We compared cystatin C and creatinine (CKD-EPI) eGFR calculated from the same request from a cardiology outpatient unit (n = 2,716), a cardiology ward (n = 980), a coronary care unit (n = 1,464), and an advanced coronary care unit (n = 518) in an observational, cross-sectional study. Results The median creatinine eGFR results are approximately 10 ml/min/1.73 m2 higher than the median cystatin C eGFR that is up to 90 ml/min/1.73 m2, irrespective of the level of care. Creatinine eGFR resulted in a less advanced eGFR category in the majority of patients with a cystatin C eGFR <60 ml/min/1.73 m2. Conclusions Our study demonstrates a difference between creatinine and cystatin C eGFR in cardiology patients. It is important to be aware of which marker is used for the reported eGFR to minimize erroneous interpretations of the test results, as this could lead to under- or overmedication. Further studies are needed to determine the best method of estimating the GFR in cardiology units. PMID:26648945

  16. [Fundamental bases of digital information processing in nuclear cardiology (III)].

    PubMed

    Cuarón, A; González, C; García Moreira, C

    1984-01-01

    This article describes the transformation of the gamma-camera images into digital form. The incidence of a gamma photon on the detector, produces two voltage pulses, which are proportional to the coordinates of the incidence points, and a digital pulse, indicative of the occurrence of the event. The coordinate pulses passes through a analog-digital converter, that is activated by the pulse. The result is the appearance of a digital number at the out-put of the converter, which is proportional to the voltage at its in-put. This number, is stored on the accumulation memory of the system, either on a list mode or on a matrix mode. Static images can be stored on a single matrix. Dynamic data can be stored on a series of matrixes, each representing a different period of acquisition. It is also possible to capture information on a series of matrixes syncronized with the electrocardiogram of the patient. In this instance, each matrix represents a distinct period of the cardiac cycle. Data stored on the memory, can be used to process and display images and quantitative histograms on a video screen. In order to do that, it is necessary to translate the digital data on the memory to voltage levels, and to transform these on light levels on the screen. This, is achieved through a digital analog converter. The reading of the digital memory must be syncronic with the electronic scanning of the video screen.

  17. Spanish Cardiac Catheterization and Coronary Intervention Registry. 24th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2014).

    PubMed

    García Del Blanco, Bruno; Hernández Hernández, Felipe; Rumoroso Cuevas, José Ramón; Trillo Nouche, Ramiro

    2015-12-01

    The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the data from the registry of the activity in Spain in 2014. Data were voluntarily provided by participating centers. The information was introduced online and was analyzed by the Steering Committee of the Working Group on Cardiac Catheterization and Interventional Cardiology. Data were reported by 106 hospitals. A total of 140 461 diagnostic procedures (125 484 coronary angiograms) were performed, representing a rate of 3014 diagnostic studies per million population. This year, the number of percutaneous coronary interventions increased to 67 611, giving a rate of 1447 interventions per million population. A total of 94 458 stents were implanted, including 64 057 drug-eluting stents and 2424 biodegradable intracoronary devices. Of the total number of percutaneous coronary interventions, 17 825 were in acute myocardial infarction, representing 26.4% of all coronary interventions. A radial approach was used in 74% of diagnostic procedures and in 70.4% of interventional procedures. The use of renal denervation decreased, whereas over 125 mitral leak closures were performed. Transcatheter aortic valve implantation procedures exceeded 1300 implantations per year, a 27% increase from 2013. The registry for 2014 shows a slight increase in coronary disease activity despite no increase in the management of ST-segment elevation myocardial infarction. Drug-eluting intracoronary devices now comprise over 70% of all intracoronary devices. A continual increase is only seen in certain structural interventional techniques, such as transcatheter aortic valve implantation and perivalvular leak closure. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  18. [Informed consent in cardiology. The Committee on Informed Consent of the Commission on Professional Matters of the Sociedad Española de Cardiología].

    PubMed

    de los Reyes López, M; Iñíguez Romo, A; Goicolea de Oro, A; Funes López, B; Castro Beiras, A

    1998-10-01

    In the last thirty years, the clinical relationship between physicians and patients has been rather modified. There are several factors that have contributed to this change: a) New ways to execute medical practises, specially referred to the development of new techniques; b) Cultural changes in our western society, mainly in the mediterranean area, where there has been progress in the recognition of patients' autonomy to decide about their own lives, health and their own bodies; c) The increasing number of lawsuits, complaints and judgements about the problems that clinical information involves, particularly the informed consent in clinical practise. We consider it necessary to make an extensive and deep discussion from all of the areas in Medicine and Law, to analyze the different ethical and legal parts of the informed consent. For that reason the Spanish Society of Cardiology offers their members a basic document in order to reflect about these facts, developing arguments, justifications and supports. This document has also considered models, conditions to their applicability according to Spanish law, and the experience we have had. Finally, there is a list of diagnostic procedures and interventional practises in cardiology that might be preceded by a written informed consent document. We considered them by the name of Spanish Society of Cardiology recommendations.

  19. An update on radiation absorbed dose to patients from diagnostic nuclear medicine procedures in Tehran: A study on four academic centers

    PubMed Central

    Motazedian, Motahareh; Tabeie, F; Vatankhah, P; Shafiei, B; Amoui, M; Atefi, M; Ansari, M; Asli, I Neshandar

    2016-01-01

    Purpose: Use of radiopharmaceuticals for diagnostic nuclear medicine procedures is one of the main sources of radiation exposure. We performed this study with respect to the rapid growth in nuclear medicine in Iran and lack of updated statistics. Materials and Methods: The data were obtained for all active Nuclear Medicine Centers affiliated to Shahid Beheshti University of Medical Sciences during 2009 and 2010. Results: The most frequently performed procedures were bone (30.16%), cardiac (28.96%), renal (17.97%), and thyroid (7.93%) scans. There was a significant decrease in the number of thyroid scintigraphies with 131I and 99mTc-sulfur colloid liver/spleen scans and tremendous increase in the frequencies of cardiac and bone scintigraphies compared to one decade ago. Conclusion: Compared to previous studies, there were striking changes in trends of diagnostic nuclear medicine procedures in Tehran. This field is still evolving in the country, and this trend will further change with the introduction of positron emission tomography scanners in future. PMID:27095860

  20. An update on radiation absorbed dose to patients from diagnostic nuclear medicine procedures in Tehran: A study on four academic centers.

    PubMed

    Motazedian, Motahareh; Tabeie, F; Vatankhah, P; Shafiei, B; Amoui, M; Atefi, M; Ansari, M; Asli, I Neshandar

    2016-01-01

    Use of radiopharmaceuticals for diagnostic nuclear medicine procedures is one of the main sources of radiation exposure. We performed this study with respect to the rapid growth in nuclear medicine in Iran and lack of updated statistics. The data were obtained for all active Nuclear Medicine Centers affiliated to Shahid Beheshti University of Medical Sciences during 2009 and 2010. The most frequently performed procedures were bone (30.16%), cardiac (28.96%), renal (17.97%), and thyroid (7.93%) scans. There was a significant decrease in the number of thyroid scintigraphies with (131)I and (99m)Tc-sulfur colloid liver/spleen scans and tremendous increase in the frequencies of cardiac and bone scintigraphies compared to one decade ago. Compared to previous studies, there were striking changes in trends of diagnostic nuclear medicine procedures in Tehran. This field is still evolving in the country, and this trend will further change with the introduction of positron emission tomography scanners in future.

  1. A case study of technology transfer: Cardiology

    NASA Technical Reports Server (NTRS)

    Schafer, G.

    1974-01-01

    Research advancements in cardiology instrumentation and techniques are summarized. Emphasis is placed upon the following techniques: (1) development of electrodes which show good skin compatibility and wearer comfort; (2) contourography - a real time display system for showing the results of EKGs; (3) detection of arteriosclerosis by digital computer processing of X-ray photos; (4) automated, noninvasive systems for blood pressure measurement; (5) ultrasonoscope - a noninvasive device for use in diagnosis of aortic, mitral, and tricuspid valve disease; and (6) rechargable cardiac pacemakers. The formation of a biomedical applications team which is an interdisciplinary team to bridge the gap between the developers and users of technology is described.

  2. Cardiology Rx for Change: improving clinical attention to tobacco use and secondhand smoke exposure in cardiology.

    PubMed

    Prochaska, Judith J; Benowitz, Neal L; Glantz, Stanton A; Hudmon, Karen Suchanek; Grossman, William

    2011-12-01

    Heart disease is the leading cause of tobacco-related death in smokers and of deaths due to secondhand smoke (SHS) exposure in nonsmokers. This study centers on the development and evaluation of an evidence-based model curriculum for improving clinical attention to tobacco use and SHS exposure in cardiology. We hypothesized that the curriculum would be associated with improvements in clinician tobacco-related knowledge, attitudes, confidence, and counseling behaviors from pre-to post-training and at the 3-month follow-up. The 1-hour Cardiology Rx for Change curriculum was evaluated with 22 cardiology fellows and 77 medical residents with consistent training effects observed between the 2 groups. Trainees' tobacco treatment knowledge increased significantly from pre- to post-training (t[81] = 6.51, P<0.001), and perceived barriers to providing cessation treatment decreased significantly (t[81] = -3.97, P<0.001). The changes, however, were not sustained at the 3-month follow-up, suggesting the need for booster training efforts. From pretraining to 3-month follow-up, the training was associated with significant sustained gains in clinician confidence for treating tobacco dependence (t[61] = 3.69, P = 0.001) and with improvements in clinicians assessing patients' readiness to quit smoking (from 61% to 79%, t[59] = 3.69,P<0.001) and providing assistance with quitting (from 47% to 59%, t[59] = 2.12, P = 0.038). Asking patients about tobacco use, advising cessation, and arranging follow-up also increased over time, but not significantly. All participants (100%) recommended the curriculum for dissemination to other training programs. Available online via http://rxforchange.ucsf.edu, Cardiology Rx for Change offers a packaged training tool for improving treatment of tobacco use and SHS exposure in cardiology care. © 2011 Wiley Periodicals, Inc.

  3. Optimizing the interventional cardiology facility: services integration in routine workflow.

    PubMed

    Gortzis, Lefteris; Kalogeropoulos, A; Alexopoulos, D; Nikiforidis, G

    2007-01-01

    Integration of administrative and clinical data, imaging, and expert services, although challenging,is a key requirement in contemporary interventional cardiology facilities (ICF). We propose a workflow-oriented hybrid system to support the ICF and investigate its feasibility and effectiveness ina referral medical center. We have developed a Java-powered hybrid system (NetCARDIO), able to support over web synchronous and asynchronous data management, realtime multimedia data telemonitoring and continuous telementoring. Data regarding procedural rates, treatment planning and radiation exposure were collected over a two-year period of routine NetCARDIO implementation(July 2002 to June 2004) and compared with data from an immediately preceding period of equal duration (January 2000 to December 2001). During the NetCARDIO period, 163 +/- 17 coronary procedures per month were performed vs.77 +/- 15 during the control period (p <0.001). Percutaneous coronary intervention was delivered 'ad hoc' in 88% of eligible patients vs. 45% (p <0.001). Mean fluoroscopy time per coronary lesion treated decreased from 594 +/- 82 s to 540 +/- 94 s(p < 0.001). Annual radiation exposure of expert interventionists was decreased by 22%. Electronic storage significantly reduced archiving costs. Real-time multimodal services sharing combined with powerful database capabilities is feasible through a web-based structure, significantly enhancing performance and cost-effectiveness of ICF. Further research is needed to promote integration of additional data sources and services.

  4. [The origins of the Czech Society of Cardiology and of Czech cardiology].

    PubMed

    Widimský, J

    2013-06-01

    The paper presents the origins of the Czech Society of Cardiology on the one hand, and the origins of Czech cardiology on the other. The Czech Society of Cardiology is the third oldest in the world (after the American and German Societies). It was founded in 1929 by Prof. Libenský. As early as in 1933, the Society organised the first international congress of cardiologists in Prague, which was attended by 200 doctors, out of which 50 were from abroad. The most participants came from France and Poland. Other participants came from England, Argentina, Belgium, the Netherlands, Italy, Romania, Spain and Switzerland. The worldwide importance of this congress is apparent from the fact that both the World Society of Cardiology and the European Society of Cardiology (EKS) were founded after World War II in the years 1950 and 1952, i.e. almost 20 years after the first international congress of cardiology in Prague. In 1964, the Fourth Congress of European Society of Cardiology was held in Prague with the participation of 1,500 specialists from 31 countries and chaired by Prof. Pavel Lukl, the later president of EKS (1964- 1968). The paper also presents the work of our specialists in WHO and the history of the international journal Cor et Vasa issued by the Avicenum publishing house in Prague in English and Russian in the years 1958- 1992. An important role in the development of our cardiology was played by certain departments and clinics. In 1951, the Institute for Cardiovascular Research (ÚCHOK) was founded in PrahaKrč, thanks to the initiative of MU Dr. František Kriegl, the Deputy Minister of Health. Its first director was Klement Weber, who published, as early as in 1929, a monograph on arrhythmias -  50 years earlier than arrhythmias started to be at the centre of attention of cardiologists. Klement Weber was one of the doctors of President T. G. Masaryk during his serious disease towards the end of his life. Jan Brod was the deputy of Klement Weber in the

  5. Development of Quality Metrics in Ambulatory Pediatric Cardiology.

    PubMed

    Chowdhury, Devyani; Gurvitz, Michelle; Marelli, Ariane; Anderson, Jeffrey; Baker-Smith, Carissa; Diab, Karim A; Edwards, Thomas C; Hougen, Tom; Jedeikin, Roy; Johnson, Jonathan N; Karpawich, Peter; Lai, Wyman; Lu, Jimmy C; Mitchell, Stephanie; Newburger, Jane W; Penny, Daniel J; Portman, Michael A; Satou, Gary; Teitel, David; Villafane, Juan; Williams, Roberta; Jenkins, Kathy

    2017-02-07

    The American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Section had attempted to create quality metrics (QM) for ambulatory pediatric practice, but limited evidence made the process difficult. The ACPC sought to develop QMs for ambulatory pediatric cardiology practice. Five areas of interest were identified, and QMs were developed in a 2-step review process. In the first step, an expert panel, using the modified RAND-UCLA methodology, rated each QM for feasibility and validity. The second step sought input from ACPC Section members; final approval was by a vote of the ACPC Council. Work groups proposed a total of 44 QMs. Thirty-one metrics passed the RAND process and, after the open comment period, the ACPC council approved 18 metrics. The project resulted in successful development of QMs in ambulatory pediatric cardiology for a range of ambulatory domains. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Molecular cardiology and genetics in the 21st century--a primer.

    PubMed

    Roberts, Robert; Gollob, Michael

    2006-10-01

    The terminology and technology of molecular genetics and recombinant DNA have become an essential part of academic cardiology and will soon be applied at the bedside. The treatise includes a brief summary of the essentials of the DNA molecule, the more common techniques, and their application to genetics and molecular cardiology. It is written to be understood by physicians, scientists, and paramedical personnel who would not necessarily have a background in molecular biology. Inherent in the DNA molecule are three properties fundamental to all of the diagnostic and therapeutic applications, namely, the ability of DNA to separate into single strands, recombine (annealment or hybridization), and the presence of the negative charge enables DNA fragments to be separated easily by electrophoresis. Genetic linkage analysis of a family with an inherited disease enables one to identify the gene without knowing its protein product. Over 50 diseases in cardiology due to single-gene disorders have been identified and multiple mutations have been detected. The new therapeutic frontier will be stem cells and nuclear transfer. Identification of genes responsible for coronary artery disease made possible by genome-wide single nucleotide polymorphism (SNP) mapping techniques paves the way for personalized medicine.

  7. Spanish Cardiac Catheterization and Coronary Intervention Registry. 23rd official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2013).

    PubMed

    García del Blanco, Bruno; Hernández Hernández, Felipe; Rumoroso Cuevas, José Ramón; Trillo Nouche, Ramiro

    2014-12-01

    The Working Group on Cardiac Catheterization and Interventional Cardiology presents its yearly report on the data from the registry of the activity in Spain corresponding to 2013. The centers introduce their data online voluntarily and the information is analyzed by the Steering Committee of the Working Group on Cardiac Catheterization. In 2013, 104 hospitals sent their data (72 public centers and 32 private). In all, 136 715 diagnostic studies were performed (120 358 coronary angiograms), with a slight decrease with respect to 2012, a reduction that was also observed in the rate, which was 2944 diagnostic studies per million population. A total of 65 912 interventional procedures were carried out during a phase of stability, for a rate of 1419 interventions per million population. Other techniques included the implantation of 99 417 stents and 1384 biodegradable intracoronary devices (64% of them drug-eluting devices). There were 18 337 procedures in acute myocardial infarction, for an increase of 7% with respect to 2012 and representing 27.8% of all the percutaneous coronary interventions. Radial access was the approach used in 71% of the diagnostic procedures and in 65% of the interventional procedures. The performance of renal denervation has nearly doubled with respect to 2012. For the first time, more than 1000 transcatheter aortic valve implantation procedures were carried out in 1 year, although the frequency increased only slightly (23%). There continued to be a slight increase in the activity in cardiac catheterization in association with ST-segment elevation myocardial infarction, whereas, with the exception of recently introduced, highly specific procedures, the use of the remainder of the procedures, among them transcatheter aortic valve implantation, leveled off. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  8. Role Of The Bureau Of Radiological Health In Assessment Of Risks From Clinical Nuclear Magnetic Resonance (NMR) Procedures

    NASA Astrophysics Data System (ADS)

    Anderson, Mary P.; Athey, T. W.; Phillips, Robert A.

    1982-12-01

    The 1976 Medical Device Amendments to the Federal Food, Drug, and Cosmetic Act provide for the classification of a medical device intended for human use into one of three regulatory classes based on the extent of control necessary to ensure safety and effectiveness: Class I, General Controls; Class II, Performance Standards; Class III, Premarket Approval. Class III devices are those for which there is insufficient information available to ensure safety and effectiveness through General Controls and Performance Standards alone. New devices such as Nuclear Magnetic Resonance Imaging systems fall under Class III because they were developed after the date of the law's enactment (28 May 1976). Investigational studies involving human subjects undertaken to develop safety and effectiveness data for a post-enactment Class III device come under the Investigational Device Exemption (IDE) Regulation (21 CFR 812). This regulation distinguishes between investigations of devices that pose a significant risk to the human subject and those that do not. A significant risk investigation "presents a potential for serious risk to the health, safety, or welfare of a subject." Procedures for obtaining an IDE differ if the device does or does not pose a significant risk. The sponsor of a clinical trial, and ultimately the Institutional Review Board (IRB), have the primary responsibility to determine whether a certain clinical use of the investigational device represents a significant risk to the subject of the investigation. A finding of significant risk does not mean that a device is too hazardous for clinical studies, but it does mean that a formal application for an IDE must be made to and approved by the Food and Drug Administration (FDA) before a clinical trial can begin. If the device is deemed not to pose a significant risk, unless otherwise notified by FDA, the sponsor is not required to submit an IDE application to FDA. Instead, the sponsor and investigators must satisfy only

  9. Advances in cardiology: clinical trial update.

    PubMed

    Howe, Andrew J; Shand, James A; Menown, Ian B A

    2011-05-01

    Multiple key cardiology trials have been presented or published over recent months, several with the potential to change clinical practice. In this article, we summarize and place in clinical context new trial findings regarding anticoagulation in the cardiac catheterization laboratory (enoxaparin, fondaparinux and unfractionated heparin), the implications of genetic polymorphisms and functional testing for antiplatelet therapy (clopidogrel and ticagrelor), new oral anticoagulants for use in atrial fibrillation (apixiban and rivaroxaban), optimal pacing strategies and pharmacological agents in heart failure (ivabradine, eplerenone, cardiac resynchronization therapy, telemonitoring and intracoronary bone marrow stem cell infusion). Clinical trials in percutaneous structural intervention (transcatheter aortic valve implantation, MONARC™ mitral annular implant, STARFlex(®) patent foramen ovale device) and advanced percutaneous coronary intervention (everolimus-eluting stents, biodegradable polymer/polymer-free technologies and contemporary use of intravascular ultrasound) are also discussed.

  10. [Genetics and molecular medicine in cardiology].

    PubMed

    Rojas Martínez, A; Ortiz López, R; Delgado Enciso, I

    2001-01-01

    The discoveries on molecular aspects of cellular function are changing the concepts of health and disease. All medical fields, including cardiology, have been enriched with several diagnostic test to determine predisposition and to detect molecular dysfunctions. This review on the genetic and molecular aspects of cardiovascular diseases is written at the Centenary of the rediscovery of Mendel's principles on heredity and at the time of the announcement of the end of the human genome sequencing task. The review starts with considerations on the pluricellular constitution of the human body, and the principles of genetics with their molecular bases; including a short description of the methods for gene mapping. The following sections give a historic synopsis on the concepts of medical genetics, molecular medicine, and the Human Genome Project. The review ends with a brief description of the spectrum of genetic diseases, using examples of cardiovascular diseases.

  11. Teaching preventive cardiology through community programs.

    PubMed

    Davidson, D M

    1990-01-01

    Entering medical students currently report positive attitudes toward the concept of preventive cardiology but express a lack of confidence in the physician's ability to change unhealthful habits of their patients. One approach to this problem has been the involvement of medical students and house staff physicians in cardiovascular health programs offered in the community. With the goal of enhancing the knowledge, attitudes, and skills of the trainees, these programs have been carried out in educational institutions at all levels, in churches, and at work sites, shopping malls, and health fairs. Informal assessment of these programs suggests that medical trainees develop an increased sense of confidence in their ability to influence positively the health habits of children and adults.

  12. [Takotsubo cardiomyopathy in a cardiology department].

    PubMed

    Cesário, Vera; Loureiro, Maria José; Pereira, Hélder

    2012-09-01

    Takotsubo cardiomyopathy, also known as transient left ventricular apical ballooning syndrome, stress-induced cardiomyopathy and broken heart syndrome, is characterized by transient left ventricular dysfunction in the absence of obstructive coronary artery disease. It was first described in 1990 in Japan, and gained worldwide recognition following the publication of several series of case reports. Its prevalence is estimated to be 1.7-2.2% of suspected acute coronary syndromes. Although takotsubo cardiomyopathy has been progressively better characterized, certain aspects remain to be clarified, and it is still under study. In this article, we report a series of ten cases of takotsubo cardiomyopathy admitted to a cardiology department, and compare the clinical, laboratory, electrocardiographic and imaging characteristics, therapeutic regimens and follow-up of these patients with those described in the latest scientific reviews.

  13. Preliminary clinical experience in cardiology with sonazoid.

    PubMed

    Marelli, C

    2000-08-17

    Sonazoid (formerly NC100100) is a new ultrasound contrast agent for intravenous injection developed by Nycomed-Amersham. It consists of perfluorocarbon microbubbles that are stabilized with a surfactant and are within a well-defined size range (median diameter approximately 3 microm). Due to the low diffusibility and blood solubility of the gas, the controlled size distribution of the microbubbles, and the flexibility of the shell, Sonazoid is a free-flowing tracer capable of crossing the pulmonary capillary bed after peripheral intravenous injection. It is stable enough for the duration of the ultrasound examination and provides echo enhancement useful for clinical requirements. The preliminary clinical experience in cardiology indications, including its use in reducing the frequency of inadequate echocardiographic studies in patients with suboptimal echocardiograms, and its use as a myocardial perfusion agent in the setting of acute myocardial ischemia is briefly discussed.

  14. [Cardiology in the Morgagni's anatomo pathological work].

    PubMed

    de Micheli, Alfredo; Iturralde, Pedro; Aranda Fraustro, Alberto

    2015-01-01

    In the XVIII century, under the influence of the "systematic spirit", characteristic of the Enlightenment age, pathological anatomy was systematized in the Morgagni's fundamental treatise De sedibus et causis morborum per anatomen indagatis, published as letters in 1761. Certain biographical data of the author are reported here as well as some his more important contributions to cardiology such as the Morgagni's, Adams', Stokes' syndrome. His points of view on sudden death and his observations on post-infarct myocardial rupture, are related also. In his global evaluation of these facts, the speculative approach always predominates. Indeed, in these anatomist's works, we find a good example of the application of epistemologic principles to the medical field.

  15. [Psychopharmacology in medical illness: cardiology, nephrology, hepatology].

    PubMed

    Telles-Correia, Diogo; Guerreiro, Diogo F; Coentre, Ricardo; Zuzarte, Pedro; Figueira, Luísa

    2009-01-01

    The high prevalence of psychiatric disturbances in the context of medical illness and its association with worse prognostic of the last one, are the reasons for which it becomes essential that the doctor, not psychiatrist, has the skills in the use of psychopharmaceuticals. A systematic review of the literature published until January of 2006 was done, through MEDLINE, using as key-words psychiatric illness, renal illness, hepatic illness, cardiovascular illness, psychopharmacology. The reviewed studies include original articles, reviews and observational studies. 39 articles were selected for its adequacy and acquired for the accomplishment of this revision. The authors intend to review the use of the several classes of psychopharmaceuticals, its risks and benefits, according to the different medical illnesses. The first part of this article will have is focus in the area of cardiology, nephrology and hepatology.

  16. Tracking patient radiation exposure: challenges to integrating nuclear medicine with other modalities

    PubMed Central

    Mercuri, Mathew; Rehani, Madan M.; Einstein, Andrew J.

    2013-01-01

    The cumulative radiation exposure to the patient from multiple radiological procedures can place some individuals at significantly increased risk for stochastic effects and tissue reactions. Approaches, such as those in the International Atomic Energy Agency’s Smart Card program, have been developed to track cumulative radiation exposures to individuals. These strategies often rely on the availability of structured dose reports, typically found in the DICOM header. Dosimetry information is currently readily available for many individual x-ray based procedures. Nuclear medicine, of which nuclear cardiology constitutes the majority of the radiation burden in the U.S., currently lags behind x-ray based procedures with respect to reporting of radiation dosimetric information. This paper discusses qualitative differences between nuclear medicine and x-ray based procedures, including differences in the radiation source and measurement of its strength, the impact of biokinetics on dosimetry, and the capability of current scanners to record dosimetry information. These differences create challenges in applying monitoring and reporting strategies used in x-ray based procedures to nuclear medicine, and integrating dosimetry information across modalities. A concerted effort by the medical imaging community, dosimetry specialists and manufacturers of imaging equipment is required to develop strategies to improve the reporting of radiation dosimetry data in nuclear medicine. Some ideas on how to address this issue are suggested. PMID:22695788

  17. Spanish Cardiac Catheterization and Coronary Intervention Registry. 25th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2015).

    PubMed

    Jiménez-Quevedo, Pilar; Serrador, Ana; Pérez de Prado, Armando; Pan, Manuel

    2016-12-01

    The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the data from the registry of the activity in 2015. All Spanish hospitals with catheterization laboratories were invited to voluntarily contribute their activity data. The information was collected online and analyzed mostly by an independent company. In 2015, 106 centers participated in the national register; 73 of these centers are public. A total of 145 836 diagnostic studies were conducted, among which 128 669 were coronary angiograms. These figures are higher than in previous years. The Spanish average of total diagnoses per million population was 3127. The number of coronary interventional procedures was very similar (67 671), although there was a slight increase in the complexity of coronary interventions: 7% in multivessel treatment and 8% in unprotected left main trunk treatment. A total of 98 043 stents were implanted, of which 74 684 were drug-eluting stents. A total of 18 418 interventional procedures were performed in the acute myocardial infarction setting, of which 81.9% were primary angioplasties. The radial approach was used in 73.3% of the diagnostic procedures and in 76.1% of interventional ones. The number of transcatheter aortic valve implantations continued to increase (1586), as well as the number of left atrial appendage closures (331). An increase in diagnostic and therapeutic procedures in acute myocardial infarction was reported in 2015. The use of the radial approach and drug-eluting stents also increased in therapeutic procedures. The progressive increase in structural procedures seen in previous years continued. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Genomic translational research: Paving the way to individualized cardiac functional analyses and personalized cardiology.

    PubMed

    Pasipoularides, Ares

    2017-03-01

    For most of Medicine's past, the best that physicians could do to cope with disease prevention and treatment was based on the expected response of an average patient. Currently, however, a more personalized/precise approach to cardiology and medicine in general is becoming possible, as the cost of sequencing a human genome has declined substantially. As a result, we are witnessing an era of precipitous advances in biomedicine and bourgeoning understanding of the genetic basis of cardiovascular and other diseases, reminiscent of the resurgence of innovations in physico-mathematical sciences and biology-anatomy-cardiology in the Renaissance, a parallel time of radical change and reformation of medical knowledge, education and practice. Now on the horizon is an individualized, diverse patient-centered, approach to medical practice that encompasses the development of new, gene-based diagnostics and preventive medicine tactics, and offers the broadest range of personalized therapies based on pharmacogenetics. Over time, translation of genomic and high-tech approaches unquestionably will transform clinical practice in cardiology and medicine as a whole, with the adoption of new personalized medicine approaches and procedures. Clearly, future prospects far outweigh present accomplishments, which are best viewed as a promising start. It is now essential for pluridisciplinary health care providers to examine the drivers and barriers to the clinical adoption of this emerging revolutionary paradigm, in order to expedite the realization of its potential. So, we are not there yet, but we are definitely on our way.

  19. Career choices for cardiology: cohort studies of UK medical graduates.

    PubMed

    Smith, Fay; Lambert, Trevor W; Pitcher, Alex; Goldacre, Michael J

    2013-01-25

    Cardiology is one of the most popular of the hospital medical specialties in the UK. It is also a highly competitive specialty in respect of the availability of higher specialty training posts. Our aims are to describe doctors' early intentions about seeking careers in cardiology, to report on when decisions about seeking a career in cardiology are made, to compare differences between men and women doctors in the choice of cardiology, and to compare early career choices with later specialty destinations. Questionnaire surveys were sent to all UK medical graduates in selected qualification years from 1974-2009, at 1, 3, 5, 7 and 10 years after graduation. One year after graduation, the percentage of doctors specifying cardiology as their first choice of long-term career rose from the mid-1990s from 2.4% (1993 cohort) to 4.2% (2005 cohort) but then fell back to 2.7% (2009 cohort). Men were more likely to give cardiology as their first choice than women (eg 4.1% of men and 1.9% of women in the 2009 cohort). The percentage of doctors who gave cardiology as their first choice of career declined between years one and five after qualification: the fall was more marked for women. 34% of respondents who specified cardiology as their sole first choice of career one year post-graduation were later working in cardiology. 24% of doctors practising as cardiologists several years after qualification had given cardiology as their sole first choice in year one. The doctors' 'domestic circumstances' were a relatively unimportant influence on specialty choice for aspiring cardiologists, while 'enthusiasm/commitment', 'financial prospects', 'experiences of the job so far' and 'a particular teacher/department' were important. Cardiology grew as a first preference one year after graduation to 2005 but is now falling. It consistently attracts a higher percentage of men than women doctors. The correspondence between early choice and later destination was not particularly strong for

  20. Career choices for cardiology: cohort studies of UK medical graduates

    PubMed Central

    2013-01-01

    Background Cardiology is one of the most popular of the hospital medical specialties in the UK. It is also a highly competitive specialty in respect of the availability of higher specialty training posts. Our aims are to describe doctors’ early intentions about seeking careers in cardiology, to report on when decisions about seeking a career in cardiology are made, to compare differences between men and women doctors in the choice of cardiology, and to compare early career choices with later specialty destinations. Methods Questionnaire surveys were sent to all UK medical graduates in selected qualification years from 1974–2009, at 1, 3, 5, 7 and 10 years after graduation. Results One year after graduation, the percentage of doctors specifying cardiology as their first choice of long-term career rose from the mid-1990s from 2.4% (1993 cohort) to 4.2% (2005 cohort) but then fell back to 2.7% (2009 cohort). Men were more likely to give cardiology as their first choice than women (eg 4.1% of men and 1.9% of women in the 2009 cohort). The percentage of doctors who gave cardiology as their first choice of career declined between years one and five after qualification: the fall was more marked for women. 34% of respondents who specified cardiology as their sole first choice of career one year post-graduation were later working in cardiology. 24% of doctors practising as cardiologists several years after qualification had given cardiology as their sole first choice in year one. The doctors’ ‘domestic circumstances’ were a relatively unimportant influence on specialty choice for aspiring cardiologists, while ‘enthusiasm/commitment’, ‘financial prospects’, ‘experiences of the job so far’ and ‘a particular teacher/department’ were important. Conclusions Cardiology grew as a first preference one year after graduation to 2005 but is now falling. It consistently attracts a higher percentage of men than women doctors. The correspondence between early

  1. Competency Testing for Pediatric Cardiology Fellows Learning Transthoracic Echocardiography: Implementation, Fellow Experience, and Lessons Learned.

    PubMed

    Levine, Jami C; Geva, Tal; Brown, David W

    2015-12-01

    There is currently great interest in measuring trainee competency at all levels of medical education. In 2007, we implemented a system for assessing cardiology fellows' progress in attaining imaging skills. This paradigm could be adapted for use by other cardiology programs. Evaluation consisted of a two-part exercise performed after years 1 and 2 of pediatric cardiology training. Part 1: a directly observed evaluation of technical skills as fellows imaged a normal subject (year 1) and a patient with complex heart disease (year 2). Part 2: fellows interpreted and wrote reports for two echocardiograms illustrating congenital heart disease. These were graded for accuracy and facility with communicating pertinent data. After 5 years of testing, fellows were surveyed about their experience. In 5 years, 40 fellows were tested at least once. Testing identified four fellows who underperformed on the technical portion and four on the interpretive portion. Surveys were completed by 33 fellows (83 %). Most (67 %) felt that intermittent observation by faculty was inadequate for assessing skills and that procedural volume was a poor surrogate for competency (58 %). Posttest feedback was constructive and valuable for 90, and 70 % felt the process helped them set goals for skill improvement. Overall, fellows felt this testing was fair and should continue. Fellow performance and responses identified programmatic issues that were creating barriers to learning. We describe a practical test to assess competency for cardiology fellows learning echocardiography. This paradigm is feasible, has excellent acceptance among trainees, and identifies trainees who need support. Materials developed could be easily adapted to help track upcoming ACGME-mandated metrics.

  2. 75 FR 3497 - Entergy Nuclear Operations, Inc., Entergy Nuclear Indian Point 2, LLC, Entergy Nuclear Indian...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-21

    ..., ``Hybrid Hearing Procedures for Expansion of Spent Fuel Storage Capacity at Civilian Nuclear Power Reactors... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Entergy Nuclear Operations, Inc., Entergy Nuclear Indian Point 2, LLC, Entergy Nuclear...

  3. Patient doses and dosimetric evaluations in interventional cardiology.

    PubMed

    Bor, Dogan; Olğar, Turan; Toklu, Türkay; Cağlan, Ayça; Onal, Elif; Padovani, Renato

    2009-03-01

    Interventional cardiological examinations may be associated with excessive radiation exposures which may cause skin injuries and higher probabilities of stochastic effects. Dose-area product (DAP) and skin doses of 325 patients were measured using alternative dosimetric techniques for different cardiological examinations. Data were collected from five different systems with the involvement of 11 cardiologists. All these dosimetric information has been collected separately for each of 10 projections together with the exposure parameters of X-ray systems. Mean DAP values measured with a transparent ion chamber were 49.1 Gy cm(2), 66.8 Gy cm(2), 106.9 Gy cm(2) and 124.7 Gy cm(2), respectively, for coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) or stent (PT-SI), coronary angiography and/or PTCA and/or stent (CA-PT-SI), and ablation examinations. Radiochromic films, thermoluminescent dosimeters (TLD) and point measurement of air kerma (AK) were carried out for skin dose assessments. Skin doses of 23 patients measured with radiochromic films were found to be between 2 Gy and 6 Gy. Although the complexity of the procedures was the major reason for these excessive doses, considerable contributions of high X-ray output of some fluoroscopy units were also noticed. In addition to the direct measurement of DAP, alternative DAP values were also determined from the skin dose measurement techniques; exposed areas were summed on digitized radiochromic films in one technique, The product of AK reading with X-ray field size measured at the patient entrance using slow X-ray films was taken as another DAP. Good correlations were found among the DAP results and also between the entrance skin doses calculated from AK measurements and direct DAP readings (R(2)=0.91). A trigger DAP value of 130 Gy cm(2) for the 2 Gy of skin doses was derived from this relationship. Collection of dosimetric data for each projection was also investigated regarding a

  4. [Role of new oral anticoagulants in interventional cardiology].

    PubMed

    Brasselet, C; Duval, S

    2012-12-01

    New oral anticoagulants constitute an important breakthrough for cardiologists and their patients. After reviewing their mechanism of action, their role in the context of interventional cardiology, particularly for patients with acute coronary syndromes, is discussed.

  5. Systematic Reviews and Meta-analyses for Cardiology Fellows.

    PubMed

    Fares, Munes; Alahdab, Fares; Alsaied, Tarek

    2016-07-01

    Participating in a scholarly activity is one of the training requirements for cardiology fellows. However, it can be very challenging to complete a research project during such a busy period of clinical training. To help the cardiology fellows in choosing and starting off a research project, a light has been shed on the process of conducting a systematic review, and the importance of this research activity, as well as its limitations.

  6. The ten advances that have defined modern cardiology.

    PubMed

    Braunwald, Eugene

    2014-07-01

    Modern cardiology was born early in the twentieth century. Here I list and review what I believe to be the ten most important advances in the twentieth century in this field. They are as follows: electrocardiography, cholesterol-induced atherosclerosis, cardiac catheterization, cardiovascular surgery, coronary angiography and percutaneous coronary angioplasty, the coronary care unit, the development of new cardiovascular drugs, preventive cardiology, cardiac imaging, and implanted cardiac pacemakers/defibrillators.

  7. Electrocardiographic interpretation skills of cardiology residents: are they competent?

    PubMed

    Sibbald, Matthew; Davies, Edward G; Dorian, Paul; Yu, Eric H C

    2014-12-01

    Achieving competency at electrocardiogram (ECG) interpretation among cardiology subspecialty residents has traditionally focused on interpreting a target number of ECGs during training. However, there is little evidence to support this approach. Further, there are no data documenting the competency of ECG interpretation skills among cardiology residents, who become de facto the gold standard in their practice communities. We tested 29 Cardiology residents from all 3 years in a large training program using a set of 20 ECGs collected from a community cardiology practice over a 1-month period. Residents interpreted half of the ECGs using a standard analytic framework, and half using their own approach. Residents were scored on the number of correct and incorrect diagnoses listed. Overall diagnostic accuracy was 58%. Of 6 potentially life-threatening diagnoses, residents missed 36% (123 of 348) including hyperkalemia (81%), long QT (52%), complete heart block (35%), and ventricular tachycardia (19%). Residents provided additional inappropriate diagnoses on 238 ECGs (41%). Diagnostic accuracy was similar between ECGs interpreted using an analytic framework vs ECGs interpreted without an analytic framework (59% vs 58%; F(1,1333) = 0.26; P = 0.61). Cardiology resident proficiency at ECG interpretation is suboptimal. Despite the use of an analytic framework, there remain significant deficiencies in ECG interpretation among Cardiology residents. A more systematic method of addressing these important learning gaps is urgently needed.

  8. Computational cardiology: how computer simulations could be used to develop new therapies and advance existing ones

    PubMed Central

    Trayanova, Natalia A.; O'Hara, Thomas; Bayer, Jason D.; Boyle, Patrick M.; McDowell, Kathleen S.; Constantino, Jason; Arevalo, Hermenegild J.; Hu, Yuxuan; Vadakkumpadan, Fijoy

    2012-01-01

    This article reviews the latest developments in computational cardiology. It focuses on the contribution of cardiac modelling to the development of new therapies as well as the advancement of existing ones for cardiac arrhythmias and pump dysfunction. Reviewed are cardiac modelling efforts aimed at advancing and optimizing existent therapies for cardiac disease (defibrillation, ablation of ventricular tachycardia, and cardiac resynchronization therapy) and at suggesting novel treatments, including novel molecular targets, as well as efforts to use cardiac models in stratification of patients likely to benefit from a given therapy, and the use of models in diagnostic procedures. PMID:23104919

  9. Metabolomics: a new era in cardiology?

    PubMed

    Mercuro, Giuseppe; Bassareo, Pier P; Deidda, Martino; Cadeddu, Christian; Barberini, Luigi; Atzori, Luigi

    2011-11-01

    The metabolome represents the collection of all metabolites in a biological cell, tissue, organ or organism, which are the end-products of cellular processes. Metabolomics is the systematic study of small-molecule metabolite profiles that specific cellular processes leave behind. RNA messenger gene expression data and proteomic analyses do not tell the whole story of what might be happening in a cell. Metabolic profiling, in turn, amplifies changes both in the proteome and the genome, and represents a more accurate approximation to the phenotype of an organism in health and disease. In this article, we have provided a description of metabolomics, in the presence of other, more familiar 'omics' disciplines, such as genomics and proteomics. In addition, we have reviewed the current rationale for metabolomics in cardiology, its basic methodology and the data actually available in human studies in this discipline. The discussed topics highlight the importance of being able to use the metabolomics information in order to understand disease mechanisms from a systems biology perspective as a noninvasive approach to diagnose, grade and treat cardiovascular diseases.

  10. Speculative Considerations about Some Cardiology Enigmas.

    PubMed

    Evora, Paulo Roberto Barbosa; Schmidt, Andre; Arcêncio, Livia; Marin-Neto, José Antonio

    2017-03-17

    Write a review text or point-of-view that takes into account the interests, if not of all, but of most readers of a scientific journal is an arduous task. The editorial can be grounded in published articles, even in a single article of undeniable importance and, it can also represent a trend of specialty. Therefore, especially for the sake of the reader's motivation, the present text was freely designed to discuss some cardiology enigmas in the context of the heart valve and coronary artery disease (CAD). Concerning the CAD five well-known enigmas will be considered: 1) The absence of arteriosclerosis in intramyocardial coronary arteries; 2) The unique and always confirmed superior evolution of the left internal thoracic artery as a coronary graft; 3) The prophylactic left internal thoracic artery graft in mildly-stenosed coronary lesions, and; 4) The high incidence of perioperative atrial fibrillation (AF) in patients with CAD, and; 5) The handling of disease-free saphenous vein graft at the time of reoperation. Concerning the cardiac valve disease these enigmas topics will be discussed: 1) Why some young patients present acute pulmonary edema as the first sign of mitral stenosis, and other patients with significant hemodynamic changes are mildly symptomatic or asymptomatic, and; 2) The enigma of aortic stenosis protection against CAD.

  11. [Cardiac rehabilitation in Spain. Preventive cardiology units].

    PubMed

    Maroto Montero, J M; de Pablo Zarzosa, C

    1998-01-01

    Secondary Prevention by controlling the main risk factors for atherosclerosis has proved a decrease in death rate and in damage of the obstructive arteries. The Cardiac Rehabilitation Programs are not well developed in Spain and nowadays they include less than the 2% of the feasible patients. The reasons for these are the lack of interest of many Cardiological Services and principally of the Administration which at present does not want to spend part of its budget to new loans although this new type of therapeutics has proved great benefits in the decrease of death rate and evident economical savings due to the diminution of hospital re-entries and Labour Incapacity. It is very important to notice that the 100% of the Spanish population is included in the Social Security and this would help the medical treatment of a high percentage of low risk patients, making use at the same time of the human and technological resources of the Health Centres and Municipal Gyms.

  12. [Cardiological aspects of fatigue states in athletes].

    PubMed

    Bigard, A X; Koulmann, N

    2006-11-01

    The physical load increase during training can lead to the development of clinical patterns of intolerance differing according to their severity, prognosis and reversibility. However, they always include fatigue as a key symptom. The aim of this paper is to review recent data on fatigue states in sportsmen, their clinical presentation and diagnostic orientations. A continuum exists, from acute fatigue states after one or several highly-intensive training sessions, to overreaching, associated to performances alteration which can be easily reversed, and to overtraining, representing a severe clinical pattern which can hardly be reversed. Overreaching and overtraining are characterized by a persisting fatigue state, associated to performances alteration and mood disorders. In an athlete with unexplained alteration of performances associated to physical fatigue, the medical interrogation is critical, in order to check the durable character of sportive performances alteration, to describe the fatigue and identify risk factors of occurrence of overtraining (training program intensity, mental stress, diet factors, hypoxic training, etc.). The use of a validated and adapted questionnaire as the one proposed by the French Society of Sports Medicine is valuable. In majority, in athletes and those doing sports regularly, the cardiological alert signs are rare, and the clinical examination by a specialist is poorly contributive, except for eliminating an organic cause of fatigue.

  13. The contributions of Carl Ludwig to cardiology.

    PubMed

    Zimmer, H G

    1999-03-01

    The basic instruments for measuring functional cardiovascular parameters and the most important discoveries made by Carl Ludwig and his disciples in cardiovascular physiology are described and put into perspective in regard to the further development of his methods and ideas. The most important apparatus was the kymograph, which, for the first time, made recording and documenting of functional parameters possible. This instrument was also used for the functional evaluation of the isolated perfused frog heart that was developed by Elias Cyon in Ludwig's Leipzig Physiological Institute. In the isolated frog heart, important phenomena were discovered such as the staircase ('Treppe'), the absolute refractory period and the all-or-none law of the heart. The isolated dog heart was used to determine the origin of the first heart sound, which was characterized as a muscle tone. To measure regional blood flow and eventually cardiac output, a flowmeter ('Stromuhr') was designed. Precise measurements of cardiac output became possible only when Adolf Fick had developed his principle, which served as the basis for the modern indicator methods. Cyon and Ludwig also discoverd the depressor nerve, which constitutes the basis of the baroreceptor reflex. Finally, the precise localization of the vasomotor centre in the ventrolateral medulla was achieved in Ludwig's Leipzig Physiological Institute. This was confirmed more than 100 years later with modern neuroanatomical methods making use of retrograde axonal transport. Thus, Ludwig and his scholars made major substantial contributions to cardiovascular knowledge that can be considered to constitute the basis of modern cardiology.

  14. European Society of Cardiology Congress 2013 highlights.

    PubMed

    Fox, Keith A A

    2014-01-01

    The European Society of Cardiology (ESC) Congress in 2013 met in Amsterdam (The Netherlands) as an innovative and interactive congress involving more than 30,000 participants. There were 10,490 abstract submissions and a total of 227 hotline, basic science hotline and trial update submissions. Participants were involved from more than 150 countries. To make the congress manageable for participants, related topics were grouped together in ‘villages’ and a smart electronic application allowed the participants to guide their way through the congress and choose the sessions of interest. The innovative new program was initiated by the ESC Congress Programme Committee and the Congress Chair (Keith AA Fox, Chair 2012–2014) has responsibility for the design and delivery of the scientific program. The spotlight of the congress was ‘the heart interacting with systemic organs’, chosen because of the importance of cardiovascular disease conditions crossing conventional boundaries. In all 572 abstracts, the work involved an interaction between the heart and another organ, such as the brain, lungs, kidney, vasculature or inflammation system. In addition, innovative new approaches linked basic science and clinical science and the new ‘hubs of the congress’ allowed excellent interaction and exchange of ideas.

  15. Is patient size important in dose determination and optimization in cardiology?

    NASA Astrophysics Data System (ADS)

    Reay, J.; Chapple, C. L.; Kotre, C. J.

    2003-12-01

    Patient dose determination and optimization have become more topical in recent years with the implementation of the Medical Exposures Directive into national legislation, the Ionising Radiation (Medical Exposure) Regulations. This legislation incorporates a requirement for new equipment to provide a means of displaying a measure of patient exposure and introduces the concept of diagnostic reference levels. It is normally assumed that patient dose is governed largely by patient size; however, in cardiology, where procedures are often very complex, the significance of patient size is less well understood. This study considers over 9000 cardiology procedures, undertaken throughout the north of England, and investigates the relationship between patient size and dose. It uses simple linear regression to calculate both correlation coefficients and significance levels for data sorted by both room and individual clinician for the four most common examinations, left ventrical and/or coronary angiography, single vessel stent insertion and single vessel angioplasty. This paper concludes that the correlation between patient size and dose is weak for the procedures considered. It also illustrates the use of an existing method for removing the effect of patient size from dose survey data. This allows typical doses and, therefore, reference levels to be defined for the purposes of dose optimization.

  16. Sample collection, preservation and submittal procedures for 10 CFR 50 and 10 CFR 50 and 10 CFR 61 nuclear power plant matrices

    SciTech Connect

    Banavali, A.D.; Moreno, E.M.; McCurdy, D.E.

    1994-12-31

    Sample collection, preservation and submittal procedures are described here for nuclear power plant 10 CFR 50 and 10 CFR 61 samples. While sample collection procedures should ensure that a sample reflects the true media type from a homogeneity standpoint, sample preservation is absolutely necessary to prevent the adsorption of analytes occurring on the walls of the container. After sample collection and preservation, the samples should be shipped to the radioanalytical laboratory as soon as possible to reduce the magnitude of analyte adsorption on the walls of the container. When samples are shipped for analysis, sample transmittal forms should be properly filled out to ensure that instructions are clear as to the isotopic analysis requested and the weight/volume of sample shipped, minimum detectable concentration (MDC) required, station code, etc.

  17. Population radiation dose from diagnostic nuclear medicine procedures in the Tehran population in 1999-2003: striking changes in only one decade.

    PubMed

    Tabeie, Faraj; Mohammadi, Hooshang; Asli, Isa Neshandar

    2013-02-01

    Use of unsealed radiopharmaceuticals in Iran's nuclear medicine centers has expanded rapidly in the last decade. As part of a nationwide survey, this study was undertaken to estimate the radiation risk due to the diagnostic nuclear medicine procedures performed in Tehran in 1999-2003. During the five years of the study, the data of 101,540 yearly examinations of diagnostic nuclear medicine were obtained for 34 (out of 40) active nuclear medicine centers in Tehran. The patients studied were aged 1 y, 5 y, 10 y, 15 y, and adults (>15 y). Compared to an earlier investigation in 1989 (which was published in 1995), striking changes were found to be occurring in the trends of nuclear medicine in Tehran in a matter of a decade. The frequency of cardiac examinations increased from less than 1% in 1989 to 43.2% (mean of 5 y) in 2003; thyroid examinations, with the relative frequency of higher than 80% in 1989, decreased to 26.7% in the current investigation (averaged for 2001); and the number of overall examinations per 1,000 population of Tehran increased from 1.9 in 1989 to 8.8 in this study (about fourfold). The decrease in relative frequency of thyroid examinations could be attributed to the lower referral policy (mainly by specialists), decreased incidence of goiter due to implementation of programs for iodine enrichment diets, introduction of fine needle aspiration (FNA), and sonography techniques for diagnosis of thyroid disease. The large increase in relative frequency of cardiac examinations could be due to the increase in the number of single photon emission computerized tomography (SPECT) systems in recent years as compared to 1989 in Tehran. The collective effective dose increased from 400 (person-Sv) in 1999 to 529 (person-Sv) in 2003, and the effective dose per capita increased from 34.80 μSv in 1999 to 44.06 μSv in 2003 (average, 35.60 μSv).

  18. [Guideline for the education of the specialist in cardiology in Spain. Comisión Nacional de la Especialidad de Cardiología].

    PubMed

    Cosín Aguilar, J; Plaza Celemín, L; Martín Durán, R; Zarco Gutiérrez, P; López Merino, V; Cortina Llosa, A; Ferreira Montero, I; García-Cosío Mir, F; Castro Beiras, A; Martínez Monzonís, A

    2000-02-01

    This article presents the program for training in cardiology. The document was elaborated by the National Committee of the Specialty of Cardiology, from the Ministry of Health and Ministry of Education, and describes the theoretical and practical aspects of training in cardiology prevailing at present in Spain.

  19. ENDF-102 data formats and procedures for the evaluated nuclear data file ENDF-6. Revision November 1995

    SciTech Connect

    McLane, V.; Dunford, C.L.; Rose, P.F.

    1995-11-01

    The ENDF formats and libraries are decided by the Cross Section Evaluation Working Group (CSEWG), a cooperative effort of national laboratories, industry, and universities in the US and Canada, and are maintained by the National Nuclear Data Center (NNDC). Earlier versions of the ENDF format provided representations for neutron cross sections and distributions, photon production from neutron reactions, a limited amount of charged-particle production from neutron reactions, photo-atomic interaction data, thermal neutron scattering data, and radionuclide production and decay data (including fission products). Version 6 (ENDF-6) allows higher incident energies, adds more complete descriptions of the distributions of emitted particles, and provides for incident charged particles and photo-nuclear data by partitioning the ENDF library into sublibraries. Decay data, fission product yield data, thermal scattering data, and photo-atomic data have also been formally placed in sublibraries. In addition, this rewrite represents an extensive update to the Version V manual.

  20. Radiation dose and image quality for paediatric interventional cardiology.

    PubMed

    Vano, E; Ubeda, C; Leyton, F; Miranda, P

    2008-08-07

    Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 microGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 microGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.

  1. Radiation dose and image quality for paediatric interventional cardiology

    NASA Astrophysics Data System (ADS)

    Vano, E.; Ubeda, C.; Leyton, F.; Miranda, P.

    2008-08-01

    Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 µGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 µGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.

  2. The preoperative cardiology consultation: goal settings and great expectations.

    PubMed

    Aslanger, Emre; Altun, Ibrahim; Guz, Goksel; Kiraslan, Omer; Polat, Nihat; Golcuk, Ebru; Oflaz, Huseyin

    2011-08-01

    Despite the availability of guidelines for preoperative cardiology consultations, their efficacy in real clinical practice remains unknown. Furthermore, there are concerns that overused cardiology consultations can lead to unnecessary investigations, prolonged hospital stays, and even cancellation of necessary surgery. In this retrospective study, we investigated: (i) the potential impact of the American Heart Association/American College of Cardiology algorithm and (ii) the potential of this algorithm for preventing unnecessary evaluation. We examined the cardiology consultation requests for 712 patients scheduled for elective surgery. Our analysis included: (i) patient characteristics, (ii) abnormalities revealed by the consultant, (iii) impact of these abnormalities on clinical decision making and therapy modification. The most common reason for consultation was 'pre-operative evaluation' (80.9%). Although our cardiologists revealed an abnormality in 67.8% and recommended further work up in 58.7% of our patients, they contributed to the clinical course in only 36.9%. Moreover, when the algorithm was applied to 'routine pre-operative evaluation' requests lacking a specific question, only 7.6% of these consultation requests required further investigation. Preoperative cardiology consultation seems to be overused. Although the fear of missing important issues leads surgeons to use a decreased threshold for pre-operative consultation requests, such a non-specific manner of pre-operative consultation request causes unnecessary investigations and decreased cost-effectiveness. Furthermore, the detection of any clinical abnormality by cardiologists surprisingly adds little to clinical decision making.

  3. [Clinical value of digital subtraction angiography in cardiology--current status and future prospects].

    PubMed

    Schmiel, F K

    1986-03-01

    Advances in digital technology have made the digital processing of X-ray images possible. The principles of processing, which can be traced back to the early origin of radiology, are characterized by the aims "image enhancement" and "functional imaging". These principles have been routinely applied in digital subtraction angiography (DSA) for visualization of non-moving vessels. DSA is used with caution in cardiology mainly because methodical problems caused by the motion of the background structures. In order to assess the clinical relevance of DSA to cardiology the following questions will be answered: Which structures can be visualized? How large is the error of the parameters determined by DSA? What is the clinical relevance of these parameters? What are the advantages of DSA with regard to the examination procedure? Using DSA the left ventricle can be visualized at rest and during exercise by intravenous injection of contrast medium. The examination procedure can easily be combined with measurements of pulmonary arterial pressure. The errors of left ventricular parameters amount to: ventricular volumes: +/- 12- +/- 18 ml; ejection fraction: +/- 8%; ventricular diameters: +/- 7- +/- 13%; wall volume: +/- 48 ml; wall thickness: +/- 1.6 mm. The image quality of aorto-coronary bypass grafts visualized by intravenously injected contrast medium is sufficient to decide whether the grafts are patent or occluded. The visualization of the proximal segments of coronary arteries by intravenous injection of contrast medium is reported in rare cases.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Improving Access to Pediatric Cardiology in Cape Verde via a Collaborative International Telemedicine Service.

    PubMed

    Lapão, Luís Velez; Correia, Artur

    2015-01-01

    This paper addresses the role of international telemedicine services in supporting the evacuation procedures from Cape Verde to Portugal, enabling better quality and cost reductions in the management of the global health system. The Cape Verde, as other African countries, health system lacks many medical specialists, like pediatric cardiologists, neurosurgery, etc. In this study, tele-cardiology shows good results as diagnostic support to the evacuation decision. Telemedicine services show benefits while monitoring patients in post-evacuation, helping to address the lack of responsive care in some specialties whose actual use will help save resources both in provision and in management of the evacuation procedures. Additionally, with tele-cardiology collaborative service many evacuations can be avoided whereas many cases will be treated and followed locally in Cape Verde with remote technical support from Portugal. This international telemedicine service enabled more efficient evacuations, by reducing expenses in travel and housing, and therefore contributed to the health system's improvement. This study provides some evidence of how important telemedicine really is to cope with both the geography and the shortage of physicians.

  5. The Next Step in Deployment of Computer Based Procedures For Field Workers: Insights And Results From Field Evaluations at Nuclear Power Plants

    SciTech Connect

    Oxstrand, Johanna; Le Blanc, Katya L.; Bly, Aaron

    2015-02-01

    The paper-based procedures currently used for nearly all activities in the commercial nuclear power industry have a long history of ensuring safe operation of the plants. However, there is potential to greatly increase efficiency and safety by improving how the human operator interacts with the procedures. One way to achieve these improvements is through the use of computer-based procedures (CBPs). A CBP system offers a vast variety of improvements, such as context driven job aids, integrated human performance tools (e.g., placekeeping, correct component verification, etc.), and dynamic step presentation. The latter means that the CBP system could only display relevant steps based on operating mode, plant status, and the task at hand. A dynamic presentation of the procedure (also known as context-sensitive procedures) will guide the operator down the path of relevant steps based on the current conditions. This feature will reduce the operator’s workload and inherently reduce the risk of incorrectly marking a step as not applicable and the risk of incorrectly performing a step that should be marked as not applicable. The research team at the Idaho National Laboratory has developed a prototype CBP system for field workers, which has been evaluated from a human factors and usability perspective in four laboratory studies. Based on the results from each study revisions were made to the CBP system. However, a crucial step to get the end users' (e.g., auxiliary operators, maintenance technicians, etc.) acceptance is to put the system in their hands and let them use it as a part of their everyday work activities. In the spring 2014 the first field evaluation of the INL CBP system was conducted at a nuclear power plant. Auxiliary operators conduct a functional test of one out of three backup air compressors each week. During the field evaluation activity, one auxiliary operator conducted the test with the paper-based procedure while a second auxiliary operator followed

  6. A Procedure for Determination of Degradation Acceptance Criteria for Structures and Passive Components in Nuclear Power Plants

    SciTech Connect

    Nie, J.; Braverman, J.; Hofmayer, C.; Choun, Y-S.; Hahm, D.; Choi, I-K.

    2012-01-30

    The Korea Atomic Energy Research Institute (KAERI) has been collaborating with Brookhaven National Laboratory since 2007 to develop a realistic seismic risk evaluation system which includes the consideration of aging of structures and components in nuclear power plants (NPPs). This collaboration program aims at providing technical support to a five-year KAERI research project, which includes three specific areas that are essential to seismic probabilistic risk assessment: (1) probabilistic seismic hazard analysis, (2) seismic fragility analysis including the effects of aging, and (3) a plant seismic risk analysis. The understanding and assessment of age-related degradations of structures, systems, and components and their impact on plant safety is the major goal of this KAERI-BNL collaboration. Four annual reports have been published before this report as a result of the collaboration research.

  7. What to Expect from the Evolving Field of Geriatric Cardiology

    PubMed Central

    Bell, Susan P.; Orr, Nicole M.; Dodson, John A.; Rich, Michael W.; Wenger, Nanette K.; Blum, Kay; Harold, John Gordon; Tinetti, Mary; Maurer, Mathew S.; Forman, Daniel E.

    2016-01-01

    The population of older adults is expanding rapidly and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. While some assume a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, and thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients. PMID:26361161

  8. What to Expect From the Evolving Field of Geriatric Cardiology.

    PubMed

    Bell, Susan P; Orr, Nicole M; Dodson, John A; Rich, Michael W; Wenger, Nanette K; Blum, Kay; Harold, John Gordon; Tinetti, Mary E; Maurer, Mathew S; Forman, Daniel E

    2015-09-15

    The population of older adults is expanding rapidly, and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with the complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. Although some assume that a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients.

  9. [Heart rate recovery after exercise in subjects undergoing cardiologic rehabilitation].

    PubMed

    Mejer, Anna; Urzedowicz, Beata; Rembek-Wieliczko, Magdalena; Koziróg, Marzena; Ciećwierz, Julita; Kowalski, Jan

    2012-12-01

    Research indicates that slow heart rate recovery 1-2 minutes after exercise is a predictor of cardiovascular mortality, sudden mortality as well. It is hardly related to myocardial ischemia; most of all, it is related to impaired activities of the parasympathetic system. The purpose of this study was to assess HRR in subjects after a surgical treatment (percutaneous coronary intervention - PCI) of acute coronary syndromes (ACS), undergoing cardiologic rehabilitation. The study comprised 58 subjects, 42 men and 16 women aged 49-68 (56.8 +/- 7.6) after ACS treated with PCI undergoing cardiologic rehabilitation (stage 2)--group I. The comparative group comprised 34 subjects, 25 men and 9 women aged 46-61 (55.5 +/- 8.9 lat) who were clinically healthy and who underwent a single sub-maximal exercise test--group II. In subjects undergoing rehabilitation, an exercise test was performed twice --before and after stage 2 of rehabilitation. HRR was defined as a difference between the peak heart rate and those after the 1st (HRR1) and 2nd (HRR) minute of recovery. After stationary rehabilitation as a part of stage 2 of cardiologic rehabilitation, HRR2 was 26.3 +/- 10.6/min and was 40.8/min +/- 13.8/min; both these values were not significantly different from values observed in healthy subjects (p > 0.05). Significant increase in HRR1 and HRR2 was observed after the completion of stage 2 of cardiologic rehabilitation in ill subjects (p < 0.05) as compared to initial values. In subjects after ACS treated with PCI, it is observed that HRR changes back to normal values observed in healthy subjects as a result of underwent cardiologic rehabilitation. HRR should become an important factor in assessing effectiveness of conducted cardiologic rehabilitation.

  10. Accurate diagnosis of CHD by Paediatricians with Expertise in Cardiology.

    PubMed

    Jacob, Hannah C; Massey, Hannah; Yates, Robert W M; Kelsall, A Wilfred

    2017-08-01

    Introduction Paediatricians with Expertise in Cardiology assess children with a full history, examination, and often perform an echocardiogram. A minority are then referred to an outreach clinic run jointly with a visiting paediatric cardiologist. The accuracy of the echocardiography diagnosis made by the Paediatrician with Expertise in Cardiology is unknown. Materials and methods We conducted a retrospective review of clinic letters for children seen in the outreach clinic for the first time between March, 2004 and March, 2011. Children with CHD diagnosed antenatally or elsewhere were excluded. We recorded the echocardiography diagnosis made by the paediatric cardiologist and previously by the Paediatrician with Expertise in Cardiology. The Paediatrician with Expertise in Cardiology referred 317/3145 (10%) children seen in the local cardiac clinics to the outreach clinic over this period, and among them 296 were eligible for inclusion. Their median age was 1.5 years (range 1 month-15.1 years). For 244 (82%) children, there was complete diagnostic agreement between the Paediatrician with Expertise in Cardiology and the paediatric cardiologist. For 29 (10%) children, the main diagnosis was identical with additional findings made by the paediatric cardiologist. The abnormality had resolved in 17 (6%) cases by the time of clinic attendance. In six (2%) patients, the paediatric cardiologist made a different diagnosis. In total, 138 (47%) patients underwent a surgical or catheter intervention. Discussion Paediatricians with Expertise in Cardiology can make accurate diagnoses of CHD in children referred to their clinics. This can allow effective triage of children attending the outreach clinic, making best use of limited specialist resources.

  11. [Present-day health education in the field of cardiology].

    PubMed

    Sidorenko, G I

    1989-03-01

    Causes of limited efficiency of efforts to disseminate cardiologic knowledge are analysed. Ways to increase education efficiency are proposed, such as educational dialogue variants, warranting an efficient system for the control of preventive work. Rationale and recommendations are given for the use of television programs and other media. Variants of the adjustment of the educational effort to the level of the audience are proposed. Educational aspects of the work of a rural cardiologic practitioner are pointed out. Formal ways of data presentation are described with reference to current possibilities of the available projection equipment.

  12. The value of independent specialty designation for interventional cardiology.

    PubMed

    Blankenship, James C; Powell, Wayne A; Gray, Dawn R; Duffy, Peter L

    2017-01-01

    Interventional cardiology has finally completed, after 26 years of advocacy, a professional hat trick: independent board certification, membership as a unique specialty in the American Medical Association House of Delegates (AMA HOD), and recognition by the Centers for Medicaid and Medicare Services (CMS) as a separate medical specialty. This article points out how these distinctions for interventional cardiology and its professional society, the Society for Cardiovascular Angiography and Interventions (SCAI), have led to clear and definite benefits for interventional cardiologists and their patients. We focus on the least understood of these three-recognition by CMS and its implications for reimbursement and quality assessment for interventional cardiologists. © 2016 Wiley Periodicals, Inc.

  13. Discharge planning in a cardiology out-patient clinic: a clinical audit.

    PubMed

    Ingram, Shirley; Khan, Barkat

    2014-01-01

    The purpose of this paper is to audit the active discharge (DC) planning process in a general cardiology clinic, by pre-assessing patients' medical notes and highlighting those suitable for potential DC to the clinic physician. The cardiology clinical nurse specialist (CNS) identified patients' for nine- to 12-month return visits one week prior to attendance. The previous consultation letter was accessed and information was documented by the CNS in the medical record. The key performance indicator (KPI) used was patient DCs for each clinic visit. The process was audited at three separate times to reflect recommended action carried out. The CNS pre-assessment and presence at the clinics significantly increased total DCs during the first period compared to usual care, 11 vs 34 per cent (p < 0.0001). During the third audit period, DCs fell (9 per cent) with a reduction in CNS pre-assessed DCs (10 per cent). Recommendations were implemented. The process was continued by clinic administration staff, colour coding all nine- to 12-month returns, resulted in a 19 per cent DC rate in 2012. CNS pre-assessment and highlighting DC suitability increased the number of patient DCs. As the CNS presence at the clinic reduced so did the rate of DC. Specific personnel need to be responsible for monitoring and reminding staff of the process; this does not always have to be medical or nursing. Implementing positive discharging procedures is aimed at improving quality, increasing efficiency and accessibility of services for patients. This audit describes a process to promote DC planning from cardiology outpatients.

  14. Development of pediatric cardiology in latin america: accomplishments and remaining challenges.

    PubMed

    Capelli, Horacio; Kreutzer, Christian; Kreutzer, Guillermo

    2011-01-01

    Until the first quarter of the 20th century, most physicians were more than happy to differentiate congenital heart lesions from rheumatic heart disease, which then was rampant. As early as 1932, Dr Rodolfo Kreutzer, from Buenos Aires, Argentina, was already involved in the study of congenital heart defects. He started off assessing children with a stethoscope and with Einthoven electrocardiography equipment. The cardiac unit at the Buenos Aires Children's Hospital was created in 1936. It established the onset of pediatric cardiology in Argentina and fueled its development in South America. Nearly at the same time, Agustin Castellanos from Cuba also became a pioneer in the assessment of congenital heart disease. He described the clinical applications of intravenous angiocardiography in 1937. Meanwhile in Mexico, Dr Ignacio Chavez founded the National Institute of Cardiology in 1944 in Mexico City. It was the first center in the world to be exclusively devoted to cardiology. From this center, Victor Rubio and Hugo Limon performed the first therapeutic cardiac catheterization in 1953. Meanwhile, Professor Euriclydes Zerbini from Sao Paulo, Brazil, built the largest and most important school of cardiac surgeons in South America. In Santiago, Chile, the Calvo Makenna Hospital was the center where Helmut Jaegger operated on the first infant with extracorporeal circulation in Latin America in 1956. The patient was a 1-month-old baby, with complete transposition of the great arteries, who underwent an Albert procedure. Currently, there are many fully equipped centers all over the region, capable of dealing with most lesions and of providing excellent medical, interventional, and surgical treatment. Outcomes have improved substantially over the last 20 years. These achievements have gone beyond our pioneers' dreams. However, many neonates and young infants die prior to surgery because referral centers are overburdened and have long surgical waiting lists. Clearly, we still

  15. Automatic management system for dose parameters in interventional radiology and cardiology.

    PubMed

    Ten, J I; Fernandez, J M; Vaño, E

    2011-09-01

    The purpose of this work was to develop an automatic management system to archive and analyse the major study parameters and patient doses for fluoroscopy guided procedures performed in cardiology and interventional radiology systems. The X-ray systems used for this trial have the capability to export at the end of the procedure and via e-mail the technical parameters of the study and the patient dose values. An application was developed to query and retrieve from a mail server, all study reports sent by the imaging modality and store them on a Microsoft SQL Server data base. The results from 3538 interventional study reports generated by 7 interventional systems were processed. In the case of some technical parameters and patient doses, alarms were added to receive malfunction alerts so as to immediately take appropriate corrective actions.

  16. Fusion Bead Procedure for Nuclear Forensics Employing Synthetic Enstatite to Dissolve Uraniferous and Other Challenging Materials Prior to Laser Ablation Inductively Coupled Plasma Mass Spectrometry.

    PubMed

    Reading, David G; Croudace, Ian W; Warwick, Phillip E

    2017-06-06

    There is an increasing demand for rapid and effective analytical tools to support nuclear forensic investigations of seized or suspect materials. Some methods are simply adapted from other scientific disciplines and can effectively be used to rapidly prepare complex materials for subsequent analysis. A novel sample fusion method is developed, tested, and validated to produce homogeneous, flux-free glass beads of geochemical reference materials (GRMs), uranium ores, and uranium ore concentrates (UOC) prior to the analysis of 14 rare earth elements (REE) via laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). The novelty of the procedure is the production of glass beads using 9 parts high purity synthetic enstatite (MgSiO3) as the glass former with 1 part of sample (sample mass ∼1.5 mg). The beads are rapidly prepared (∼10 min overall time) by fusing the blended mixture on an iridium strip resistance heater in an argon-purged chamber. Many elements can be measured in the glass bead, but the rare earth group in particular is a valuable series in nuclear forensic studies and is well-determined using LA-ICP-MS. The REE data obtained from the GRMs, presented as chondrite normalized patterns, are in very good agreement with consensus patterns. The UOCs have comparable patterns to solution ICP-MS methods and published data. The attractions of the current development are its conservation of sample, speed of preparation, and suitability for microbeam analysis, all of which are favorable for nuclear forensics practitioners and geochemists requiring REE patterns from scarce or valuable samples.

  17. Mind the Gap: Representation of Medical Education in Cardiology-Related Articles and Journals.

    PubMed

    Allred, Clint; Berlacher, Kathryn; Aggarwal, Saurabh; Auseon, Alex J

    2016-07-01

    Cardiology fellowship programs are at the interface of medical education and the care of patients suffering from the leading cause of mortality in the United States, yet there is an apparent lack of research guiding the effective education of fellows. We sought to quantify the number of publications in cardiology journals that pertained to the education of cardiology trainees and the number of cardiologists participating in education research. For the period between January and December 2012, we cataloged cardiology-specific and general medical/medical education journals and sorted them by impact factor. Tables of content were reviewed for articles with an educational focus, a cardiology focus, or both. We recorded the authors' areas of medical training, and keywords from each cardiology journal's mission statement were reviewed for emphasis on education. Twenty-six cardiology journals, containing 6645 articles, were reviewed. Only 4 articles had education themes. Ten general medical and 15 medical education journals contained 6810 articles. Of these, only 7 focused on medical education in cardiology, and none focused on cardiology fellowship training. Among the 4887 authors of publications in medical education journals, 25 were cardiologists (less than 1%), and among the 1036 total words in the mission statements of all cardiology journals, the term "education" appeared once. Published educational research is lacking in cardiology training, and few cardiologists appear to be active members of the education scholarship community. Cardiology organizations and academic journals should support efforts to identify target areas of study and publish scholarship in educational innovation.

  18. Patient and staff doses in paediatric interventional cardiology derived from experimental measurements with phantoms.

    PubMed

    Ubeda, Carlos; Vano, Eliseo; Miranda, Patricia; Aguirre, Daniel; Riquelme, Nemorino; Dalmazzo, Dandaro; Galaz, Sergio

    2016-01-01

    The aim of this paper was to determine experimentally the entrance surface air kerma (ESAK) and kerma-area product (KAP) levels to patients and scatter doses at the cardiologist's eyes during paediatric interventional cardiology (IC) procedures for Chile, on the basis of measurements taken from X-ray systems characterization for different thicknesses of polymethyl methacrylate, together with the average values of fluoroscopy time and number of cine frames for ten paediatric IC procedures. The range of cumulative ESAK values when the different clinical procedures were simulated was from 2 to 1100 mGy. KAP values ranged from 0.30 to 150 Gy cm(2). Scatter doses at cardiologist's eyes for the simulated procedures ranged from 0.20 to 116 µSv per procedure. Large differences between the X-ray systems were found in our study. Standardized guidelines in terms of X-ray system setting and protocols should be developed for hospitals that perform paediatric IC procedures in Chile.

  19. [Pediatric cardiology and congenital heart disease: from fetus to adult].

    PubMed

    Subirana, M Teresa; Oliver, José M; Sáez, José M; Zunzunegui, José L

    2012-01-01

    This article contains a review of some of the most important publications on congenital heart disease and pediatric cardiology that appeared in 2010 and up until September 2011. Of particular interest were studies on demographic changes reported in this patient population and on the need to manage the patients' transition from the pediatric to the adult cardiology department. This transition has given rise to the appearance of new areas of interest: for example, pregnancy in women with congenital heart disease, and the effect of genetic factors on the etiology and transmission of particular anomalies. In addition, this review considers some publications on fetal cardiology from the perspective of early diagnosis and, if possible, treatment. There follows a discussion on new contributions to Eisenmenger's syndrome and arrhythmias, as well as on imaging techniques, interventional catheterization and heart transplantation. Finally, there is an overview of the new version of clinical practice guidelines on the management of adult patients with congenital heart disease and of recently published guidelines on pregnancy in women with heart disease, both produced by the European Society of Cardiology.

  20. Burnout, Perceived Stress, and Depression among Cardiology Residents in Argentina

    ERIC Educational Resources Information Center

    Waldman, Silvina V.; Diez, Juan Cruz Lopez; Arazi, Hernan Cohen; Linetzky, Bruno; Guinjoan, Salvador; Grancelli, Hugo

    2009-01-01

    Objective: Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these…

  1. Weekly Interdisciplinary Colloquy on Cardiology: A Decade of Experiment.

    ERIC Educational Resources Information Center

    Wehrmacher, William H.; And Others

    1981-01-01

    An experimental, continuing, weekly interdisciplinary colloquy on cardiology is described. It is organized between the departments of medicine and physiology of Loyola University Medical Center to promote interaction between basic scientists and practicing physicians in the medical school. (Author/MLW)

  2. Comparison of Two Educational Strategies in Teaching Preventive Cardiology.

    ERIC Educational Resources Information Center

    Stroup-Benham, Christine A.; And Others

    This study assessed the impact of two educational strategies: text only versus text plus small group discussion, among two groups of third-year internal medicine clerkship students in a preventive cardiology course. The course was a required, 12-week Internal Medical clerkship at the University of Texas Medical Branch. The first group reviewed…

  3. Burnout, Perceived Stress, and Depression among Cardiology Residents in Argentina

    ERIC Educational Resources Information Center

    Waldman, Silvina V.; Diez, Juan Cruz Lopez; Arazi, Hernan Cohen; Linetzky, Bruno; Guinjoan, Salvador; Grancelli, Hugo

    2009-01-01

    Objective: Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these…

  4. Update on ischemic heart disease and critical care cardiology.

    PubMed

    Marín, Francisco; Díaz-Castro, Oscar; Ruiz-Nodar, Juan Miguel; García de la Villa, Bernardo; Sionis, Alessandro; López, Javier; Fernández-Ortiz, Antonio; Martínez-Sellés, Manuel

    2014-02-01

    This article summarizes the main developments reported in 2013 on ischemic heart disease, together with the most important innovations in the management of acute cardiac patients. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  5. Weekly Interdisciplinary Colloquy on Cardiology: A Decade of Experiment.

    ERIC Educational Resources Information Center

    Wehrmacher, William H.; And Others

    1981-01-01

    An experimental, continuing, weekly interdisciplinary colloquy on cardiology is described. It is organized between the departments of medicine and physiology of Loyola University Medical Center to promote interaction between basic scientists and practicing physicians in the medical school. (Author/MLW)

  6. Nuclear reprogramming.

    PubMed

    Halley-Stott, Richard P; Pasque, Vincent; Gurdon, J B

    2013-06-01

    There is currently particular interest in the field of nuclear reprogramming, a process by which the identity of specialised cells may be changed, typically to an embryonic-like state. Reprogramming procedures provide insight into many mechanisms of fundamental cell biology and have several promising applications, most notably in healthcare through the development of human disease models and patient-specific tissue-replacement therapies. Here, we introduce the field of nuclear reprogramming and briefly discuss six of the procedures by which reprogramming may be experimentally performed: nuclear transfer to eggs or oocytes, cell fusion, extract treatment, direct reprogramming to pluripotency and transdifferentiation.

  7. Potential and Limitations of Cochrane Reviews in Pediatric Cardiology: A Systematic Analysis.

    PubMed

    Poryo, Martin; Khosrawikatoli, Sara; Abdul-Khaliq, Hashim; Meyer, Sascha

    2017-02-27

    Evidence-based medicine has contributed substantially to the quality of medical care in pediatric and adult cardiology. However, our impression from the bedside is that a substantial number of Cochrane reviews generate inconclusive data that are of limited clinical benefit. We performed a systematic synopsis of Cochrane reviews published between 2001 and 2015 in the field of pediatric cardiology. Main outcome parameters were the number and percentage of conclusive, partly conclusive, and inconclusive reviews as well as their recommendations and their development over three a priori defined intervals. In total, 69 reviews were analyzed. Most of them examined preterm and term neonates (36.2%), whereas 33.3% included also non-pediatric patients. Leading topics were pharmacological issues (71.0%) followed by interventional (10.1%) and operative procedures (2.9%). The majority of reviews were inconclusive (42.9%), while 36.2% were conclusive and 21.7% partly conclusive. Although the number of published reviews increased during the three a priori defined time intervals, reviews with "no specific recommendations" remained stable while "recommendations in favor of an intervention" clearly increased. Main reasons for missing recommendations were insufficient data (n = 41) as well as an insufficient number of trials (n = 22) or poor study quality (n = 19). There is still need for high-quality research, which will likely yield a greater number of Cochrane reviews with conclusive results.

  8. Update on heart failure, heart transplant, congenital heart disease, and clinical cardiology.

    PubMed

    Almenar, Luis; Zunzunegui, José Luis; Barón, Gonzalo; Carrasco, José Ignacio; Gómez-Doblas, Juan José; Comín, Josep; Barrios, Vivencio; Subirana, M Teresa; Díaz-Molina, Beatriz

    2013-04-01

    In the year 2012, 3 scientific sections-heart failure and transplant, congenital heart disease, and clinical cardiology-are presented together in the same article. The most relevant development in the area of heart failure and transplantation is the 2012 publication of the European guidelines for heart failure. These describe new possibilities for some drugs (eplerenone and ivabradine); expand the criteria for resynchronization, ventricular assist, and peritoneal dialysis; and cover possibilities of percutaneous repair of the mitral valve (MitraClip(®)). The survival of children with hypoplastic left heart syndrome in congenital heart diseases has improved significantly. Instructions for percutaneous techniques and devices have been revised and modified for the treatment of atrial septal defects, ostium secundum, and ventricular septal defects. Hybrid procedures for addressing structural congenital heart defects have become more widespread. In the area of clinical cardiology studies have demonstrated that percutaneous prosthesis implantation has lower mortality than surgical implantation. Use of the CHA2DS2-VASc criteria and of new anticoagulants (dabigatran, rivaroxaban and apixaban) is also recommended. In addition, the development of new sequencing techniques has enabled the analysis of multiple genes.

  9. Interoperable computerized smart card based system for health insurance and health services applied in cardiology.

    PubMed

    Cocei, Horia-Delatebea; Stefan, Livia; Dobre, Ioana; Croitoriu, Mihai; Sinescu, Crina; Ovricenco, Eduard

    2002-01-01

    In 1999 Romania started its health care reform by promulgating the Health Insurance Law. A functional and efficient health care system needs procedures for monitoring and evaluation of the medical services, communication between different service providers and entities involved in the system, integration and availability of the information. The final goal is a good response to the needs and demands of the patients and of the real life. For this project we took into account, on one hand, the immediate need for computerized systems for the health care providers and, on the other hand, the large number of trials and experiments with health smart cards across Europe. Our project will implement a management system based on electronic patient records to be used in all cardiology clinics and will experiment the health smart cards, will promote and demonstrate the capabilities of the smart card technology. We focused our attention towards a specific and also critical category of patients, those with heart diseases, and also towards a critical sector of the health care system--the emergency care. The patient card was tested on a number of 150 patients at a cardiology clinic in Bucharest. This was the first trial of a health smart card in Romania.

  10. A national programme for patient and staff dose monitoring in interventional cardiology.

    PubMed

    Sánchez, R; Vano, E; Fernández, J M; Sotil, J; Carrera, F; Armas, J; Rosales, F; Pifarre, X; Escaned, J; Angel, J; Diaz, J F; Bosa, F; Saez, J R; Goicolea, J

    2011-09-01

    A national programme on patient and staff dose evaluation in interventional cardiology made in cooperation with the haemodynamic section of the Spanish Society of Cardiology has recently been launched. Its aim is to propose a set of national diagnostic reference levels (DRLs) for patients as recommended by the International Commission on Radiological Protection and to initiate several optimisation actions to improve radiological protection of both patients and staff. Six hospitals have joined the programme and accepted to submit their data to a central database. First to be acquired were the quality control data of the X-ray systems and radiation doses of patients and professionals. The results from 9 X-ray systems, 1467 procedures and staff doses from 43 professionals were gathered. Provisional DRLs resulted in 44 Gy cm(2) for coronary angiography and 78 Gy cm(2) for interventions. The X-ray systems varied up to a factor of 5 for dose rates in reference conditions. Staff doses showed that 50 % of interventional cardiologists do not use their personal dosemeters correctly.

  11. [The Sociedad Española de Cardiología on the Internet: current resources and future prospects. The Internet Committee of the Sociedad Española de Cardiología].

    PubMed

    Arribas, F; Elízaga, J; Bosch, X

    1998-10-01

    The Internet can help physicians to identify needed clinical information quickly providing continued medical education. Internet also improves medical information of the non-medical population. Researchers have quick access to library catalogs, Medline and other important databases from the most recognized research centers. Furthermore, it can put physicians in ready contact with other specialists for communication and consultation, facilitates administrative procedures of multicenter studies and accelerates editorial processes of biomedical journals. Since its creation, the website of the Spanish Society of Cardiology has evolved rapidly to the present model, providing different kinds of services to its members including faster communication, information from national and international societies and congresses, earlier access to the full content of Revista Española de Cardiología and to a variety of graphic resources and of continuing education. Nowadays, the website of the Spanish Society of Cardiology is consulted by one thousand visitors a week, even at weekends. The degree of activity increases from 3 h P.M. with a peak from 11 h P.M. to 1 h A.M. In the near future, our website will incorporate its own courses of continuing medical education with on-line evaluation and credit granting, will give support to multicenter studies and will initiate the publication and discussion of clinical cases of interest.

  12. Applications of CdTe to nuclear medicine. Final report

    SciTech Connect

    Entine, G.

    1985-05-07

    Uses of cadmium telluride (CdTe) nuclear detectors in medicine are briefly described. They include surgical probes and a system for measuring cerebral blood flow in the intensive care unit. Other uses include nuclear dentistry, x-ray exposure control, cardiology, diabetes, and the testing of new pharmaceuticals. (ACR)

  13. Management of cardiovascular conditions in a cohort of patients with HIV: experience from a joint HIV/cardiology clinic.

    PubMed

    Koganti, Sudheer; Kinloch-de Loes, Sabine; Hutchinson, Samantha; Johnson, Margaret; Rakhit, Roby D

    2015-10-01

    The aim of this study was to assess cardiovascular diagnoses and management in a cohort of patients diagnosed with HIV, and the performance of a joint HIV/Cardiology Clinic in a tertiary hospital setting. A retrospective analysis was performed on all patients referred to a joint HIV/Cardiology Clinic at our hospital. Data on 120 patients were collected. In this predominantly male population (male 101 and female 19) coronary artery disease (CAD) was the most common diagnosis (34%, n = 41). Other diseases included hypertension (12.5%, n = 15), cardiomyopathy (12.5%, n = 15) and arrhythmia (6%, n = 8). The majority of remaining cases included non-cardiac chest pain and palpitations. In addition to usual primary and secondary preventive measures for CAD, complex procedures, such as percutaneous coronary intervention, cardiac resynchronisation therapy for left ventricular systolic dysfunction and radiofrequency ablation for arrhythmias, were carried out. Overall cardiovascular mortality among the group was 2.5% (n = 3) over 4 years. The results indicate the efficacy of a specialist joint HIV/Cardiology Clinic in diagnosing and managing various cardiac conditions in a complex cohort of patients with HIV. © Royal College of Physicians 2015. All rights reserved.

  14. Staff lens doses in interventional urology. A comparison with interventional radiology, cardiology and vascular surgery values.

    PubMed

    Vano, E; Fernandez, J M; Resel, L E; Moreno, J; Sanchez, R M

    2016-03-01

    The purpose of this work is to evaluate radiation doses to the lens of urologists during interventional procedures and to compare them with values measured during interventional radiology, cardiology and vascular surgery. The measurements were carried out in a surgical theatre using a mobile C-arm system and electronic occupational dosimeters (worn over the lead apron). Patient and staff dose measurements were collected in a sample of 34 urology interventions (nephrolithotomies). The same dosimetry system was used in other medical specialties for comparison purposes. Median and 3rd quartile values for urology procedures were: patient doses 30 and 40 Gy cm(2); personal dose equivalent Hp(10) over the apron (μSv/procedure): 393 and 848 (for urologists); 21 and 39 (for nurses). Median values of over apron dose per procedure for urologists resulted 18.7 times higher than those measured for radiologists and cardiologists working with proper protection (using ceiling suspended screens) in catheterisation laboratories, and 4.2 times higher than the values measured for vascular surgeons at the same hospital. Comparison with passive dosimeters worn near the eyes suggests that dosimeters worn over the apron could be a reasonable conservative estimate for ocular doses for interventional urology. Authors recommend that at least the main surgeon uses protective eyewear during interventional urology procedures.

  15. The importance of pre-clinical animal testing in interventional cardiology.

    PubMed

    Suzuki, Yoriyasu; Yeung, Alan C; Ikeno, Fumiaki

    2008-11-01

    The treatment of cardiovascular disease has changed dramatically over the past 2 decades, allowing patients to live longer and better quality lives. The introduction of new therapies has contributed much to this success. Nowhere has this been more evident than in interventional cardiology, where percutaneous cardiovascular intervention has evolved in the past 2 decades from a quirky experimental procedure to a therapeutic cornerstone for patients with symptomatic cardiovascular disease. The development of these technologies from the earliest stages requires preclinical experiments using animal models. Once introduced into the clinical arena, an understanding of therapeutic mechanisms of these devices can be ascertained through comparisons of animal model research findings with clinical pathological specimens. This review provides an overview of the emerging role, results of preclinical studies and development, and evaluation of animal models for percutaneous cardiovascular intervention technologies for patients with symptomatic cardiovascular disease.

  16. A framework for clinical reasoning in adult cardiology

    PubMed Central

    de la Calzada, Carlos S

    2015-01-01

    It is well known that an expert clinician formulates a diagnostic hypothesis with little clinical data. In comparison, students have difficulties in doing so. The mental mechanism of diagnostic reasoning is almost unconscious and therefore difficult to teach. The purpose of this essay (devoted to 2nd-year medical students) is to present an integrating framework to teach clinical reasoning in cardiology. By analyzing cardiology with a synthetic mind, it becomes apparent that although there are many diseases, the heart, as an organ, reacts to illness with only six basic responses. The clinical manifestations of heart diseases are the direct consequence of these cardiac responses. Considering the six cardiac responses framework, diagnostic reasoning is done in three overlapping steps. With the presented framework, the process of reasoning becomes more visual and needs less clinical data, resembling that of the expert clinician. PMID:26203294

  17. Safety of pharmacotherapy of osteoporosis in cardiology patients.

    PubMed

    Zapolski, Tomasz; Wysokiński, Andrzej

    2010-01-01

    The commonest medical conditions following menopause are osteoporosis and atherosclerotic disease. This review considers the safety of pharmacotherapy of osteoporosis in cardiology patients. Drugs used for osteoporosis treatment may have adverse effects on the cardiovascular system. This article has detailed analysed of current drug classes, such as the bisphosphonates and strontium ranelate, as well as reviewed of the controversy surrounding hormone replacement therapy (HRT) and the selective estrogen receptor modulators (SERMs). Additionally, we discuss the adverse effects on the heart of calcium and drugs influencing calcium metabolism such as vitamin D, parathormone and calcitonin. We look at the interference between osteoporosis treatment and the drugs used for atherosclerosis. Moreover, the side effects on bones of cardiology drugs are analysed. Lastly, the possible advantages of selected drugs used for cardiovascular diseases in terms of osteoporosis prevention are evaluated.

  18. The future of interventional cardiology lies in the left atrium.

    PubMed

    Solomon, Stephen B

    2004-01-01

    The historic focus of interventional cardiology has been on treating atherosclerotic coronary artery disease. Balloons, stents, and debulking devices have been the mainstay tools of the interventionalist. However, as engineering skills have developed and clinical techniques have improved, new clinical avenues for the interventionalist beyond the coronary vessels are starting to evolve. One of the most opportunistic areas in cardiology for the interventionalist is the left atrium where treatment of clinically important issues such as mitral regurgitation, left atrial thrombus, atrial fibrillation, patent foramen ovale, and atrial septal defect may be approached. Additionally, the left atrium is a source of important hemodynamic information that can be captured with new implantable devices. While in the past the trans-septal puncture has been infrequently used, the future may hold this technique as one of the most common. The following manuscript describes the status of some of the newest opportunities for interventionalists that lie beyond atherosclerotic disease and within the left atrium.

  19. European Society of Cardiology (ESC) Congress Report from London 2015.

    PubMed

    Nishiguchi, Tsuyoshi; Akasaka, Takashi

    2015-01-01

    The Annual Congress of the European Society of Cardiology (ESC) was held in London from 29 August to 2 September 2015. It is the leading conference in cardiology in the world, with presentations on the latest scientific discoveries, innovations, technology, education, and clinical practices. More than 32,000 delegates and 5,000 exhibitors from 140 countries participated, sharing a number of scientific presentations, including 28 clinical hot lines, 18 clinical trial updates, 20 registry studies, 12 basic and translational science hot line studies, and 4,533 abstract studies. Japan had the highest number of accepted abstracts at the Congress, indicating the great contribution of Japanese scientists and the Japanese Circulation Society.

  20. C-arm rotation as a method for reducing peak skin dose in interventional cardiology.

    PubMed

    Pasciak, Alexander S; Bourgeois, Austin C; Jones, A Kyle

    2014-01-01

    Prolonged interventional cardiology (IC) procedures may result in radiation-induced skin injury, a potentially preventable cause of patient morbidity. Rotating the C-arm during an IC procedure may reduce this risk, although the methods by which the technique can be practically applied remains unexplored. A previous study demonstrated that C-arm rotation often increases peak skin dose (PSD) in interventional radiology procedures. The purpose of this study was to determine whether C-arm rotation reduces the PSD in IC procedures and, if so, under what circumstances. Simulations were performed using a numerical ray-tracing algorithm to analyse the effect of C-arm rotation on PSD across a range of patient sizes, C-arm configurations and procedure types. Specific data from modern fluoroscopes and patient dimensions were used as inputs to the simulations. In many cases, modest C-arm rotation angles completely eliminated overlap between X-ray field sites on the skin. When overlap remained, PSD increases were generally small. One exception was craniocaudal rotation, which tended to increase PSD. C-arm rotation was most effective for large patients and small X-ray field sizes. Small patients may not benefit from C-arm rotation as a procedural modification. The use of a prophylactic method where the C-arm was rotated between small opposing oblique angles was effective in reducing PSD. With the exception of rotation to steep craniocaudal angles, rotating the C-arm reduces PSD in IC procedures when used as either a procedural modification or a prophylactic strategy. Tight collimation increases the benefit of C-arm rotation.

  1. C-arm rotation as a method for reducing peak skin dose in interventional cardiology

    PubMed Central

    Pasciak, Alexander S; Bourgeois, Austin C; Jones, A Kyle

    2014-01-01

    Purpose Prolonged interventional cardiology (IC) procedures may result in radiation-induced skin injury, a potentially preventable cause of patient morbidity. Rotating the C-arm during an IC procedure may reduce this risk, although the methods by which the technique can be practically applied remains unexplored. A previous study demonstrated that C-arm rotation often increases peak skin dose (PSD) in interventional radiology procedures. The purpose of this study was to determine whether C-arm rotation reduces the PSD in IC procedures and, if so, under what circumstances. Materials and methods Simulations were performed using a numerical ray-tracing algorithm to analyse the effect of C-arm rotation on PSD across a range of patient sizes, C-arm configurations and procedure types. Specific data from modern fluoroscopes and patient dimensions were used as inputs to the simulations. Results In many cases, modest C-arm rotation angles completely eliminated overlap between X-ray field sites on the skin. When overlap remained, PSD increases were generally small. One exception was craniocaudal rotation, which tended to increase PSD. C-arm rotation was most effective for large patients and small X-ray field sizes. Small patients may not benefit from C-arm rotation as a procedural modification. The use of a prophylactic method where the C-arm was rotated between small opposing oblique angles was effective in reducing PSD. Conclusions With the exception of rotation to steep craniocaudal angles, rotating the C-arm reduces PSD in IC procedures when used as either a procedural modification or a prophylactic strategy. Tight collimation increases the benefit of C-arm rotation. PMID:25568803

  2. Aspirin and clopidogrel: a sweeping combination in cardiology.

    PubMed

    Manolis, Antonis S; Tzeis, Stylianos; Andrikopoulos, George; Koulouris, Spyros; Melita, Helen

    2005-07-01

    important large-scale clinical trials currently ongoing. Newer data are being accumulated from studies where indications for the use of clopidogrel and aspirin continue to expand into other patient groups, rendering this dual antiplatelet drug therapy a sweeping combination in Cardiology. However, important issues remain to be further and more thoroughly explored about the benefit of this antiplatelet drug combination in these other patient groups, such as in patients with heart failure, where preliminary data indicate a favorable effect on thrombotic vascular events, in patients with atrial fibrillation, where there is hope that this combination may replace or be an alternative treatment modality to coumadin in certain subpopulations, in patients undergoing demanding catheter ablation procedures, where data point to a protective effect from thromboembolic events. Another pertaining issue to be further investigated is the occurrence of drug-resistance observed in some patients for both these antithrombotic agents. This article is a comprehensive review of all these data and the landmark trials on the two antiplatelet agents, the issues involved and the current recommendations for their use in patients with atherosclerotic heart disease and other cardiovascular disorders and procedures.

  3. Advances in software for faster procedure and lower radiotracer dose myocardial perfusion imaging.

    PubMed

    Piccinelli, Marina; Garcia, Ernest V

    2015-01-01

    The American Society of Nuclear Cardiology has recently published documents that encourage laboratories to take all the appropriate steps to greatly decrease patient radiation dose and has set the goal of 50% of all myocardial perfusion studies performed with an associated radiation exposure of 9mSv by 2014. In the present work, a description of the major software techniques readily available to shorten procedure time and decrease injected activity is presented. Particularly new reconstruction methods and their ability to include means for resolution recovery and noise regularization are described. The use of these improved reconstruction algorithms results in a consistent reduction in acquisition time, injected activity and consequently in the radiation dose absorbed by the patient. The clinical implications to the use of these techniques are also described in terms of maintained and even improved study quality, accuracy and sensitivity for the detection of heart disease.

  4. Phosphoproteomics and molecular cardiology: techniques, applications and challenges.

    PubMed

    Sun, Zeyu; Hamilton, Karyn L; Reardon, Kenneth F

    2012-09-01

    Protein phosphorylation has been widely documented as a key regulatory and signaling mechanism associated with many cardiac diseases. Recent advances in phosphoproteomic technologies such as phosphopeptide enrichment, novel mass spectrometry applications, and bioinformatic tools have resulted in high-throughput identification and quantitation of protein phosphorylation in a global manner. This review summarizes mainstream phosphoproteomic workflows and highlights the most recent applications of phosphoproteomics used in a range of molecular cardiology research.

  5. Year in review 2007: Critical Care – cardiology

    PubMed Central

    2008-01-01

    This review summarises key research papers in the fields of cardiology and intensive care published during 2007 in Critical Care. To create a context and for comparison with the papers described in the review, we cite studies on the same subject published in other journals. The papers have been grouped into four categories: venous oximetry, cardiac surgery, perioperative fluid optimisation, and haemodynamic monitoring. PMID:18983703

  6. Accidental nuclear war: Modifications to superpower arsenals and to procedures for handling them could substantially reduce the risk of unintended Armageddon

    SciTech Connect

    Blair, B.G.; Kendall, H.W.

    1990-12-01

    If nuclear war breaks out in the coming decade or two, it will probably be by accident. The threat of a cold-blooded, calculated first strike is vanishing, but beneath the calm surface of constructive diplomacy among the traditional nuclear rivals lurks the danger of unpremeditated use of nuclear weapons. The accidental, unauthorized or inadvertent use of these weapons has become the most plausible path to nuclear war. Both superpowers, as well as France, Great Britain and China - long-standing members of the nuclear club - are potential sources of accidental missile launch. The emergence of fledgling nuclear powers such as India, Pakistan and Israel - some armed with ballistic missiles - pushes nuclear safeguards even closer to the top of the international security agenda. The chances of unwanted nuclear war would be reduced significantly if tamper proof, coded locks were installed on all nuclear weapons and if methods were put in place to disarm nuclear forces even after launch. In addition, the US and the Soviet Union should reduce their reliance on the dangerous policy of launch on warning and reduce the launch readiness of their nuclear forces. The social and political upheavals in the Soviet Union underscore fears of unintended nuclear war. Civil turmoil raises the possibility that rebellious ethnic groups or splinter organizations could capture nuclear weapons. Other, deeper fault lines run through the whole of Soviet society and may be capable of cracking the foundations of its nuclear command system. Although the US faces no such civil unrest, the country's system of nuclear command carries some risk that nuclear weapons might be used contrary to the intentions of legitimate authorities.

  7. Cardiac ablation procedures

    MedlinePlus

    ... a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific ...

  8. A practical method for skin dose estimation in interventional cardiology based on fluorographic DICOM information.

    PubMed

    Matthews, Lucy; Dixon, Matthew; Rowles, Nick; Stevens, Greg

    2016-03-01

    A practical method for skin dose estimation for interventional cardiology patients has been developed to inform pre-procedure planning and post-procedure patient management. Absorbed dose to the patient skin for certain interventional radiology procedures can exceed thresholds for deterministic skin injury, requiring documentation within the patient notes and appropriate patient follow-up. The primary objective was to reduce uncertainty associated with current methods, particularly surrounding field overlap. This was achieved by considering rectangular field geometry incident on a spherical patient model in a polar coordinate system. The angular size of each field was quantified at surface of the sphere, i.e. the skin surface. Computer-assisted design software enabled the modelling of a sufficient dataset that was subsequently validated with radiochromic film. Modelled overlap was found to agree with overlap measured using film to within 2.2° ± 2.0°, showing that the overall error associated with the model was < 1 %. Mathematical comparison against exposure data extracted from procedural Digital Imaging and Communication in Medicine files was used to generate a graphical skin dose map, demonstrating the dose distribution over a sphere centred at the interventional reference point. Dosimetric accuracy of the software was measured as between 3.5 and 17 % for different variables.

  9. [Spanish Registry on Cardiac Catheterization Interventions. 11th official report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001)].

    PubMed

    Hernández, José M; Goicolea, Javier; Durán, Juan M; Augé, José M

    2002-11-01

    The results of the Spanish Registry of the Working Group on cardiac catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001) are presented. One-hundred-and-three centers contributed data, all the cardiac catheterization laboratories in Spain; 97 centers performed mainly adult catheterization and 6 carried out only pediatric procedures. In 2001, 95,430 diagnostic catheterization procedures were performed, with 79,607 coronary angiograms, representing a total increase of 8.4% over 2000. The population-adjusted incidence was 1947 coronary angiograms per 106 inhabitants. Coronary interventions increased by 15.4% compared with 2000, with a total of 31,290 procedures and an incidence of coronary interventions of 761 per 106 inhabitants. Coronary stents were the most frequently used devices with 39,356 implanted in 2001, and increase of 33.4% over 2000. Stenting accounted for 88.2% of procedures. Direct stenting was done in 11,280 procedures (40.9%). IIb-IIIa glycoprotein inhibitors were given in 7,012 procedures (22.4%). Multivessel percutaneous coronary interventions were performed in 8,445 cases (27%) and interventions were performed ad hoc during diagnostic study in 23,144 cases (74 %).A total of 3,845 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, an increase of 22.9% over 2000 and 12.3% of all interventional procedures. Among non-coronary interventions, atrial septal defect closure was performed more often (161 cases, a 60% increase over 2000). Pediatric interventions increased by 15.4% (from 817 to 943 cases).Lastly, we would like to underline the high rate of reporting by laboratories, which allowed the Registry to compile data that are highly representative of hemodynamic interventions in Spain.

  10. Interventional pediatric cardiology: state of the art and future directions.

    PubMed

    Rao, P S

    1998-01-01

    Although the interventional pediatric cardiology began in the early 1950s, it was not until the mid-1980s that a full spectrum of transcatheter interventions in children could be undertaken including balloon atrial septostomy which has been in usage since 1966. Enormous developments have occurred even from the mid-1980s to date. In this review, current state-of-the-art for each broad area of therapeutic catheterization is presented. A large variety of lesions could be opened-up or closed, as the case may be and the results of these interventions were either similar to or better than those reported for the alternative surgical therapy. Indeed, therapeutic catheterization techniques have replaced the conventional surgery for many lesions and are threatening to do so for others. However, long-term follow-up results are scanty and are needed. Further miniaturization of catheters/sheaths used in interventional pediatric cardiology and development of new technology for the lesions which are not amenable to currently available transcatheter methods are awaited. The future seems to be bright for interventional pediatric cardiology.

  11. Report from The International Society for Nomenclature of Paediatric and Congenital Heart Disease: cardiovascular catheterisation for congenital and paediatric cardiac disease (Part 2 - Nomenclature of complications associated with interventional cardiology).

    PubMed

    Bergersen, Lisa; Giroud, Jorge Manuel; Jacobs, Jeffrey Phillip; Franklin, Rodney Cyril George; Béland, Marie Josée; Krogmann, Otto Nils; Aiello, Vera Demarchi; Colan, Steven D; Elliott, Martin J; Gaynor, J William; Kurosawa, Hiromi; Maruszewski, Bohdan; Stellin, Giovanni; Tchervenkov, Christo I; Walters, Henry Lane; Weinberg, Paul; Everett, Allen Dale

    2011-06-01

    Interventional cardiology for paediatric and congenital cardiac disease is a relatively young and rapidly evolving field. As the profession begins to establish multi-institutional databases, a universal system of nomenclature is necessary for the field of interventional cardiology for paediatric and congenital cardiac disease. The purpose of this paper is to present the results of the efforts of The International Society for Nomenclature of Paediatric and Congenital Heart Disease to establish a system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease, focusing both on procedural nomenclature and the nomenclature of complications associated with interventional cardiology. This system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease is a component of The International Paediatric and Congenital Cardiac Code. This manuscript is the second part of the two-part series. Part 1 covered the procedural nomenclature associated with interventional cardiology as treatment for paediatric and congenital cardiac disease. Part 2 will cover the nomenclature of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease.

  12. Review of paediatric cardiology services in district general hospitals in the United Kingdom.

    PubMed

    Andrews, Hannah; Singh, Yogen

    2016-03-01

    Following the Safe and Sustainable review of Paediatric Services in 2012/2013, National Health Service England recommended that local paediatric cardiology services should be provided by specially trained paediatricians with expertise in cardiology in all non-specialist hospitals. To understand the variation in local paediatric cardiology services provided across district general hospitals in the United Kingdom. An internet-based questionnaire was sent out via the Paediatrician with Expertise in Cardiology Special Interest Group and the Neonatologists with Interest in Cardiology and Haemodynamics contact databases and the National Health Service directory. Non-responders were followed-up via telephone. The response rate was 80% (141 of 177 hospitals), and paediatricians with expertise in cardiology were available in 68% of those. Local cardiology clinics led by paediatricians with expertise in cardiology were provided in 96 hospitals (68%), whereas specialist outreach clinics were held in 123 centres (87%). A total of 11 hospitals provided neither specialist outreach clinics nor any local cardiology clinics led by paediatricians with expertise in cardiology. Paediatric echocardiography services were provided in 83% of the hospitals, 12-lead electrocardiogram in 96%, Holter electrocardiogram in 91%, and exercise testing in only 47% of the responding hospitals. Telemedicine facilities were established in only 52% of the centres, where sharing echocardiogram images via picture archiving and communication system was used most commonly. There has been a substantial increase in the availability of paediatricians with expertise in cardiology since 2008. Most of the hospitals are well-supported by specialist cardiology centres via outreach clinics; however, there remains significant variation in the local paediatric cardiology services provided across district general hospitals in the United Kingdom.

  13. Contrast-induced nephropathy in interventional cardiology

    PubMed Central

    Sudarsky, Doron; Nikolsky, Eugenia

    2011-01-01

    Development of contrast-induced nephropathy (CIN), ie, a rise in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2–3 days after contrast administration, is strongly associated with both increased inhospital and late morbidity and mortality after invasive cardiac procedures. The prevention of CIN is critical if long-term outcomes are to be optimized after percutaneous coronary intervention. The prevalence of CIN in patients receiving contrast varies markedly (from <1% to 50%), depending on the presence of well characterized risk factors, the most important of which are baseline chronic renal insufficiency and diabetes mellitus. Other risk factors include advanced age, anemia, left ventricular dysfunction, dehydration, hypotension, renal transplant, low serum albumin, concomitant use of nephrotoxins, and the volume of contrast agent. The pathophysiology of CIN is likely to be multifactorial, including direct cytotoxicity, apoptosis, disturbances in intrarenal hemodynamics, and immune mechanisms. Few strategies have been shown to be effective to prevent CIN beyond hydration, the goal of which is to establish brisk diuresis prior to contrast administration, and to avoid hypotension. New strategies of controlled hydration and diuresis are promising. Studies are mixed on whether prophylactic oral N-acetylcysteine reduces the incidence of CIN, although its use is generally recommended, given its low cost and favorable side effect profile. Agents which have been shown to be ineffective or harmful, or for which data supporting routine use do not exist, include fenoldopam, theophylline, dopamine, calcium channel blockers, prostaglandin E1, atrial natriuretic peptide, statins, and angiotensin-converting enzyme inhibitors. PMID:21912486

  14. Contrast-induced nephropathy in interventional cardiology.

    PubMed

    Sudarsky, Doron; Nikolsky, Eugenia

    2011-01-01

    Development of contrast-induced nephropathy (CIN), ie, a rise in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, is strongly associated with both increased inhospital and late morbidity and mortality after invasive cardiac procedures. The prevention of CIN is critical if long-term outcomes are to be optimized after percutaneous coronary intervention. The prevalence of CIN in patients receiving contrast varies markedly (from <1% to 50%), depending on the presence of well characterized risk factors, the most important of which are baseline chronic renal insufficiency and diabetes mellitus. Other risk factors include advanced age, anemia, left ventricular dysfunction, dehydration, hypotension, renal transplant, low serum albumin, concomitant use of nephrotoxins, and the volume of contrast agent. The pathophysiology of CIN is likely to be multifactorial, including direct cytotoxicity, apoptosis, disturbances in intrarenal hemodynamics, and immune mechanisms. Few strategies have been shown to be effective to prevent CIN beyond hydration, the goal of which is to establish brisk diuresis prior to contrast administration, and to avoid hypotension. New strategies of controlled hydration and diuresis are promising. Studies are mixed on whether prophylactic oral N-acetylcysteine reduces the incidence of CIN, although its use is generally recommended, given its low cost and favorable side effect profile. Agents which have been shown to be ineffective or harmful, or for which data supporting routine use do not exist, include fenoldopam, theophylline, dopamine, calcium channel blockers, prostaglandin E(1), atrial natriuretic peptide, statins, and angiotensin-converting enzyme inhibitors.

  15. Monitoring device safety in interventional cardiology.

    PubMed

    Matheny, Michael E; Ohno-Machado, Lucila; Resnic, Frederic S

    2006-01-01

    A variety of postmarketing surveillance strategies to monitor the safety of medical devices have been supported by the U.S. Food and Drug Administration, but there are few systems to automate surveillance. Our objective was to develop a system to perform real-time monitoring of safety data using a variety of process control techniques. The Web-based Data Extraction and Longitudinal Time Analysis (DELTA) system imports clinical data in real-time from an electronic database and generates alerts for potentially unsafe devices or procedures. The statistical techniques used are statistical process control (SPC), logistic regression (LR), and Bayesian updating statistics (BUS). We selected in-patient mortality following implantation of the Cypher drug-eluting coronary stent to evaluate our system. Data from the University of Michigan Consortium Bare-Metal Stent Study was used to calculate the event rate alerting boundaries. Data analysis was performed on local catheterization data from Brigham and Women's Hospital from July 1, 2003, shortly after the Cypher release, to December 31, 2004, including 2,270 cases with 27 observed deaths. The single-stratum SPC had alerts in months 4 and 10. The multistrata SPC had alerts in months 5, 10, and 18 in the moderate-risk stratum, and months 1, 4, 7, and 10 in the high-risk stratum. The only cumulative alerts were in the first month for the high-risk stratum of the multistrata SPC. The LR method showed no monthly or cumulative alerts. The BUS method showed an alert in the first month for the high-risk stratum. The system performed adequately within the Brigham and Women's Hospital Intranet environment based on the design goals. All three cumulative methods agreed that the overall observed event rates were not significantly higher for the new medical device than for a closely related medical device and were consistent with the observation that the initial concerns about this device dissipated as more data accumulated.

  16. Effects of prednisone on biomarkers of tubular damage induced by radiocontrast in interventional cardiology.

    PubMed

    Ribichini, Flavio; Gambaro, Alessia; Pighi, Michele; Pesarini, Gabriele; Ferraro, Pietro Manuel; Zuppi, Cecilia; Baroni, Silvia; Penitente, Romina; Ferrero, Valeria; Vassanelli, Corrado

    2013-01-01

    Contrast-induced nephropathy (CI-AKI) is a complication of diagnostic/therapeutic hemodynamic procedures in cardiology, which may also cause renal cholesterolinic atheroembolism. Despite the 
severe clinical impact of these complications, there is no optimal therapy for preventing and treating them. We suggest a short course of high-dose steroids as an effective preventive measure. Patients at risk of CI-AKI (n = 38) undergoing cardiovascular procedures were assigned 1:1 to 1 of 2 experimental arms (prednisone+hydration vs. hydration alone). Oral prednisone 1 mg/kg was administered 12 hours before, at 6 am on the same day, and 24 hours following the procedure. Serum creatinine was tested immediately before and again 24-48 hours after the procedure; neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), protein and albumin were assayed in spot urine before and 6 hours after the procedure.
 NGAL and KIM-1 tended to rise after the procedure, but to a lesser degree in the prednisone group (delta NGAL: hydration = +128%, prednisone = +46%; 
p = 0.26; delta KIM-1: hydration = +99%, prednisone = +11%; p = 0.02). Proteinuria and albuminuria decreased significantly in the prednisone group. In 5 patients developing CI-AKI, their delta NGAL and delta KIM-1 did not differ from the values seen in patients without 
CI-AKI. Hypertension, peripheral arteriopathy and use of low-dose aspirin or diuretics were positive predictors of baseline NGAL, while treatment with calcium channel blockers and statins were negative predictors. Statins were negative predictors of baseline KIM-1. A short course of prednisone reduces the procedure-induced changes in biomarkers of renal tubular damage. This study suggests that steroids had a tubule-protecting effect.

  17. Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings

    PubMed Central

    Jena, Anupam B.; Prasad, Vinay; Goldman, Dana P.; Romley, John

    2014-01-01

    IMPORTANCE Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. OBJECTIVE To analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011 during dates of 2 national cardiology meetings compared with identical nonmeeting days in the 3 weeks before and after conferences (AMI, 8570 hospitalizations during 82 meeting days and 57 471 during 492 nonmeeting days; heart failure, 19 282 during meeting days and 11 4591 during nonmeeting days; cardiac arrest, 1564 during meeting days and 9580 during nonmeeting days). Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals and for low-and high-risk patients. Differences in treatment utilization were assessed. EXPOSURES Hospitalization during cardiology meeting dates. MAIN OUTCOMES AND MEASURES Thirty-day mortality, procedure rates, charges, length of stay. RESULTS Patient characteristics were similar between meeting and nonmeeting dates. In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%–21.2%] vs 24.8% [95% CI, 22.9%–26.6%]; P < .001; cardiac arrest, 59.1% [95% CI, 51.4%–66.8%] vs 69.4% [95% CI, 66.2%–72.6%]; P = .01). Adjusted mortality for high-risk AMI in teaching hospitals was similar between meeting and nonmeeting dates (39.2% [95% CI, 31.8%–46.6%] vs 38.5% [95% CI, 35.0%–42.0%]; P = .86), although adjusted percutaneous

  18. Mortality and treatment patterns among patients hospitalized with acute cardiovascular conditions during dates of national cardiology meetings.

    PubMed

    Jena, Anupam B; Prasad, Vinay; Goldman, Dana P; Romley, John

    2015-02-01

    Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. To analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates. Retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011 during dates of 2 national cardiology meetings compared with identical nonmeeting days in the 3 weeks before and after conferences (AMI, 8570 hospitalizations during 82 meeting days and 57,471 during 492 nonmeeting days; heart failure, 19,282 during meeting days and 11,4591 during nonmeeting days; cardiac arrest, 1564 during meeting days and 9580 during nonmeeting days). Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals and for low- and high-risk patients. Differences in treatment utilization were assessed. Hospitalization during cardiology meeting dates. Thirty-day mortality, procedure rates, charges, length of stay. Patient characteristics were similar between meeting and nonmeeting dates. In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%-21.2%] vs 24.8% [95% CI, 22.9%-26.6%]; P < .001; cardiac arrest, 59.1% [95% CI, 51.4%-66.8%] vs 69.4% [95% CI, 66.2%-72.6%]; P = .01). Adjusted mortality for high-risk AMI in teaching hospitals was similar between meeting and nonmeeting dates (39.2% [95% CI, 31.8%-46.6%] vs 38.5% [95% CI, 35.0%-42.0%]; P = .86), although adjusted percutaneous coronary intervention (PCI) rates were lower during meetings (20.8% vs 28.2%; P = .02). No

  19. Monitoring Device Safety in Interventional Cardiology

    PubMed Central

    Matheny, Michael E.; Ohno-Machado, Lucila; Resnic, Frederic S.

    2006-01-01

    Objective: A variety of postmarketing surveillance strategies to monitor the safety of medical devices have been supported by the U.S. Food and Drug Administration, but there are few systems to automate surveillance. Our objective was to develop a system to perform real-time monitoring of safety data using a variety of process control techniques. Design: The Web-based Data Extraction and Longitudinal Time Analysis (DELTA) system imports clinical data in real-time from an electronic database and generates alerts for potentially unsafe devices or procedures. The statistical techniques used are statistical process control (SPC), logistic regression (LR), and Bayesian updating statistics (BUS). Measurements: We selected in-patient mortality following implantation of the Cypher drug-eluting coronary stent to evaluate our system. Data from the University of Michigan Consortium Bare-Metal Stent Study was used to calculate the event rate alerting boundaries. Data analysis was performed on local catheterization data from Brigham and Women's Hospital from July 1, 2003, shortly after the Cypher release, to December 31, 2004, including 2,270 cases with 27 observed deaths. Results: The single-stratum SPC had alerts in months 4 and 10. The multistrata SPC had alerts in months 5, 10, and 18 in the moderate-risk stratum, and months 1, 4, 7, and 10 in the high-risk stratum. The only cumulative alerts were in the first month for the high-risk stratum of the multistrata SPC. The LR method showed no monthly or cumulative alerts. The BUS method showed an alert in the first month for the high-risk stratum. Conclusion: The system performed adequately within the Brigham and Women's Hospital Intranet environment based on the design goals. All three cumulative methods agreed that the overall observed event rates were not significantly higher for the new medical device than for a closely related medical device and were consistent with the observation that the initial concerns about this

  20. Variable-target-function and build-up procedures for the calculation of protein conformation. Application to bovine pancreatic trypsin inhibitor using limited simulated nuclear magnetic resonance data.

    PubMed

    Vásquez, M; Scheraga, H A

    1988-02-01

    An implementation of the variable-target-function procedure, first introduced by Braun and Go [W. Braun and N. Go, J. Mol. Biol. 186, 611-626 (1985)], has been used to generate conformations of the small protein bovine pancreatic trypsin inhibitor (BPTI), given a limited set of simulated data that could be obtained by nuclear magnetic resonance (NMR) techniques. A hybrid strategy was also used to calculate conformations of BPTI, given the same information. In the hybrid strategy, low-energy structures of medium-size fragments (decapeptides) of BPTI were generated using the variable-target-function method, followed by restrained energy optimization. The low-energy conformations were used as a basis to build up the complete fifty-eight-residue BPTI molecule. By using the variable-target-function approach, in which energy considerations were not introduced until full conformations of the entire BPTI molecule had been generated, it was not possible to obtain calculated structures with rms deviations from the X-ray conformation of less than 1.6 A for the alpha-carbons. On the other hand, with the hybrid strategy, which involved the consideration of realistic energy terms in the early stages of the calculations, it was possible to calculate low-energy conformations of BPTI with rms deviations from the X-ray structure of 1.06 to 1.50 A for the alpha-carbons. When the rms deviations were computed along the amino acid sequence, it was found that there was a good correlation between deviations among the calculated structures and deviations from the X-ray structure.

  1. Comparing spatial expression dynamics of bovine blastocyst under three different procedures: in-vivo, in-vitro derived, and somatic cell nuclear transfer embryos.

    PubMed

    Nagatomo, Hiroaki; Akizawa, Hiroki; Sada, Ayari; Kishi, Yasunori; Yamanaka, Ken-ichi; Takuma, Tetsuya; Sasaki, Keisuke; Yamauchi, Nobuhiko; Yanagawa, Yojiro; Nagano, Masashi; Kono, Tomohiro; Takahashi, Masashi; Kawahara, Manabu

    2015-11-01

    There has been no work on spatiotemporal transcriptomic differences of blastocysts using in vivo- and in vitro-derived, and somatic cell nuclear transfer (SCNT) embryos. Here, we first compared the lineage-differentially transcriptomic profiles of in vivo- and in vitro-derived embryos by microarray analysis using divided into inner cell mass (ICM)-and trophectoderm (TE)-side samples, as well as those derived from SCNT in order to explore lineage-differentially expressed genes that are associated with preimplantation development in cattle. The transcriptomic profiles of the ICM-specific and TE-specific genes were similar between in vitro-derived embryos and in vivo-derived embryos, whereas SCNT embryos exhibited unusual lineage-differentially gene expression regulation at the blastocyst stage. The genes expressed in a spatiotemporal manner between developmentally normal in-vivo derived blastocysts and developmentally abnormal SCNT blastocysts might play critical roles for preimplantation development. Comparing spatial expression dynamics of bovine blastocyst under three different procedures revealed that CIITA was expressed in ICM-side samples of all the embryo types. CIITA is known as the master regulator of major histocompatibility complexes (MHC) class II genes that express in antigen-presenting cells but its biological function in preimplantation embryo is still unknown in mammals. Knockdown of CIITA expression in in vitro-derived embryos did not affect cleavage, but disrupted development of embryos into the blastocyst stage. These findings provide the novel transcriptomic information on blastocyst formation, raising the possibility that immune function-related gene directly plays important roles in bovine preimplantation development.

  2. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision.

    PubMed

    Verberne, Hein J; Acampa, Wanda; Anagnostopoulos, Constantinos; Ballinger, Jim; Bengel, Frank; De Bondt, Pieter; Buechel, Ronny R; Cuocolo, Alberto; van Eck-Smit, Berthe L F; Flotats, Albert; Hacker, Marcus; Hindorf, Cecilia; Kaufmann, Philip A; Lindner, Oliver; Ljungberg, Michael; Lonsdale, Markus; Manrique, Alain; Minarik, David; Scholte, Arthur J H A; Slart, Riemer H J A; Trägårdh, Elin; de Wit, Tim C; Hesse, Birger

    2015-11-01

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf .

  3. Mind the Gap: Representation of Medical Education in Cardiology-Related Articles and Journals

    PubMed Central

    Allred, Clint; Berlacher, Kathryn; Aggarwal, Saurabh; Auseon, Alex J.

    2016-01-01

    Background Cardiology fellowship programs are at the interface of medical education and the care of patients suffering from the leading cause of mortality in the United States, yet there is an apparent lack of research guiding the effective education of fellows. Objective We sought to quantify the number of publications in cardiology journals that pertained to the education of cardiology trainees and the number of cardiologists participating in education research. Methods For the period between January and December 2012, we cataloged cardiology-specific and general medical/medical education journals and sorted them by impact factor. Tables of content were reviewed for articles with an educational focus, a cardiology focus, or both. We recorded the authors' areas of medical training, and keywords from each cardiology journal's mission statement were reviewed for emphasis on education. Results Twenty-six cardiology journals, containing 6645 articles, were reviewed. Only 4 articles had education themes. Ten general medical and 15 medical education journals contained 6810 articles. Of these, only 7 focused on medical education in cardiology, and none focused on cardiology fellowship training. Among the 4887 authors of publications in medical education journals, 25 were cardiologists (less than 1%), and among the 1036 total words in the mission statements of all cardiology journals, the term “education” appeared once. Conclusions Published educational research is lacking in cardiology training, and few cardiologists appear to be active members of the education scholarship community. Cardiology organizations and academic journals should support efforts to identify target areas of study and publish scholarship in educational innovation. PMID:27413435

  4. The IAEA’s activities on radiation protection in interventional cardiology

    PubMed Central

    Rehani, MM

    2007-01-01

    The International Atomic Energy Agency (IAEA) under its mandate of developing and applying standards of radiation safety has initiated a number of activities in recent years on radiation protection in interventional cardiology. These activities are implemented through four mechanisms, namely training, providing information through the website, research projects and assistance to Member States through Technical Cooperation (TC) projects. Major international initiatives have been taken in the area of training where more than half a dozen regional training courses have been conducted for cardiologists from over 50 countries. Additionally four national training events for over 300 medical and paramedical staff members involved in interventional procedures were held. The training material is freely available on CD from the IAEA. The newly established website provides information on radiation protection issues [1]. Two coordinated research projects have just been completed where peak skin doses to patients undergoing high dose interventional procedures were studied and factors to manage patient doses were identified. The technical cooperation projects involving protection in cardiac interventional procedures have 30 countries as participants. PMID:21614275

  5. Scatter and staff dose levels in paediatric interventional cardiology: a multicentre study.

    PubMed

    Ubeda, Carlos; Vano, Eliseo; Gonzalez, Luciano; Miranda, Patricia; Valenzuela, Edith; Leyton, Fernando; Oyarzun, Carlos

    2010-06-01

    Interventional cardiology procedures usually imply high doses to the staff, as paediatric cardiologists need to stay closer to the patient than during adult procedures. Also, biplane systems are used that imply an additional source of staff doses. The objective of this paper is to measure scatter doses in four X-ray systems, using polymethyl methacrylate phantoms with thicknesses ranging from 4 to 16 cm to simulate paediatric patients, for the different acquisition modes. Scatter dose rates measured at the position of cardiologist's eyes ranged from 0.8 to 12 mSv h(-1), and about twice the above values at lower extremities, as a linear function of the surface air kerma at the phantom, keeping the irradiated area constant. Therefore, the respective personal dose equivalent for the lens of the eyes may be around 0.5 and 1 mSv throughout the procedure, if additional protection is not used. Simultaneous cine acquisition in biplane systems yielded scatter doses to cardiologists, increased by factors from 5 to 21, compared with a single C-arm acquisition case and depending on geometry. Knowledge of scatter doses for different operation modes, patient thicknesses and the biplane operation should help paediatric cardiologists to adopt conservative attitudes in respect of their occupational radiation risks.

  6. The new European Society of Cardiology guidelines on myocardial revascularisation: an appraisal.

    PubMed

    Nauta, Sjoerd T; Gaspersz, Marcia; Deckers, Jaap W

    2012-01-01

    The latest European Society of Cardiology (ESC) guidelines on myocardial revascularisation are reviewed. The nearly 300 recommendations make it difficult to apply them in their totality. The authors would propose 20-30 recommendations per guideline based on sound clinical evidence. Also, the scope of the current guidelines is very wide as it includes topics already incorporated in other guidelines, such as strategies for pre-intervention diagnosis and imaging as well as on secondary prevention. Some recommendations in the new guidelines are sensible and will not be disputed. In particular, the encouragement of a balanced multidisciplinary decision process (the 'heart team') is welcome. Although coronary revascularisation in unstable high risk patients is well accepted, this is less the case for the low risk patient with chest pain. This issue is controversial and a balanced discussion of the pros and cons of percutaneous coronary intervention is missing. Despite convincing evidence indicating lack of benefit of percutaneous coronary intervention for chronic total occlusion, this procedure is not discouraged. Lastly, most committee members were interventional cardiologists or cardiac surgeons. Guideline committees should be representative of the whole group of professionals as the interpretation of the evidence by specialists may be biased. There may be a role for procedure oriented guidelines but, in that case, the items at issue should remain confined to matters directly related to technical aspects of the procedure.

  7. [Transradial approach in interventional cardiology: "quod licet femoralisti, non licet radialisti"].

    PubMed

    Lukenda, Josip

    2012-01-01

    Transradial approach has been used in invasive cardiology since 1989 and since 1995 for PCI. Croatia is late in using this technique for about one whole decade. The advantage of transradial approach over femoral approach are serious local complications of (2.6-2.8%), more frequent with modem therapy (7.4%), occasionally requiring surgical repair (2.4%). Major adverse cardiovascular events are significantly more occurring with femoral (3.8-6.55%) compared to transradial approach (2.5-3.7%), while in the MORTAL study total mortality is higher as well. Patients prefer transradial approach due to it being less painful and uncomfortable, and also because of greater mobility after the procedure. Time spent for patient care by nurses is shortened by half than what it used to be, and the final savings per patient is $290. An unfavorable aspect of transradial approach is clinically insignificant radial artery occlusion (0.6%-1.4%), as well as higher radiation exposure, for 12% in practice. Procedural time is similar, but it could take up to 3 minutes longer. Access site crossover is more often with transradial (4.7-7.6%), compared to femoral procedure (1.4-2.0%), but PCI failure is independent of approach. All unfavorable aspects are diminishing with experience of a cardiologist. Now, some of the Croatian centers, such as General Hospital Zadar, use transradial approach in 67% of catheterizations, 64% of PCI, and 38% of all primary PCIs.

  8. [Results of a structural diagnosis of patients with chronic dyspnoea recruited from two cardiological practices].

    PubMed

    Ewert, R; Obst, A; Bahr, C; Weirich, C; Henschel, F; Rink, A

    2013-01-01

    While well validated algorithms exist for the diagnosis of patients with acute dyspnoea, such generally valid procedural instructions are lacking for patients with chronic dyspnoea. The diagnostic approach presented here is based on investigations of 246 patients with chronic dyspnoea recruited from two cardiological practices using a self-developed multi-level procedure. Besides anamnestic and clinical examinations, different diagnostic procedures, available in the ambulant range, are included. The results suggest that in over 50 % of the cases the cause of chronic dyspnoea can be determined from anamnestic and clinical examinations as well as from electrocardiogram and echocardiography. Additional inclusion of lung function and capillary blood gas analysis permitted a sufficient clarification in over 80 % of the cases. In a further step, cardiopulmonary exercise testing clarified the reasons for chronic dyspnoea in approximately 10 % of the remaining patients. Threshold values of lung function parameters as used for the differentiation of acute dyspnoea, do not seem suitable for the diagnosis of patients with chronic dyspnoea. By means of a simple step-wise diagnostic algorithm, applicable under ambulant conditions, the cause of chronic dyspnoea could sufficiently be clarified in more than 95 % of the cases.

  9. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    SciTech Connect

    Not Available

    1990-02-02

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens.

  10. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    SciTech Connect

    Not Available

    1990-02-02

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not? by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens.

  11. Position paper: proposal for a core curriculum for a European Sports Cardiology qualification.

    PubMed

    Heidbuchel, Hein; Papadakis, Michael; Panhuyzen-Goedkoop, Nicole; Carré, François; Dugmore, Dorian; Mellwig, Klaus-Peter; Rasmusen, Hanne Kruuse; Solberg, Erik E; Borjesson, Mats; Corrado, Domenico; Pelliccia, Antonio; Sharma, Sanjay

    2013-10-01

    Sports cardiology is a new and rapidly evolving subspecialty. It aims to elucidate the cardiovascular effects of regular exercise and delineate its benefits and risks, so that safe guidance can be provided to all individuals engaging in sports and/or physical activity in order to attain the maximum potential benefit at the lowest possible risk. The European Society of Cardiology (ESC) advocates systematic preparticipation cardiovascular screening in an effort to identify competitive athletes at risk of exercise-related cardiovascular events and sudden cardiac death. However, the implementation of preparticipation screening is hindered because of lack of structured training and as a result lack of sufficient expertise in the field of sports cardiology. In 2008 the European Society of Cardiology published a core curriculum for the general cardiologist, in which sports cardiology was incorporated within the topic 'Rehabilitation and Exercise Physiology'. However, the exponential rise in knowledge and the growing demand for expertise in the field of sports cardiology dictates the need to systematically structure the knowledge base of sports cardiology into a detailed curriculum. We envisage that the curriculum would facilitate more uniform training and guideline implementation throughout Europe, and safeguard that evaluation and guidance of competitive athletes or individuals who wish to engage in leisure-time sports activities is performed by physicians with expertise in the field. The current manuscript provides a comprehensive curriculum for sports cardiology, which may serve as a framework upon which universities and national and international health authorities will develop the training, evaluation and accreditation in sports cardiology.

  12. [Criteria catalogue for Integrated Health Care in cardiology].

    PubMed

    Frantz, E

    2006-01-01

    This paper comprises criteria for projects of Integrated Health Care in cardiology. With these criteria, projects can be assessed for their congruence with essentials that have been assigned by the German Cardiac Society, the Association of German Hospital Cardiologists and the Association of German Practice Cardiologists. The main purpose is to ensure that evidence-based medicine is the basis for the contracts and that all valid guidelines have been observed when services have been agreed. Possibly this paper may be the basis to award an approval to projects that meet all the criteria. This paper is no model contract.

  13. e-Teaching in pediatric cardiology: A paradigm shift

    PubMed Central

    Maheshwari, Sunita; Zheleva, Bistra; Rajasekhar, Veeralakshmi; Batra, Bipin

    2015-01-01

    Background: Training of postgraduate students has traditionally been done in person in a hospital setting with hands-on training with each faculty member imparting knowledge to 2 to 4 students per year. Supplementing their practical education with online instruction could make a significant difference in standardizing pediatric cardiology education in India. Objective: To present the rationale, methods and survey results of a live e-Teaching methodology implemented for Pediatric cardiology trainees in association with the National Board of Examinations, India. Materials and Methods: Between March 2010 and March 2014, 310 e-classes were conducted in the Pediatric cardiac sciences by 24 e-teachers. Content of the e-Learning program was based on a 2-year pediatric cardiology curriculum and included twice-weekly live online video training sessions, a library of recorded sessions and online test quizzes for the students. A total of 231 students accessed the program at various times over the 4-year period. Results: In our study, requests for access to the e-lectures increased from 10/year the first year to 100/year by the fourth year with feedback surveys conveying a high satisfaction level from the students and a high need for this knowledge. The advantages of virtual live e-Learning included the fact that one teacher can teach multiple students in multiple geographic locations at the same time, obviating the issue of quality teacher shortage and the same content can be disseminated to all students undergoing specialist training so there is a national consensus on diagnostic and management approach among all trainees. Additionally, the e-classes can be recorded and replayed so they can be viewed repeatedly by the same group or new trainees. Conclusion: This is the first sustained use of e-Teaching in a medical super-specialty in India. We believe that e-Teaching is an innovative solution that can be applied, not just to Pediatric Cardiology as we have done, but to all

  14. The role of exercise testing in pediatric cardiology.

    PubMed

    Massin, Martial M

    2014-05-01

    Exercise testing for cardiac disease in children differs in many aspects from the tests performed in adults; their cardiovascular response to exercise presents different characteristics, which are essential for the interpretation of hemodynamic data. Moreover, diseases that are associated with myocardial ischemia are very rare in young patients, and the main indications for exercise testing are evaluation of exercise capacity and identification of exercise-induced arrhythmias. This article describes the specificity of exercise testing in pediatric cardiology, in terms of techniques, indications and interpretation of data.

  15. Longer-term impact of cardiology e-consults.

    PubMed

    Wasfy, Jason H; Rao, Sandhya K; Kalwani, Neil; Chittle, Melissa D; Richardson, Calvin A; Gallen, Kathleen M; Isselbacher, Eric M; Kimball, Alexandra B; Ferris, Timothy G

    2016-03-01

    Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P < .001). After the introduction of cardiac e-consults, the increase in traditional cardiac visit requests was less than the increase in traditional visit requests for control specialties (4.5% vs 10.1%, P < .001). For e-consults with at least 6 months of follow-up, 75.6% patients did not have any type of traditional cardiology visit during the follow-up period. E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total

  16. [Methods of the elaboration of data of the cardiological importance].

    PubMed

    Marchesi, C; Taddei, A; Varanini, M

    1987-12-01

    This paper deals with some introductory topics of signal processing and decision making in cardiology. In both instances the matter is referred to general schemes well suited to host different applications. Signal processing is divided in some phases: acquisition, storing, analysis and each of them is described with applications to specific signals. In a similar manner the methods for decision making have been simplified to a scheme including a "knowledge base" and an "inference method". The scheme is used to classify various implementations. Bayes analysis and expert systems have been introduced with some details.

  17. e-Teaching in pediatric cardiology: A paradigm shift.

    PubMed

    Maheshwari, Sunita; Zheleva, Bistra; Rajasekhar, Veeralakshmi; Batra, Bipin

    2015-01-01

    Training of postgraduate students has traditionally been done in person in a hospital setting with hands-on training with each faculty member imparting knowledge to 2 to 4 students per year. Supplementing their practical education with online instruction could make a significant difference in standardizing pediatric cardiology education in India. To present the rationale, methods and survey results of a live e-Teaching methodology implemented for Pediatric cardiology trainees in association with the National Board of Examinations, India. Between March 2010 and March 2014, 310 e-classes were conducted in the Pediatric cardiac sciences by 24 e-teachers. Content of the e-Learning program was based on a 2-year pediatric cardiology curriculum and included twice-weekly live online video training sessions, a library of recorded sessions and online test quizzes for the students. A total of 231 students accessed the program at various times over the 4-year period. In our study, requests for access to the e-lectures increased from 10/year the first year to 100/year by the fourth year with feedback surveys conveying a high satisfaction level from the students and a high need for this knowledge. The advantages of virtual live e-Learning included the fact that one teacher can teach multiple students in multiple geographic locations at the same time, obviating the issue of quality teacher shortage and the same content can be disseminated to all students undergoing specialist training so there is a national consensus on diagnostic and management approach among all trainees. Additionally, the e-classes can be recorded and replayed so they can be viewed repeatedly by the same group or new trainees. This is the first sustained use of e-Teaching in a medical super-specialty in India. We believe that e-Teaching is an innovative solution that can be applied, not just to Pediatric Cardiology as we have done, but to all branches of specialist and super-specialist medical training in

  18. [Spanish Society of Cardiology ethical framework (executive summary)].

    PubMed

    de los Reyes López, Manuel; Martín Luengo, Cándido; Brugada Terradellas, Josep; Sanz Romero, Ginés; Lidón Corbí, Rosa María; Martín Burrieza, Fernando

    2006-12-01

    The Spanish Society of Cardiology (SEC) has produced an Ethical Framework Document. This document is divided into two distinct parts that deal, respectively, with the responsibilities of the SEC as an organization and the responsibilities of its professional members. The SEC makes recommendations on how its members should carry out their daily clinical practice, provides a professional perspective on public commitments as a scientific association, and aims to ensure that any views, recommendations, and advice expressed provide the basis for an informed debate on ethical problems in our field of work.

  19. Current research in nuclear medicine and molecular imaging in Italy: highlights of the 10th National Congress of the Italian Association of Nuclear Medicine and Molecular Imaging.

    PubMed

    Cuocolo, A

    2011-06-01

    The 10th National Congress of the Italian Association of Nuclear Medicine and Molecular Imaging (AIMN) took place in Rimini on March 18-21, 2011 under the chairmanship of Professor Stefano Fanti. The program was of excellent quality and put a further step for the settlement of the standardized AIMN congress structure. A large industrial exhibition demonstrated the latest technological innovations and developments within the field. The congress was a great success with more than 1100 total participants and more than 360 abstracts received. Of these, 40 abstracts were accepted for oral and 285 for poster presentations. The original investigations presented were related to different areas of nuclear medicine and molecular imaging, with particular focus on advances in instrumentation and data processing, progress in radiochemistry and pharmacy, novel diagnostics and therapeutics, and new insights in well established areas of clinical application, such as oncology, cardiology, neurology, psychiatry, endocrinology, paediatrics, and infection and inflammation. Noteworthy, several presentations at this congress, focusing on quantitative interpretation of the imaging data and on pragmatic endpoints, such as adverse outcomes, identified when nuclear medicine procedures achieved clinical effectiveness for patient care and patient management and further demonstrated that nuclear medicine plays a crucial role in the contemporary medical scenario. This highlights lecture is only a brief summary of the large amount of data presented and discussed, which can be found in much greater detail in the congress abstract book, published as volume 55, supplement 1 of the Q J Nucl Med Mol Imaging in April 2011.

  20. Nuclear telemedicine

    NASA Astrophysics Data System (ADS)

    Morrison, R. T.; Szasz, I. J.

    1990-06-01

    Diagnostic nuclear medicine patient images have been transniitted for 8 years from a regional conununity hospital to a university teaching hospital 700 kiloinetres away employing slow scan TV and telephone. Transruission and interpretation were done at the end of each working day or as circumstances required in cases of emergencies. Referring physicians received the nuclear medicine procedure report at the end of the completion day or within few minutes of completion in case of emergency procedures. To date more than 25 patient studies have been transmitted for interpretation. Blinded reinterpretation of the original hard copy data of 350 patient studies resulted in 100 agreement with the interpretation of transmitted data. This technique provides high quality diagnostic and therapeutic nuclear medicine services in remote hospitals where the services of an on-site nuclear physician is not available. 2. HISTORY Eight years ago when the nuclear medicine physician at Trail Regional Hospital left the Trail area and an other could not be recruited we examined the feasibility of image transmission by phone for interpretation since closing the department would have imposed unacceptable physical and financial hardship and medical constraints on the patient population the nearest nuclear medicine facility was at some 8 hours drive away. In hospital patients would have to be treated either based purely on physical findings or flown to Vancouver at considerable cost to the health care system (estimated cost $1500.

  1. Nuclear Cardiology Practice in Asia: Analysis of Radiation Exposure and Best Practice for Myocardial Perfusion Imaging - Results From the IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS).

    PubMed

    Pascual, Thomas N B; Mercuri, Mathew; El-Haj, Noura; Bom, Henry Hee-Sung; Lele, Vikram; Al-Mallah, Mouaz H; Luxenburg, Osnat; Karthikeyan, Ganesan; Vitola, Joao; Mahmarian, John J; Better, Nathan; Shaw, Leslee J; Rehani, Madan M; Kashyap, Ravi; Paez, Diana; Dondi, Maurizio; Einstein, Andrew J

    2017-03-24

    This paper examines the current status of radiation exposure to patients in myocardial perfusion imaging (MPI) in Asia.Methods and Results:Laboratories voluntarily provided information on MPI performed over a 1-week period. Eight best practice criteria regarding MPI were predefined by an expert panel. Implementation of ≥6 best practices (quality index [QI] ≥6) was pre-specified as a desirable goal for keeping radiation exposure at a low level. Radiation effective dose (ED) in 1,469 patients and QI of 69 laboratories in Asia were compared against data from 239 laboratories in the rest of the world (RoW). Mean ED was significantly higher in Asia (11.4 vs. 9.6 mSv; P<0.0001), with significantly lower doses in South-East vs. East Asia (9.7 vs. 12.7 mSv; P<0.0001). QI in Asia was lower than in RoW. In comparison with RoW, Asian laboratories used thallium more frequently, used weight-based technetium dosing less frequently, and trended towards a lower rate of stress-only imaging. MPI radiation dose in Asia is higher than that in the RoW and linked to less consistent use of laboratory best practices such as avoidance of thallium, weight-based dosing, and use of stress-only imaging. Given that MPI is performed in Asia within a diverse array of medical contexts, laboratory-specific adoption of best practices offers numerous opportunities to improve quality of care.

  2. Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values

    SciTech Connect

    Ubeda, Carlos; Miranda, Patricia; Vano, Eliseo

    2015-02-15

    Purpose: To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Methods: Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Results: Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm{sup 2} for <1 yr; 1.74 and 1.90 Gy cm{sup 2} for 1 to <5 yr; 2.83 and 3.22 Gy cm{sup 2} for 5 to <10 yr; and 7.34 and 8.68 Gy cm{sup 2} for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm{sup 2}/kg) for diagnostic and therapeutic procedures. Conclusions: The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there

  3. Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values.

    PubMed

    Ubeda, Carlos; Miranda, Patricia; Vano, Eliseo

    2015-02-01

    To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm(2) for <1 yr; 1.74 and 1.90 Gy cm(2) for 1 to <5 yr; 2.83 and 3.22 Gy cm(2) for 5 to <10 yr; and 7.34 and 8.68 Gy cm(2) for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm(2) /kg) for diagnostic and therapeutic procedures. The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there may be large differences in child size. These DRLs were

  4. Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values.

    PubMed

    Ubeda, Carlos; Miranda, Patricia; Vano, Eliseo

    2015-02-01

    To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm2 for <1 yr; 1.74 and 1.90 Gy cm2 for 1 to <5 yr; 2.83 and 3.22 Gy cm2 for 5 to <10 yr; and 7.34 and 8.68 Gy cm2 for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm2/kg) for diagnostic and therapeutic procedures. The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there may be large differences in child size. These DRLs were obtained at the

  5. Mathematical methods in medicine: neuroscience, cardiology and pathology.

    PubMed

    Amigó, José M; Small, Michael

    2017-06-28

    The application of mathematics, natural sciences and engineering to medicine is gaining momentum as the mutual benefits of this collaboration become increasingly obvious. This theme issue is intended to highlight the trend in the case of mathematics. Specifically, the scope of this theme issue is to give a general view of the current research in the application of mathematical methods to medicine, as well as to show how mathematics can help in such important aspects as understanding, prediction, treatment and data processing. To this end, three representative specialties have been selected: neuroscience, cardiology and pathology. Concerning the topics, the 12 research papers and one review included in this issue cover biofluids, cardiac and virus dynamics, computational neuroscience, functional magnetic resonance imaging data processing, neural networks, optimization of treatment strategies, time-series analysis and tumour growth. In conclusion, this theme issue contains a collection of fine contributions at the intersection of mathematics and medicine, not as an exercise in applied mathematics but as a multidisciplinary research effort that interests both communities and our society in general.This article is part of the themed issue 'Mathematical methods in medicine: neuroscience, cardiology and pathology'. © 2017 The Author(s).

  6. Simulation-based planning of surgical interventions in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison

    2012-11-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. This is particularly true in pediatric cardiology, due to the wide variation in anatomy observed in congenital heart disease patients. While medical imaging provides increasingly detailed anatomical information, clinicians currently have limited knowledge of important fluid mechanical parameters. Treatment decisions are therefore often made using anatomical information alone, despite the known links between fluid mechanics and disease progression. Patient-specific simulations now offer the means to provide this missing information, and, more importantly, to perform in-silico testing of new surgical designs at no risk to the patient. In this talk, we will outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We will then present new methodology for coupling optimization with simulation and uncertainty quantification to customize treatments for individual patients. Finally, we will present examples in pediatric cardiology that illustrate the potential impact of these tools in the clinical setting.

  7. Training fellows in paediatric cardiology: the Harvard experience.

    PubMed

    Brown, David W; Allan, Catherine K; Newburger, Jane W

    2016-12-01

    The Fellowship Program of the Department of Cardiology at Boston Children's Hospital seeks to train academically oriented leaders in clinical care and laboratory and clinical investigation of cardiovascular disease in the young. The core clinical fellowship involves 3 years in training, comprising 24 months of clinical rotations and 12 months of elective and research experience. Trainees have access to a vast array of research opportunities - clinical, basic, and translational. Clinical fellows interested in basic science may reverse the usual sequence and start their training in the laboratory, deferring clinical training for 1 or more years. An increasing number of clinical trainees apply to spend a fourth year as a senior fellow in one of the subspecialty areas of paediatric cardiology. From the founding of the Department to the present, we have maintained a fundamental and unwavering commitment to training and education in clinical care and research in basic science and clinical investigation, as well as to the training of outstanding young clinicians and investigators.

  8. Simulation based planning of surgical interventions in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison L.

    2013-10-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.

  9. [Cardiological follow-up in patients with Fabry disease].

    PubMed

    Pieruzzi, Federico; Pieroni, Maurizio; Chimenti, Cristina; Frustaci, Andrea; Sarais, Cristiano; Cecchi, Franco

    2010-01-01

    Fabry disease is a rare tesaurismosis due to a deficit of the lysosomal enzyme activity of alpha-galactosidase, needed for the normal catabolism of globotriaosylceramides (GL3). Fabry cardiac involvement has several clinical manifestations: concentric left ventricular hypertrophy without left ventricular dilation and severe loss of left ventricular systolic function, mitral and aortic valvulopathy, disorders of the atrioventricular conduction or repolarization, and compromised diastolic function. Differentiating Fabry disease from similar conditions is often quite straightforward, e.g., cardiac amyloidosis is often associated with low electrocardiographic voltages, and systemic symptoms are usually associated with hemochromatosis and sarcoidosis. However, sometimes second-level (genetic analysis, alpha-galactosidase levels) or invasive investigations are required, which can include endomyocardial biopsy. Diagnostic imaging techniques have been described, but they lack specificity. Echocardiographic imaging with tissue Doppler analysis and/or strain rate analysis can allow diagnosis of Fabry disease even before left ventricular hypertrophy becomes apparent. This review illustrates the techniques for staging cardiac involvement and damage in Fabry disease and for the long-term follow-up of Fabry patients with or without cardiac involvement. Careful cardiac monitoring is especially important in elderly female carriers, who often develop renal disorders and/or left ventricular hypertrophy as the only manifestations of their late Fabry disease. In some clinical series, Fabry disease was diagnosed in 12% of women with adult-onset hypertrophic cardiomyopathy. Cardiological problems and outcomes of enzyme replacement therapy, associated with or without other cardiological treatments, are also discussed.

  10. Mathematical methods in medicine: neuroscience, cardiology and pathology

    PubMed Central

    Amigó, José M.

    2017-01-01

    The application of mathematics, natural sciences and engineering to medicine is gaining momentum as the mutual benefits of this collaboration become increasingly obvious. This theme issue is intended to highlight the trend in the case of mathematics. Specifically, the scope of this theme issue is to give a general view of the current research in the application of mathematical methods to medicine, as well as to show how mathematics can help in such important aspects as understanding, prediction, treatment and data processing. To this end, three representative specialties have been selected: neuroscience, cardiology and pathology. Concerning the topics, the 12 research papers and one review included in this issue cover biofluids, cardiac and virus dynamics, computational neuroscience, functional magnetic resonance imaging data processing, neural networks, optimization of treatment strategies, time-series analysis and tumour growth. In conclusion, this theme issue contains a collection of fine contributions at the intersection of mathematics and medicine, not as an exercise in applied mathematics but as a multidisciplinary research effort that interests both communities and our society in general. This article is part of the themed issue ‘Mathematical methods in medicine: neuroscience, cardiology and pathology’. PMID:28507240

  11. Simulation based planning of surgical interventions in pediatric cardiology.

    PubMed

    Marsden, Alison L

    2013-10-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.

  12. European Society of Cardiology (ESC) congress report from Barcelona 2014.

    PubMed

    Muramatsu, Takashi; Ozaki, Yukio

    2014-01-01

    The Annual Congress of the European Society of Cardiology (ESC) was held in Barcelona from 30th August to 3rd September 2014. More than 30,300 attendees from around the world shared the latest original research, including 27 clinical Hot Line studies, 12 basic science Hot Lines, 15 clinical trial updates, 19 registry studies, and 4,597 abstracts. Many important issues were presented, including novel treatment strategies for heart failure, acute coronary syndrome, interventional treatment for structural heart disease, renal denervation, novel anticoagulant therapies, atrial fibrillation and so on. In addition, 5 new ESC clinical practice guidelines (ie, myocardial revascularization, non-cardiac surgery, acute pulmonary embolism, hypertrophic cardiomyopathy, and aortic disease) were launched. It should be noted that Japan has recently been ranked in the top position in terms of the number of abstract submissions. Based on these activities, the ESC Congress has been recognized as the dominant scientific and educational forum for healthcare professionals in cardiology. We report the highlights and several key presentations of the ESC Congress 2014. The scientific activities and growing contributions of Japanese cardiologists or cardiovascular surgeons enhance the favorable relationship between the ESC and the Japanese Circulation Society.

  13. Simulation based planning of surgical interventions in pediatric cardiology

    PubMed Central

    Marsden, Alison L.

    2013-01-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting. PMID:24255590

  14. Stent coating: a new approach in interventional cardiology.

    PubMed

    Wieneke, Heinrich; Sawitowski, Thomas; Wnendt, Stephan; Fischer, Alfons; Dirsch, Olaf; Karoussos, Ira Ariadne; Erbel, Raimund

    2002-09-01

    Since its introduction in clinical cardiology, several studies have shown the superiority of coronary stent implantation as compared to conventional angioplasty. However, restenosis still remains a major drawback of this new technique. Basic research in animal models could identify stent-related factors like stent-material and stent-design as major determinants of intima proliferation. Since materials with good biocompatibility often have unsuitable mechanical properties and vice versa, the concept of stent coating has been developed to allow the combination of favorable characteristics from different materials. In general, passive coatings, which only serve as a barrier between the stainless steel and the tissue, and active coatings, which directly interfere with the process of intima proliferation have been identified. Currently there are several passive coatings commercially available with good results in animal models and preliminary reports from clinical studies. As any surface induces some kind of tissue reaction promoting restenosis, an active stent coating with antiproliferative drugs has been proposed. However, while animal studies revealed convincing results, preliminary clinical studies not only showed active stent coating effective in preventing restenosis, but also demonstrated the potential risks of this new approach. Although this technique may harbor some specific risks, with the introduction of stent coating a new chapter of interventional cardiology has been flipped open.

  15. [Scientific evidence-based cardiology: the principles and practice].

    PubMed

    Carneiro, A V

    2000-09-01

    Every clinical cardiologist, no matter what the clinical work (invasive or non-invasive), has to face several problems concerning clinical knowledge and medical information in everyday practice. Diagnostic and therapeutic advances in cardiology are occurring at an increasing pace and every cardiologist responsible for patient care in hospitals, clinics or emergency rooms needs to be up-to-date in order to provide the best possible medical care. On the other hand, society is increasingly making doctors accountable for the provision of good quality care in a cost-effective way. In the context of scarce resources, this situation requires a rigorous and rational approach by the individual cardiologist. These apparent contradictions can be solved by practicing evidence-based cardiology (EBC). This review introduces the concept of EBC, its principles, practice, and methodological steps: 1) formulation of a structured clinical activity; 2) scientific evidence; 3) critical appraisal of this evidence using explicit methods; and 4) synthesis and practical application of this evidence. In this sense, EBC arises from the patient, and after the best possible scientific evidence is selected, it is applied to the individual case. EBC allows the individual cardiologist to keep up with the medical literature while improving reading habits and the form in which relevant clinical information is selected. It also increases confidence in the clinical decisions, reducing practice variation as well as improving doctor-patient communication. Lastly EBC can be used as a powerful tool for pre, post and continuous medical education.

  16. Possible helio-geomagnetic activity influence on cardiological cases

    NASA Astrophysics Data System (ADS)

    Katsavrias, Christos

    Eruptive solar events as flares and coronal mass ejections (CMEs) occur during solar activ-ity periods. Energetic particles, fast solar wind plasma and electromagnetic radiation pass through interplanetary space, arrive on Earth's ionosphere-magnetosphere and produce various disturbances. It is well known the negative influence of geomagnetic substorms on the human technological applications on geospace. During the last 25 years, many studies concerning the possible influence on the human health are published. Increase of the Acute Coronary Syn-dromes and disorders of the Cardiac Rhythm, increase of accidents as well as neurological and psychological disorders (e.g. increase of suicides) during or near to the geomagnetic storms time interval are reported. In this study, we research the problem in Greece, focusing on patients with Acute Myocardial Infraction, hospitalized in the 2nd Cardiological Department of the General Hospital of Nikaea (Piraeus City), for the time interval 1997-2007 (23rd solar cycle) and also to the arrival of emergency cardiological cases to Emergency Department of two greek hospitals, the General Hospital of Lamia City and the General Hospital of Veria City during the selected months, with or without helio-geomagnetic activity, of the 23rd solar cycle. Increase of cases is recorded during the periods with increase helio-geomagnetic activity. The necessity of continuing the research for a longer period and with a bigger sample is high; so as to exact more secure conclusions.

  17. Assessment of radiation dose in nuclear cardiovascular imaging using realistic computational models

    SciTech Connect

    Xie, Tianwu; Lee, Choonsik; Bolch, Wesley E.; Zaidi, Habib

    2015-06-15

    Purpose: Nuclear cardiology plays an important role in clinical assessment and has enormous impact on the management of a variety of cardiovascular diseases. Pediatric patients at different age groups are exposed to a spectrum of radiation dose levels and associated cancer risks different from those of adults in diagnostic nuclear medicine procedures. Therefore, comprehensive radiation dosimetry evaluations for commonly used myocardial perfusion imaging (MPI) and viability radiotracers in target population (children and adults) at different age groups are highly desired. Methods: Using Monte Carlo calculations and biological effects of ionizing radiation VII model, we calculate the S-values for a number of radionuclides (Tl-201, Tc-99m, I-123, C-11, N-13, O-15, F-18, and Rb-82) and estimate the absorbed dose and effective dose for 12 MPI radiotracers in computational models including the newborn, 1-, 5-, 10-, 15-yr-old, and adult male and female computational phantoms. Results: For most organs, {sup 201}Tl produces the highest absorbed dose whereas {sup 82}Rb and {sup 15}O-water produce the lowest absorbed dose. For the newborn baby and adult patient, the effective dose of {sup 82}Rb is 48% and 77% lower than that of {sup 99m}Tc-tetrofosmin (rest), respectively. Conclusions: {sup 82}Rb results in lower effective dose in adults compared to {sup 99m}Tc-labeled tracers. However, this advantage is less apparent in children. The produced dosimetric databases for various radiotracers used in cardiovascular imaging, using new generation of computational models, can be used for risk-benefit assessment of a spectrum of patient population in clinical nuclear cardiology practice.

  18. Assessment of radiation dose in nuclear cardiovascular imaging using realistic computational models

    PubMed Central

    Xie, Tianwu; Lee, Choonsik; Bolch, Wesley E.; Zaidi, Habib

    2015-01-01

    Purpose: Nuclear cardiology plays an important role in clinical assessment and has enormous impact on the management of a variety of cardiovascular diseases. Pediatric patients at different age groups are exposed to a spectrum of radiation dose levels and associated cancer risks different from those of adults in diagnostic nuclear medicine procedures. Therefore, comprehensive radiation dosimetry evaluations for commonly used myocardial perfusion imaging (MPI) and viability radiotracers in target population (children and adults) at different age groups are highly desired. Methods: Using Monte Carlo calculations and biological effects of ionizing radiation VII model, we calculate the S-values for a number of radionuclides (Tl-201, Tc-99m, I-123, C-11, N-13, O-15, F-18, and Rb-82) and estimate the absorbed dose and effective dose for 12 MPI radiotracers in computational models including the newborn, 1-, 5-, 10-, 15-yr-old, and adult male and female computational phantoms. Results: For most organs, 201Tl produces the highest absorbed dose whereas 82Rb and 15O-water produce the lowest absorbed dose. For the newborn baby and adult patient, the effective dose of 82Rb is 48% and 77% lower than that of 99mTc-tetrofosmin (rest), respectively. Conclusions: 82Rb results in lower effective dose in adults compared to 99mTc-labeled tracers. However, this advantage is less apparent in children. The produced dosimetric databases for various radiotracers used in cardiovascular imaging, using new generation of computational models, can be used for risk-benefit assessment of a spectrum of patient population in clinical nuclear cardiology practice. PMID:26127049

  19. [Analysis of the safety culture in a Cardiology Unit managed by processes].

    PubMed

    Raso-Raso, Rafael; Uris-Selles, Joaquín; Nolasco-Bonmatí, Andreu; Grau-Jornet, Guillermo; Revert-Gandia, Rosa; Jiménez-Carreño, Rebeca; Sánchez-Soriano, Ruth M; Chamorro-Fernández, Carlos I; Marco-Francés, Elvira; Albero-Martínez, José V

    2017-04-03

    The safety culture is one of the requirements to prevent the occurrence of adverse effects, however has not been studied in the field of cardiology. The objective is to evaluate the safety culture in a cardiology unit has implemented and certified an integrated quality and risk management for patient safety system.

  20. Linux thin-client conversion in a large cardiology practice: initial experience.

    PubMed

    Echt, Martin P; Rosen, Jordan

    2004-01-01

    Capital Cardiology Associates (CCA) is a single-specialty cardiology practice with offices in New York and Massachusetts. In 2003, CCA converted its IT system from a Microsoft-based network to a Linux network employing Linux thin-client technology with overall positive outcomes.

  1. Impact of a Preventive Cardiology Curriculum on Knowledge and Attitudes of First-Year Medical Students.

    ERIC Educational Resources Information Center

    Veitia, Marie C.; And Others

    1993-01-01

    A study of 54 first-year Marshall University (West Virginia) medical students found that a preventive cardiology curriculum improved both knowledge of and attitudes about preventive cardiology in general and on all 4 subscales (epidemiological evidence, risk factor characteristics, pathophysiology, primary interventions). (Author/MSE)

  2. Impact of a Preventive Cardiology Curriculum on Knowledge and Attitudes of First-Year Medical Students.

    ERIC Educational Resources Information Center

    Veitia, Marie C.; And Others

    1993-01-01

    A study of 54 first-year Marshall University (West Virginia) medical students found that a preventive cardiology curriculum improved both knowledge of and attitudes about preventive cardiology in general and on all 4 subscales (epidemiological evidence, risk factor characteristics, pathophysiology, primary interventions). (Author/MSE)

  3. Entrance surface air kerma in X-ray systems for paediatric interventional cardiology: a national survey.

    PubMed

    Ubeda, C; Vano, E; Miranda, P; Valenzuela, E; Vergara, F; Guarda, E

    2015-07-01

    The aims of this work were to report the results of a national survey on entrance surface air kerma (ESAK) values for different phantom thicknesses and operation modes in paediatric interventional cardiology (IC) systems and to compare them with previous values. The national survey also offers suggested investigation levels (ILs) for ESAK in paediatric cardiac procedures. ESAK was measured on phantoms of 4-16 cm thickness of polymethyl methacrylate slabs. For low fluoroscopy mode (FM), ESAK rates ranged from 0.11 to 33.1 mGy min(-1) and for high FM from 0.34 to 61.0 mGy min(-1). For cine mode, values of ESAK per frame were from 1.9 to 78.2 µGy fr(-1). The ILs were suggested as the third quartile of the values measured. This research showed lower ESAK values than in previous research, particularly for ESAK values in cine modes. This work represents a first step towards launching a national programme in paediatric dosimetry for IC procedures. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Radiation dose and image quality for paediatric interventional cardiology systems. A national survey in Chile.

    PubMed

    Ubeda, Carlos; Vano, Eliseo; Miranda, Patricia; Leyton, Fernando; Martinez, Luis Carlos; Oyarzun, Carlos

    2011-11-01

    Radiation dose and image quality for paediatric protocols in all five X-ray fluoroscopy systems used for interventional cardiology procedures existing in Chile have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object (TO) and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-16 cm of PMMA). Images from fluoroscopy (low (FL), medium and high) and cine (CI) modes have been archived in DICOM format. Signal-to-noise ratio (SNR), figure of merit (FOM) and high-contrast spatial resolution (HCSR) have been computed from the images. The ratio between the maximum and the minimum value of ESAK per frame for a given fluoroscopy mode between the five systems ranges from 2 to 5 and from 14 to 38 for CI mode. SNR, FOM and HCSR showed a great variability for the different acquisition modes (AMs) and PMMA thickness. In the near future, it is urgent to upgrade Chilean legislation on radiation protection to incorporate quality assurance programmes that will allow us to evaluate and optimise the X-ray systems used in medical applications. Increments in doses per frame when increasing phantom thickness and when used CI runs instead of FL runs can be considered by the cardiologist in the good management of patient dose and allow them to select the best imaging AM during clinical procedures.

  5. The current and future state of interventional cardiology: a critical appraisal.

    PubMed

    Meier, Bernhard

    2006-01-01

    After 75 years of invasive and over 50 years of interventional cardiology, cardiac catheter-based procedures have become the most frequently used interventions of modern medicine. Patients undergoing a percutaneous coronary intervention (PCI) outnumber those with coronary artery bypass surgery by a factor of 2 to 4. The default approach to PCI is the implantation of a (drug-eluting) stent, in spite of the fact that it improves the results of balloon angioplasty only in about 25% of cases. The dominance of stenting over conservative therapy or balloon angioplasty on one hand and bypass surgery on the other hand is a flagrant example of how medical research is digested an applied in real life. Apart from electrophysiological interventions, closure ot the patent foramen ovale and percutaneous replacement of the aortic valve in the elderly have the potential of becoming daily routine procedures in catheterization laboratories around the world. Stem cell regeneration of vessels or heart muscle, on the other hand, may remain a dream never to come true.

  6. [Heart catheterization in Mexico. Results of the 1996 census of heart catheterization services by the Mexican Society of Cardiology].

    PubMed

    Gaspar H, J; Guadalajara Boo, J F; de la Llata Romero, M

    1996-01-01

    The findings of the 1996 Cardiac Catheterization Laboratory Survey of the Sociedad Mexicana de Cardiología are presented. There are 52 cardiac catheterization laboratory departments distributed in 16 cities of which Mexico City has 20, Guadalajara 6 and Monterrey 5. Ninety-six percent are in hospitals where heart surgery can be performed and 8 (17%) have a training program in cardiac catheterization. Only two (3.8%) are exclusively dedicated to pediatric cardiac catheterization. In 1995, 19,214 diagnostic procedures and 2,429 PTCAs were done. A total of 270 physicians were reported to have privileges to perform cardiac catheterization. The geographical distribution of the cath labs, procedure volumes and number of physicians performing catheterization are discussed.

  7. [Nuclear Medicine in Germany. Updated key data and trends from official statistics].

    PubMed

    Hellwig, Dirk; Marienhagen, Jörg; Menhart, Karin; Grosse, Jirka

    2017-04-05

    Updated presentation of the spectrum of nuclear medicine in-vivo examinations and therapies from officially available statistics on out-patient and in-patient care as well as trends of structural data on nuclear medicine in Germany. Data from the German Federal Health Monitoring, from the frequency statistics of the statutory health insurance for out-patients and from the German Medical Association were used and supplemented by data from selective literature searches. In descending order, thyroid, bone and cardiac scans continue to be the most frequent nuclear medicine procedures. With a marked increase of PET/CT and SPECT/CT, the number of basic scintigraphies is declining. Cardiac, lung and brain scans as well as lymph scintigraphies are increasingly requested, bone and thyroid scan decrease. The consultation of nuclear medicine physicians in private practices is increasing by 4 % per year (2009: 2 164 664; 2015: 2 687 359). The number of nuclear medicine physicians in the out-patient sector rose significantly (2009: 756, 2015: 939, growth 24 %) and has remained constant due to restrictions since 2013. The specialist recognitions of women in nuclear medicine increased (proportion currently 46 %). In hospitals, more PET(/CT) scanners (2009: 97; 2015: 125) and fewer gamma cameras (2009: 594; 2015: 550) are operated. The number of non-thyroid (and also out-patient) radionuclide therapies continued to increase. With increased use of hybrid technologies, the nuclear medicine spectrum shows positive trends especially in nuclear cardiology and extra-thyroid therapy. These developments must be taken into account when amending regulations of specialist training and medical student teaching.

  8. Assessing the cost of a cardiology residency program with a cost construction model.

    PubMed

    Franzini, L; Chen, S C; McGhie, A I; Low, M D

    1999-09-01

    Although the total costs of graduate medical education are difficult to quantify, this information is of great importance in planning over the next decade. A cost construction model was used to quantify the costs of teaching faculty, cardiology fellows' salaries and benefits, overhead (physical plant, equipment, and support staff), and other costs associated with the cardiology residency program at the University of Texas-Houston during the 1996 to 1997 academic year. Surveys of cardiology faculty and fellows, checked by the program director, were conducted to determine the time spent in teaching activities; access to institutional and departmental financial records was obtained to quantify associated costs. The model was then developed and examined for a range of assumptions concerning cardiology fellows' productivity, replacement costs, and the cost allocation of activities jointly producing clinical care and education. The instructional cost of training (cost of didactic, direct clinical supervision, preparation for teaching, and teaching-related administration, plus the support of the teaching program) was estimated at $73,939 per cardiology fellow per year. This cost was less than the estimated replacement value of the teaching and clinical services provided by cardiology fellows, $100,937 per cardiology fellow per year. Sensitivity analysis, with different assumptions on cardiology fellows' productivity and replacement costs, varied the cost estimates but generally represented the cardiology residency program as an asset. Cost construction models can be used as a tool to estimate variations in resource requirements resulting from changes in curriculum or educators' costs. In this residency, the value of the teaching and clinical services provided by cardiology fellows exceeded the cost of the resources used in the educational program.

  9. Nuclear imaging in pediatrics

    SciTech Connect

    Siddiqui, A.R.

    1985-01-01

    The author's intent is to familiarize practicing radiologists with the technical aspects and interpretation of nuclear medicine procedures in children and to illustrate the indications for nuclear medicine procedures in pediatric problems. Pediatric doses, dosimetry, sedation, and injection techniques, organ systems, oncology and infection, testicular scanning and nuclear crystography, pediatric endocrine and skeletal systems, ventilation and perfusion imaging of both congenital and acquired pediatric disorders, cardiovascular problems, gastrointestinal, hepatobiliary, reticuloendothelial studies, and central nervous system are all topics which are included and discussed.

  10. Patient radiation doses in interventional cardiology in the U.S.: Advisory data sets and possible initial values for U.S. reference levels

    SciTech Connect

    Miller, Donald L.; Hilohi, C. Michael; Spelic, David C.

    2012-10-15

    Purpose: To determine patient radiation doses from interventional cardiology procedures in the U.S and to suggest possible initial values for U.S. benchmarks for patient radiation dose from selected interventional cardiology procedures [fluoroscopically guided diagnostic cardiac catheterization and percutaneous coronary intervention (PCI)]. Methods: Patient radiation dose metrics were derived from analysis of data from the 2008 to 2009 Nationwide Evaluation of X-ray Trends (NEXT) survey of cardiac catheterization. This analysis used deidentified data and did not require review by an IRB. Data from 171 facilities in 30 states were analyzed. The distributions (percentiles) of radiation dose metrics were determined for diagnostic cardiac catheterizations, PCI, and combined diagnostic and PCI procedures. Confidence intervals for these dose distributions were determined using bootstrap resampling. Results: Percentile distributions (advisory data sets) and possible preliminary U.S. reference levels (based on the 75th percentile of the dose distributions) are provided for cumulative air kerma at the reference point (K{sub a,r}), cumulative air kerma-area product (P{sub KA}), fluoroscopy time, and number of cine runs. Dose distributions are sufficiently detailed to permit dose audits as described in National Council on Radiation Protection and Measurements Report No. 168. Fluoroscopy times are consistent with those observed in European studies, but P{sub KA} is higher in the U.S. Conclusions: Sufficient data exist to suggest possible initial benchmarks for patient radiation dose for certain interventional cardiology procedures in the U.S. Our data suggest that patient radiation dose in these procedures is not optimized in U.S. practice.

  11. DOSE MEASUREMENTS TO THE LENS IN NUCLEAR MEDICINE AND IN FLUOROSCOPY-GUIDED INTERVENTIONAL PROCEDURES: ANALYSIS OF THE RESULTS AND ASSESSMENT OF THE EFFECTIVENESS OF PROTECTIVE EYEWEAR ANTI-X.

    PubMed

    Sarti, G; Busca, F; Carpano, L; Dottore, F Del; Dall'ara, D; Sanniti, S

    2016-09-01

    The new limit of 20 mSv to the lens raises the need for further assessment of the equivalent dose to the lens for nuclear medicine and interventional radiology operators. (a) A measurement campaign was performed in nuclear medicine, (b) a routine monitoring was organised in interventional procedures and (c) the effectiveness of protective eyewear was assessed. In nuclear medicine, for photon fields, the adequacy of Hp(0.07) of dosemeter worn on the trunk is confirmed; with (90)Y, the annual values of Hp(3) measured in therapeutic session are <5 mSv. In interventional procedures, routine monitoring of the dose to the lens must be maintained where the values of Hp(0.07) dosemeter worn on the trunk are higher than one-third of the new limits. The measures carried out have shown that the attenuation factor mean of the protective glasses is equal to ∼4 (range 1.7-11.4). © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Patient-centered imaging: shared decision making for cardiac imaging procedures with exposure to ionizing radiation.

    PubMed

    Einstein, Andrew J; Berman, Daniel S; Min, James K; Hendel, Robert C; Gerber, Thomas C; Carr, J Jeffrey; Cerqueira, Manuel D; Cullom, S James; DeKemp, Robert; Dickert, Neal W; Dorbala, Sharmila; Fazel, Reza; Garcia, Ernest V; Gibbons, Raymond J; Halliburton, Sandra S; Hausleiter, Jörg; Heller, Gary V; Jerome, Scott; Lesser, John R; Raff, Gilbert L; Tilkemeier, Peter; Williams, Kim A; Shaw, Leslee J

    2014-04-22

    The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An imaging protocol with effective dose ≤3 mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20 mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of cardiac imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the imaging community to create an accountability framework to safely drive appropriate imaging utilization.

  13. Patient-Centered Imaging: Shared Decision Making for Cardiac Imaging Procedures with Exposure to Ionizing Radiation

    PubMed Central

    Einstein, Andrew J.; Berman, Daniel S.; Min, James K.; Hendel, Robert C.; Gerber, Thomas C.; Carr, J. Jeffrey; Cerqueira, Manuel D.; Cullom, S. James; DeKemp, Robert; Dickert, Neal; Dorbala, Sharmila; Garcia, Ernest V.; Gibbons, Raymond J.; Halliburton, Sandra S.; Hausleiter, Jörg; Heller, Gary V.; Jerome, Scott; Lesser, John R.; Fazel, Reza; Raff, Gilbert L.; Tilkemeier, Peter; Williams, Kim A.; Shaw, Leslee J.

    2014-01-01

    Objective To identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Background An NIH-NHLBI/NCI-sponsored symposium was held in November 2012 to address these issues. Methods Symposium participants, working in three tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. Results Use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An imaging protocol with effective dose ≤3mSv is considered very low risk, not warranting extensive discussion or written consent. However, a protocol effective dose <20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. Conclusions The development of cardiac imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the imaging community to create an accountability framework to safely drive appropriate imaging utilization. PMID:24530677

  14. Role and importance of biochemical markers in clinical cardiology.

    PubMed

    Panteghini, Mauro

    2004-07-01

    This paper reviews the current contribution of the biochemical marker determination to clinical cardiology and discusses some important developments in this field. Biochemical markers play a pivotal role in the diagnosis and management of patients with acute coronary syndrome (ACS), as witnessed by the incorporation of cardiac troponins into new international guidelines for patients with ACS and in the re-definition of myocardial infarction. Despite the success of cardiac troponins, there is still a need for the development of early markers that can reliably rule out ACS from the emergency room at presentation and also detect myocardial ischaemia in the absence of irreversible myocyte injury. Under investigation are two classes of indicators: markers of early injury/ischaemia and markers of inflammation and coronary plaque instability and disruption. Finally, with the characterisation of the cardiac natriuretic peptides, Laboratory Medicine is also assuming a role in the assessment of cardiac function.

  15. Open source cardiology electronic health record development for DIGICARDIAC implementation

    NASA Astrophysics Data System (ADS)

    Dugarte, Nelson; Medina, Rubén.; Huiracocha, Lourdes; Rojas, Rubén.

    2015-12-01

    This article presents the development of a Cardiology Electronic Health Record (CEHR) system. Software consists of a structured algorithm designed under Health Level-7 (HL7) international standards. Novelty of the system is the integration of high resolution ECG (HRECG) signal acquisition and processing tools, patient information management tools and telecardiology tools. Acquisition tools are for management and control of the DIGICARDIAC electrocardiograph functions. Processing tools allow management of HRECG signal analysis searching for indicative patterns of cardiovascular pathologies. Telecardiology tools incorporation allows system communication with other health care centers decreasing access time to the patient information. CEHR system was completely developed using open source software. Preliminary results of process validation showed the system efficiency.

  16. [One-stop outpatient cardiology clinics: 10 years' experience].

    PubMed

    Falces, Carlos; Sadurní, Josep; Monell, Joan; Andrea, Rut; Ylla, Miquel; Moleiro, Angels; Cantillo, Jordi

    2008-05-01

    A one-stop outpatient cardiology clinic was set up at the Vic General Hospital in Spain in 1996. The aims were to provide patients with a rapid response, and to ensure that, on the same day, they saw a specialist and were referred for any relevant investigations required, primarily echocardiography, exercise testing, and Holter monitoring. We report experience from 10 years of follow-up, involving 19,515 consultations. The mean waiting time for a consultation was 3 days. We analyzed the reasons for the consultations, the investigations carried out, and the reductions in follow-up visits and hospital admissions. Primary care physicians' level of satisfaction was increased by this approach. The one-stop clinic proved feasible in clinical practice and proved robust during the follow-up period. This clinical model was beneficial for patients, was highly acceptable to primary care physicians, reduced the need for patients to contact the hospital, and, possibly, reduced hospital admissions.

  17. Exploiting expert systems in cardiology: a comparative study.

    PubMed

    Economou, George-Peter K; Sourla, Efrosini; Stamatopoulou, Konstantina-Maria; Syrimpeis, Vasileios; Sioutas, Spyros; Tsakalidis, Athanasios; Tzimas, Giannis

    2015-01-01

    An improved Adaptive Neuro-Fuzzy Inference System (ANFIS) in the field of critical cardiovascular diseases is presented. The system stems from an earlier application based only on a Sugeno-type Fuzzy Expert System (FES) with the addition of an Artificial Neural Network (ANN) computational structure. Thus, inherent characteristics of ANNs, along with the human-like knowledge representation of fuzzy systems are integrated. The ANFIS has been utilized into building five different sub-systems, distinctly covering Coronary Disease, Hypertension, Atrial Fibrillation, Heart Failure, and Diabetes, hence aiding doctors of medicine (MDs), guide trainees, and encourage medical experts in their diagnoses centering a wide range of Cardiology. The Fuzzy Rules have been trimmed down and the ANNs have been optimized in order to focus into each particular disease and produce results ready-to-be applied to real-world patients.

  18. Task Force on Sudden Cardiac Death, European Society of Cardiology.

    PubMed

    Priori, S G; Aliot, E; Blømstrom-Lundqvist, C; Bossaert, L; Breithardt, G; Brugada, P; Camm, J A; Cappato, R; Cobbe, S M; Di, Mario C; Maron, B J; McKenna, W J; Pedersen, A K; Ravens, U; Schwartz, P J; Trusz-Gluza, M; Vardas, P; Wellens, H J J; Zipes, D P

    2002-01-01

    The European Society of Cardiology has convened a Task Force on Sudden Cardiac Death in order to provide a comprehensive, educational document on this important topic. The main document has been published in the European Heart Journal in August 2001. The Task Force has now summarized the most important clinical issues on sudden cardiac death and provided tables with recommendations for risk stratification and for prophylaxis of sudden cardiac death. The present recommendations are specifically intended to encourage the development and revision of national guidelines on prevention of sudden cardiac death. The common challenge for cardiologists, physicians of other medical specialties and health professionals throughout Europe is to realize the potential for sudden cardiac death prevention and to contribute to public health efforts to reduce its burden.

  19. A qualitative model for computer-assisted instruction in cardiology.

    PubMed Central

    Julen, N.; Siregar, P.; Sinteff, J. P.; Le Beux, P.

    1998-01-01

    CARDIOLAB is an interactive computational framework dedicated to teaching and computer-aided diagnosis in cardiology. The framework embodies models that simulate the heart's electrical activity. They constitute the core of a Computer-Assisted Instruction (CAI) program intended to teach, in a multimedia environment, the concepts underlying rhythmic disorders and cardiac diseases. The framework includes a qualitative model (QM) which is described in this paper. During simulation using QM, dynamic sequences representing impulse formation and conduction processes are produced along with the corresponding qualitative descriptions. The corresponding electrocardiogram (ECG) and ladder diagram are also produced, and thus, both qualitative notions and quantitative facts can be taught via the model. We discuss how qualitative models in particular, and computational models in general can enhance the teaching capability of CAI programs. Images Figure 1 Figure 2 PMID:9929258

  20. A cooperative model for integration in a cardiology outpatient clinic.

    PubMed Central

    Cornet, R.; van Mulligen, E. M.; Timmers, T.

    1994-01-01

    With the increasing amount of digitally stored patient information, such as images and findings, the possibility and need arise for a system which is able to both store and display this information in a structured, user-friendly way. In the common situation where different information systems are used within one department, this means that the various information systems have to be integrated. However, integration requires more complex management of data, processes and windows. This management can be handled by a Workspace Manager, which controls inter-application tasks, and interaction with the user. Furthermore, this Workspace Manager supports the user with the definition of complex tasks such as collecting problem-related patient information from the various remote systems. In an outpatient clinic for cardiology this architecture is used to achieve cooperative integration of an open Computer Patient Record with a range of information-specific services. Images Figure 4 PMID:7949997

  1. Platelet function tests in clinical cardiology: unfulfilled expectations.

    PubMed

    Gorog, Diana A; Fuster, Valentin

    2013-05-28

    This review is a critical evaluation of publications in the past decade on the usefulness of platelet function tests (PFTs) in clinical cardiology, in aiding diagnosis, predicting risk, and monitoring therapy. The ideal PFT should: 1) detect baseline platelet hyperreactivity; 2) allow individualization of antiplatelet medication; 3) predict thrombotic risk; and 4) predict bleeding risk. The practicalities of clinical cardiology demand rapid, accurate, and reliable tests that are simple to operate at the bedside and available 24 h a day, 7 days a week. Point-of-care PFTs most widely evaluated clinically include PFA-100 and VerifyNow. None of these tests can reliably detect platelet hyperreactivity and thus identify a prothrombotic state. Identification of antiplatelet nonresponsiveness or hyporesponsiveness is highly test specific, and does not allow individualization of therapy. The power of PFTs in predicting thrombotic events for a given individual is variable and often modest, and alteration of antithrombotic treatment on the basis of the results of PFTs has not been shown to alter clinical outcome. PFTs in current mainstream use cannot reliably assess bleeding risk. These tests have been in use for over a decade, but the hopes raised by PFTs in clinical practice remain unfulfilled. Although physiologically relevant measurement of platelet function now is more important than ever, a critical reappraisal of available techniques in light of clinical requirements is needed. The use of native blood, global stimulus instead of individual agonists, contribution of thrombin generation by activated platelets to the test results, and establishment of a PFT therapeutic range for each antiplatelet drug should be considered and is discussed.

  2. Medication reconciliation in patients hospitalized in a cardiology unit.

    PubMed

    Magalhães, Gabriella Fernandes; Santos, Gláucia Noblat de Carvalho; Santos, Gláucia Beisl Noblat de Carvalho; Rosa, Mário Borges; Noblat, Lúcia de Araújo Costa Beisl

    2014-01-01

    To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies. This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies. A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm. The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

  3. Medication Reconciliation in Patients Hospitalized in a Cardiology Unit

    PubMed Central

    Magalhães, Gabriella Fernandes; Santos, Gláucia Beisl Noblat de Carvalho; Rosa, Mário Borges; Noblat, Lúcia de Araújo Costa Beisl

    2014-01-01

    Objectives To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies. Method This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies. Results A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm. Conclusion The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit. PMID:25531902

  4. On New Spain and Mexican medicinal botany in cardiology.

    PubMed

    de Micheli-Serra, Alfredo Alessandro; Izaguirre-Ávila, Raúl

    2014-01-01

    Towards the middle of the XVI century, the empirical physician Martín de la Cruz, in New Spain, compiled a catalogue of the local medicinal herbs and plants, which was translated into Latin by Juan Badiano, professor at the Franciscan college of Tlatelolco. On his side, Dr. Francisco Hernández, the royal physician (protomédico) from 1571 until 1577, performed a systematic study of the flora and fauna in this period. His notes and designs were not published at that time, but two epitomes of Hernández' works appeared, respectively, in 1615 in Mexico and in 1651 in Rome. During the XVIII century, two Spanish scientific expeditions arrived to these lands. They were led, respectively, by the Spanish naturalist Martín Sessé and the Italian seaman, Alessandro Malaspina di Mulazzo, dependent from the Spanish Government. These expeditions collected and carried rich scientific material to Spain. At the end of that century, the Franciscan friar Juan Navarro depicted and described several Mexican medicinal plants in the fifth volume of his botanic work. In the last years of the colonial period, the fundamental works of Humboldt and Bonpland on the geographic distribution of the American plants were published. In the modern age, the first research about the Mexican medicinal botany was performed in the laboratory of the Instituto Médico Nacional [National Medical Institute] under the leadership of Dr. Fernando Altamirano, who started pharmacological studies in this country. Later, trials of cardiovascular pharmacology were performed in the small laboratories of the cardiological unit at the General Hospital of Mexico City, on Dr. Ignacio Chávez' initiative. The Mexican botanical-pharmacological tradition persists alive and vigorous at the Instituto Nacional de Cardiología and other scientific institutions of the country.

  5. [Outsourced service management of the catheterization laboratory in the cardiology department: lights and shadows].

    PubMed

    Inama, Giuseppe; Claus, Marco; Nossai, Wanda S Pinna; Pedrinazzi, Claudio; Durin, Ornella; Catanoso, Antonio; Cacucci, Michele; Valentini, Paolo; Rizzini, Angelo Lodi; Agricola, Pietro; Romagnoli, Giulio; Magarini, Anna Maria; Bruni, Ezio; Aguzzi, Regolo; Soccini, Fulvio; Maltagliati, Diego

    2008-04-01

    The aim of this study was to compare the economic impact and results achieved by recourse to outsourced management of the procedures carried out in the electrophysiology and catheterization laboratory of the Department of Cardiology of the Crema Hospital with the in-house setting up and operation of the same activities. The comparison between the two possible options, "make" or "buy in", was made using the methodology of advanced direct costing, which provides for the allocation of only direct fixed and variable costs to clinical procedures, the subject of calculation. In addition to the financial evaluation, the quality variables showing the advantages and limitations of outsourcing in terms of organizational improvements, streamlining of the organizational structure, operational efficiency and improvement of the quality of service, were examined. The financial evaluation from 2002 to 2006 came out in favor of "make" as opposed to "buy in". Income derived from diagnosis-related-group payments for the more than 4000 procedures carried out was Euro26.239.034,96. On the basis of the economical evaluation the second contribution margin was slightly inferior with the "buy in" than with the "make" hypothesis. Specifically, it is Euro16.397.669,96 in the "buy in" and Euro16.753.579,16 in the "make" hypothesis, with a difference of Euro355.909,20 (-2%). The economic advantage lies with the "make" alternative compared with "buy in", nevertheless, outsourcing offers greater operational efficiency, better cost control, setting up of the laboratory within a very short time, simplified administration (single point of contact) and an opportunity to concentrate on core business. However, there are limitations due to greater dependence on the supplier, not all the equipment provided for under the contract was used, and loss of management know-how in non-core business areas.

  6. Waist circumference as a vital sign in cardiology 20 years after its initial publication in the American Journal of Cardiology.

    PubMed

    Després, Jean-Pierre

    2014-07-15

    In 1994, we reported in The American Journal of Cardiology that a simple anthropometric measurement, waist circumference, was related to the amount of abdominal visceral adipose tissue measured by computed tomography. An elevated waist circumference was also found to be associated with several features of the cardiometabolic risk profile such as glucose intolerance, hyperinsulinemia, and an atherogenic dyslipidemic profile that included hypertriglyceridemia and reduced high-density lipoprotein cholesterol levels. Although a linear relation was found between waist circumference and these metabolic alterations, we reported that a waist circumference value of about 100 cm was associated with a high probability of finding diabetogenic and atherogenic abnormalities. The present short report provides a brief update of issues that have been raised regarding the measurement of waist circumference and its clinical use over a period of 20 years since the original publication.

  7. A new experimental procedure for determination of photoelectric efficiency of a NaI(Tl) detector used for nuclear medicine liquid waste monitoring with traceability to a reference standard radionuclide calibrator.

    PubMed

    Ceccatelli, A; Campanella, F; Ciofetta, G; Marracino, F M; Cannatà, V

    2010-02-01

    To determine photopeak efficiency for (99m)Tc of the NaI(Tl) detector used for liquid waste monitoring at the Nuclear Medicine Unit of IRCCS Paediatric Hospital Bambino Gesù in Rome, a specific experimental procedure, with traceability to primary standards, was developed. Working with the Italian National Institute for Occupational Prevention and Safety, two different calibration source geometries were employed and the detector response dependence on geometry was investigated. The large percentage difference (almost 40%) between the two efficiency values obtained showed that geometrical effects cannot be neglected.

  8. Report of the American College of Cardiology (ACC) Scientific Sessions 2016, Chicago.

    PubMed

    Mano, Toshiaki; Yamamoto, Kazuhiro

    2016-05-25

    The 65(th)Annual Scientific Sessions of the American College of Cardiology (ACC) were held at McCormick Place, Chicago, from April 2-4, 2016. The ACC Scientific Sessions are one of the 2 major scientific cardiology meetings in the USA and one of the major scientific meetings of cardiology in the world. It had an attendance of 18,769 and over 2,000 oral and poster abstracts, including 8 late-breaking clinical trials. This report presents the key presentations and the highlights from the ACC Scientific Sessions 2016 in Chicago. (Circ J 2016; 80: 1308-1313).

  9. Highlights of the annual meeting of the Association for European Paediatric and Congenital Cardiology.

    PubMed

    Konta, Laura; Hayes, Nicholas; Qureshi, Shakeel A

    2013-09-01

    The 47th annual meeting of the Association for European Paediatric and Congenital Cardiology was held on 22-25th May 2013 in London, UK. This is one of the largest scientific meetings in Europe within the field of congenital cardiac disease and was held in association with the Japanese Society of Pediatric Cardiology and Cardiac Surgery, and Asia Pacific Pediatric Cardiology Society. There were 900 submitted abstracts and over 1000 delegates from 57 countries attended. We have summarized some of the highlights of the meeting below.

  10. Implications for cardiology nurse practitioner billing: a comparison of hospital versus office practice.

    PubMed

    Hull-Grommesh, Lori; Ellis, Elizabeth Fuselier; Mackey, Thomas A

    2010-06-01

    To discuss the implications for cardiology nurse practitioner (NP) billing and compare and contrast inpatient Medicare billing practices versus outpatient Medicare billing practices. Selected articles, text books, and government websites. In today's complex and expensive healthcare system, there has been a steady decline in the reimbursement rate for professional services to hospitals and physicians. NPs can have a significant impact on reducing this decline by billing for services provided. The cardiology NP can enhance institutional reimbursement quality and patient safety. The different billing methods such as independent billing, shared billing, and incident to billing by the cardiology NP can be complex.

  11. 3D-Printing in Congenital Cardiology: From Flatland to Spaceland

    PubMed Central

    Deferm, Sébastien; Meyns, Bart; Vlasselaers, Dirk; Budts, Werner

    2016-01-01

    Medical imaging has changed to a great extent over the past few decades. It has been revolutionized by three-dimensional (3D) imaging techniques. Despite much of modern medicine relying on 3D imaging, which can be obtained accurately, we keep on being limited by visualization of the 3D content on two-dimensional flat screens. 3D-printing of graspable models could become a feasible technique to overcome this gap. Therefore, we printed pre- and postoperative 3D-models of a complex congenital heart defect. With this example, we intend to illustrate that these models hold value in preoperative planning, postoperative evaluation of a complex procedure, communication with the patient, and education of trainees. At this moment, 3D printing only leaves a small footprint, but makes already a big impression in the domain of cardiology and cardiovascular surgery. Further studies including more patients and more validated applications are needed to streamline 3D printing in the clinical setting of daily practice. PMID:27195174

  12. Multimedia platform for authoring and presentation of clinical rounds in cardiology

    NASA Astrophysics Data System (ADS)

    Ratib, Osman M.; Allada, Vivekanand; Dahlbom, Magdalena; Lapstra, Lorelle

    2003-05-01

    We developed a multimedia presentation platform that allows retrieving data from any digital and analog modalities and to prepare a script of a clinical presentation in an XML format. This system was designed for cardiac multi-disciplinary conferences involving different cardiology specialists as well as cardiovascular surgeons. A typical presentation requires preparation of summary reports of data obtained from the different investigations and imaging techniques. An XML-based scripting methodology was developed to allow for preparation of clinical presentations. The image display program uses the generated script for the sequential presentation of different images that are displayed on pre-determined presentation settings. The ability to prepare and present clinical conferences electronically is more efficient and less time consuming than conventional settings using analog and digital documents, films and videotapes. The script of a given presentation can further be saved as part of the patient record for subsequent review of the documents and images that supported a given medical or therapeutic decision. This also constitutes a perfect documentation method for surgeons and physicians responsible of therapeutic procedures that were decided upon during the clinical conference. It allows them to review the relevant data that supported a given therapeutic decision.

  13. 3D-Printing in Congenital Cardiology: From Flatland to Spaceland.

    PubMed

    Deferm, Sébastien; Meyns, Bart; Vlasselaers, Dirk; Budts, Werner

    2016-01-01

    Medical imaging has changed to a great extent over the past few decades. It has been revolutionized by three-dimensional (3D) imaging techniques. Despite much of modern medicine relying on 3D imaging, which can be obtained accurately, we keep on being limited by visualization of the 3D content on two-dimensional flat screens. 3D-printing of graspable models could become a feasible technique to overcome this gap. Therefore, we printed pre- and postoperative 3D-models of a complex congenital heart defect. With this example, we intend to illustrate that these models hold value in preoperative planning, postoperative evaluation of a complex procedure, communication with the patient, and education of trainees. At this moment, 3D printing only leaves a small footprint, but makes already a big impression in the domain of cardiology and cardiovascular surgery. Further studies including more patients and more validated applications are needed to streamline 3D printing in the clinical setting of daily practice.

  14. The analysis of a cardiological network in a regulated setting: a spatial interaction approach.

    PubMed

    Lippi Bruni, Matteo; Nobilio, Lucia; Ugolini, Cristina

    2008-02-01

    We analyse referral patterns for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in the Emilia Romagna region of Italy, a procedure for which the assumption of a negative association between volume and adverse outcomes is used to justify its territorial concentration. Nevertheless, recent clinical evidence shows PTCA superiority for immediate treatment of acute myocardial infarction, which advises an increase in the number of points of delivery. Our paper aims to develop analytical tools designed to provide support to policy makers when they are asked to evaluate the spatial distribution of catheterisation laboratories that perform PTCA. Information is drawn from the regional administrative hospital discharge data (SDO) for the year 2002. We first use entropy indexes to investigate the spatial accessibility of the cardiological network. Secondly, by means of a gravity model estimated using Bayesian techniques we identify the determinants of patient flows in terms of demand and supply factors. Our results suggest that information on destinations is processed hierarchically and that agglomeration-like forces are dominant. Furthermore, although self-sufficiency of provision at the provincial level has been achieved to a large extent, there is still scope to improve the organisational efficiency of the network.

  15. Telematics in medicine: a network infrastructure to optimize processes in cardiology and heart surgery.

    PubMed

    Hülsken, G; Rothenburger, M; Etz, C; Löher, A; Schmid, C; Scheld, H H

    2007-06-01

    During the past 2 decades, cardiac surgery has developed into a high-tech field. Increasing numbers of urgent surgical procedures mean that the time interval from diagnosis to surgical treatment must become ever shorter. Optimizing inconvenient and slow processes such as postal correspondence by using internet services is therefore mandatory in current cardiosurgical practice, and this includes the electronic transfer of patient data and diagnostic imaging material [12]. This study focuses on the internet connection of several cardiac referral centers to a cardiosurgical institution. Eleven cath lab centers were connected to a cardiosurgical center by internet. Auser program was especially developed to optimize connecting processes with the department. Data conversion was based on HL7 codes and angiograms were based on CD-ROM mediums and the DICOM standard. An online registration based on the HL7 communications standard was provided. All cath lab centers were successfully connected to the cardiosurgical institution. Angiography data were transmitted within 30 +/- 15minutes. The time interval from diagnosis to decision for surgery decreased from 36 +/- 13 hours to 1 +/- 0.5 hours (p = 0.01). Urgent or emergent surgery could be provided after 18 +/- 19 hours, compared to 56 +/- 35 hours before (p = 0.02). Special programs transmitting data via the internet significantly reduces the time interval from diagnosis to surgical treatment. Standardizing data transmitting processes from referral centers markedly optimizes cardiological and cardiosurgical treatments and could thereby improve survival rates and reduce costs.

  16. Nuclear environment survivability. Final report

    SciTech Connect

    Not Available

    1994-04-15

    This Test Operation Procedure (TOP) provides a general outline of the test and analysis procedures required to determine the effects of specified nuclear environment on Army materiel. The purpose of these test and analysis procedures is to ascertain the degree to which the Operational Requirements Document (ORD), Independent Evaluation Plan (IEP)/ Independent Assessment Plan (IAP) criteria, and Army Nuclear Hardening Criteria (NHC) are met.

  17. The search of the best mode of the reserve power supply consumption during the nuclear reactor’s emergency shutdown procedures in case of force majeure circumstances

    NASA Astrophysics Data System (ADS)

    Zagrebaev, A. M.; Trifonenkov, A. V.

    2017-01-01

    This article deals with the problem of the control mode choice for a power supply system in case of force majeure circumstances. It is not known precisely, when a force majeure incident occurs, but the threatened period is given, when the incident is expected. It is supposed, that force majeure circumstances force nuclear reactor shutdown at the moment of threat coming. In this article the power supply system is considered, which consists of a nuclear reactor and a reserve power supply, for example, a hydroelectric pumped storage power station. The reserve power supply has limited capacity and it doesn’t undergo the threatened incident. The problem of the search of the best reserve supply time-distribution in case of force majeure circumstances is stated. The search is performed according to minimization of power loss and damage to the infrastructure. The software has been developed, which performs automatic numerical search of the approximate optimal control modes for the reserve power supply.

  18. [The GIPSY-RECPAM model: a versatile approach for integrated evaluation in cardiologic care].

    PubMed

    Carinci, F

    2009-01-01

    Tree-structured methodology applied for the GISSI-PSICOLOGIA project, although performed in the framework of earliest GISSI studies, represents a powerful tool to analyze different aspects of cardiologic care. The GISSI-PSICOLOGIA project has delivered a novel methodology based on the joint application of psychometric tools and sophisticated statistical techniques. Its prospective use could allow building effective epidemiological models relevant to the prognosis of the cardiologic patient. The various features of the RECPAM method allow a versatile use in the framework of modern e-health projects. The study used the Cognitive Behavioral Assessment H Form (CBA-H) psychometrics scales. The potential for its future application in the framework of Italian cardiology is relevant and particularly indicated to assist planning of systems for integrated care and routine evaluation of the cardiologic patient.

  19. How will 2014 European Society of Cardiology Congress influence our daily practice?

    PubMed

    Yılmaz, M Birhan

    2014-12-01

    European Cardiology Congress which was held in Barcelona in this year; was a meeting with striking results of the presented scientific studies. Herein, a brief overview of congress highlights is presented.

  20. Nucleology, nuclear medicine, molecular nuclear medicine and subspecialties.

    PubMed

    Grammaticos, Philip C

    2005-01-01

    Henry N. Wagner Jr started the presentation of the highlights of the 39th Annual Meeting of the Society of Nuclear Medicine by quoting: "The economist JM Keynes said: "the difficult lies not in new ideas but in escaping from the old ones". Many changes have taken place in the actual term describing our specialty during the last 15 years. Cardiologists have adopted an important chapter of nuclear medicine and to describe that they use the term of "nuclear cardiology". Radiologists have proposed the term "radionuclide radiology". "Nuclear endocrinology", "nuclear oncology", "nuclear nephrology" may be considered as terms describing chapters of nuclear medicine related to other specialties. Will that indicate that our specialty will be divided into smaller chapters and be offered to colleagues working in other specialties leaving to us the role of the supervisor or perhaps the radioprotection officer for in vivo studies? Of course this role is now being exercised by our colleagues in medical physics. It is suggested to use the word " nucleology", instead of "nuclear medicine" where "nuclear" is used as an adjective. Thus, we will avoid being part of another specialty and cardiologists would use the term cardiac nucleology where "cardiac" is the adjective. The proposed term "nucleology" as compared to the existing term "nuclear medicine" has the advantage of being simpler, correct from the grammar point of view and not related to combined terms that may seem to offer part of our specialty to other specialties. At present our specialty faces many problems. The term "nucleology" supports our specialty from the point of view of terminology. During the 3rd International Meeting of Nuclear Medicine of N. Greece which was held in Thessaloniki, Macedonia, Greece on 4-6 November 2005, a discussion arose among participants as to whether the name of "nucleology" could replace the existing name of "nuclear medicine". Finally, a vote (between "yes" and "no") for the new proposed

  1. Occupational cataracts and lens opacities in interventional cardiology (O'CLOC study): are X-Rays involved?

    PubMed Central

    2010-01-01

    Background The eye is well known to be sensitive to clearly high doses (>2 Gy) of ionizing radiation. In recent years, however, cataracts have been observed in populations exposed to lower doses. Interventional cardiologists are repeatedly and acutely exposed to scattered ionizing radiation (X-rays) during the diagnostic and therapeutic procedures they perform. These "low" exposures may cause damage to the lens of the eye and induce early cataracts, known as radiation-induced cataracts. The O'CLOC study (Occupational Cataracts and Lens Opacities in interventional Cardiology) was designed to test the hypothesis that interventional cardiologists, compared with an unexposed reference group of non-interventional cardiologists, have an increased risk of cataracts. Method/Design The O'CLOC study is a cross-sectional study that will include a total of 300 cardiologists aged at least 40 years: one group of exposed interventional cardiologists and another of non-interventional cardiologists. The groups will be matched for age and sex. Individual information, including risk factors for cataracts (age, diabetes, myopia, etc.), will be collected during a telephone interview. A specific section of the questionnaire for the exposed group focuses on occupational history, including a description of the procedures (type, frequency, radiation protection tool) used. These data will be used to classify subjects into "exposure level" groups according to cumulative dose estimates. Eye examinations for all participants will be performed to detect cataracts, even in the early stages (lens opacities, according to LOCS III, the international standard classification). The analysis will provide an estimation of the cataract risk in interventional cardiology compared with the unexposed reference group, while taking other risk factors into account. An analysis comparing the risks according to level of exposure is also planned. Discussion This epidemiological study will provide further evidence

  2. Association of Physician Certification in Interventional Cardiology with In-Hospital Outcomes of Percutaneous Coronary Intervention

    PubMed Central

    Fiorilli, Paul N.; Minges, Karl E.; Herrin, Jeph; Messenger, John C.; Ting, Henry H.; Nallamothu, Brahmajee K.; Lipner, Rebecca S.; Hess, Brian J.; Holmboe, Eric S.; Brennan, Joseph J.; Curtis, Jeptha P.

    2015-01-01

    Background The value of American Board of Internal Medicine (ABIM) certification has been questioned. We evaluated the association of interventional cardiology (ICARD) certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010. Methods and Results We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined ICARD status using ABIM data. We compared in-hospital outcomes of patients treated by certified and non-certified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary endpoints were all-cause in-hospital mortality and bleeding complications. Secondary endpoints included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5,175 physicians, case mix and unadjusted outcomes were similar among certified and non-certified physicians. The adjusted risks of in-hospital mortality (OR 1.10, 95% CI 1.02-1.19) and emergency CABG (OR 1.32, 95% CI 1.12-1.56) were higher in the non-ICARD certified group, but the risks of bleeding, vascular complications, and the composite endpoint were not statistically significantly different between groups. Conclusions We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency CABG in patients treated by non-ICARD certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes, and indicate a need to enhance the value of subspecialty certification. PMID:26384518

  3. [The practical clinical guidelines of the Sociedad Española de Cardiología on interventional cardiology: coronary angioplasty and other technics].

    PubMed

    Esplugas, E; Alfonso, F; Alonso, J J; Asín, E; Elizaga, J; Iñiguez, A; Revuelta, J M

    2000-02-01

    Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association.

  4. Redesigning the nuclear medicine reading room.

    PubMed

    Zemariame, Nigist; Knight, Nancy; Siegel, Eliot L

    2011-11-01

    The process of image review and interpretation has become increasingly complex and challenging for today's nuclear medicine physician from many perspectives, especially with regard to workstation integration and reading room ergonomics. With the recent proliferation of hybrid imaging systems, this complexity has increased rapidly, along with the number of studies performed. At the same time, clinicians throughout the health care enterprise are expecting remote access to nuclear medicine images whereas nuclear medicine physicians require reliable access at the point of care to the electronic medical record and to medical images from radiology and cardiology. The authors discuss the background and challenges related to integration of nuclear medicine into the health care enterprise and provide a series of recommendations for advancing successful integration efforts. Also addressed are unique characteristics of the nuclear medicine environment as well as ergonomic, lighting, and environmental considerations in the design and redesign of the modern reading room.

  5. Tomsk Cardiology Center program on lasers in cardiovascular: first results

    NASA Astrophysics Data System (ADS)

    Gordov, Eugeni P.; Karpov, Rostislav S.; Dudko, Victor A.; Shipulin, Vladimir M.

    1994-12-01

    Recent progress in biomedical optics resulted in increased activity in this area at a number of different centers. Reported are the first results of the program directed to incorporate at Tomsk Cardiology Center experience gained in Tomsk optical profile research institutions in areas of light-matter interaction, high resolution spectroscopy, laser physics and relevant software and their usage in cardiac therapy, surgery, and diagnostics. To coordinate research work in this direction the special unit-laboratory of laser medicine is organized at the Center. Laboratory activity goes in the following directions: study of spectral properties of vessel walls in norm and atherosclerosis, comparative study of different wavelength laser radiation action on normal and atherosclerotically damaged tissues, novel approach to intravascular imaging, and usage of high sensitive laser spectroscopy for early diagnosis of cardiac diseases. The spectroscopic study of AP and normal tissue is aimed at understanding of differences in internal energy structures and ways of energy migration which are of critical importance for reaching selective laser action on normal and deceased tissues. To compare thermal, mechanical, and photo-chemical variations of tissues caused by laser radiation the XeCl excimer laser with Raman shifting cell and Nd:YAG laser with second, third, and fourth harmonic converters are employed. Fine influence of pulse duration, intensity, and repetition rates on AP removal is considered in laboratory experiments with vessel samples. Preliminary results on theoretical consideration for determination of spectroscopically detectable markers of some cardiac diseases are reported as well.

  6. Update: Innovation in cardiology (II). Telecardiology: past, present and future.

    PubMed

    Sørensen, Jacob Thorsted; Clemmensen, Peter; Sejersten, Maria

    2013-03-01

    Technological advances over the past decades have allowed improved diagnosis and monitoring of patients with acute coronary syndromes as well as patients with advanced heart failure. High-quality digital recordings transmitted wirelessly by cellular telephone networks have augmented the prehospital use of transportable electrocardiogram machines as well as implantable devices for arrhythmia monitoring and therapy. The impact of prehospital electrocardiogram recording and interpretation in patients suspected of acute myocardial infarction should not be underestimated. It enables a more widespread access to rapid reperfusion therapy, thereby reducing treatment delay, morbidity and mortality. Further, continuous electrocardiogram monitoring has improved arrhythmia diagnosis and dynamic ST-segment changes have been shown to provide important prognostic information in patients with acute ST-elevation myocardial infarction. Likewise, remote recording or monitoring of arrhythmias and vital signs seem to improve outcome and reduce the necessity of re-admissions or outpatient contacts in patients with heart failure or arrhythmias. In the future telemonitoring and diagnosis is expected to further impact the way we practice cardiology and provide better care for the patient with cardiovascular disease.

  7. The initial Trinidad experience with Cine MRI in clinical cardiology.

    PubMed

    Thomas, C N; Maharaj, P; Bodapati, S; John, R; Rahaman, R; Henry, R; Brann, S

    2002-03-01

    We describe the initial Trinidad experience with Magnetic Resonance Imaging (MRI) and Cine MRI as a diagnostic tool in clinical cardiology. Six patients from the following categories were referred for Cine MRI evaluation: congenital heart disease, valvular heart disease, aortic diseases, cardiomyopathy and intracardiac mass. All patients underwent echocardiography. MRI and Cine MRI were performed on all patients using a Siemens Magnetom 1.0 Tesla MR system at MRI Trinidad and Tobago Ltd. Selected patients underwent Angiography and/or computed tomography (CT) scanning. Clinical data and images of the six patients evaluated are described. MRI and Cine MRI provided excellent anatomical and functional details of the heart and aorta in five patients with dissection of the aorta, aneurysm of the ascending aorta, suspected left ventricular apical thrombus, infiltrative cardiomyopathy and arrhythmogenic right ventricular dysplasia. Technical difficulty was experienced with one patient who had a congenital defect (common atrium). In this study, Cine MRI provided excellent images in all but one patient. This new noninvasive technique enhanced diagnostic capabilities and facilitated management in patients with certain cardiovascular diseases.

  8. [Innovations in cardiology. We are too fast with new methods].

    PubMed

    Diegeler, A

    2016-03-01

    Cardiology is rapidly developing on many levels. New treatment methods are introduced at ever decreasing intervals. Against the background of economization of other areas in medicine, dangers are lurking here for patients if safety, usefulness and sustainability of the treatment methods cannot be sufficiently proven. The German Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) aims to adjust the regulatory framework for the approval of new medical products to the legal requirements of the European Union. With the establishment of the Institute for Quality Assessment and Transparency in Health Care (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, IQTIG) more precise quality controls should be carried out. Implantation registers will be soon implemented and the routinely performed quality control of different interventions will be coordinated across different healthcare sectors in order to achieve a better understanding of long-term results. Medicine in general and the safety of patients in particular, ultimately benefit from more stringent controls, neutrality and transparency in the assessment of new methods.

  9. The potential role of MRI in veterinary clinical cardiology.

    PubMed

    Gilbert, Stephen H; McConnell, Fraser J; Holden, Arun V; Sivananthan, Mohan U; Dukes-McEwan, Joanna

    2010-02-01

    Over the last decade, magnetic resonance imaging (MRI) has become established as a useful referral diagnostic method in veterinary medicine that is widely used in small animal brain and spinal diseases, aural, nasal and orbital disorders, planning soft tissue surgery, oncology and small animal and equine orthopaedics. The use of MRI in these disciplines has grown due to its unparalleled capability to image soft tissue structures. This has been exploited in human cardiology where, despite the inherent difficulties in imaging a moving, contractile structure, cardiac MRI (CMRI) has become the optimal technique for the morphological assessment and quantification of ventricular function. Both CMRI hardware and software systems have developed rapidly in the last 10 years but although several preliminary veterinary CMRI studies have been reported, the technique's growth has been limited and is currently used primarily in clinical research. A review of published studies is presented with a description of CMRI technology and the potential of CMRI is discussed along with some of the reasons for its limited usage.

  10. Prophylactic use of vancomycin in adult cardiology and cardiac surgery.

    PubMed

    Movahed, Mohammad-Reza; Kasravi, Babak; Bryan, Charles S

    2004-03-01

    The recent appearance of Staphylococcus aureus and Staphylococcus epidermidis strains that have reduced susceptibility to vancomycin, and the spread of vancomycin-resistant enterococci, raise the specter of endovascular infections that will be difficult or impossible to cure with available drugs. We review issues concerning the prophylactic use of vancomycin in adult cardiology and cardiac surgery with special attention to dosing and indications. There is no indication for the routine use of prophylactic vancomycin in pacemaker implantations, cardiac catheterization, and transesophageal echocardiography. In institutions with a high incidence of methicillin-resistant S. aureus and S. epidermidis, vancomycin may be used for antibiotic prophylaxis in place of cephalosporins for pacemaker or defibrillator implantation. The strongest evidence in support of the prophylactic use of vancomycin is during cardiac surgeries, particularly valvular surgeries in institutions with a high prevalence of methicillin-resistant S. aureus and S. epidermidis. When vancomycin is used prior to open heart surgery, the dose should be 15 mg/kg rather than the standard 1 g dose that is often recommended in the literature and used by 85% of institutional pharmacists who responded to our survey. Cardiologists and cardiac surgeons should assume leadership roles in promoting its responsible use.

  11. Update in cardiology: vascular risk and cardiac rehabilitation.

    PubMed

    Galve, Enrique; Alegría, Eduardo; Cordero, Alberto; Fácila, Lorenzo; Fernández de Bobadilla, Jaime; Lluís-Ganella, Carla; Mazón, Pilar; de Pablo Zarzosa, Carmen; González-Juanatey, José Ramón

    2014-03-01

    Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  12. Interprofessional teamwork in Swedish pediatric cardiology: a national exploratory study.

    PubMed

    Birkeland, Anna-Lena; Hägglöf, Bruno; Dahlgren, Lars; Rydberg, Annika

    2013-07-01

    This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden.

  13. DICOM media interchange standards for cardiology: initial interoperability demonstration.

    PubMed Central

    Elion, J. L.

    1995-01-01

    The first multi-vendor demonstration of digital exchange of cardiac image data was held in conjunction with the annual scientific sessions of the American College of Cardiology (ACC) in March, 1995. This was the culmination of several years of effort by the ACC to help extend the DICOM standard to be suitable for cardiac images exchanged on removeable media. The software was designed to help system implementors with little or no DICOM experience quickly acquire this technology. File content can be specified and manipulated in human-readable form, and converted as needed to its binary equivalent. Images were selected from those submitted from a variety of sources, and a recordable CD (CD-R) created with 30 echocardiograms and 30 angiograms). A prototype display program was created that reads the DICOM directory ("DICOMDIR"), allows user interaction, and decompresses the image files. This paper describes the ACC's interoperability demonstration with 29 vendors, the CD-R of images that was used, and the software used by the participants. PMID:8563354

  14. [About the origin, evolution and irradiation of Mexican cardiology].

    PubMed

    de Micheli, Alfredo

    2014-01-01

    The Mexican cardioangiology started in the nineteen century thanks to first endeavors of surgeons and physicians related to local academies and to School of Medicine, established in 1833 by Dr. Valentin Gómez Farías. Dr. Manuel Carpio, the future first head of department of physiology in this school, translated to Spanish language and published, in 1823, the article On pectoriloquo of the French physician Marat and later performed some experiments on the heart' motion. During the Secont Empire (1864-1867), the physician Samuel von Basch performed studies to define the arterial hypertension, called by him "latent atherosclerosis", i.e. the "essential hypertension". Once he had returned to his country, he invented in 1880, a sphygmomanometer of mercury column, that was the model for the instrument constructed by the Italian physician Scipione Riva-Rocci and presented in 1896. In our time, Dr. Demetrio Sodi Pallares systematized a metabolic therapy called "polarizing therapy", i.e. capable of repolarizing the heart's cells partly depolarized due to hypoxia or direct aggressions. These were the first steps in Mexico on the way to a promising medicine starting and the great adventure of Mexican cardiology.

  15. Nuclear disarmament verification

    SciTech Connect

    DeVolpi, A.

    1993-12-31

    Arms control treaties, unilateral actions, and cooperative activities -- reflecting the defusing of East-West tensions -- are causing nuclear weapons to be disarmed and dismantled worldwide. In order to provide for future reductions and to build confidence in the permanency of this disarmament, verification procedures and technologies would play an important role. This paper outlines arms-control objectives, treaty organization, and actions that could be undertaken. For the purposes of this Workshop on Verification, nuclear disarmament has been divided into five topical subareas: Converting nuclear-weapons production complexes, Eliminating and monitoring nuclear-weapons delivery systems, Disabling and destroying nuclear warheads, Demilitarizing or non-military utilization of special nuclear materials, and Inhibiting nuclear arms in non-nuclear-weapons states. This paper concludes with an overview of potential methods for verification.

  16. The development of iodine-123-methyl-branched fatty acids and their applications in nuclear cardiology

    SciTech Connect

    Knapp, F.F. Jr.; Ambrose, K.R.; Kropp, J.; Biersack, H.J.; Goodman, M.M.; Franken, P.; Reske, S.N.; Som, P.; Sloof, G.W.; Visser, F.C.

    1993-06-01

    Continued Interest in the use of iodine-1 23-labeled fatty acids for myocardial Imaging results from observations from a variety of studies that in many types of cardiac disease, regional fatty acid myocardial uptake patterns are often different than regional distribution of flow tracers. These differences may reflect alterations in important parameters of metabolism which can be useful for patient management or therapeutic strategy decision making. In addition, use of iodine-I 23-labeled fatty acid distribution may represent a unique metabolic probe to relate some aspects of the metabolism of these substrates with the regional viability of cardiac tissue. The use of such viability markers could provide important prognostic information on myocardial salvage, helping to identify patients for revascularization or angioplasty. Clinical studies are currently in progress with the iodine-123-labeled 1 5-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) fatty acid analogue at several institutions. The goals of this paper are to discuss development of the concept of metabolic trapping of fatty acids, to briefly review development and evaluation of various radioiodinated methyl-branched fatty acids and to discuss recent patient studies with iodine-123 (BMIPP) using single photon emission computerized tomography (SPECT).

  17. The development of iodine-123-methyl-branched fatty acids and their applications in nuclear cardiology

    SciTech Connect

    Knapp, F.F. Jr.; Ambrose, K.R. ); Kropp, J.; Biersack, H.J. . Inst. fuer Klinische und Experimentelle Nuklearmedizin); Goodman, M.M. . Dept. of Radiology); Franken, P. . Nuclear Medicine Dept.); Reske, S.N. (Ulm Univ. (Germany

    1993-01-01

    Continued Interest in the use of iodine-1 23-labeled fatty acids for myocardial Imaging results from observations from a variety of studies that in many types of cardiac disease, regional fatty acid myocardial uptake patterns are often different than regional distribution of flow tracers. These differences may reflect alterations in important parameters of metabolism which can be useful for patient management or therapeutic strategy decision making. In addition, use of iodine-I 23-labeled fatty acid distribution may represent a unique metabolic probe to relate some aspects of the metabolism of these substrates with the regional viability of cardiac tissue. The use of such viability markers could provide important prognostic information on myocardial salvage, helping to identify patients for revascularization or angioplasty. Clinical studies are currently in progress with the iodine-123-labeled 1 5-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) fatty acid analogue at several institutions. The goals of this paper are to discuss development of the concept of metabolic trapping of fatty acids, to briefly review development and evaluation of various radioiodinated methyl-branched fatty acids and to discuss recent patient studies with iodine-123 (BMIPP) using single photon emission computerized tomography (SPECT).

  18. Performance evaluation of D-SPECT: a novel SPECT system for nuclear cardiology

    NASA Astrophysics Data System (ADS)

    Erlandsson, Kjell; Kacperski, Krzysztof; van Gramberg, Dean; Hutton, Brian F.

    2009-05-01

    D-SPECT (Spectrum Dynamics, Israel) is a novel SPECT system for cardiac perfusion studies. Based on CZT detectors, region-centric scanning, high-sensitivity collimators and resolution recovery, it offers potential advantages over conventional systems. A series of measurements were made on a β-version D-SPECT system in order to evaluate its performance in terms of energy resolution, scatter fraction, sensitivity, count rate capability and resolution. Corresponding measurements were also done on a conventional SPECT system (CS) for comparison. The energy resolution of the D-SPECT system at 140 keV was 5.5% (CS: 9.25%), the scatter fraction 30% (CS: 34%), the planar sensitivity 398 s-1 MBq-1 per head (99mTc, 10 cm) (CS: 72 s-1 MBq-1), and the tomographic sensitivity in the heart region was in the range 647-1107 s-1 MBq-1 (CS: 141 s-1 MBq-1). The count rate increased linearly with increasing activity up to 1.44 M s-1. The intrinsic resolution was equal to the pixel size, 2.46 mm (CS: 3.8 mm). The average reconstructed resolution using the standard clinical filter was 12.5 mm (CS: 13.7 mm). The D-SPECT has superior sensitivity to that of a conventional system with similar spatial resolution. It also has excellent energy resolution and count rate characteristics, which should prove useful in dynamic and dual radionuclide studies.

  19. Performance evaluation of D-SPECT: a novel SPECT system for nuclear cardiology.

    PubMed

    Erlandsson, Kjell; Kacperski, Krzysztof; van Gramberg, Dean; Hutton, Brian F

    2009-05-07

    D-SPECT (Spectrum Dynamics, Israel) is a novel SPECT system for cardiac perfusion studies. Based on CZT detectors, region-centric scanning, high-sensitivity collimators and resolution recovery, it offers potential advantages over conventional systems. A series of measurements were made on a beta-version D-SPECT system in order to evaluate its performance in terms of energy resolution, scatter fraction, sensitivity, count rate capability and resolution. Corresponding measurements were also done on a conventional SPECT system (CS) for comparison. The energy resolution of the D-SPECT system at 140 keV was 5.5% (CS: 9.25%), the scatter fraction 30% (CS: 34%), the planar sensitivity 398 s(-1) MBq(-1) per head ((99m)Tc, 10 cm) (CS: 72 s(-1) MBq(-1)), and the tomographic sensitivity in the heart region was in the range 647-1107 s(-1) MBq(-1) (CS: 141 s(-1) MBq(-1)). The count rate increased linearly with increasing activity up to 1.44 M s(-1). The intrinsic resolution was equal to the pixel size, 2.46 mm (CS: 3.8 mm). The average reconstructed resolution using the standard clinical filter was 12.5 mm (CS: 13.7 mm). The D-SPECT has superior sensitivity to that of a conventional system with similar spatial resolution. It also has excellent energy resolution and count rate characteristics, which should prove useful in dynamic and dual radionuclide studies.

  20. [