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1
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Bodard S, Guinebert S, Dimopoulos PM, Tacher V, Cornelis FH. Contribution and advances of robotics in percutaneous oncological interventional radiology. Bull Cancer 2024; 111:967-979. [PMID: 39198085 DOI: 10.1016/j.bulcan.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/13/2024] [Accepted: 06/03/2024] [Indexed: 09/01/2024]
Abstract
The advent of robotic systems in interventional radiology marks a significant evolution in minimally invasive medical procedures, offering enhanced precision, safety, and efficiency. This review comprehensively analyzes the current state and applications of robotic system usage in interventional radiology, which can be particularly helpful for complex procedures and in challenging anatomical regions. Robotic systems can improve the accuracy of interventions like microwave ablation, radiofrequency ablation, and irreversible electroporation. Indeed, studies have shown a notable decrease of an average 30% in the mean deviation of probes, and a 40% lesser need for adjustments during interventions carried out with robotic assistance. Moreover, this review highlights a 35% reduction in radiation dose and a stable-to-30% reduction in operating time associated with robot-assisted procedures compared to manual methods. Additionally, the potential of robotic systems to standardize procedures and minimize complications is discussed, along with the challenges they pose, such as setup duration, organ movement, and a lack of tactile feedback. Despite these advancements, the field still grapples with a dearth of randomized controlled trials, which underscores the need for more robust evidence to validate the efficacy and safety of robotic system usage in interventional radiology.
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Affiliation(s)
- Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Necker Hospital, University of Paris-Cité, 149 rue de Sèvres, 75015 Paris, France; CNRS UMR 7371, Inserm U 1146, laboratoire d'imagerie biomédicale, Sorbonne University, 75006 Paris, France.
| | - Sylvain Guinebert
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Platon M Dimopoulos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Interventional Radiodolgy Dpt, University Hospital of Patras with memorial, 26504 Rio, Greece
| | - Vania Tacher
- Unité Inserm U955 n(o) 18, service d'imagerie médicale, hôpital Henri-Mondor, université Paris-Est, AP-HP, Créteil, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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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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3
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Bodard S, Guinebert S, Tacher V, Cornelis FH. The Emergence of robotics in liver interventional radiology: Navigating New Frontiers. Eur J Radiol 2024; 175:111482. [PMID: 38691945 DOI: 10.1016/j.ejrad.2024.111482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Sylvain Bodard
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; University of Paris Cité, Department of Radiology, Necker Hospital, 149 rue de Sèvre, 75015, Paris, France; Sorbonne University, CNRS UMR 7371, INSERM U 1146, Laboratoire d'Imagerie Biomédicale, 75006, Paris, France.
| | - Sylvain Guinebert
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; University of Paris Cité, Department of Radiology, Necker Hospital, 149, Rue de Sèvre, 75015, Paris, France
| | - Vania Tacher
- PARIS EST University, Unité INSERM U955 n°18, AP-HP, Henri Mondor Hospital, Department of Radiology, 94000, Créteil, France
| | - Francois H Cornelis
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; Sorbonne University, Department of Radiology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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4
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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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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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6
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101181. [PMID: 39131968 PMCID: PMC11307799 DOI: 10.1016/j.jscai.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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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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Lima TVM, Del Castillo TR, Heinrich M, Zihlmann S, Benitez RL, Roos JE. Impact of the incorrect use of lead drapes on staff and patient doses in interventional radiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021505. [PMID: 35072655 DOI: 10.1088/1361-6498/ac4e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
To evaluate the usefulness of commercially available scatter reduction drapes in mitigating staff exposure in interventional radiology and the potential harmful effects of drape malpositioning in terms of exposure levels to both patients and staff. An anthropomorphic phantom was irradiated on an angiography device under three scenarios: no drape and correct and incorrect drape positioning. Different levels of incorrect drape positioning relative to the field-of-view (FOV) were evaluated: slight, mild and severe. Real-time dosimeter systems (positioned on the operator's eye, chest and thyroid) were used to evaluate accumulative doses and dose rates. Different obstruction levels were evaluated and compared to the observer's perception. Additionally, patient exposure was evaluated for all scenarios using a dose area product (DAP). Up to a mild obstruction, by using the drape a dose reduction of up to 86% was obtained while a severe obstruction produced a 1000% increase in exposure, respectively for all dosimeter positions compared to the use of no drape. A similar order of magnitude was observed for patient exposure. Good agreement was obtained for the observer perception of the FOV obstruction up to 25% of the FOV; for larger obstructions, an overestimate of the obstruction was observed. Patient lead drapes can reduce staff doses in interventional radiology procedures even when mildly malpositioned and obscuring the FOV. Special attention to protective drape positioning is necessary, since the severe obstruction of the FOV results in a large increase in both operator and patient exposure.
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Affiliation(s)
- Thiago V M Lima
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Mirjam Heinrich
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stephanie Zihlmann
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Ruben Lopez Benitez
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Justus E Roos
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
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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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Abstract
There has been a rapid development in the field of interventional radiology over recent years, and this has led to a rapid increase in the number of interventional radiology procedures being performed. There is, however, a growing concern regarding radiation exposure to the patients and the operators during these procedures. In this article, we review the basics of radiation exposure, radiation protection techniques, radiation protection tools available to interventional radiologists, and radiation protection during pregnancy.
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Affiliation(s)
- Tushar Garg
- Department of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Apurva Shrigiriwar
- Department of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
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13
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Behr-Meenen C, von Boetticher H, Kersten JF, Nienhaus A. Radiation Protection in Interventional Radiology/Cardiology-Is State-of-the-Art Equipment Used? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13131. [PMID: 34948742 PMCID: PMC8700859 DOI: 10.3390/ijerph182413131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
Interventional radiology/cardiology is one of the fields with the highest radiation doses for workers. For this reason, the International Commission on Radiological Protection (ICRP) published new recommendations in 2018 to shield staff from radiation. This study sets out to establish the extent to which these recommendations are observed in Germany. For the study, areas were selected which are known to have relatively high radiation exposure along with good conditions for radiological protection-interventional cardiology, radiology and vascular surgery. The study was advertised with the aid of an information flyer which was distributed via organisations including the German Cardiac Society (Deutsche Gesellschaft für Kardiologie- Herz- und Kreislaufforschung e. V.). Everyone who participated in our study received a questionnaire to record their occupational medical history, dosimetry, working practices, existing interventional installations and personal protective equipment. The results were compared with international recommendations, especially those of the ICRP, based on state-of-the-art equipment. A total of 104 respondents from eight German clinics took part in the survey. Four participants had been medically diagnosed with cataracts. None of the participants had previously worn an additional dosimeter over their apron to determine partial-body doses. The interventional installations recommended by the ICRP have not been fitted in all examination rooms and, where they have been put in place, they are not always used consistently. Just 31 participants (36.6%) stated that they "always" wore protective lead glasses or a visor. This study revealed considerable deficits in radiological protection-especially in connection with shielding measures and dosimetric practices pertaining to the head and neck-during a range of interventions. Examination rooms without the recommended interventional installations should be upgraded in the future. According to the principle of dose minimization, there is considerable potential for improving radiation protection. Temporary measurements should be taken over the apron to determine the organ-specific equivalent dose to the lens of the eye and the head.
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Affiliation(s)
- Christiane Behr-Meenen
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
| | - Heiner von Boetticher
- Division for Medical Radiation Physics, Faculty VI: Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26121 Oldenburg, Germany;
| | - Jan Felix Kersten
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
- Department of Occupational Medicine, Toxic Substances, Health Service Research, German Statuary Institution for Accident Insurance and Prevention for Health and Welfare Services (BGW), 22089 Hamburg, Germany
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14
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Grau M, Eldergash O, Amin SS, Kowald T, Schnabel J, Wißmann A, Simka S, Chavan A, Mathys C, Poppe B, Schmuck B, Thomas RP. Are X-ray Safety Glasses Alone Enough for Adequate Ocular Protection in Complex Radiological Interventions? HEALTH PHYSICS 2021; 120:641-647. [PMID: 33879646 DOI: 10.1097/hp.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT The maximum annual radiation ocular dose limit for medical staff has been reduced to 20 mSv in the current European directive 2013/59/Euratom. This multi-centric study aims at reporting the protected and unprotected eye lens doses in different fluoroscopically guided interventions and to evaluate any other factors that could influence the ocular dose. From July 2018 to July 2019, ocular radiation doses of six interventionists of four departments during complex interventions were recorded with a thermoluminescent dosimeter in front of and behind radiation protection glasses to measure the protected and unprotected doses. The position of personnel, intervention type, fluoroscopy time, total body dose and use of pre-installed protection devices like lead acrylic shields were also systematically recorded. Linear regression analysis was used to estimate the doses at 2 y and 5 y. The annual unprotected/protected ocular doses of six interventionists were 67/21, 32.7/3.3, 27.4/5.1, 7/0, 21.8/2.2, and 0/0 mSv, respectively. The unprotected dose crossed the 20-mSv annual limits for four interventionists and protected dose for one less experienced interventionist. The estimated 5-y protected ocular dose of this interventionist was 101.318 mSv (95%CI 96.066-106.57), also crossing the 5-y limit. The use of a lead acrylic shield was observed to have a significant effect in reducing ocular doses. The annual unprotected and protected ocular doses for interventionists dealing with complex interventions could cross the present permitted yearly limit. The measurement of significant protected ocular dose behind the radiation protection glasses emphasizes the additional indispensable role of pre-installed radiation protection devices and training in reducing radiation doses for complex procedures.
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Affiliation(s)
| | - Osama Eldergash
- Institute of Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Sandeep Sunder Amin
- Institute of Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Tobias Kowald
- Institute of Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Johannes Schnabel
- Institute of Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Anika Wißmann
- Institute of Diagnostic and Interventional Radiology, Ammerland Klinik GmbH, Westerstede
| | - Sebastian Simka
- Institute of Diagnostic and Interventional Radiology, Ammerland Klinik GmbH, Westerstede
| | - Ajay Chavan
- Institute of Diagnostic and Interventional Radiology, Christliches Krankenhaus Quakenbrück, Quakenbrück
| | | | - Björn Poppe
- Department of Medical Radiation Physics, Pius-Hospital, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Bernhard Schmuck
- Division of Radiology, Clinic for Vascular Medicine, Vascular Centre, Rotes Kreuz Krankenhaus, Bremen
| | - Rohit Philip Thomas
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University, Marburg
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15
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Girgin R. An Anatolian study on the current knowledge and attitudes of urology operating room staff on ionizing radiation. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-020-00117-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To evaluate current approaches to ionizing radiation by personnel working in urology operating room at all levels of health service in Anatolia, Turkey.
Methods
A questionnaire was e-mailed to urology operating room personnel including MDs at different academic levels, between August and September 2020 in Anatolia, Turkey. The questionnaire included demographic questions and questions about ionizing radiation, exposure and protection.
Results
Of the 173 (11.9%) respondents, 44.5% were doctors, 24.9% were nurses, 20.8% were radiology technicians, and 9.8% were other operating room personnel. While most participants (73.4%) had some knowledge of radiation, only 42.2% stated they had received radiation-specific training. The two most commonly used personal protective equipments (PPEs) among respondents (79.8%) were lead aprons and thyroid protectors. Interestingly, both types of PPE were preferred among those who had not received radiation safety training. Conversely, besides lead aprons and thyroid protectors; gonadal protection, goggles and gloves were the preferred PPEs among respondents who had received radiation training (p < 0.001). Radiology technicians exhibited the highest compliance rate for dosimeter usage (100%), followed by faculty members (37.5%), urology specialists (36.7%) nurses (27.9%), operating room staff (17.6%) and assistants (15%). While differences in compliance were statistically significant (p < 0.001), no significant relationship was found between radiation protection measures and years of experience, daily fluoroscopy exposure or education level.
Conclusions
Despite advances in medical science, our findings suggest that many hospital personnel are still insensitive to the dangers of fluoroscopy, which is of great importance in urology operating rooms.
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16
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Lawson M, Kuganesan A, Parry G, Badawy MK. THE EFFICACY OF RADPAD AS A RADIATION PROTECTION TOOL IN CT FLUOROSCOPY GUIDED LUNG BIOPSIES. RADIATION PROTECTION DOSIMETRY 2020; 191:328-334. [PMID: 33120428 DOI: 10.1093/rpd/ncaa169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 08/04/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
Computed tomography fluoroscopy is now the preferred technique for percutaneous lung biopsies. However, concern regarding operator and patient radiation dose remains, which warrants further exploration into dose optimisation tools. This phantom-study aims to assess the dose reduction capabilities of RADPAD, a single-use patient drape designed to decrease staff exposure to scattered radiation. Dosemeters at the waist and eye levels were used to determine the whole-body and lens exposure during simulated lung biopsy procedures while using RADPAD and other combinations of personal protective equipment. RADPAD resulted in a 36% and 38% dose reduction for whole-body and eye exposure, respectively. However, when used in combination with radioprotective eyewear and aprons, RADPAD did not reduce the radiation dose further. Consequently, the use of standard personal protective equipment is a more cost-effective option for staff dose reduction. RADPAD is useful in the reduction of radiation dose to unprotected regions.
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Affiliation(s)
- Michael Lawson
- Monash Imaging, Monash Health, Clayton, VIC 3168, Australia
| | | | - Georgia Parry
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Mohamed Khaldoun Badawy
- Monash Imaging, Monash Health, Clayton, VIC 3168, Australia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia
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17
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Abstract
The trend towards more minimally invasive procedures in the past few decades has resulted in an exponential growth in fluoroscopy-guided catheter-based cardiology procedures. As these techniques are becoming more commonly used and developed, the adverse effects of radiation exposure to the patient, operator, and ancillary staff have been a subject of concern. Although occupational radiation dose limits are being monitored and seldom reached, exposure to chronic, low dose radiation has been shown to have harmful biological effects that are not readily apparent until years after. Given this, it is imperative that reducing radiation dose exposure in the cardiac catheterization laboratory remains a priority. Staff education and training, radiation dose monitoring, ensuring use of proper personal protective equipment, employment of shields, and various procedural techniques in minimizing radiation must always be diligently employed. Special care and consideration should be extended to pregnant women working in the cardiac catheterization laboratory. This review article presents a practical approach to radiation dose management and discusses best practice recommendations in the cardiac catheterization laboratory.
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Affiliation(s)
- Sylvia Marie R Biso
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mladen I Vidovich
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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18
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Doyen B, Vlerick P, Soenens G, Vermassen F, Van Herzeele I. Team perception of the radiation safety climate in the hybrid angiography suite: A cross-sectional study. Int J Surg 2020; 77:48-56. [PMID: 32200059 DOI: 10.1016/j.ijsu.2020.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/09/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Good radiation safety practice in the angiosuite is essential to protect patients and healthcare workers. Most strategies aim to advance radiation safety through technological upgrades and educational initiatives. However, safety literature suggests that additional ways to improve radiation safety in the angiosuite do exist. The safety climate reflects the way team members perceive various key characteristics of their work environment and is closely related to relevant safety outcomes. A specific 'radiation safety climate' has not been described nor studied in the hybrid angiosuite. This study explores the radiation safety climate in the hybrid angiosuite and its relation to team members' radiation safety behavior, knowledge and motivation. MATERIALS AND METHODS Vascular surgeons, fellows/trainees and operating room nurses active in the angiosuite at five hospitals were invited to complete an online self-report questionnaire assessing the radiation safety climate (28 items); radiation safety behavior; radiation safety knowledge and radiation safety motivation. Relations between climate scores and behavior were investigated using Pearson correlations. Mediation was analyzed using the Baron and Kenny analysis. P-Values < 0.05 were considered statistically significant. RESULTS No major differences were identified in total radiation safety climate scores between centers or team member functions. Scale reliability for radiation safety climate was good to excellent (α > 0.663). Total radiation safety climate scores were positively related to the radiation safety behavior score (r = 0.403; p = 0.015). This relation was partially mediated by radiation safety knowledge (β = 0.1730; 95% CI: [0.0475; 0.3512]), while radiation safety motivation did not act as a mediator: (β = 0.010; 95% CI: [-0.0561; 0.0998]). CONCLUSION A well-developed radiation safety climate in the hybrid angiosuite fosters positive radiation safety behaviors, which may partially be explained through improved radiation safety knowledge transfer. Further research on (radiation) safety climate and its impact on radiation safety-related outcome measures for patients is recommended.
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Affiliation(s)
- Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Peter Vlerick
- Department of Work, Organisation and Society, Ghent University, Ghent, Belgium
| | - Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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19
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Yu C. Don't be Caught Half-dressed When Working with Radiation. Cardiovasc Intervent Radiol 2019; 43:369-375. [PMID: 31844952 DOI: 10.1007/s00270-019-02391-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/03/2019] [Indexed: 11/29/2022]
Abstract
A typical 2-piece personal protective equipment apron covers only half the body. However, with radiation exposure there is evidence of the following: (1) Left-sided head exposure estimates equal to 100,000 chest X-rays over a 20-year career, (2) direct linear relationship between stroke and concentration of dose, (3) increases in ischemic heart disease and myocardial infarction, (4) accelerated aging processes, and (5) increased double-stranded DNA breaks in circulating lymphocytes when lower legs are exposed. Every exposure to ionizing radiation involves a health risk that accumulates. Interventionalists are treating more patients, more complex patients, using new complicated devices. Juxtaposed with the global obesity epidemic, the result is an unprecedented level of radiation exposure for those who use radiation in their daily work. By implementing a simple system of shields, we can dramatically reduce our radiation dose. This would give us a better chance to live a longer, healthier life, and pass quality DNA to our children. This narrative review examines the efficacy of protective barriers to reduce medical occupational radiation exposure and risk.
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Affiliation(s)
- Charlie Yu
- RadPro, 101 Cashew Rd. #06-03, Singapore, 679672, Singapore.
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20
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Ison GR, Allahwala U, Weaver JC. Radiation Management in Coronary Angiography: Percutaneous Coronary Intervention for Chronic Total Occlusion at the Frontier. Heart Lung Circ 2019; 28:1501-1509. [DOI: 10.1016/j.hlc.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/10/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
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21
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Husain MAA, Hashim S, Zakaria N, Mohamed Zin MR. Development of underwater radiography scanner for reactor-pool experiment at the TRIGA PUSPATI reactor. MethodsX 2018; 5:1346-1363. [PMID: 30416978 PMCID: PMC6218652 DOI: 10.1016/j.mex.2018.10.011] [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: 08/06/2018] [Accepted: 10/10/2018] [Indexed: 11/01/2022] Open
Abstract
This paper describes the development of a custom-designed underwater scanner to support the experimental works for characterizing irradiated fuel stored in the TRIGA PUSPATI pool by means of radiography technique. Materials used to build the scanner are aluminum 6061, lead and teflon. Three main units that make up the scanner are rig structure, arm block and collimator. Collimator is designed to control radiation exposure by opening and closing the shutter. The experimental works were conducted underwater at 5-m depth hence water tightness is one of the main design criteria. Radiation in terms of gamma energy is captured by radiography film which after development and processing revealed the image of the radiation impact in terms of pixel and gray value. The film size used is 4in x 8in which was slot in the collimator. To validate the scanner, fuel element containing 8.5 wt% and 12 wt% enriched Uranium 235 were used. It was found that the experimental output is consistent with the fuel type and confirmed that the scanner is viable for fuel characterization study.
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Affiliation(s)
- Mohamad Annuar Assadat Husain
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia.,Atomic Energy Licensing Board, 43800 Dengkil, Selangor, Malaysia
| | - Suhairul Hashim
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia
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22
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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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23
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Abstract
Interventional radiology in veterinary medicine was adapted from techniques developed in human medicine, and has a variety of applications to treat disease in multiple body systems. Fluoroscopy is required for almost all interventional procedures, requiring knowledge of proper safety techniques for working with ionizing radiation. There are a wide variety of catheters, wires, sheaths, stents, and embolics used in veterinary medicine. Familiarity with their indications and sizing compatibility is essential for procedural success.
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24
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Will X-ray Safety Glasses Become Mandatory for Radiological Vascular Interventions? Cardiovasc Intervent Radiol 2018; 41:1074-1080. [DOI: 10.1007/s00270-018-1960-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
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25
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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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26
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Abstract
This article reviews the issue of occupational radiation exposure as a deterrent to recruitment of women into the field of interventional radiology and provides the reader with three strategies to optimize radiation protection during fluoroscopically guided procedures. These include personal protective shielding, use of ancillary shielding, and techniques that limit fluoroscopy x-ray tube output. When optimal radiation safety practices are implemented as the norm in the IR suite, very little extra needs to be done to ensure that fetal dose of a pregnant interventionalist is negligible.
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Affiliation(s)
- M Victoria Marx
- Keck School of Medicine, University of Southern California, LAC+USC Medical Center, Los Angeles, CA.
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27
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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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28
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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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29
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Som S, Patel AK, Sethi V, Faraz H, Admani I, Mathur A, Parrillo JE, Vaidya P. Barriers for transradial coronary angiography and interventions in 2016. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:221-225. [PMID: 27889310 DOI: 10.1016/j.carrev.2016.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Sumit Som
- Interventional Cardiology, Rutgers New Jersey Medical School, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey, 07601.
| | - Ankitkumar K Patel
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Virender Sethi
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Haroon Faraz
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Irfan Admani
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Atish Mathur
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Joseph E Parrillo
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
| | - Pranaychandra Vaidya
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, New Jersey 07601.
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30
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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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31
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Martin CJ. EYE LENS DOSIMETRY FOR FLUOROSCOPICALLY GUIDED CLINICAL PROCEDURES: PRACTICAL APPROACHES TO PROTECTION AND DOSE MONITORING. RADIATION PROTECTION DOSIMETRY 2016; 169:286-291. [PMID: 26454269 DOI: 10.1093/rpd/ncv431] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Doses to the eye lenses of clinicians undertaking fluoroscopically guided procedures can exceed the dose annual limit of 20 mSv, so optimisation of radiation protection is essential. Ceiling-suspended shields and disposable radiation absorbing pads can reduce eye dose by factors of 2-7. Lead glasses that shield against exposures from the side can lower doses by 2.5-4.5 times. Training in effective use of protective devices is an essential element in achieving good protection and acceptable eye doses. Effective methods for dose monitoring are required to identify protection issues. Dosemeters worn adjacent to the eye provide the better option for interventional clinicians, but an unprotected dosemeter worn at the neck will give an indication of eye dose that is adequate for most interventional staff. Potential requirements for protective devices and dose monitoring can be determined from risk assessments using generic values for dose linked to examination workload.
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Affiliation(s)
- Colin J Martin
- Department of Clinical Physics and Bio-engineering, University of Glasgow, Glasgow, UK
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32
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Tok A, Akbas A, Aytan N, Aliskan T, Cicekbilek I, Kaba M, Tepeler A. Are the urology operating room personnel aware about the ionizing radiation? Int Braz J Urol 2016; 41:982-9. [PMID: 26689525 PMCID: PMC4756976 DOI: 10.1590/s1677-5538.ibju.2014.0351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/26/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose: We assessed and evaluated attitudes and knowledge regarding ionizing radiation of urology surgery room staff. Materials and Methods: A questionnaire was sent by e-mail to urology surgery room personnel in Turkey, between June and August 2013. The questionnaire included demographic questions and questions regarding radiation exposure and protection. Results: In total, 127 questionnaires were answered. Of them, 62 (48.8%) were nurses, 51 (40.2%) were other personnel, and 14 (11%) were radiological technicians. In total, 113 (89%) participants had some knowledge of radiation, but only 56 (44.1%) had received specific education or training regarding the harmful effects of radiation. In total, 92 (72.4%) participants indicated that they used a lead apron and a thyroid shield. In the subgroup that had received education about the harmful effects of radiation, the use ratio for all protective procedures was 21.4% (n=12); this ratio was only 2.8% (n=2) for those with no specific training; the difference was statistically significant (p=0.004). Regarding dosimeters, the use rates were 100% for radiology technicians, 46.8% for nurses, and 31.4% for other hospital personnel; these differences were statistically significant (p<0.001). No significant relationship between working period in the surgery room, number of daily fluoroscopy procedures, education, task, and use of radiation protection measures was found. Conclusions: It is clear that operating room-allied health personnel exposed to radiation do not have sufficient knowledge of ionizing radiation and they do not take sufficient protective measures.
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Affiliation(s)
- Adem Tok
- Department of Urology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Alparslan Akbas
- Department of Urology, Faculty of Medicine, Canakkale 18 Mart University, Canakkale, Turkey
| | - Nimet Aytan
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Tamer Aliskan
- Department of Urology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Izzet Cicekbilek
- Department of Urology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Mehmet Kaba
- Department of Urology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Christopoulos G, Makke L, Christakopoulos G, Kotsia A, Rangan BV, Roesle M, Haagen D, Kumbhani DJ, Chambers CE, Kapadia S, Mahmud E, Banerjee S, Brilakis ES. Optimizing Radiation Safety in the Cardiac Catheterization Laboratory. Catheter Cardiovasc Interv 2015; 87:291-301. [DOI: 10.1002/ccd.25959] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Georgios Christopoulos
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Lorenza Makke
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Georgios Christakopoulos
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Anna Kotsia
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Michele Roesle
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Donald Haagen
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Dharam J. Kumbhani
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine; Sulpizio Cardiovascular Center, University of California; San Diego California
| | - Subhash Banerjee
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
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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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Editor's Choice – Minimizing Radiation Exposure During Endovascular Procedures: Basic Knowledge, Literature Review, and Reporting Standards. Eur J Vasc Endovasc Surg 2015; 50:21-36. [DOI: 10.1016/j.ejvs.2015.01.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/27/2015] [Indexed: 12/30/2022]
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Efficacy of a Radiation Absorbing Shield in Reducing Dose to the Interventionalist During Peripheral Endovascular Procedures: A Single Centre Pilot Study. Cardiovasc Intervent Radiol 2014; 38:573-8. [DOI: 10.1007/s00270-014-0997-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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Gorman T, Dropkin J, Kamen J, Nimbalkar S, Zuckerman N, Lowe T, Szeinuk J, Milek D, Piligian G, Freund A. Controlling health hazards to hospital workers. New Solut 2014; 23 Suppl:1-167. [PMID: 24252641 DOI: 10.2190/ns.23.suppl] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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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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Mori H, Koshida K, Ishigamori O, Matsubara K. A novel removable shield attached to C-arm units against scattered X-rays from a patient’s side. Eur Radiol 2014; 24:1794-9. [DOI: 10.1007/s00330-014-3186-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/29/2014] [Accepted: 04/09/2014] [Indexed: 11/29/2022]
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Gonzales JP, Moran C, Silberzweig JE. Reduction of Operator Radiation Dose by an Extended Lower Body Shield. J Vasc Interv Radiol 2014; 25:462-8, 468.e1. [DOI: 10.1016/j.jvir.2013.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 01/26/2023] Open
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JONES MICHAELA, COCKER MARY, KHIANI RAJ, FOLEY PAUL, QURESHI NORMAN, WONG KELVINC, RAJAPPAN KIM, BETTS TIMOTHYR. The Benefits of Using a Bismuth-Containing, Radiation-Absorbing Drape in Cardiac Resynchronization Implant Procedures. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:828-33. [DOI: 10.1111/pace.12349] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 11/07/2013] [Accepted: 11/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- MICHAEL A. JONES
- Oxford Heart Centre; John Radcliffe Hospital; Oxford University Hospitals NHS trust; Oxford UK
| | - MARY COCKER
- Radiation Physics and Protection Department; Oxford University Hospitals NHS Trust; Oxford UK
| | - RAJ KHIANI
- Oxford Heart Centre; John Radcliffe Hospital; Oxford University Hospitals NHS trust; Oxford UK
| | - PAUL FOLEY
- Oxford Heart Centre; John Radcliffe Hospital; Oxford University Hospitals NHS trust; Oxford UK
| | - NORMAN QURESHI
- Oxford Heart Centre; John Radcliffe Hospital; Oxford University Hospitals NHS trust; Oxford UK
| | - KELVIN C.K. WONG
- Oxford Heart Centre; John Radcliffe Hospital; Oxford University Hospitals NHS trust; Oxford UK
| | - KIM RAJAPPAN
- Oxford Heart Centre; John Radcliffe Hospital; Oxford University Hospitals NHS trust; Oxford UK
| | - TIMOTHY R. BETTS
- Oxford Heart Centre; John Radcliffe Hospital; Oxford University Hospitals NHS trust; Oxford UK
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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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Physicians' Radiation Exposure in the Catheterization Lab. JACC Cardiovasc Interv 2013; 6:1095-102. [DOI: 10.1016/j.jcin.2013.05.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/26/2013] [Accepted: 05/09/2013] [Indexed: 11/17/2022]
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Lynskey GE, Powell DK, Dixon RG, Silberzweig JE. Radiation Protection in Interventional Radiology: Survey Results of Attitudes and Use. J Vasc Interv Radiol 2013; 24:1547-51.e3. [DOI: 10.1016/j.jvir.2013.05.039] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/24/2022] Open
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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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Khong PL, Ringertz H, Donoghue V, Frush D, Rehani M, Appelgate K, Sanchez R. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP 2013; 42:1-63. [PMID: 23218172 DOI: 10.1016/j.icrp.2012.10.001] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Paediatric patients have a higher average risk of developing cancer compared with adults receiving the same dose. The longer life expectancy in children allows more time for any harmful effects of radiation to manifest, and developing organs and tissues are more sensitive to the effects of radiation. This publication aims to provide guiding principles of radiological protection for referring clinicians and clinical staff performing diagnostic imaging and interventional procedures for paediatric patients. It begins with a brief description of the basic concepts of radiological protection, followed by the general aspects of radiological protection, including principles of justification and optimisation. Guidelines and suggestions for radiological protection in specific modalities - radiography and fluoroscopy, interventional radiology, and computed tomography - are subsequently covered in depth. The report concludes with a summary and recommendations. The importance of rigorous justification of radiological procedures is emphasised for every procedure involving ionising radiation, and the use of imaging modalities that are non-ionising should always be considered. The basic aim of optimisation of radiological protection is to adjust imaging parameters and institute protective measures such that the required image is obtained with the lowest possible dose of radiation, and that net benefit is maximised to maintain sufficient quality for diagnostic interpretation. Special consideration should be given to the availability of dose reduction measures when purchasing new imaging equipment for paediatric use. One of the unique aspects of paediatric imaging is with regards to the wide range in patient size (and weight), therefore requiring special attention to optimisation and modification of equipment, technique, and imaging parameters. Examples of good radiographic and fluoroscopic technique include attention to patient positioning, field size and adequate collimation, use of protective shielding, optimisation of exposure factors, use of pulsed fluoroscopy, limiting fluoroscopy time, etc. Major paediatric interventional procedures should be performed by experienced paediatric interventional operators, and a second, specific level of training in radiological protection is desirable (in some countries, this is mandatory). For computed tomography, dose reduction should be optimised by the adjustment of scan parameters (such as mA, kVp, and pitch) according to patient weight or age, region scanned, and study indication (e.g. images with greater noise should be accepted if they are of sufficient diagnostic quality). Other strategies include restricting multiphase examination protocols, avoiding overlapping of scan regions, and only scanning the area in question. Up-to-date dose reduction technology such as tube current modulation, organ-based dose modulation, auto kV technology, and iterative reconstruction should be utilised when appropriate. It is anticipated that this publication will assist institutions in encouraging the standardisation of procedures, and that it may help increase awareness and ultimately improve practices for the benefit of patients.
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Current attitudes of Turkish anesthesiologists to radiation exposure. J Anesth 2013; 27:874-8. [PMID: 23653104 DOI: 10.1007/s00540-013-1623-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the attitudes of anesthesiologists to radiation exposure and current safety practice in Turkey. METHODS The study enrolled anesthesiologists from all over Turkey, including all levels of academic degrees and all types of different institutions. Questionnaire forms were sent via e-mail to 505 anesthesiologists. The survey collected demographic data such as age, gender, position, and the institution at which the participant worked, and data about the frequency of radiation exposure during procedures and the participant's attitudes concerning radiation safety measures during these procedures. RESULTS The questionnaire forms were delivered to 491 anesthesiologists, and 301 (61.3 %) of these were returned. Of these, 9 had not completed the questionnaire because of a lack of exposure to radiation. Among the remaining 292 personnel, the weekly frequencies of radiation exposure were more than five times (36.7 %), one to five times (50.3 %), and less than once (13 %) per week, respectively. Only a few anesthesiologists regularly wore a lead apron (30.11 %) and a thyroid shield (11.3 %) during procedures involving radiation exposure. CONCLUSIONS This study demonstrated that nearly all anesthesiologists are regularly exposed to radiation and that few anesthesiologists in Turkey wear protective clothing, which is essential for radiation protection. Therefore, if it is not, increasing awareness about radiation protection should be an integral part of medical training and education.
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Durán A, Hian SK, Miller DL, Le Heron J, Padovani R, Vano E. Recommendations for occupational radiation protection in interventional cardiology. Catheter Cardiovasc Interv 2013; 82:29-42. [PMID: 23475846 DOI: 10.1002/ccd.24694] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 10/06/2012] [Indexed: 11/08/2022]
Abstract
The radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational radiation protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. These recommendations for occupational radiation protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.
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Affiliation(s)
- Ariel Durán
- Cardiology Department, University Hospital, Montevideo, Uruguay
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Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, Einstein AJ, Geiger B, Heintz P, Padovani R, Sim KH. ICRP PUBLICATION 120: Radiological protection in cardiology. Ann ICRP 2013; 42:1-125. [PMID: 23141687 DOI: 10.1016/j.icrp.2012.09.001] [Citation(s) in RCA: 238] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff(1) in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission's published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy.
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