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Lauten P, Lapp H, Goebel B. Addressing the Occupational Risk of Radiation Exposure in the Evolving Field of Interventional Echocardiography. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100328. [PMID: 39290673 PMCID: PMC11403041 DOI: 10.1016/j.shj.2024.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 09/19/2024]
Abstract
Interventional echocardiography (IE) is a relatively new subspecialty in the field of cardiology that has rapidly evolved to occupy a critical role in the treatment of structural heart disease. Despite this, clear competency guidelines are only now being issued, and, of pressing importance, the health risks associated with the profession, particularly occupational radiation exposure, still need to be recognized and appropriately addressed for both specialists and trainees in IE as well as for supporting sonographers. This review will briefly discuss the extensive training interventional echocardiographers need in advanced imaging modalities and will then present standard measures as well as possible innovative devices that can be implemented to reduce ionizing radiation exposure for those working in the field of IE.
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Affiliation(s)
- Philipp Lauten
- Heart Valve Unit, Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Harald Lapp
- Heart Valve Unit, Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Björn Goebel
- Heart Valve Unit, Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Bad Berka, Germany
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Patel AH, Patel V, Tang Y, Shah S, Tang G, Kern MJ. Implementing a 'Lead [Apron]-Free' Cardiac Catheterization: Current Status. Curr Cardiol Rep 2024; 26:1021-1029. [PMID: 39052162 PMCID: PMC11379795 DOI: 10.1007/s11886-024-02102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW In this review, we discuss the status of novel radiation shielding and other methods to reduce radiation exposure and its associated health risks within the CCL. RECENT FINDINGS There are many devices on the market each with its unique advantages and inherent flaws. Several are available for widespread use with promising data, while others still in development. The field of percutaneous transcatheter interventions includes complex procedures often involving significant radiation exposure. Increased radiation exposes the proceduralist and CCL staff to potential harm from both direct effects of radiation but also from the ergonomic consequences of daily use of heavy personal protective equipment. Here we discuss several innovative efforts to reduce both radiation exposure and orthopedic injury within the CCL that are available, leading to a safer daily routine in a "lead [apron]-free" environment.
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Affiliation(s)
- Akash H Patel
- Division of Cardiology, University of California, Irvine, California, USA
| | - Vishal Patel
- Division of Cardiology, University of California, Irvine, California, USA
| | - Yicheng Tang
- Division of Cardiology, University of California, Irvine, California, USA
| | - Sai Shah
- Division of Internal Medicine, University of California, Irvine, California, USA
| | - George Tang
- Division of Cardiology, University of California, Irvine, California, USA
| | - Morton J Kern
- Division of Cardiology, University of California - Irvine and VA Long Beach, Long Beach, California, USA.
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Saha S, Kapoor A, Raut K, Katheria A, Khare H, Sahu A, Khanna R, Kumar S, Garg N, Tewari S. RAdiation Dose Attenuation using RADPAD in CATH lab for primary and secondary operators - RADAR-CATH STUDY. ASIAINTERVENTION 2024; 10:135-143. [PMID: 39070977 PMCID: PMC11261659 DOI: 10.4244/aij-d-23-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/15/2024] [Indexed: 07/30/2024]
Abstract
Background Radiation injury is an important concern for interventional cardiologists and needs to be addressed. RADPAD is a radiation protection drape that has been shown to reduce the radiation exposure of the primary operator (PO). While Indian data on radiation exposure of the PO in the cath lab are scarce, the exposure of the secondary operator (SO) is even less well studied. Aims The aim of this study was to evaluate the efficacy of RADPAD drapes in reducing radiation doses in the cath lab for the primary as well as the secondary operator. Methods A total of 160 patients (40 patients each with single vessel disease [SVD], double vessel disease [DVD] and triple vessel disease [TVD] undergoing coronary angioplasty, and 40 patients undergoing balloon mitral valvuloplasty [BMV]) were randomised in a 1:1 pattern to undergo a procedure with or without the use of RADPAD. Results For patients with SVD, DVD and TVD undergoing percutaneous coronary intervention (PCI) and those undergoing BMV, the % reduction with the use of RADPAD reduced the PO's received dose (in mrem) by 65%, 54%, 28% and 67%, respectively, as compared to without RADPAD. The % reduction in relative operator exposure for the PO for the 4 groups was 55%, 34%, 18% and 75%, respectively, with the use of RADPAD. The corresponding % reduction for the SO's received dose (in mrem) was 80%, 63%, 33% and 69% and for relative operator exposure was 74%, 46%, 23% and 76% in the 4 groups, respectively. Conclusions RADPAD significantly reduces the radiation exposure of the primary and secondary operator during prolonged complex PCI and BMV procedures.
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Affiliation(s)
- Sandeepan Saha
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Kamlesh Raut
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Arpita Katheria
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Harshit Khare
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Ankit Sahu
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Naveen Garg
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
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Veillette JB, Carrier MA, Rinfret S, Mercier J, Arsenault J, Paradis JM. Occupational Risks of Radiation Exposure to Cardiologists. Curr Cardiol Rep 2024; 26:601-622. [PMID: 38625456 DOI: 10.1007/s11886-024-02056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE OF REVIEW Invasive cardiologists are exposed to large amounts of ionizing radiation. This review aims to summarize the main occupational risks in a radiation-exposed cardiology practice. RECENT FINDINGS We carried out a literature review on the subject. The studies reviewed allowed us to list six main health risk categories possibly associated with radiation exposure among cardiologists: deoxyribonucleic acid (DNA) and biochemical damages; cancers; ocular manifestations; olfaction, vascular, and neuropsychological alterations; musculoskeletal problems; and reproductive risks. Our descriptive analysis demonstrates higher risks of DNA damage and lens opacities among radiation-exposed cardiology staff. Surveys and questionnaires have demonstrated a higher risk of musculoskeletal disease in exposed workers. Studies reported no difference in cancer frequency between radiation-exposed workers and controls. Changes in olfactory performance, neuropsychological aspects, and vascular changes have also been reported. Limited literature supports the security of continuing radiation-exposed work during pregnancy. Therefore, there is an urgent need to increase knowledge of the occupational risks of radiation exposure and to adopt technologies to reduce them.
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Affiliation(s)
- Jean-Benoît Veillette
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Marc-Antoine Carrier
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Stéphane Rinfret
- Department of Interventional Cardiology, Georgia Heart Institute, Gainesville, GA, USA
| | - Julien Mercier
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jean Arsenault
- Department of Engineering, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Jean-Michel Paradis
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada.
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Bahar AR, Khanal R, Hamza M, Goru RK, Shafiq A, Haider MZ, Basit SA, Bahar Y, Umer AM, Sattar Y, Alraies MC. Assessing the Efficacy of RADPAD Protection Drape in Reducing Radiation Exposure to Operators in the Cardiac Catheterization Laboratory: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e59215. [PMID: 38807800 PMCID: PMC11132176 DOI: 10.7759/cureus.59215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 05/30/2024] Open
Abstract
One of the leading environmental hazards, ionizing radiation, is linked to several detrimental health consequences in the body. RADPAD (Worldwide Innovations & Technologies, Inc., Kansas City, Kansas) is a sterile, lead-free, lightweight, disposable radiation protection shield. We conducted a systematic review and meta-analysis to determine the effectiveness of RADPAD protection drapes in the cardiac catheterization lab and how they can aid interventional cardiologists in becoming subjected to less scatter radiation. PubMed, Embase, and Google Scholar were searched for studies discussing the efficacy of RADPAD protection drapes in reducing radiation exposure to operators in the cardiac catheterization laboratory. A random-effects model was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) for endpoints: primary operator exposure dose, dose area product (DAP), relative exposure, and screening time. Our analysis included 892 patients from six studies. Compared to the No-RADPAD group, primary operator exposure dose (E) was significantly lower in the RADPAD group (OR: -0.9, 95% CI: -1.36 to -0.43, I2 = 80.5%, p = 0.0001). DAP was comparable between both groups (OR: 0.008, 95% CI: -0.12 to -0.14, I2 = 0%, p = 0.9066). There was no difference in the relative exposure (E/DAP) (OR: -0.47, 95% CI: -0.96 to 0.02, I2 = 0%, p = 0.90) and screening time (OR: 0.13, 95% CI: 0.08 to 0.35, I2 = 0%, p = 0.22) between the two groups. The interventional cardiology laboratory is exposed to significantly less scatter radiation during procedures owing to the RADPAD protective drape. Consequently, all catheterization laboratories could be advised to employ RADPAD protective drapes.
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Affiliation(s)
- Abdul Rasheed Bahar
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Resha Khanal
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Mohammad Hamza
- Internal Medicine, Guthrie Cortland Medical Center, Cortland, USA
| | - Rohit K Goru
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Aimen Shafiq
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Salman Abdul Basit
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Yasemin Bahar
- Internal Medicine, Wayne State University, Detroit, USA
| | - Ahmed Muaaz Umer
- Internal Medicine, Camden Clark Medical Center, Parkersburg, USA
| | - Yasar Sattar
- Cardiology, West Virginia University, Morgantown, USA
| | - M Chadi Alraies
- Cardiology, Wayne State University Detroit Medical Center, Detroit, USA
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Mussmann B, Larsen TR, Godballe M, Abdi AJ, Kantsø A, Jakobsen AR, Nielsen MV, Jensen J. Radiation dose to multidisciplinary staff members during complex interventional procedures. Radiography (Lond) 2024; 30:512-516. [PMID: 38241981 DOI: 10.1016/j.radi.2024.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Complex interventional radiology procedures involve extensive fluoroscopy and image acquisition while staff are in-room. Monitoring occupational radiation dose is crucial in optimization. The purpose was to determine radiation doses received by staff involved in complex interventional procedures performed in a dedicated vascular or neuro intervention room. METHODS Individual real-time radiation dose for all staff involved in vascular and neuro-interventional procedures in adult patients was recorded over a one-year period using wireless electronic dosimeters attached to the apron thyroid shield. A reference dosimeter was attached to the C-arm near the tube housing to measure scattered, unshielded radiation. Radiology staff carried shoulder thermo-luminescent dosimeters with monthly read-out to monitor dose over time. RESULTS Occupational radiation dose was measured in 99 interventional procedures. In many cases prostate artery embolization procedures exposed radiologists to high radiation doses with a median of 15.0 μSv and a very large spread, i.e. 0.2-152.5 μSv. In all procedures except uterine fibroid embolization radiographers were exposed to lower doses than those of radiologists, with endovascular aortic repair being the procedure with highest median exposure to assisting radiographers, i.e. 2.2 μSv ranging from 0.1 to 36.1 μSv. Median radiation dose for the reference dosimeter was 670 μGy while median staff dose for all procedures combined was 3.2 μGy. CONCLUSION Radiation doses for multiple staff were determined and the ratio between staff dose and reference dosimeter indicated proper use of shielding in general. Some high-dose procedures may need further optimization for certain staff members, especially those not primarily employed in radiology. IMPLICATIONS FOR PRACTICE The study provides benchmark doses that may be used widely in audits and in the ongoing effort to optimize radiation protection for staff in interventional radiology.
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Affiliation(s)
- B Mussmann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, 2nd. Floor. 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Pilestedet 48, Oslo, Norway.
| | - T R Larsen
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - M Godballe
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - A J Abdi
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, 2nd. Floor. 5000 Odense C, Denmark; Department of Clinical Engineering, Region of Southern Denmark, Kloevervaenget 18, 5000 Odense C, Denmark
| | - A Kantsø
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - A R Jakobsen
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - M V Nielsen
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - J Jensen
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, 2nd. Floor. 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
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Sharma AB, Agrawal R. Reduction in Primary Operator Radiation Dose Exposure During Coronary Angioplasty Using Radiation Absorbing Drape. Cureus 2023; 15:e46619. [PMID: 37937037 PMCID: PMC10626564 DOI: 10.7759/cureus.46619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/09/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) involves the use of ionizing radiation and is a common procedure in a cardiac catheterization suite. The RADPAD® surgical drape (Worldwide Innovations & Technologies, Inc., Lenexa, KS) has been developed to reduce scatter radiation exposure to primary operators during routine PCI procedures. This study aims to assess the efficacy of RADPAD drapes in reducing radiation dose in the catheterization laboratory. Methods This was a single-center, prospective, observational study that aimed to compare the primary operator dose received with and without the use of a commercially available shield (RADPAD) during PCI. A total of 53 consecutive patients undergoing PCI were randomized in a 1:1 pattern to receive either the RADPAD (study group) or no RADPAD (control group). Standard shielding and personal protective equipment were used. Radiation exposure to the primary operator, total fluoroscopy time, number of cine acquisitions, and air kerma were recorded for each procedure. A one-way ANOVA calculator, including the Tukey honestly significant difference (HSD) test, was used to compare the mean values of radiation exposure. Scatterplot analysis and linear regression slopes of dose relative to air kerma were performed. All shields were reused once only. Results The study compared radiation exposure during PCI procedures between patients who received radiation attenuation devices (RADPAD) and those who did not. The RADPAD group had 30 patients, while the NO RADPAD group had 23 patients. There was a significant difference in the number of coronary angiography and single/multi-vessel PCI procedures between the two groups. There was no significant difference in procedural time or air kerma dose between the groups, but the RADPAD group had a significantly lower radiation dose (mean dose of 3.679 mrem) compared to the NO RADPAD group (mean dose of 8.12 mrem) (p < 0.00001). The primary operator dose per unit of air kerma was also significantly lower in the RADPAD group. Overall, the use of RADPAD resulted in a significant reduction in radiation exposure during PCI procedures. Conclusion The present study provides further evidence for the efficacy of using radiation-absorbing drapes (RADPAD) in reducing primary operator radiation dose exposure during coronary angioplasty. The equipment for radiation dose reduction of patients also reduces the radiation dose of medical staff. Therefore, the use of RADPAD is recommended as a safe and effective measure for reducing operator radiation dose exposure during coronary angioplasty.
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Keenen TL, Demirel S, Gheen A, Casabarro B, Fleishman D. Intraoperative Fluoroscopy Radiation Using OEC 9900 Elite C-arm: Risk and Method for Decreasing Exposure. HEALTH PHYSICS 2023; 124:380-390. [PMID: 36880954 DOI: 10.1097/hp.0000000000001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
ABSTRACT The use of intraoperative fluoroscopy in surgery produces scattered radiation that can expose all operating room personnel to measurable and, in some cases, substantial radiation doses. The goal of this work is to assess and document potential radiation doses to various staff positions in a simulated standard operating room environment. Adult-sized mannequins wearing standard lead protective aprons were placed at seven positions around large and small BMI cadavers. Doses were recorded in real time at thyroid level with Bluetooth-enabled dosimeters for a variety of fluoroscope settings and imaging views. A total of 320 images were acquired, resulting in 2,240 dosimeter readings from the seven mannequins. Doses were compared to cumulative air kerma (CAK) calculations provided by the fluoroscope. There was a strong correlation between the CAK and the recorded scattered radiation doses ( P < 0.001). Radiation doses could be reduced by manipulating C-arm manual technique settings [e.g., turning off the automatic exposure control (AEC) and using pulse (PULSE) or low dose (LD) settings]. Staff position and patient size also affected the recorded doses. The highest radiation doses were recorded across all settings for the mannequin positioned immediately adjacent to the C-arm x-ray tube. The larger BMI cadaver generated greater scattered radiation than the smaller BMI cadaver for all views and settings. This work provides suggestions for reducing exposure to operating room personnel beyond standard techniques of reducing beam-on time, increasing the distance from the radiation source, and use of shielding. Simple changes in C-arm settings (turning AEC off, avoiding DS setting, use of PULSE or LD settings) can markedly reduce dose to staff.
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Affiliation(s)
- Timothy L Keenen
- Oregon Health and Sciences University, Dept of Orthopedics and Rehabilitation, Portland, OR
| | | | | | - Benjamin Casabarro
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd., Indianapolis, IN 46202
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Bhat KG, Guleria VS, Singla M, Bohra V, Kumar J R, Bharadwaj P, Datta R, Hasija PK. Minimizing Scattered Radiation dose in Cardiac Catheterization laboratory during interventional procedures using Lead free Drape – MILD Study. Indian Heart J 2022; 74:201-205. [PMID: 35427629 PMCID: PMC9243615 DOI: 10.1016/j.ihj.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 10/26/2022] Open
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Jansen MM, Koster A, van Herwaarden JA, Hazenberg CEVB. Reduction of Occupational Radiation Exposure During Endovascular Treatment of Peripheral Artery Disease Using Radiation Absorbing Drapes. Ann Vasc Surg 2022; 84:336-343. [PMID: 35257909 DOI: 10.1016/j.avsg.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND A chronic exposure to low dose radiation, as encountered in endovascular procedures, may impact the health of surgeons and radiologists over a timespan of several months to a lifetime. This study evaluates the feasibility and efficacy of a radiation absorbing sterile drape (RADPAD) to reduce operator exposure during the endovascular treatment of obstructive peripheral artery disease (PAD). METHODS Between February 2016 and September 2017, patients with PAD who received percutaneous transluminal angioplasty, stent placement, remote endarterectomy, or a combination thereof were included in this nonrandomized study. Patients were equally divided over a study cohort (with RADPAD) and a control cohort (without RADPAD). The unshielded body dose (E) of the staff was measured via electronic dosimeters placed at a chest height of the first operator (FO), second operator (SO), and sterile nurse (SN). A virtual maximum operator (MO) dose was constructed, yielding the highest dose per fluoroscopy run for either of the operators. Simultaneously, the dose area product (DAP) and C-arm settings for each fluoroscopy run were extracted. Staff exposures of the study cohort and control cohort were compared in terms of relative exposure (E/DAP). A secondary analysis involved an analysis of the individual fluoroscopy runs using a multivariate generalized linear mixed effect model. RESULTS In total, 49 patients were included in this study. The use of RADPAD was technically feasible. Significant reductions of relative exposure were observed when comparing the study cohort with the control cohort. The relative exposure of the FO was reduced with 66.5% (1.82 vs. 0.61 μSv/Gycm2, P < 0.001), the relative exposure of the SO with 68.3% (0.55 vs. 0.17 μSv/Gycm2, P = 0.02), and the relative exposure of the MO with 65.8% (2.06 vs. 0.71 μSv/Gycm2, P < 0.001). Dose levels of SN were too low to draw conclusions under the current sample size. The multivariate generalized linear mixed effect model showed a significant correlation between absolute exposure of the MO and the use of the RADPAD (odds: 0.51, P < 0.001). CONCLUSIONS Usage of a radiation absorbing drape (RADPAD) during endovascular treatment of PAD results in statistically significant reduction in a relative operator dose while presenting no drawbacks. The use of these drapes is advised in future peripheral endovascular procedures.
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Affiliation(s)
- Marloes M Jansen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Arjan Koster
- Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Gutierrez-Barrios A, Cañadas-Pruaño D, Noval-Morillas I, Gheorghe L, Zayas-Rueda R, Calle-Perez G. Radiation protection for the interventional cardiologist: Practical approach and innovations. World J Cardiol 2022; 14:1-12. [PMID: 35126868 PMCID: PMC8788173 DOI: 10.4330/wjc.v14.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/06/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and medical staff. In recent years, radiation dose in cardiac catheterization interventions has become a topic of increasing interest in interventional cardiology and there is a strong interest in reducing radiation exposure during the procedures. This review presents the current status of radiation protection in the cardiac catheterization laboratory and summarizes a practical approach for radiation dose management for minimizing radiation exposure. This review also presents recent innovations that have clinical potential for reducing radiation during cardiac interventions.
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Affiliation(s)
| | | | | | - Livia Gheorghe
- Department of Cardiology, Hospital Puerta del Mar, Cadiz 11009, Spain
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12
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Efficacy of MAVIG X-Ray Protective Drapes in Reducing CTO Operator Radiation. J Interv Cardiol 2022; 2021:3146104. [PMID: 34987314 PMCID: PMC8692020 DOI: 10.1155/2021/3146104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background The MAVIG X-ray protective drape (MXPD) has been shown to reduce operator radiation dose during percutaneous coronary interventions (PCI). Whether MXPDs are also effective in reducing operator radiation during chronic total occlusion (CTO) PCI, often with dual access, is unknown. Methods We performed a prospective, randomized-controlled study comparing operator radiation dose during CTO PCI (n = 60) with or without pelvic MXPDs. The primary outcomes were the difference in first operator radiation dose (μSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the two groups. The effectiveness of MXPD in CTO PCI was compared with non-CTO PCI using a patient-level pooled analysis with a previously published non-CTO PCI randomized study. Results The use of the MXPD was associated with a 37% reduction in operator dose (weighted median dose 26.0 (IQR 10.00–29.47) μSv in the drape group versus 41.8 (IQR 30.82–60.59) μSv in the no drape group; P < 0.001) and a 60% reduction in relative operator dose (median dose 3.5 (IQR 2.5–5.4) E/DAPx10−3 in the drape group versus 8.6 (IQR 4.2–12.5) E/DAPx10−3 in the no drape group; P=0.001). MXPD was equally effective in reducing operator dose in CTO PCI compared with non-CTO PCI (P value for interaction 0.963). Conclusions The pelvic MAVIG X-ray protective drape significantly reduced CTO operator radiation dose. This trial is clinically registered with https://www.clinicaltrials.gov (unique identifier: NCT04285944).
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Olschewski M, Ullrich H, Brandt M, Steven S, Ahoopai M, Blessing R, Petrescu A, Wenzel P, Munzel T, Gori T. Effectiveness of a Real-Time X-ray Dosimetry Monitor in Reducing Radiation Exposure in Coronary Procedures: The ESPRESSO-Raysafe Randomized Trial. J Clin Med 2021; 10:jcm10225350. [PMID: 34830632 PMCID: PMC8621135 DOI: 10.3390/jcm10225350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background—Several methods to reduce radiation exposure in the setting of coronary procedures are available on the market, and we previously showed that additional radiation shields reduce operator exposure during radial interventions. We set out to examine the efficacy of real-time personal dosimetry monitoring in a real-world setting of radial artery catheterization. Methods and Results—In an all-comer prospective, parallel study, consecutive coronary diagnostic and intervention procedures were performed with the use of standard radiation shield alone (control group) or with the addition of a real-time dosimetry monitoring system (Raysafe, Billdal, Sweden, monitoring group). The primary outcome was the difference in exposure of the primary operator among groups. Additional endpoints included patient, nurse, second operator exposure and fluoroscopy time. A total of 700 procedures were included in the analysis (n = 369 in the monitoring group). There were no differences among groups in patients’ body mass index (p = 0.232), type of procedure (intervention vs. diagnostic, p = 0.172), and patient sex (p = 0.784). Fluoroscopy time was shorter in the monitoring group (5.6 (5.1–6.2) min vs. 7.0 (6.1–7.7) min, p = 0.023). Radiation exposure was significantly lower in the monitoring group for the patient (135 (115–151) µSv vs. 208 (176–245) µSv, p < 0.0001) but not for the first operator (9 (7–11) µSv vs. 10 (8–11), p = 0.70) and the assistant (2 (1–2) µSv vs. 2 (1–2) µSv, p = 0.121). Conclusions—In clinical daily practice, the use of a real-time dosimetry monitoring device reduces patient radiation exposure and fluoroscopy time without an effect on operator radiation exposure.
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14
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Fernandez R, Ellwood L, Barrett D, Weaver J. Safety and effectiveness of strategies to reduce radiation exposure to proceduralists performing cardiac catheterization procedures: a systematic review. JBI Evid Synth 2021; 19:4-33. [PMID: 32868713 DOI: 10.11124/jbisrir-d-19-00343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this systematic review was to synthesize the best available evidence on the effect of various radiation protection strategies on radiation dose received by proceduralists performing cardiac catheterization procedures involving fluoroscopy. INTRODUCTION Cardiac catheterization procedures under fluoroscopy are the gold standard diagnostic and treatment method for patients with coronary artery disease. The growing demand of procedures means that proceduralists are being exposed to increasing amounts of radiation, resulting in an increased risk of deterministic and stochastic effects. Standard protective strategies and equipment such as lead garments reduce radiation exposure; however, the evidence surrounding additional equipment is contradictory. INCLUSION CRITERIA Randomized controlled trials that compared the use of an additional radiation protection strategy with conventional radiation protection methods were considered for inclusion. The primary outcome of interest was the radiation dose received by the proceduralist during cardiac catheterization procedures. METHODS A three-step search was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library (CENTRAL). Trials published in the English language with adult participants were included. Trials published from database inception until July 2019 were eligible for inclusion. The methodological quality of the included studies was assessed using the JBI critical appraisal checklist for randomized controlled trials. Quantitative data were extracted from the included papers using the JBI data extraction tool. Results that could not be pooled in meta-analysis were reported in a narrative form. RESULTS Fifteen randomized controlled trials were included in the review. Six radiation protection strategies were assessed: leaded and unleaded pelvic or arm drapes, transradial protection board, remotely controlled mechanical contrast injector, extension tubing for contrast injection, real-time radiation monitor, and a reduction in frame rate to 7.5 frames per second. Pooled data from two trials demonstrated a statistically significant decrease in the mean radiation dose (P < 0.00001) received by proceduralists performing transfemoral cardiac catheterization on patients who received a leaded pelvic drape compared to standard protection. One trial that compared the use of unleaded pelvic drapes placed on patients compared to standard protection reported a statistically significant decrease (P = 0.004) in the mean radiation dose received by proceduralists.Compared to standard protection, two trials that used unleaded arm drapes for patients, one trial that used a remotely controlled mechanical contrast injector, and one trial that used a transradial protection board demonstrated a statistically significant reduction in the radiation dose received by proceduralists.Similarly, using a frame rate of 7.5 versus 15 frames per second and monitoring radiation dose in real-time radiation significantly lowered the radiation dose received by the proceduralist. One trial demonstrated no statistically significant difference in proceduralist radiation dose among those who used the extension tubing compared to standard protection (P = 1). CONCLUSIONS This review provides evidence to support the use of leaded pelvic drapes for patients as an additional radiation protection strategy for proceduralists performing transradial or transfemoral cardiac catheterization. Further studies on the effectiveness of using a lower fluoroscopy frame rate, real-time radiation monitor, and transradial protection board are needed.
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Affiliation(s)
- Ritin Fernandez
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia.,School of Nursing, University of Wollongong, Sydney, NSW, Australia
| | - Laura Ellwood
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia
| | - David Barrett
- Interventional Cardiology, St Andrews Private Hospital, Ipswich, QLD, Australia
| | - James Weaver
- Cardiology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
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15
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McCutcheon K, Vanhaverbeke M, Pauwels R, Dabin J, Schoonjans W, Bennett J, Adriaenssens T, Dubois C, Sinnaeve P, Desmet W. Efficacy of MAVIG X-Ray Protective Drapes in Reducing Operator Radiation Dose in the Cardiac Catheterization Laboratory: A Randomized Controlled Trial. Circ Cardiovasc Interv 2020; 13:e009627. [PMID: 33092401 DOI: 10.1161/circinterventions.120.009627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interventional cardiologists are occupationally exposed to high doses of ionizing radiation. The MAVIG X-ray protective drape (MXPD) is a commercially available light weight, lead-free shield placed over the pelvic area of patients to minimize operator radiation dose. The aim of this study was to examine the efficacy of the MXPD during routine cardiac catheterization, including percutaneous coronary interventions. METHODS We performed a prospective, randomized controlled study comparing operator radiation dose during cardiac catheterization and percutaneous coronary intervention (n=632) with or without pelvic MXPD. We measured operator radiation dose at 4 sites: left eye, chest, left ring finger, and right ring finger. The primary outcomes were the difference in first operator radiation dose (µSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the 2 groups. RESULTS The use of the MXPD was associated with a 50% reduction in operator radiation dose (median dose 30.5 [interquartile range, 23.0-39.7] µSv in no drape group versus 15.3 [interquartile range, 11.1-20.0] µSv in the drape group; P<0.001) and a 57% reduction in relative operator dose (P<0.001). The largest absolute reduction in dose was observed at the left finger (median left finger dose for the no drape group was 104.9 [75.7-137.4] µSv versus 41.9 [32.6-70.6] µSv in the drape group; P<0.001). CONCLUSIONS The pelvic MXPD significantly reduces first operator radiation dose during routine cardiac catheterization and percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04285944.
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Affiliation(s)
- Keir McCutcheon
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Maarten Vanhaverbeke
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Ruben Pauwels
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.)
| | - Jérémie Dabin
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Werner Schoonjans
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Johan Bennett
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Christophe Dubois
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Peter Sinnaeve
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Walter Desmet
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
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16
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Leistner DM, Schlender LS, Steiner J, Erbay A, Klotsche J, Schauerte P, Haghikia A, Rauch-Kröhnert U, Sinning D, Lauten A, Mochmann HC, Skurk C, Landmesser U, Stähli BE. A randomised comparison of monoplane versus biplane fluoroscopy in patients undergoing percutaneous coronary intervention: the RAMBO trial. EUROINTERVENTION 2020; 16:672-679. [PMID: 32392169 DOI: 10.4244/eij-d-20-00217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Interventional cardiologists are exposed to substantial occupational ionising radiation. This study sought to investigate differences in radiation exposure in biplane versus monoplane coronary angiography and percutaneous coronary interventions (PCI). METHODS AND RESULTS RAMBO (RAdiation exposure in Monoplane versus Biplane cOronary angiography and interventions) was a prospective, randomised, two-arm, single-centre, open-label trial, enrolling a total of 430 patients undergoing coronary angiography. Patients were randomly assigned to biplane or monoplane imaging. The primary efficacy measure, the operator radiation dose at the level of the left arm as measured by a wearable electronic dosimeter, was significantly higher in the biplane as compared to the monoplane group (4 [1-13] µSv vs 2 [0-6.8] µSv, p<0.001). The dose area product was 11,955 (7,095-18,246) mGy*cm2 and 8,349 (5,851-14,159) mGy*cm2 in the biplane and the monoplane groups, respectively (p<0.001). While fluoroscopy time did not differ between the groups (p=0.89), the amount of contrast medium was lower with biplane as compared with monoplane imaging (p<0.001). CONCLUSIONS Biplane imaging for coronary angiography and PCI is related to an increased radiation exposure for the interventional cardiologist as compared with monoplane imaging. Monoplane imaging should be considered for advanced radioprotection in cardiac catheterisation, with biplane imaging used for selected cases only.
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Affiliation(s)
- David M Leistner
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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17
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Anadol R, Brandt M, Merz N, Knorr M, Ahoopai M, Geyer M, Krompiec D, Wenzel P, Münzel T, Gori T. Effectiveness of additional X-ray protection devices in reducing scattered radiation in radial intervention: the ESPRESSO randomised trial. EUROINTERVENTION 2020; 16:663-671. [PMID: 32338611 DOI: 10.4244/eij-d-19-00945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS We aimed to examine the impact of three different radiation protection devices in a real-world setting of radial artery catheterisation. METHODS AND RESULTS In an all-comer randomised trial, consecutive coronary radial diagnostic and intervention procedures were assigned in a 1:1:1 ratio to shield-only protection (shield group), shield and overlapping 0.5 mm Pb panel curtain (shield+curtain group) or shield, curtain and additional 75x40 cm, 0.5 mm Pb drape placed across the waist of the patient (shield+curtain+drape group). A total of 614 radial procedures were randomised (n=193 shield, n=220 shield+curtain, n=201 shield+curtain+drape). There were no differences among the groups in patient or procedural characteristics. The primary endpoint (relative exposure ratio between the operators' exposure in μSv and the patient's exposure, dose area product in cGy·cm2) was significantly lower in the shield+curtain+drape group for both the first operator (20% reduction vs shield, 16% vs shield+curtain, p=0.025) and the assistant (39% reduction vs shield, 25% vs shield+curtain, p=0.009). CONCLUSIONS The use of an additional drape reduced the radiation exposure of both the first operator and the second operator during routine radial procedures; a shield-attached curtain alone was only partially effective. ClinicalTrials.gov identifier: NCT03634657
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Affiliation(s)
- Remzi Anadol
- Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin Mainz and DZHK Standort Rhein-Main, Mainz, Germany
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18
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Affiliation(s)
- Ariel Roguin
- 2 Hillel Yaffe Medical Centre, Technion - Israel Institute of Technology, Hadera, Israel
| | - James Nolan
- Department of Cardiology, Royal Stoke University Hospital and Keele University, Stoke-on-Trent, Staffordshire, UK
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19
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Arrivi A, Pucci G, Vaudo G, Bier N, Bock C, Casavecchia M, Bazzucchi M, Dominici M. Operators' radiation exposure reduction during cardiac catheterization using a removable shield. Cardiovasc Interv Ther 2020; 35:379-384. [PMID: 32034690 DOI: 10.1007/s12928-020-00646-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
Abstract
Cardiac catheterization through radial access is associated with significant ionizing radiation exposure for the operator. We aimed at evaluating whether a removable shield placed upon the patient could impact favorably on annual radiation exposure for the operator. We designed a pre-post study comparing radiation exposure in a total of five operators under standard protection procedures (first period) and after applying a removable shield (second period). Each period included all the procedures performed in 1 year. Radiation exposure was measured through three dosimeters on each operator. A total of 1610 procedures were performed during the first period, and 1670 during the second period. For each operator, Fluoroscopy Time (FT) per exam did not differ between the two periods (13.1 ± 1 vs 12.9 ± 2 min/exam, p = 0.73), whereas Dose-Area Product (DAP) per procedure was slightly higher in the second period (5.247 ± 651 vs 6.374 ± 967 mGy/cm2, p < 0.01). The use of a removable shield significantly reduced operators' radiation dose at the left bracelet (64.3 ± 13.3 μSv/exam vs 23.8 ± 6.0 μSv/exam, p = 0.003). This remained significant even after adjustment for DAP per procedure (p = 0.015) and number of operators participating to each procedure (p = 0.013), whereas no significant difference was observed for card (5.6 ± 10.5 μSv/exam vs 0.9 ± 0.3 μSv/exam, p = 0.36) and neck bands (3.3 ± 4.5 μSv/exam vs 2.0 ± 2.0 μSv/exam, p = 0.36) dosimeters. The use of a removable shield during cardiac catheterization reduces radiation exposure at the level of the operator's upper limb, whereas no difference was found for other body parts. This may help in reducing radiation exposure of operator's hand. DAP increase merits further investigation.
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Affiliation(s)
- Alessio Arrivi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - G Pucci
- Unit of Internal Medicine, "Santa Maria" University Hospital, Terni, Italy.,Department of Medicine, University of Perugia, Perugia, Italy
| | - G Vaudo
- Unit of Internal Medicine, "Santa Maria" University Hospital, Terni, Italy.,Department of Medicine, University of Perugia, Perugia, Italy
| | - N Bier
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - C Bock
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - M Casavecchia
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - M Bazzucchi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - M Dominici
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy.,Department of Medicine, University of Perugia, Perugia, Italy
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20
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Khaleghi Fard A, Alian AHM, Pourafkari L, Ghojazadeh M, Tarighatnia A, Farajollahi A. IMPACT OF PELVIC AND RAD-BOARD LEAD SHIELDS ON OPERATOR AND PATIENT RADIATION DOSE IN TRANS-RADIAL CORONARY PROCEDURES. RADIATION PROTECTION DOSIMETRY 2019; 187:108-114. [PMID: 31135929 DOI: 10.1093/rpd/ncz147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 04/19/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Trans-radial approach for cardiac catheterisation procedures has long been associated with high operator and patient radiation dose. The aim of the present study was to determine the effect of pelvic and radial shields on decreasing coronary procedure radiation doses. METHODS A total of 418 patients randomly underwent diagnostic and therapeutic cardiac procedures with and without the pelvic and rad-board lead shields during the procedures. The operator and patient doses were then determined by means of a personal dosimeter and dose area product (DAP), respectively. RESULTS The shields decreased the operator radiation dose by 40% in coronary angiography (CA) and by 45% during angioplasty (PCI). These results were achieved at the cost of increased patient radiation dose. CONCLUSION Pelvic lead shields combined with rad-board shields are highly effective in reducing operator radiation dose in trans-radial approach, but it is only achieved at the cost of increased patient DAP.
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Affiliation(s)
- Aida Khaleghi Fard
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Faculty of Medicine, Department of Medical Physics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Anesthesiology Department, University of Buffalo, Buffalo, USA
| | - Morteza Ghojazadeh
- Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Tarighatnia
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Faculty of Medicine, Department of Medical Physics, Tabriz University of Medical Sciences, Tabriz, Iran
- Interventional Cardiology Unit, Aalinasab Hospital, Tabriz, Iran
| | - Alireza Farajollahi
- Faculty of Medicine, Department of Medical Physics, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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Aquino A, Khiabani AJ, Henn MC, Zajarias A, Melby SJ, Sintek M, Lasala J, Kachroo P, Novak E, Maniar HS. Radiation Exposure During Transcatheter Valve Replacement: What Cardiac Surgeons Need to Know. Ann Thorac Surg 2019; 109:118-122. [PMID: 31288016 DOI: 10.1016/j.athoracsur.2019.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve replacement expose operators to radiation. These procedures differ primarily in whether they are performed via a transfemoral (TF) or an alternative access (AA) approach. This study compared operator radiation exposure during transcatheter valve implantation when performed via a TF vs an AA approach, when performed in a catheterization lab vs a hybrid operating room (OR), and investigated the potential benefit of disposable shielding. METHODS Dosimeters were worn during TAVR-TF (n = 50) and TAVR-AA (n = 31) procedures by operators. All TAVR-AA procedures were performed in a hybrid OR and TF procedures were performed in either catheterization labs (n = 16) or a hybrid OR (n = 34). Disposable radiation shielding pads (RADPAD; Worldwide Innovations and Technologies, Inc, Kansas City) or a placebo were added in a randomized, blinded fashion. RESULTS Team radiation exposure was higher after TAVR-AA vs TAVR-TF (median 15.1 mRad [interquartile range: IQR 8.6, 32.4] vs 5.5 mRad [IQR 2.4, 9.8], P < .001). TAVR-TF procedures required the same amount of fluoroscopy time regardless of where they were performed (20.3 ± 7.4 min in hybrid OR vs 19.0 ± 6.4 min in catheterization lab, P = .55). However, radiation exposure for TAVR-TF remained higher when performed in a hybrid OR (median 9.0 mRad [IQR 4.5, 11.9] vs 2.2 mRad [IQR 1.3, 2.8], P < .001). Radiation exposure was greatest for TAVR-AA (median 15.1 mRad [IQR 8.6, 32.4]). The use of RADPAD did not decrease radiation exposure (median 9.0 mRad [IQR 4.5, 14.7] vs 9.4 mRad [IQR 2.8, 19.5], P = .82). CONCLUSIONS Procedures performed in the hybrid OR were associated with higher operator radiation exposure. In comparison with the TF approach, AA cases had the highest levels of operator radiation. This is particularly important in cases of transcatheter mitral valve replacement that can only be done via an AA approach. The use of disposable radiation shielding in this series did not attenuate operator radiation exposure. Radiation shielding within hybrid ORs should be scrutinized in an effort to remain on par with that found within catheterization labs.
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Affiliation(s)
- Alejandro Aquino
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Ali J Khiabani
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Matthew C Henn
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Alan Zajarias
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Spencer J Melby
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Marc Sintek
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - John Lasala
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Eric Novak
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Hersh S Maniar
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri.
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22
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Anadol R, Brandt M, Merz N, Knorr M, Ahoopai M, Geyer M, Krompiec D, Wenzel P, Münzel T, Gori T. Effectiveness of additional X-ray protection devices in reducing Scattered radiation in radial interventions: protocol of the ESPRESSO randomised trial. BMJ Open 2019; 9:e029509. [PMID: 31272982 PMCID: PMC6615829 DOI: 10.1136/bmjopen-2019-029509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A number of devices have been developed to minimise operator radiation exposure in the setting of cardiac catheterisation. The effectiveness of these devices has traditionally been explored in transfemoral coronary procedures; however, less is known for the transradial approach. We set out to examine the impact of three different radiation protection devices in a real-world setting. METHODS AND DESIGN Consecutive coronary diagnostic and intervention procedures are randomised in a 1:1:1 ratio to a shield-only protection (shield group), shield and overlapping 0.5 mm Pb panel curtain (curtain group) or shield, curtain and additional 75×40 cm, 0.5 mm Pb drape placed across the waist of the patient (drape group).The primary outcome is the difference in relative exposure of the primary operator among groups. Relative exposure is defined as the ratio between operator's exposure (E in μSv) and patient exposure (dose area product in cGy·cm2). ETHICS AND DISSEMINATION The protocol complies with good clinical practice and the ethical principles described in the Declaration of Helsinki and is approved by the local ethics committee. The results of the trial will be published as original article(s) in medical journals and/or as presentation at congresses. TRIAL REGISTRATION NUMBER NCT03634657.
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Affiliation(s)
- Remzi Anadol
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
- DZHK, Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Moritz Brandt
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Nico Merz
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Majid Ahoopai
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Martin Geyer
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Damian Krompiec
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Phillip Wenzel
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
- DZHK, Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Tommaso Gori
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
- DZHK, Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
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Patet C, Ryckx N, Arroyo D, Cook S, Goy J. Efficacy of the SEPARPROCATH® radiation drape to reduce radiation exposure during cardiac catheterization: A pilot comparative study. Catheter Cardiovasc Interv 2019; 94:387-391. [DOI: 10.1002/ccd.28130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/25/2018] [Accepted: 01/20/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Camille Patet
- Department of CardiologyUniversity and Hospital of Fribourg Fribourg Switzerland
| | - Nick Ryckx
- Department of Radiation PhysicsLausanne University Hospital Lausanne Switzerland
| | - Diego Arroyo
- Department of CardiologyUniversity and Hospital of Fribourg Fribourg Switzerland
| | - Stéphane Cook
- Department of CardiologyUniversity and Hospital of Fribourg Fribourg Switzerland
| | - Jean‐Jacques Goy
- Department of CardiologyUniversity and Hospital of Fribourg Fribourg Switzerland
- Department of CardiologyClinique Cecil, Hirslanden AG Lausanne Switzerland
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Shah P, Khanna R, Kapoor A, Goel PK. Efficacy of RADPAD protection drape in reducing radiation exposure in the catheterization laboratory-First Indian study. Indian Heart J 2018; 70 Suppl 3:S265-S268. [PMID: 30595271 PMCID: PMC6310698 DOI: 10.1016/j.ihj.2018.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/15/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Occupational radiation exposureis a growing problem due to increasing number and complexity of interventional procedures.The RADPAD is a lead-free sterile drape containing bismuth and barium that reduces scatter radiation during fluoroscopic procedures. We aimed to study the radiation exposure reduction to operators with the use of RADPAD and also measureradiation doses in different angiographic projections. METHODS 65 randomly selected patients undergoing elective complex percutaneous coronary intervention (PCI) procedures from January 2017 to 2017 were randomized in a 1:1 pattern with or without the RADPAD. Primary endpoint was the ratio of operator received dose in mrem to total radiation in Gyat the end of the procedure which was designated ''Relative operator exposure'', with or without RADPAD. RESULTS Despite similar fluoroscopy times (20.4 ± 9.4 min with RADPAD vs. 19.4 ± 9.2 min without RADPAD, P = 0.871) and total radiation dose (3.4 ± 4.3 Gy with RADPAD vs. 2.3 ± 1.4 Gy, P = 0.198), the relative operator exposure was significantly less with RADPAD (1.39 ± 0.95) as compared to no RADPAD group (2.27 ± 1.4) (p = 0.004) amounting to a 39% reduction. Additionally mean radiation dose per shoot of recorded Left anterior oblique (LAO) oriented projections was 34.4 ± 15.7mGyvs 24.9 ± 12.9 mGy for a non LAO oriented projection. (p < 0.001). CONCLUSION RADPAD significantly reduces radiation exposure to the primary operator during prolonged complex PCI procedures. Further, amongst all views, LAO views have significantly higher emitted radiation as compared to Non LAO views and need more radiation protection.
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Dabin J, Maeremans J, Berus D, Schoonjans W, Tamborino G, Dens J, Kayaert P. DOSIMETRY DURING PERCUTANEOUS CORONARY INTERVENTIONS OF CHRONIC TOTAL OCCLUSIONS. RADIATION PROTECTION DOSIMETRY 2018; 181:120-128. [PMID: 29351645 DOI: 10.1093/rpd/ncx303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/24/2017] [Indexed: 06/07/2023]
Abstract
Percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) increase the risk of high radiation exposure for both the patient and the cardiologist. This study evaluated the maximum dose to the patients' skin (MSD) and the exposure of the cardiologists during CTO-PCI. Moreover, the efficiency of radioprotective drapes to reduce cardiologist exposure was assessed. Patient dose was measured during 31 procedures; dose to the cardiologist's extremities were measured during 65 procedures, among which 31 were performed with radioprotective drapes. The MSD was high (median: 1254 mGy; max: 6528 mGy), and higher than 2 Gy for 33% of the patients. The dose to the cardiologists' extremities per procedure was also of concern (median: 25-465 μSv), particularly to the left eye (median: 68 μSv; max: 187 μSv). Radioprotective drapes reduced the exposure to physician's upper limbs and eyes; especially to the left side (from -28 to -49%).
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Affiliation(s)
- Jérémie Dabin
- Research in Dosimetric Application, Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, Mol, Belgium
| | - Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Martelarenlaan 42, Hasselt, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk, Belgium
| | - Danielle Berus
- Radiation Protection Department, Vrije Universiteit Brussel and UZ Brussel, Laarbeeklaan 103, Brussels, Belgium
| | - Werner Schoonjans
- Research in Dosimetric Application, Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, Mol, Belgium
| | - Giulia Tamborino
- Research in Dosimetric Application, Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, Mol, Belgium
| | - Jo Dens
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Martelarenlaan 42, Hasselt, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk, Belgium
| | - Peter Kayaert
- Department of Cardiology, UZ Brussel, Laarbeeklaan 103, Brussels, Belgium
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26
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Marcusohn E, Postnikov M, Musallam A, Yalonetsky S, Mishra S, Kerner A, Poliakov A, Roguin A. Usefulness of Pelvic Radiation Protection Shields During Transfemoral Procedures-Operator and Patient Considerations. Am J Cardiol 2018; 122:1098-1103. [PMID: 30057233 DOI: 10.1016/j.amjcard.2018.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022]
Abstract
Interventional cardiologists are increasingly exposed to radiation-induced hazards. The MAVIG shield is a lead-free drape and the RADPAD is a sterile, disposable, and lead-free shield, placed on the patient with the aim to minimize operator-received scatter radiation. The objective of the trial was to examine their efficacy in a real-world situation. We randomized 125 patients who underwent coronary procedures from the right femoral artery into 3 groups: Control group (n = 48 [39%]) without additional protection, MAVIG lead shield (n = 38 [30%]) and RADPAD shield (n = 39 [31%]). Multiple radiation dosimeters were used in each case. All 3 groups were with similar baseline and procedural characteristics. Fluoroscopy time and number of views were similar in all 3 study groups. Compared with the standard (no shield) protection [3.5 ± 5.57 mSv], the scatter radiation was reduced by a factor of 5 for the MAVIG group [0.46 ± 1.6 mSv and p = 0.001] and a factor of 4 for the RADPAD group [1.16 ± 2.29 mSv and p = 0.01]. The physician's radiation decreased with the 2 shields, but only the MAVIG shield showed statistically significant lower radiation: 0.49 ± 0.42 mSv in the standard group versus 0.26 ± 0.3 mSv in the MAVIG and 0.35 ± 0.44 mSv in the RADPAD (p = 0.135 for RADPAD and p = 0.005 for MAVIG). Patient's exposure was statistically similar to the control group. Although numerically there was an increase in radiation with the RADPAD and decrease with the MAVIG. CONCLUSIONS Our study found no statistically increase in patient radiation while the operator's radiation exposure was reduced. Decreasing scatter radiation can be done effectively using simple measurements and is of major importance.
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27
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Kohlbrenner R, Lehrman ED, Taylor AG, Kohi MP, Fidelman N, Kumar V, Conrad M, Kolli KP. Operator Dose Reduction during Transjugular Liver Biopsy Using a Radiation-Attenuating Drape: A Prospective, Randomized Study. J Vasc Interv Radiol 2018; 29:1248-1253. [DOI: 10.1016/j.jvir.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/26/2022] Open
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Prevention of Contrast and Radiation Injury During Coronary Angiography and Percutaneous Coronary Intervention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:32. [DOI: 10.1007/s11936-018-0621-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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29
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McNeice AH, Brooks M, Hanratty CG, Stevenson M, Spratt JC, Walsh SJ. A retrospective study of radiation dose measurements comparing different cath lab X-ray systems in a sample population of patients undergoing percutaneous coronary intervention for chronic total occlusions. Catheter Cardiovasc Interv 2018; 92:E254-E261. [DOI: 10.1002/ccd.27541] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew H. McNeice
- Department of Cardiology; Belfast Health and Social Care Trust, c/o Level 9, Belfast City Hospital, Lisburn Road; Belfast BT9 7AB Northern Ireland
| | - Matthew Brooks
- Department of Cardiology; Edinburgh Royal Infirmary; Edinburgh, Scotland
| | - Colm G. Hanratty
- Department of Cardiology; Belfast Health and Social Care Trust, c/o Level 9, Belfast City Hospital, Lisburn Road; Belfast BT9 7AB Northern Ireland
| | - Michael Stevenson
- Department of Epidemiology & Public Health; Queen's University, University Road; Belfast Northern Ireland
| | - James C. Spratt
- Department of Cardiology; Edinburgh Royal Infirmary; Edinburgh, Scotland
- Forth Valley Hospital; Larbert Scotland
| | - Simon J. Walsh
- Department of Cardiology; Belfast Health and Social Care Trust, c/o Level 9, Belfast City Hospital, Lisburn Road; Belfast BT9 7AB Northern Ireland
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30
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Smith JR, Marsh RM, Silosky MS. Is lead shielding of patients necessary during fluoroscopic procedures? A study based on kyphoplasty. Skeletal Radiol 2018; 47:37-43. [PMID: 28821928 DOI: 10.1007/s00256-017-2756-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the benefits, risks, and limitations associated with wrapping a patient with lead shielding during fluoroscopy-guided kyphoplasty procedures as a way to reduce operator radiation exposure. MATERIALS AND METHODS An anthropomorphic phantom was used to mimic a patient undergoing a kyphoplasty procedure under fluoroscopic guidance. Radiation measurements of the air kerma rate (AKR) were made at several locations and under various experimental conditions. First, AKR was measured at various angles along the horizontal plane of the phantom and at varying distances from the phantom, both with and without a lead apron wrapped around the lower portion of the phantom (referred to here as phantom shielding). Second, the effect of an operator's apron was simulated by suspending a lead apron between the phantom and the measurement device. AKR was measured for the four shielding conditions-phantom shielding only, operator apron only, both phantom shielding and operator apron, and no shielding. Third, AKR measurements were made at various heights and with varying C-arm angle. RESULTS At all locations, the phantom shielding provided no substantial protection beyond that provided by an operator's own lead apron. Phantom shielding did not reduce AKR at a height comparable to that of an operator's head. CONCLUSIONS Previous reports of using patient shielding to reduce operator exposure fail to consider the role of an operator's own lead apron in radiation protection. For an operator wearing appropriate personal lead apparel, patient shielding provides no substantial reduction in operator dose.
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Affiliation(s)
- Joshua R Smith
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA
| | - Rebecca M Marsh
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA.
| | - Michael S Silosky
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA
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31
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Ting CY, Wu WS, Tang KT, Wang HE, Lin CC. Evaluation of radiation dose during the percutaneous angioplasty for arteriovenous shunt assembling. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vlastra W, Delewi R, Sjauw KD, Beijk MA, Claessen BE, Streekstra GJ, Bekker RJ, van Hattum JC, Wykrzykowska JJ, Vis MM, Koch KT, de Winter RJ, Piek JJ, Henriques JP. Efficacy of the RADPAD Protection Drape in Reducing Operators’ Radiation Exposure in the Catheterization Laboratory. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.006058. [DOI: 10.1161/circinterventions.117.006058] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/15/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Wieneke Vlastra
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Ronak Delewi
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Krischan D. Sjauw
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Marcel A. Beijk
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Bimmer E. Claessen
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Geert J. Streekstra
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Robbert J. Bekker
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Juliette C. van Hattum
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Joanna J. Wykrzykowska
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Marije M. Vis
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Karel T. Koch
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Robbert J. de Winter
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Jan J. Piek
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - José P.S. Henriques
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
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Ordiales JM, Nogales JM, Vano E, López-Mínguez JR, Alvarez FJ, Ramos J, Martínez G, Sánchez RM. Occupational dose reduction in cardiac catheterisation laboratory: a randomised trial using a shield drape placed on the patient. RADIATION PROTECTION DOSIMETRY 2017; 174:255-261. [PMID: 27247448 DOI: 10.1093/rpd/ncw139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/11/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the occupational radiation dose in interventional cardiology by using a shielding drape on the patient. A random study with and without the protective material was conducted. The following control parameters were registered: demographic data, number of stents, contrast media volume, fluoroscopy time, number of cine images, kerma-area product and cumulative air kerma. Occupational dose data were obtained by electronic active dosemeters. No statistically significant differences in the analysed control parameters were registered. The median dose value received by the interventional cardiologist was 50% lower in the group with a shielding drape with a statistically significant p-value <0.001. In addition, the median value of the maximum scatter radiation dose was 31% lower in this group with a statistically significant p-value <0.001. This study showed that a shielding drape is a useful tool for reducing the occupational radiation dose in a cardiac catheterisation laboratory.
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Affiliation(s)
- J M Ordiales
- Medical Physics Department, Hospital de Mérida, Mérida, Spain
- Sensory Systems Research Group, University of Extremadura, Badajoz, Spain
| | - J M Nogales
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - E Vano
- Medical Physics Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - J R López-Mínguez
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - F J Alvarez
- Sensory Systems Research Group, University of Extremadura, Badajoz, Spain
- Department Electrical Engineering, Electronics and Automation, University of Extremadura Badajoz, Spain
| | - J Ramos
- Medical Physics Department, Hospital de Mérida, Mérida, Spain
| | - G Martínez
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital de Mérida, Mérida, Spain
| | - R M Sánchez
- Medical Physics Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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Monzen H, Tamura M, Shimomura K, Onishi Y, Nakayama S, Fujimoto T, Matsumoto K, Hanaoka K, Kamomae T. A novel radiation protection device based on tungsten functional paper for application in interventional radiology. J Appl Clin Med Phys 2017; 18:215-220. [PMID: 28422397 PMCID: PMC5689848 DOI: 10.1002/acm2.12083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/17/2017] [Accepted: 02/17/2017] [Indexed: 11/11/2022] Open
Abstract
Tungsten functional paper (TFP), which contains 80% tungsten by weight, has radiation‐shielding properties. We investigated the use of TFP for the protection of operators during interventional or therapeutic angiography. The air kerma rate of scattered radiation from a simulated patient was measured, with and without TFP, using a water‐equivalent phantom and fixed C‐arm fluoroscopy. Measurements were taken at the level of the operator's eye, chest, waist, and knee, with a variable number of TFP sheets used for shielding. A Monte Carlo simulation was also utilized to analyze the dose rate delivered with and without the TFP shielding. In cine mode, when the number of TFP sheets was varied through 1, 2, 3, 5, and 10, the respective reduction in the air kerma rate relative to no TFP shielding was as follows: at eye level, 24.9%, 29.9%, 41.6%, 50.4%, and 56.2%; at chest level, 25.3%, 33.1%, 34.9%, 46.1%, and 44.3%; at waist level, 45.1%, 57.0%, 64.4%, 70.7%, and 75.2%; and at knee level, 2.1%, 2.2%, 2.1%, 2.1%, and 2.1%. In fluoroscopy mode, the respective reduction in the air kerma rate relative to no TFP shielding was as follows: at eye level, 24.8%, 30.3%, 34.8%, 51.1%, and 58.5%; at chest level, 25.8%, 33.4%, 35.5%, 45.2%, and 44.4%; at waist level, 44.6%, 56.8%, 64.7%, 71.7%, and 77.2%; and at knee level, 2.2%, 0.0%, 2.2%, 2.8%, and 2.5%. The TFP paper exhibited good radiation‐shielding properties against the scattered radiation encountered in clinical settings, and was shown to have potential application in decreasing the radiation exposure to the operator during interventional radiology.
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Affiliation(s)
- Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, Osakasayama, 589-8511, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, Osakasayama, 589-8511, Japan.,Clinical Radiology Service Division, Kindai University Hospital, Osakasayama, 589-8511, Japan
| | - Kohei Shimomura
- Clinical Radiology Service Division, Kindai University Hospital, Osakasayama, 589-8511, Japan
| | - Yuichi Onishi
- Division of Clinical Radiology Service, Okayama Central Hospital, Okayama, 700-0017, Japan
| | - Shinichi Nakayama
- Division of Clinical Radiology Service, Okayama Central Hospital, Okayama, 700-0017, Japan
| | - Takahiro Fujimoto
- Clinical Radiology Service Division, Kyoto University Hospital, Kyoto, 606-8507, Japan
| | - Kenji Matsumoto
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, Osakasayama, 589-8511, Japan.,Clinical Radiology Service Division, Kindai University Hospital, Osakasayama, 589-8511, Japan
| | - Kohei Hanaoka
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, Osakasayama, 589-8511, Japan.,Clinical Radiology Service Division, Kindai University Hospital, Osakasayama, 589-8511, Japan
| | - Takeshi Kamomae
- Department of Therapeutic Radiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
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35
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Efficacy of RADPAD protective drape during coronary angiography. Herz 2017; 43:310-314. [DOI: 10.1007/s00059-017-4560-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 12/22/2022]
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36
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Miller TR, Zhuo J, Jindal G, Shivashankar R, Beaty N, Gandhi D. The Efficacy of Shielding Systems for Reducing Operator Exposure during Neurointerventional Procedures: A Real-World Prospective Study. AJNR Am J Neuroradiol 2017; 38:450-454. [PMID: 28007766 DOI: 10.3174/ajnr.a5038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neurointerventional surgery may expose patients and physician operators to substantial amounts of ionizing radiation. Although strategies for reducing patient exposure have been explored in the medical literature, there has been relatively little published in regards to decreasing operator exposure. The purpose of this study was to evaluate the efficacy of shielding systems in reducing physician exposure in a modern neurointerventional practice. MATERIALS AND METHODS Informed consent was obtained from operators for this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study. Operator radiation exposure was prospectively measured during 60 consecutive neurointerventional procedures from October to November 2013 using a 3-part lead shielding system. Exposure was then evaluated without lead shielding in a second 60-procedure block from April to May 2014. A radiation protection drape was randomly selected for use in half of the cases in each block. Two-way analysis of covariance was performed to test the effect of shielding systems on operator exposure while controlling for other covariates, including procedure dose-area product. RESULTS Mean operator procedure dose was 20.6 μSv for the entire cohort and 17.7 μSv when using some type of shielding. Operator exposure significantly correlated with procedure dose-area product, but not with other covariates. After we adjusted for procedure dose-area product, the use of lead shielding or a radiation protection drape significantly reduced operator exposure by 45% (F = 12.54, P < .0001) and 29% (F = 7.02, P = .009), respectively. The difference in protection afforded by these systems was not statistically significant (P = .46), and their adjunctive use did not provide additional protection. CONCLUSIONS Extensive lead shielding should be used as much as possible in neurointerventional surgery to reduce operator radiation exposure to acceptable levels. A radiation protection drape is a reasonable alternative when standard lead shielding is unavailable or impractical to use without neglecting strategies to minimize the dose.
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Affiliation(s)
- T R Miller
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - J Zhuo
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - G Jindal
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - R Shivashankar
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - N Beaty
- Neurosurgery (N.B.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Gandhi
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
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Abstract
OBJECTIVE The purposes of this article are to review available data regarding the range of protection devices and garments with a focus on eye protection and to summarize techniques for reducing scatter radiation exposure. CONCLUSION Fluoroscopy operators and staff can greatly reduce their radiation exposure by wearing properly fitted protective garments, positioning protective devices to block scatter radiation, and adhering to good radiation practices. By understanding the essentials of radiation physics, protective equipment, and the features of each imaging system, operators and staff can capitalize on opportunities for radiation protection while minimizing ergonomic strain. Practicing and promoting a culture of radiation safety can help fluoroscopy operators and staff enjoy long, productive careers helping patients.
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Christopoulos G, Papayannis AC, Alomar M, Christakopoulos GE, Kotsia A, Michael TT, Rangan BV, Roesle M, Shorrock D, Makke L, Maragkoudakis S, Mohammad A, Sarode K, Chambers CE, Banerjee S, Brilakis ES. Determinants of operator and patient radiation exposure during cardiac catheterization: Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial. Catheter Cardiovasc Interv 2015; 88:1046-1055. [DOI: 10.1002/ccd.26341] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/08/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Georgios Christopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Mohammed Alomar
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Anna Kotsia
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Tesfaldet T. Michael
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Michele Roesle
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Deborah Shorrock
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Lorenza Makke
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Spyros Maragkoudakis
- Department of Cardiovascular Diseases, University of Heraklion; Heraklion Greece
| | - Atif Mohammad
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Karan Sarode
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
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39
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Radiation-Induced Cataractogenesis: A Critical Literature Review for the Interventional Radiologist. Cardiovasc Intervent Radiol 2015; 39:151-60. [DOI: 10.1007/s00270-015-1207-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
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40
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Gilligan P, Lynch J, Eder H, Maguire S, Fox E, Doyle B, Casserly I, McCann H, Foley D. Assessment of clinical occupational dose reduction effect of a new interventional cardiology shield for radial access combined with a scatter reducing drape. Catheter Cardiovasc Interv 2015; 86:935-40. [DOI: 10.1002/ccd.26009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/11/2015] [Accepted: 04/11/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Paddy Gilligan
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - J. Lynch
- School of Physics, Dublin Institute of Technology; Dublin 8 Ireland
| | - H. Eder
- Department for Radiation Protection; Bavarian Office for Occupational Health and Safety; München Germany
| | - S. Maguire
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - E. Fox
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - B. Doyle
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - I. Casserly
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - H. McCann
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
| | - D. Foley
- Department of Diagnostic Imaging; Mater Private Hospital; Dublin 7 Ireland
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Muniraj T, Aslanian HR, Laine L, Farrell J, Ciarleglio MM, Deng Y, Ho H, Jamidar PA. A double-blind, randomized, sham-controlled trial of the effect of a radiation-attenuating drape on radiation exposure to endoscopy staff during ERCP. Am J Gastroenterol 2015; 110:690-6. [PMID: 25823765 DOI: 10.1038/ajg.2015.85] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/17/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Endoscopic retrograde cholangiopancreatography (ERCP) is associated with radiation exposure to the endoscopist and staff that may be significant in high-volume centers. We investigated whether a radiation-attenuating drape over the fluoroscopy image intensifier reduces radiation exposure during ERCP. METHODS We performed a prospective, randomized, double-blind trial of 100 therapeutic ERCPs at a tertiary-care university center. Procedures were randomly assigned to groups receiving lead-free radiation-attenuating drapes (n=50) or identical sham drapes (n=50). The drapes were suspended around the fluoroscopy image intensifier during ERCP. The primary end point was the effective dose of radiation measured at the endoscopist's eye and neck, and at the assisting nurse's neck. The cumulative annual radiation exposure was also estimated. RESULTS Fluoroscopy time, absorbed radiation dose, and dose area product were similar in the study groups. Mean effective dose for sham vs. radiation-attenuating drape was 0.21±0.27 vs. 0.02±0.02 mSv at the endoscopist's eye, 0.35±0.44 vs. 0.03±0.03 mSv at the endoscopist's neck, and 0.27±0.34 vs. 0.02±0.02 mSv at the nurse's neck (P<0.0001 for all comparisons). The relative risk reduction in radiation was 90%, 91%, and 93% at the three sites. At a high-volume center in which an endoscopist performs 500 therapeutic ERCPs per year, the estimated cumulative annual effective dose at the endoscopist's eye level is 126 mSv with conventional protection and 12 mSv with a radiation-attenuating drape, with the recommended limit being 20 mSv. CONCLUSIONS The addition of a radiation-attenuating drape around the image intensifier during ERCP significantly decreases radiation exposure to endoscopists and staff by ∼90%.
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Affiliation(s)
| | - Harry R Aslanian
- Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut, USA
| | - Loren Laine
- 1] Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut, USA [2] VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - James Farrell
- Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut, USA
| | - Maria M Ciarleglio
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Henry Ho
- Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut, USA
| | - Priya A Jamidar
- Section of Digestive Disease, Yale School of Medicine, New Haven, Connecticut, USA
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Musallam A, Volis I, Dadaev S, Abergel E, Soni A, Yalonetsky S, Kerner A, Roguin A. A randomized study comparing the use of a pelvic lead shield during trans-radial interventions: Threefold decrease in radiation to the operator but double exposure to the patient. Catheter Cardiovasc Interv 2015; 85:1164-70. [DOI: 10.1002/ccd.25777] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/29/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Anees Musallam
- Department of Cardiology; Rambam Medical Center; Haifa Israel
| | - Ina Volis
- Technion, Faculty of Medicine; Haifa Israel
| | - Svetlana Dadaev
- Department of Cardiology; Rambam Medical Center; Haifa Israel
| | - Eitan Abergel
- Department of Cardiology; Rambam Medical Center; Haifa Israel
| | - Amit Soni
- Department of Cardiology; Rambam Medical Center; Haifa Israel
| | - Sergey Yalonetsky
- Department of Cardiology; Rambam Medical Center; Haifa Israel
- Technion, Faculty of Medicine; Haifa Israel
| | - Arthur Kerner
- Department of Cardiology; Rambam Medical Center; Haifa Israel
- Technion, Faculty of Medicine; Haifa Israel
| | - Ariel Roguin
- Department of Cardiology; Rambam Medical Center; Haifa Israel
- Technion, Faculty of Medicine; Haifa Israel
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Sailer AM, Schurink GWH, Bol ME, de Haan MW, van Zwam WH, Wildberger JE, Jeukens CRLPN. Occupational Radiation Exposure During Endovascular Aortic Repair. Cardiovasc Intervent Radiol 2014; 38:827-32. [PMID: 25476871 DOI: 10.1007/s00270-014-1025-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/23/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study was to evaluate the radiation exposure to operating room personnel and to assess determinants for high personal doses during endovascular aortic repair. MATERIALS AND METHODS Occupational radiation exposure was prospectively evaluated during 22 infra-renal aortic repair procedures (EVAR), 11 thoracic aortic repair procedures (TEVAR), and 11 fenestrated or branched aortic repair procedures (FEVAR). Real-time over-lead dosimeters attached to the left breast pocket measured personal doses for the first operators (FO) and second operators (SO), radiology technicians (RT), scrub nurses (SN), anesthesiologists (AN), and non-sterile nurses (NSN). Besides protective apron and thyroid collar, no additional radiation shielding was used. Procedural dose area product (DAP), iodinated contrast volume, fluoroscopy time, patient's body weight, and C-arm angulation were documented. RESULTS Average procedural FO dose was significantly higher during FEVAR (0.34 ± 0.28 mSv) compared to EVAR (0.11 ± 0.21 mSv) and TEVAR (0.06 ± 0.05 mSv; p = 0.003). Average personnel doses were 0.17 ± 0.21 mSv (FO), 0.042 ± 0.045 mSv (SO), 0.019 ± 0.042 mSv (RT), 0.017 ± 0.031 mSv (SN), 0.006 ± 0.007 mSv (AN), and 0.004 ± 0.009 mSv (NSN). SO and AN doses were strongly correlated with FO dose (p = 0.003 and p < 0.001). There was a significant correlation between FO dose and procedural DAP (R = 0.69, p < 0.001), iodinated contrast volume (R = 0.67, p < 0.001) and left-anterior C-arm projections >60° (p = 0.02), and a weak correlation with fluoroscopy time (R = 0.40, p = 0.049). CONCLUSION Average FO dose was a factor four higher than SO dose. Predictors for high personal doses are procedural DAP, iodinated contrast volume, and left-anterior C-arm projections greater than 60°.
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Affiliation(s)
- Anna M Sailer
- Department of Radiology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands,
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Dixon S, Schick D, Harper J. Radiation protection methods for the interventionalist's hands: use of an extension tube. Cardiovasc Intervent Radiol 2014; 38:463-9. [PMID: 24798133 DOI: 10.1007/s00270-014-0893-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/06/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Cumulative radiation exposure to the hands during certain interventional procedures may be high. It is important to decrease the amount of radiation to the operator due to the possibility of deterministic effects. We performed a pilot study to demonstrate a significant decrease in operator dose when using extension tubing (ET) in combination with shielding and collimation during a simulated percutaneous transhepatic cholangiogram (PTC) procedure. METHODS A whole body, anthropomorphic phantom was used to simulate the patient. A Unfors-Xi Survey detector (to measure scatter) supported by a retort stand and trolley was placed in various positions to simulate the position of hands and eyes/thyroid of an interventionalist. Radiation dose was measured simulating left and right-sided PTC punctures with and without a lead shield, and with and without ET. RESULTS Regarding the radiation dose to the hands; the use of an ET reduces dose by 54 % in right-sided PTC punctures without a shield and by 91 % if used in combination with a shield. For left-sided PTC punctures, ET reduces hand dose by 75 %. The use of collimation decreases hand dose by approximately 60 %. The use of shielding reduces dose to the eyes/thyroid by 98 %. CONCLUSIONS The dose to the hands can be significantly reduced with the appropriate use of a shield, ET, and tight collimation. The use of a shield is paramount to reduce dose to the eyes/thyroid. It is important for interventionalists to adhere to radiation protective practice considering the potential deterministic effects during a lifelong career.
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Affiliation(s)
- Shaheen Dixon
- Department of Interventional Radiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia,
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45
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Liu H, Jin Z, Jing L. Comparison of radiation dose to operator between transradial and transfemoral coronary angiography with optimised radiation protection: a phantom study. RADIATION PROTECTION DOSIMETRY 2014; 158:412-420. [PMID: 24162374 DOI: 10.1093/rpd/nct261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A growing concern in applying radial access in cardiac catheterisation is the increased operator radiation exposure. This study used an anthropomorphic phantom to simulate transradial and transfemoral coronary angiography with optimised radiation protection conditions. Operator radiation exposure was measured with thermoluminescent dosemeters at predefined locations. Compared with the femoral route, the radial route was associated with a dose decrease of 15 % at the operator's chest level with optimised radiation shielding. However, radiation exposure to the operator's hand remained significantly higher when applying radial access even with collective protective equipment used (by a factor of 2). Furthermore, the efficiency of operator radiation protection was found to be dependent on the tube incidence. Awareness should be raised about the significant increase of radiation exposure to operators' hands in transradial coronary angiography. Protection to reduce the dose level to the hands is necessary and should be further improved.
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Affiliation(s)
- Huiliang Liu
- Division of Cardiology, General Hospital of Chinese People's Armed Police Forces, No. 69, Yongding Road, Haidian District, Beijing 100039, China
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46
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Kloeze C, Klompenhouwer EG, Brands PJM, van Sambeek MRHM, Cuypers PWM, Teijink JAW. Editor's choice--Use of disposable radiation-absorbing surgical drapes results in significant dose reduction during EVAR procedures. Eur J Vasc Endovasc Surg 2014; 47:268-72. [PMID: 24445087 DOI: 10.1016/j.ejvs.2013.12.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Because of the increasing number of interventional endovascular procedures with fluoroscopy and the corresponding high annual dose for interventionalists, additional dose-protecting measures are desirable. The purpose of this study was to evaluate the effect of disposable radiation-absorbing surgical drapes in reducing scatter radiation exposure for interventionalists and supporting staff during an endovascular aneurysm repair (EVAR) procedure. MATERIALS This was a randomized control trial in which 36 EVAR procedures were randomized between execution with and without disposable radiation-absorbing surgical drapes (Radpad: Worldwide Innovations & Technologies, Inc., Kansas City, US, type 5511A). Dosimetric measurements were performed on the interventionalist (hand and chest) and theatre nurse (chest) with and without the use of the drapes to obtain the dose reduction and effect on the annual dose caused by the drapes. RESULTS Use of disposable radiation-absorbing surgical drapes resulted in dose reductions of 49%, 55%, and 48%, respectively, measured on the hand and chest of the interventionalist and the chest of the theatre nurse. CONCLUSIONS The use of disposable radiation-absorbing surgical drapes significantly reduces scatter radiation exposure for both the interventionalist and the supporting staff during EVAR procedures.
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Affiliation(s)
- C Kloeze
- Department of Medical Physics, ICMT, Catharina Hospital, Eindhoven, The Netherlands
| | - E G Klompenhouwer
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - P J M Brands
- Department of Medical Physics, ICMT, Catharina Hospital, Eindhoven, The Netherlands
| | - M R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - P W M Cuypers
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - J A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands.
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47
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McEntegart M, Spratt JC. Procedure planning for chronic total occlusion percutaneous coronary intervention. Interv Cardiol 2013. [DOI: 10.2217/ica.13.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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48
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Mohapatra A, Greenberg RK, Mastracci TM, Eagleton MJ, Thornsberry B. Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg 2013; 58:702-9. [PMID: 23810300 DOI: 10.1016/j.jvs.2013.02.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To characterize radiation exposure to patients and operating room personnel during fluoroscopic procedures. METHODS Patient dose information was collected from the imaging equipment. Real-time dosimetry was used to measure doses to the operators, scrub nurse, radiologic technologist (RT), and anesthesiologist in 39 cases of endovascular thoracoabdominal aortic aneurysm repair using fenestrated endografts. Overall equivalent doses and dose rates at time points of interest were noted and compared with the corresponding patient doses. RESULTS The dosimeter on the anesthesia equipment received 143 μSv (38-247) more radiation per case than the average operator, and the scrub nurse and RT received 106 μSv (66-146) and 100 μSv (55-145) less, respectively. Adjusting for protective lead aprons by the Webster methodology, the average operator received an effective dose of 38 μSv. Except for the RT, personnel doses were well correlated with patient dose as measured by kerma area product (KAP) (r = .82 for average operator, r = .85 for scrub nurse, and r = .86 for anesthesia; all P < .001) but less well correlated with fluoroscopy time or cumulative air kerma (CAK). When preoperative cone beam computed tomography was performed, the equivalent dose to the RT was 1.1 μSv (0.6-1.5) when using shielding and 37 μSv (22-53) when unshielded. Digital subtraction acquisitions accounted for a large fraction of all individuals' doses. Decreasing field size (and thus, increasing magnification) was associated with decreased KAP (r = .47; P < .001) and increased CAK (r = -.56; P < .001). The square of the field size correlated strongly with the KAP/CAK ratio (r = .99; P < .001). Increased lateral angulation of the C-arm increased both CAK and KAP (at field size, 22 cm; r = .54 and r = .44; both P < .001) and the average dose rate to an operator was 1.78 (1.37-2.31) times as high in a lateral projection as in a posterior-anterior projection. CONCLUSIONS Personnel doses were best correlated with KAP and less well correlated with fluoroscopy time or CAK. The dosimeter on the anesthesia equipment recorded the highest doses attributable to ineffective shielding. Operators can reduce the effective dose to themselves, the patient, and other personnel by minimizing the use of digital subtraction acquisitions, avoiding lateral angulation, using higher magnification levels when possible, and being diligent about the use of shielding during fluoroscopy cases.
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Affiliation(s)
- Abhisekh Mohapatra
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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