Assessment of Newer Radiation Dose Reduction Techniques During Coronary Angiography.

Aims To evaluate the impact of Allura Clarity technology on radiation exposure in patients undergoing diagnostic coronary angiography. Methods A retrospective analysis was undertaken of invasive coronary angiograms performed by a single experienced operator in Cork University Hospital (CUH) (Allura Xper FD10 angiography system). In order to reduce operator variability, we also analysed cases performed by the same operator in the Bon Secours Hospital Cork (BSHC) (Allura Clarity FD10 angiography system). Cases were selected consecutively, having excluded those involving percutaneous coronary intervention, graft studies, aortography, ventriculography, right heart studies or fractional flow reserve studies. Results A total of 178 patients were included, equally distributed between the CUH arm (n=89) and the BSHC arm (n=89). Cohorts were very well matched in terms of age, gender, Body Mass Index, and procedural approach. The median radiation dose in CUH was a Dose Area Product (DAP) of 10,460 mGy.cm2 vs. median DAP of 12,795 mGy.cm2 in BSHC (p=0.148). The median fluoroscopy time in CUH was 2.25mins vs. median fluoroscopy time of 2.17mins in BSHC (p=0.675). Conclusion The use of the Allura Clarity system for diagnostic coronary angiography did not result in a significant difference in radiation dose or fluoroscopy time when compared to the reference Allura Xper system. Further research is needed to investigate the benefit of this new image noise reduction technology in diagnostic coronary angiography.

Jejunal dilatation in Crohn's disease. Intestinal obstruction or intestinal edema?

Although dilatation of the jejunum is a well-recognized feature of Crohn's disease there has been no systematic inquiry as to whether this is related simply to distal intestinal obstruction or to other factors such as hypoalbuminemia and mucosal disease. Barium follow-up examinations of 21 patients with Crohn's disease who had serum albumin concentrations of 2.1-4.4 g/dl were reviewed. Fourteen of these patients (67%) had increased mean jejunal width. All patients with direct radiologic evidence of a stricture (six patients) had increased jejunal caliber, but this only accounted for 43% of patients with this abnormality. Of the remaining eight patients, six had hypoalbuminemia, three of whom had serum albumin concentrations less than or around 2.7 g/dl, the previously determined "albumin threshold" for jejunal dilatation. We conclude that increased jejunal caliber in Crohn's disease not only occurs in association with distal intestinal stenosis but also with severe hypoalbuminemia in the absence of obstruction. We were unable to define a cause of jejunal dilatation in 36% of these patients, but propose that functional obstruction due to distal nonstenosing inflammatory disease may be a factor.