Influence of the target vessel on the location and area of maximum skin dose during percutaneous coronary intervention.

BACKGROUND: A number of cases involving radiation-associated patient skin injury attributable to percutaneous coronary intervention (PCI) have been reported. Knowledge of the location and area of the patient's maximum skin dose (MSD) in PCI is necessary to reduce the risk of skin injury. PURPOSE: To determine the location and area of the MSD in PCI, and separately analyze the effects of different target vessels. MATERIAL AND METHODS: 197 consecutive PCI procedures were studied, and the location and area of the MSD were calculated by a skin-dose mapping software program: Caregraph. The target vessels of the PCI procedures were divided into four groups based on the American Heart Association (AHA) classification. RESULTS: The sites of the MSD for AHA #1-3, AHA #4, and AHA #11-15 were located mainly on the right back skin, the lower right or center back skin, and the upper back skin areas, respectively, whereas the MSD sites for the AHA #5-10 PCI were widely spread. The MSD area for the AHA #4 PCI was larger than that for the AHA #11-15 PCI (P<0.0001). CONCLUSION: Although the radiation associated with PCI can be widely spread and variable, we observed a tendency regarding the location and area of the MSD when we separately analyzed the data for different target vessels. We recommend the use of a smaller radiation field size and the elimination of overlapping fields during PCI.

Femoral nonunion fracture treated with recombinant human bone morphogenetic protein-2 in a dog.

This is the first report on successful treatment of spontaneous nonunion fracture of a dog by use of recombinant human bone morphogenetic protein-2 (rhBMP-2). A 4-year-old Pomeranian dog with a 2-year history of femoral nonunion fracture was treated with implantation of rhBMP-2. The dog had received surgical correction twice prior to the admission but radiography of the affected limb revealed a typical figure of nonunion fracture. Glossly, the fractured ends were sclerotic and the area between the ends was filled with fibrous tissue. After debridement the femoral shaft was fixed by an 8-hole plate. rhBMP-2 at a total dose of 256 micrograms was implanted with a synthetic carrier into the 8-mm defect formed by the debridement. Callus formation responding to rhBMP-2 was radiographically observed at 2 weeks after implantation and the defect reached radiographic union by 8 weeks after implantation. The plate was removed at 9 months after implantation. Any complications were not observed for 5 months after removal of the plate.