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"Throughout this book, you will see many images and videos of what the heart prep at theUniversity of Minnesota’s Visible Heart Lab can produce. The results of Professor Iaizzo andhis research team exceeded my most optimistic projections of the value of the investment.The Visible Heart Lab brings a new depth of understanding to what actually is going on insidebeating animal and human hearts. It has helped to reshape how the industry designs andevaluates products. It changed how we made decisions on products to fund or not fund andimpacted how we ran our business. In advocating for the investment, Tim Laske, Mark Hjelle,and I made one mistake—we underestimated what Dr. Iaizzo and his team were capable ofaccomplishing. We would not make that mistake again. I do not believe failure is ever consideredas an option by his team."

"The success of the first edition of Percutaneous treatment of left side cardiac valves has convinced us of the need to update this book in order to keep pace with the continuing rapid and dynamic evolution in the discipline. Once again, this practical guide is designed to provide the reader with complete state of the art information on the techniques and approaches to percutaneous treatment of left side cardiac valve disease. Numerous images will help the reader to understand in detail the steps of each procedure. The potential complications and expected or potential morbidity from each procedure are discussed in depth, and the best ways to manage them are carefully explained. The book is also intended as a reference covering the up-to-date knowledge contained in the literature on the application of transcatheter techniques to cardiac valves."

"Pendahuluan: Coronary Artery Disease (CAD) merupakan salah satu penyakit kardiovaskular yang menjadi penyebab utama kematian di dunia. Tindakan kateterisasi dengan menggunakan teknik transradial arteri (TRA) telah mampu menurunkan angka morbiditas dan angka mortalitas dari CAD, tetapi prosedur ini juga berkontribusi untuk terjadinya komplikasi yang cukup besar. Tujuan: dari penelitian ini untuk mengidentifikasi pengaruh handgrip exercise dynamometer terhadap nyeri, edema dan hematoma pada pasien CAD post transradial cardiac catheterization. Metode: Desain penelitian ini menggunakan quasi experiment design dengan bentuk pre test and post test nonequivalent control group. Teknik sampling yang digunakan dalam penelitian ini adalah non probability sampling yaitu Convinience sampling. Nyeri dan edema merupakan hasil utama dari penelitian ini yang dipantau dan diukur 2 jam setelah intervensi sedangkan hematoma dipantau dan diukur 24 jam setelah intervensi. Hasil: Terdapat penurunan skala nyeri dan edema yang signifikan sesudah dilakukan handgrip exercise pada kelompok intervensi dengan p value = 0,000. Tidak ada penurunan skala nyeri dan edema sesudah pada tindakan yang diberikan sesuai SOP Rumah sakit secara signifikan dengan p value > 0,05. Terdapat perbedaan yang signifikan median penurunan skala nyeri dan edema sesudah dilakukan handgrip exercise pada kelompok intervensi dibandingkan dengan kelompok kontrol (p value < 0,05). Terdapat perbedaan yang signifikan pada kejadian hematoma sesudah dilakukan handgrip exercise pada kelompok intervensi yaitu 5,8% dibandingkan dengan kelompok kontrol 80,8% (p value < 0,05). Kesimpulan: handgrip exercise dynamometer dapat menurunkan nyeri, edema dan hematoma pada pasien CAD posttransradial cardiac catetherization.

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Introduction: Coronary Artery Disease (CAD) is leading cause of mortality worldwide. Catheterization using the transradial arterial (TRA) technique has been able to reduce morbidity and mortality rates from CAD, but this procedure also contributes to the occurrence of complications. Aim: this study to identify the effect of the handgrip exercise dynamometer on pain, edema and hematoma in CAD patients post transradial cardiac catheterization. Method: This research design uses a quasi experimental design with the form of a pre test and post test nonequivalent control group. The sampling technique used in this research is non-probability sampling, namely convenience sampling. Pain and edema were the main outcomes of this study which were monitored and measured 2 hours after the intervention while hematoma was monitored and measured 24 hours after the intervention. Results: There was a significant reduction in pain and edema before and after handgrip exercise in the intervention group with p value = 0.000. There was no significant reduction in the pain and edema scale before and after the intervention given according to the hospital SOP with a p value < 0.05. There was a significant difference in the median reduction in pain and edema after handgrip exercise in the intervention group compared to the control group (p value < 0.05). There was a significant difference in the incidence of hematoma after handgrip exercise in the intervention group, namely 5.8% compared to the control group, 80.8% (p value < 0.05). Conclusion: handgrip exercise dynamometer can reduce pain, edema and hematoma in CAD posttransradial cardiac catetherization patients."

"Pelaksanaan prosedur kateterisasi yang seringkali membutuhkan banyak waktu dan penggunaan radiasi fluoroskopi sebagai alat bantu membuat pasien menerima dosis radiasi yang cukup tinggi. Optimasi antara dosis yang diterima pasien dan informasi citra yang diperoleh untuk keperluan medis perlu dilakukan untuk meminimalisasi efek samping radiasi yang mungkin timbul. Penelitian ini bertujuan untuk menentukan mode eksposi yang paling optimal dari mode fluoroskopi dan cine pada pasien dewasa menggunakan variasi konsentrasi agen kontras iodin (10%, 12%, dan 14%) dan diameter sample (1, 2, 4, dan 6 mm) menggunakan satuan Figure of Merit (FOM) . Fantom in-house dan lembaran akrilik digunakan sebagai pengganti tubuh pasien. Entrance Surface Air Kerma (ESAK) diukur menggunakan detektor bilik ionisasi RadCal®. Pixel value untuk tiap variasi yang digunakan diperoleh menggunakan software ImageJ untuk memperoleh nilai Signal-to-Noise Ratio (SNR). Hasilnya mode Low Dose pada fluoroskopi dan 15 fps Normal Dose pada cine memiliki nilai FOM tertinggi dengan nilai masing-masing 1.07 ± 0.14 dan 0.21 ± 0.02. Hasil penelitian menunjukkan bahwa perlunya studi lebih lanjut mengenai penggunaan FOM sebagai parameter optimasi.

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The lengthy procedure and the use of radiation-based fluoroscopy in interventional procedure makes patient radiation dose inevitably high. Optimization between dose and image quality used for clinical purpose is essential to fulfill the ALARA (As Low As Reasonably Achievable) principle. This study was aimed to determine the optimum exposure among each fluoroscopy and cine modes on adult patient using a variety of contrast agent concentration (of 10%, 12%, and 14%), object size (1,2,4, and 6 mm) employing Figure of Merit (FOM) as parameter. In-house phantom and acrylic sheets with total thickness of 21,5 cm was exposed with poste-anterior projection to simulate the clinical setting. Measurement of surface dose and Signal-to-Noise Ratio (SNR) were performed using RadCal® ionization chamber and ImageJ software, respectively. The result show that Low Dose mode for fluoroscopy and 15 fps Normal Dose for cine mode have the greatest calculated FOM values of 1.07 ± 0.14 and 0.21 ± 0.02, respectively. This research also found that further studies are needed to evaluate the use of FOM as optimization parameter."

"Perkembangan teknologi memainkan peranan penting dalam ketersediaan parameter pencitraan pada prosedur kateterisasi jantung, yang berdampak pada perlunya dilakukan optimasi pada kualitas citra dan tingkat dosis radiasi guna menentukan kombinasi parameter optimasi yang optimal. Pada kasus pasien anak (pediatrik), keperluan optimasi menjadi sangat penting sebab waktu hidup pasien yang lebih panjang dan sel yang lebih rentan terhadap radiasi. Tujuan dari penelitian ini adalah menentukan parameter pencitraan yang optimal di antara variasi yang diberikan, yakni mode pencitraan, diameter pembuluh darah (8, 6, 4, 2, dan 1 mm), dan konsentrasi media kontras berbasis Iodin (16%, 14%, 12%, dan 10% pada larutan plasma darah), dengan Figure of Merit (FOM) sebagai parameter. Fantom dibuat sebagai pengganti pasien pediatrik. Pengukuran Entrance Surface Air Kerma (ESAK) dan dosis keluaran dilakukan bersamaan dengan kalkulasi Signal-to-Noise Ratio (SNR) dari masing-masing variasi. Dari kalkulasi dosis dan kualitas citra, FOM untuk semua variasi dapat dikalkulasi dan kondisi optimum dapat ditentukan. Sebagai hasil, mode low dose pada fluoroskopi dan mode 15 fps low contrast mode ditentukan sebagai mode paling optimum untuk pasien berketebalan 10 cm. Ditemukan pula bahwa material timah tidak cocok digunakan dalam studi karena nilai SNR yang terlalu jauh jika dibandingkan dengan larutan Iodin.

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Technological development plays an essential role in expanding the breadth of imaging parameters in cardiac catheterization procedure, consequencing on the need of optimization involving image quality and dose level to consider the most favorable parameter combination. In the case of paediatric patients, the awareness is greater owing to the longer life expectancy as well as higher vulnerability against radiation effects in younger cells. The purpose of this study is to assess the most favorable imaging parameters among varied factors, i.e. the available imaging modes, vessel diameter (8, 6, 4, 2, and 1 mm), and iodine-based contrast agent’s concentration (16%, 14%, 12%, and 10% in a blood plasma solution), employing Figure of Merit (FOM) as optimization parameter. In house phantom was constructed to accommodate all variations within the dimensional constrain of a paediatric patient. Measurements of Entrance Surface Air Kerma (ESAK) and exit dose were performed along with calculations of Signal-to-Noise Ratio (SNR) of each varied objects. From the measured dose and image quality, calculation of FOM was done resulting that of all modes, it was favorable to employ low dose fluoroscopy mode and lower frame/s mode in cine acquisition due to low delivered dose and insignificant image quality change among the modes. Higher frame/s cine modes were, however, usable when clinical situation dictates with the expense of the dose level being twice as much as the lower frame rate cine modes. This work also found that the use of Tin as Iodine replacement for research purposes is inadvisable."

"[ABSTRAKDosimeter film Radiochromic XR-RV3 merupakan salah satu tipe dosimeter yangdapat digunakan untuk mengukur dosis pasien pada prosedur kateterisasi jantungdengan fluoroskopi sebagai pemandu. Namun, perlu dipastikan pengaruhkeberadaan film Radiochromic XR-RV3 terhadap kualitas citra. Penelitian inimenggunakan fantom Kat Ped sebagai representasi jantung dewasa danmembandingkan secara kuantitatif kualitas citra fantom yang dieksposi denganmenggunakan film dan tanpa menggunakan film GafChromic XR-RV3. Kuantitasikualitas citra yang digunakan sebagai pembanding adalah Signal to noise ratio(SNR) dan resolusi kontras tinggi. Signal to noise ratio (SNR) yang diperolehdianalisa menggunakan statistik t-test dengan confidence level 95%. Hasil analisamenunjukkan tidak terdapat perbedaan SNR yang signifikan dengan menggunakanfilm dan tanpa menggunakan film pada mode fluoroskopi low dose, normal dosedan high dose dengan diskrepansi SNR <10%. Pada mode cine 15 fps low dan 15fps normal, terdapat kenaikan SNR dengan menggunakan film dengan diskrepansi<13% sedangkan pada mode cine 15 fps boost dan 25 fps coronary tidak terdapatperbedaan signifikan SNR dengan diskrepansi rerata < 7%. Pada high contrastanalisa t-test untuk kedua mode fluoroscopy dan Cine tidak menunjukkan adanyaperbedaan signifikan dengan hasil non rejected pada confidence level 95%.ABSTRACTRadiochromic XR-RV3 film dosimeter is a type of dosimeter that can be used tomeasure patient dose on cardiac catheterization procedure with fluoroscopy as aguide. However, it is necessary to ensure the effect of Radiochromic XR-RV3 filmto image quality. This study used a Kat Ped phantom as a representation of theadult heart and quantitatively compare the image quality by using a phantom thatexposed with film and without using film GafChromic XR-RV3. Quantitation ofimage quality used for comparison is the signal to noise ratio (SNR) and highcontrast resolution. Signal to noise ratio (SNR) obtained statistically analyzedusing t-test with 95% confidence level. The analysis results showed no significantdifference in SNR using film and without using film on a low dose mode, thenormal dose, and high dose flouroscopy with SNR discrepancy <10%. In the cinemode of 15 fps low and 15 fps normal, there is an increased SNR by using filmwith discrepancy <13%, while in the cine mode of 15 fps boost and 25 fpscoronary there are no significant differences with mean SNR discrepancy <7%. Athigh contrast t-test analysis for both Fluoroscopy and Cine mode, result showed nosignificant difference with the results of non-rejected at the 95 % confidence level., Radiochromic XR-RV3 film dosimeter is a type of dosimeter that can be used tomeasure patient dose on cardiac catheterization procedure with fluoroscopy as aguide. However, it is necessary to ensure the effect of Radiochromic XR-RV3 filmto image quality. This study used a Kat Ped phantom as a representation of theadult heart and quantitatively compare the image quality by using a phantom thatexposed with film and without using film GafChromic XR-RV3. Quantitation ofimage quality used for comparison is the signal to noise ratio (SNR) and highcontrast resolution. Signal to noise ratio (SNR) obtained statistically analyzedusing t-test with 95% confidence level. The analysis results showed no significantdifference in SNR using film and without using film on a low dose mode, thenormal dose, and high dose flouroscopy with SNR discrepancy <10%. In the cinemode of 15 fps low and 15 fps normal, there is an increased SNR by using filmwith discrepancy <13%, while in the cine mode of 15 fps boost and 25 fpscoronary there are no significant differences with mean SNR discrepancy <7%. Athigh contrast t-test analysis for both Fluoroscopy and Cine mode, result showed nosignificant difference with the results of non-rejected at the 95 % confidence level.]"