51
|
Monaco MGL, Carta A, Tamhid T, Porru S. Anti-X Apron Wearing and Musculoskeletal Problems Among Healthcare Workers: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165877. [PMID: 32823627 PMCID: PMC7459898 DOI: 10.3390/ijerph17165877] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
Interventional radiology activities and other medical practices using ionising radiation have become increasingly prevalent. In this context, the use of anti-X aprons, in association with awkward postures and non-ergonomic working conditions, might cause the onset of musculoskeletal disorders (MSDs). This research aims to evaluate the evidence about the correlation between wearing anti-X aprons and work-related MSDs. A systematic scoping review of articles published between 1990 and 2020 was conducted by searching the PubMed, Scopus, Embase, and Web of Science databases. Twelve cross-sectional studies, conducted among interventional physicians, nurses, and technicians, were finally included. Five studies primarily investigated the association between use of anti-X aprons and MSDs, showing that a higher prevalence of disorders was not always associated with the use of protective aprons. No studies investigated the impact of anti-X aprons on fitness for work assessment, particularly in subjects with MSDs. There is no complete agreement about the correlation between anti-X apron-wearing and the occurrence of MSDs, although the possible discomfort of workers using anti-X aprons appears more evident. Further studies are needed to objectify the role of these protective devices in the genesis of MSDs and to offer specific ergonomic solutions for healthcare workers.
Collapse
Affiliation(s)
- Maria Grazia Lourdes Monaco
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Correspondence: ; Tel.: +39-045-812-3946
| | - Angela Carta
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Health, University of Verona, 37134 Verona, Italy
| | - Tishad Tamhid
- Postgraduate School of Occupational Medicine, University of Verona, 37134 Verona, Italy;
| | - Stefano Porru
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Health, University of Verona, 37134 Verona, Italy
| |
Collapse
|
52
|
Salam T, Wilson L, Bohannan S, Morin M. Safety and Effectiveness of a Novel Fluoroless Transseptal Puncture Technique for Lead-free Catheter Ablation: A Case Series. J Innov Card Rhythm Manag 2020; 11:4079-4085. [PMID: 32368383 PMCID: PMC7192152 DOI: 10.19102/icrm.2020.110405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 01/07/2023] Open
Abstract
Increasing awareness of the health risks associated with the exposure of patients and staff in the catheterization laboratory to radiation has encouraged the pursuit of efforts to reduce the use of fluoroscopy during catheter ablation procedures. Although nonfluoroscopic guidance of ablation catheters has been previously described, transseptal access is still perceived as the last remaining barrier to completely fluoroless ablations. This study examined the safety and effectiveness of transseptal puncture and radiofrequency (RF) catheter ablation using a completely fluoroless approach. Three hundred eighty-two consecutive cases that had undergone completely nonfluoroscopic RF catheter ablation were evaluated. Ablation procedures were performed for atrial fibrillation, atrial flutter, atrioventricular reentry tachycardia, and pulmonary vein complex/ventricular tachycardia. Transseptal puncture and RF ablation were conducted under three-dimensional electroanatomic mapping and intracardiac echocardiography image guidance. Fluoroless transseptal puncture and catheter ablation were completed successfully in all cases, with no intraoperative complications. One patient required minimal use of fluoroscopy to visualize sheath advancement through an existing inferior vena cava filter. Procedural time was approximately 2.2 hours from transvenous access until case conclusion; transseptal access was obtained within 28 minutes of procedure initiation. Arrhythmia was found to recur in 27% of cases on average three months after the procedure. We demonstrate the safety and effectiveness of a completely fluoroless transseptal puncture and RF ablation technique that eliminates radiation exposure and enables complex electrophysiology procedures to be performed in a lead-free environment.
Collapse
Affiliation(s)
- Tariq Salam
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Lane Wilson
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Sara Bohannan
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Michael Morin
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| |
Collapse
|
53
|
Klein LW, Goldstein JA, Haines D, Chambers C, Mehran R, Kort S, Valentine CM, Cox D. SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory: Shifting the Paradigm for Healthcare Workers' Protection. J Am Coll Cardiol 2020; 75:1718-1724. [PMID: 32273037 DOI: 10.1016/j.jacc.2020.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
54
|
Tetteh E, Sarker P, Radley C, Hallbeck MS, Mirka GA. Effect of surgical radiation personal protective equipment on EMG-based measures of back and shoulder muscle fatigue: A laboratory study of novices. APPLIED ERGONOMICS 2020; 84:103029. [PMID: 31983396 DOI: 10.1016/j.apergo.2019.103029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
Interventional radiologists are at increased risk for musculoskeletal discomfort/disorders and this has been linked to the use of radiation personal protective equipment (rPPE). This study examined the effects of rPPE on the development of fatigue of the erector spinae and trapezius muscles. Surface electromyography (EMG) was used to capture muscle activity, and both time domain (average rectified value) and frequency domain (median frequency) measures were considered in the assessment of localized muscle fatigue. Sixteen participants performed a simulated surgical procedure requiring intermittent 30° flexed static trunk posture with and without rPPE on separate days. The results showed that the rPPE condition demonstrated significantly greater (p < 0.05) downward shift in median frequency in the left lumbar erector spinae and left lower thoracic erector spinae consistent with task-induced localized muscle fatigue. Ergonomic intervention strategies are discussed.
Collapse
Affiliation(s)
- Emmanuel Tetteh
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Pramiti Sarker
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Caleb Radley
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gary A Mirka
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA.
| |
Collapse
|
55
|
Vélez M. MJ. Riesgos osteomusculares: Patología ortopédica en el cardiólogo intervencionista. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
56
|
Klein LW, Goldstein JA, Haines D, Chambers C, Mehran R, Kort S, Valentine CM, Cox D. SCAI multi‐society position statement on occupational health hazards of the catheterization laboratory: Shifting the paradigm for Healthcare Workers' Protection. Catheter Cardiovasc Interv 2020; 95:1327-1333. [DOI: 10.1002/ccd.28579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Lloyd W. Klein
- University of California, San Francisco San Francisco California
| | | | - David Haines
- William Beaumont School of Medicine Royal Oak Michigan
| | | | | | | | | | - David Cox
- Brookwood Baptist Health Birmingham Alabama
| |
Collapse
|
57
|
|
58
|
Goya M, Frame D, Gache L, Ichishima Y, Tayar DO, Goldstein L, Lee SHY. The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta-analysis of efficiency, effectiveness, and safety outcomes. J Cardiovasc Electrophysiol 2020; 31:664-673. [PMID: 31976603 PMCID: PMC7078927 DOI: 10.1111/jce.14367] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
Aims The optimal use of intracardiac echocardiography (ICE) may reduce fluoroscopy time and procedural complications during endocardial ablation of cardiac arrhythmias. Due to limited evidence in this area, we conducted the first systematic literature review and meta‐analysis to evaluate outcomes associated with the use of ICE. Methods and Results Studies reporting the use of ICE during ablation procedures vs without ICE were searched using PubMed/MEDLINE. A meta‐analysis was performed on the 19 studies (2186 patients) meeting inclusion criteria, collectively representing a broad range of arrhythmia mechanisms. Use of ICE was associated with significant reductions in fluoroscopy time (Hedges' g −1.06; 95% confidence interval [CI] −1.81 to −0.32; P < .01), fluoroscopy dose (Hedges' g −1.27; 95% CI −1.91 to −0.62; P < .01), and procedure time (Hedges' g −0.35; 95% CI −0.64 to −0.05; P = .02) vs ablation without ICE. A 6.95 minute reduction in fluoroscopy time and a 15.2 minute reduction in procedure time was observed between the ICE vs non‐ICE groups. These efficiency gains were not associated with any decreased effectiveness or safety. Sensitivity analyses limiting studies to an atrial fibrillation (AF) only population yielded similar results to the main analysis. Conclusion The use of ICE in the ablation of cardiac arrhythmias is associated with significantly lower fluoroscopy time, fluoroscopy dose, and shorter procedure time vs ablation without ICE. These efficiency improvements did not compromise the clinical effectiveness or safety of the procedure.
Collapse
Affiliation(s)
- Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Diana Frame
- Real World Evidence, CTI Clinical Trial & Consulting, Covington, Kentucky
| | - Larry Gache
- Real World Evidence, CTI Clinical Trial & Consulting, Covington, Kentucky
| | | | | | - Laura Goldstein
- Health Economics & Market Access, Johnson & Johnson Medical Devices, Irvine, California
| | - Stephanie Hsiao Yu Lee
- Health Economics & Market Access, Johnson & Johnson Medical Asia Pacific, Singapore, Singapore
| |
Collapse
|
59
|
The Current State of Surgical Ergonomics Education in U.S. Surgical Training: A Survey Study. Ann Surg 2020; 269:778-784. [PMID: 29381528 DOI: 10.1097/sla.0000000000002592] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the current state of surgical ergonomics education in the United States. BACKGROUND The burden of work-related musculoskeletal disorders (MSDs) in surgeons is high and no overarching strategy for redress exists. Twelve distinct specialties describe an unmet need for surgical ergonomics education (SEE). This study aimed to define the current state of SEE in U.S. surgical training programs. METHODS We performed a descriptive analysis of a 20-item questionnaire of ACGME-certified program directors from 14 surgical and interventional medical specialties. Formal SEE was defined as any organized education module that reviewed the occupation-specific burden of common work-related MSDs and described a framework for prevention via occupation-specific applied ergonomics. Program directors were queried regarding SEE provision, characteristics, and perceived trainee attitude toward the education. RESULTS Questionnaires were received from 130 of 441 (29.5%) program directors. Two (1.5%) provided formal SEE and 33 (25.4%) provided informal SEE, which consisted of unstructured intraoperative directives and isolated lectures. Two programs previously provided SEE but discontinued the effort due to lack of an evidence-based framework and instructors. Trainees appeared to think that learning surgical ergonomics skills was a worthwhile time investment in 100% and 76.7% of current formal and informal SEE, respectively. CONCLUSION SEE is rarely provided in any capacity (25.4%), let alone in a consistent or evaluable fashion (1.5%). Impediments to sustainable SEE include lack of an evidence-based framework for education and instructors. An evidence-based, reproducible, and accreditation council-compliant SEE module would be a valuable resource for the surgical and interventional medical communities.
Collapse
|
60
|
Association between Radiation Exposure and Endothelium-Dependent Vasodilation: Results from Clinical and Experimental Studies. J Vasc Interv Radiol 2020; 31:42-48. [PMID: 31831324 DOI: 10.1016/j.jvir.2019.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/09/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023] Open
|
61
|
Safirstein JG. Optimizing Transradial Access: Radiation, Contrast, Access Site Crossover, and Ergonomics. Interv Cardiol Clin 2020; 9:99-105. [PMID: 31733745 DOI: 10.1016/j.iccl.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article summarizes the data comparing radiation exposure and contrast use between transradial and transfemoral cardiac catheterizations. It also reviews the important features that may predict access site failure and crossover. In addition, it reviews the concept of ergonomics in the catheterization laboratory and how clinicians can improve the transradial approach.
Collapse
Affiliation(s)
- Jordan G Safirstein
- Department of Cardiology, Transradial Intervention, Morristown Medical Center, Meade Level B, 100 Madison Avenue, Morristown, NJ 07960, USA.
| |
Collapse
|
62
|
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.
Collapse
Affiliation(s)
- Charlie Yu
- RadPro, 101 Cashew Rd. #06-03, Singapore, 679672, Singapore.
| |
Collapse
|
63
|
Characteristics and Consequences of Work-Related Musculoskeletal Pain among Cardiac Sonographers Compared with Peer Employees: A Multisite Cross-Sectional Study. J Am Soc Echocardiogr 2019; 32:1138-1146. [DOI: 10.1016/j.echo.2019.04.416] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 11/21/2022]
|
64
|
Austin K, Schoenberger H, Saha S. Special situations: Performance of endoscopy while pregnant. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
65
|
Harris LM. Occupational injuries versus radiation exposure. J Vasc Surg 2019; 70:251. [PMID: 31230643 DOI: 10.1016/j.jvs.2018.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Linda M Harris
- Division of Vascular Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| |
Collapse
|
66
|
Sarkozy A, De Potter T, Heidbuchel H, Ernst S, Kosiuk J, Vano E, Picano E, Arbelo E, Tedrow U. Occupational radiation exposure in the electrophysiology laboratory with a focus on personnel with reproductive potential and during pregnancy: A European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS). Europace 2018; 19:1909-1922. [PMID: 29126278 DOI: 10.1093/europace/eux252] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/07/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Andrea Sarkozy
- University Antwerp and University Hospital of Antwerp, Cardiology department, Antwerp, Belgium
| | - Tom De Potter
- Cardiology Department, OLV Hospital, Moorselbaan, 164 Aalst B-9300, Belgium
| | - Hein Heidbuchel
- University Antwerp and University Hospital of Antwerp, Cardiology department, Antwerp, Belgium
| | - Sabine Ernst
- Cardiology Department, Royal Brompton And Harefield Hospital Sydney Street Chelsea Wing, Level 4 London, SW3 6NP, UK
| | - Jedrzej Kosiuk
- Cardiology Department, University Hospital of Leipzig, Leipzig, Germany
| | - Eliseo Vano
- Department Radiology, Medical School and San Carlos University Hosp Radiology, Madrid 28040, Spain
| | | | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. IDIBAPS, Institut d'Investigació August Pi i Sunyer, Hospital Clínic de Barcelona Villarroel, 17008036 Barcelona, Spain
| | - Usha Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street Boston, MA 02115, USA
| |
Collapse
|
67
|
Bunch TJ. Let go to grow: Reconciling your dependence on fluoroscopy for atrial fibrillation ablations. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1412-1413. [PMID: 30191577 DOI: 10.1111/pace.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Jared Bunch
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
68
|
|
69
|
Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg 2018; 153:e174947. [PMID: 29282463 DOI: 10.1001/jamasurg.2017.4947] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Physicians in procedural specialties are at high risk for work-related musculoskeletal disorders (MSDs). This has been called "an impending epidemic" in the context of the looming workforce shortage; however, prevalence estimates vary by study. Objectives To estimate the prevalence of work-related MSDs among at-risk physicians and to evaluate the scope of preventive efforts. Data Sources and Study Selection Systematic search in MEDLINE (Ovid), Embase (Elsevier), Web of Science, PubMed (National Center for Biotechnology Information), and 2 clinical trial registries, without language restriction, for studies reporting on the prevalence and prevention of work-related MSDs among at-risk physicians published until December 2016. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for meta-analyses and systematic reviews of observational studies were used. At-risk physicians were defined as surgeons and medical interventionalists. Studies reporting on specific disorders or pain assessed with validated instruments were included. Data Extraction and Synthesis Study characteristics; disease prevalence for the neck, shoulder, back, and upper extremity; and measures of resulting disability were recorded. Study estimates were pooled using random-effects meta-analytic models. Main Outcomes and Measures Career prevalence of injuries and 12-month prevalence of pain. Results Among 21 articles (5828 physicians [mean age, 46.0 years; 78.5% male; 12.8 years in practice; 14.4 hours performing procedures per week]) included in this systematic review and meta-analysis, pooled crude prevalence estimates of the most common work-related MSDs were degenerative cervical spine disease in 17% (457 of 2406 physicians) (95% CI, 12%-25%), rotator cuff pathology in 18% (300 of 1513 physicians) (95% CI, 13%-25%), degenerative lumbar spine disease in 19% (544 of 2449 physicians) (95% CI, 5%-16%), and carpal tunnel syndrome in 9% (256 of 2449 physicians) (95% CI, 5%-16%). From 1997 to 2015, the prevalence of degenerative cervical spine disease and degenerative lumbar spine disease increased by 18.3% and 27%, respectively. Pooled prevalence estimates for pain ranged from 35% to 60% and differed by assessment instrument. Of those with a work-related MSD, 12% (277 of 2319 physicians) (95% CI, 7%-18%) required a leave of absence, practice restriction or modification, or early retirement. Heterogeneity was considerable for all crude analyses (mean I2 = 93.5%) but was lower for sensitivity analyses (mean I2 = 72.3%). Interventions focused on products and behaviors. Twelve at-risk specialties described a gross lack of awareness and an unmet need for ergonomics education. Conclusions and Relevance Prevalence estimates of work-related MSDs among at-risk physicians appear to be high. Further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders in this population.
Collapse
Affiliation(s)
- Sherise Epstein
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emily H Sparer
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Bao N Tran
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Qing Z Ruan
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jack T Dennerlein
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Dhruv Singhal
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
70
|
Ko S, Kang S, Ha M, Kim J, Jun JK, Kong KA, Lee WJ. Health Effects from Occupational Radiation Exposure among Fluoroscopy-Guided Interventional Medical Workers: A Systematic Review. J Vasc Interv Radiol 2018; 29:353-366. [PMID: 29306599 DOI: 10.1016/j.jvir.2017.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/30/2017] [Accepted: 10/09/2017] [Indexed: 01/06/2023] Open
Abstract
A systematic review was conducted to provide an overview of the health effects of occupational radiation exposure from interventional fluoroscopy procedures on medical radiation workers. Among the 34 studies that met the inclusion criteria, most studies were cross-sectional (76%) and published after 2011 (65%) in a handful of countries. Although diverse outcomes were reported, most studies focused on cataracts. Radiation health effects were rarely assessed by risk per unit dose. Interventional radiation medical workers represent a small subset of the population studied worldwide. Further epidemiologic studies should be conducted to evaluate health outcomes among interventional radiation medical workers.
Collapse
Affiliation(s)
- Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02855, South Korea; Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Seonghoon Kang
- Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea; Department of Occupational and Environmental Medicine, Korea University Ansan Hospital, Gyeonggi-do, South Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea
| | - Jaeyoung Kim
- Department of Preventive Medicine, Keimyung University College of Medicine, Daegu, South Korea
| | - Jae Kwan Jun
- National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do, South Korea
| | - Kyoung Ae Kong
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02855, South Korea; Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea.
| |
Collapse
|
71
|
Madder RD, LaCombe A, VanOosterhout S, Mulder A, Elmore M, Parker JL, Jacoby ME, Wohns D. Radiation Exposure Among Scrub Technologists and Nurse Circulators During Cardiac Catheterization: The Impact of Accessory Lead Shields. JACC Cardiovasc Interv 2017; 11:206-212. [PMID: 29102573 DOI: 10.1016/j.jcin.2017.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/08/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was performed to determine if the use of an accessory lead shield is associated with a reduction in radiation exposure among staff members during cardiac catheterization. BACKGROUND Accessory lead shields that protect physicians from scatter radiation are standard in many catheterization laboratories, yet similar shielding for staff members is not commonplace. METHODS Real-time radiation exposure data were prospectively collected among nurses and technologists during 764 consecutive catheterizations. The study had 2 phases: in phase I (n = 401), standard radiation protection measures were used, and in phase II (n = 363), standard radiation protection measures were combined with an accessory lead shield placed between the staff member and patient. Radiation exposure was reported as the effective dose normalized to dose-area product (EDAP). RESULTS Use of an accessory lead shield in phase II was associated with a 62.5% lower EDAP per case among technologists (phase I: 2.4 [4.3] μSv/[mGy × cm2] × 10-5; phase II: 0.9 [2.8] μSv/[mGy × cm2] × 10-5; p < 0.001) and a 63.6% lower EDAP per case among nurses (phase I: 1.1 [3.1] μSv/[mGy × cm2] × 10-5; phase II: 0.4 [1.8] μSv/[mGy × cm2] × 10-5; p < 0.001). By multivariate analysis, accessory shielding remained independently associated with a lower EDAP among both technologists (34.2% reduction; 95% confidence interval: 20.1% to 45.8%; p < 0.001) and nurses (36.4% reduction; 95% confidence interval: 19.7% to 49.6%; p < 0.001). CONCLUSIONS The relatively simple approach of using accessory lead shields to protect staff members during cardiac catheterization was associated with a nearly two-thirds reduction in radiation exposure among nurses and technologists.
Collapse
Affiliation(s)
- Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
| | - Andrew LaCombe
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| | - Stacie VanOosterhout
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| | - Abbey Mulder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| | - Matthew Elmore
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| | - Jessica L Parker
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| | - Mark E Jacoby
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| | - David Wohns
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| |
Collapse
|
72
|
Wang H, Chen Q, Liu G, Tian Y, Zhang F, Qu J, Lim D, Feng Z. The Comparison of Health Status Between Male and Female Medical Radiation Workers in China. RADIATION PROTECTION DOSIMETRY 2017; 175:508-516. [PMID: 28096311 DOI: 10.1093/rpd/ncw380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/11/2016] [Indexed: 06/06/2023]
Abstract
To assess the health statue of chronically exposed Chinese medical radiation workers. A cross-sectional study of 530 medical radiation workers in a city of China was conducted to document the health status and the monitored annually absorbed doses. Long-term and low-dose radiation exposure can affect a number of health indicators in the individuals, which covered the cardiovascular system, hematologic system, ophthalmology, liver and kidney's functions, chromosome aberration and micronucleus. The differences in the health status between male and female individuals were associated with job types and exposed years of service. The monitored doses of individuals were lower than the limit value of the national standard. The health status in chronically exposed individuals demonstrated some gender difference associated with length of exposure and work type. This study provides some evidence to understand the health status of medical radiation workers in China and have the potentially to inform screening and clinical diagnosis.
Collapse
Affiliation(s)
- Hui Wang
- Department of Occupational Health and Occupational Medicine, School of Public Health, Shandong University, Jinan, Shandong Province250012, China
| | - Qianshu Chen
- Dezhou Center for Disease Control and Prevention, Shandong253000, China
| | - Guochao Liu
- Department of Occupational Health and Occupational Medicine, School of Public Health, Shandong University, Jinan, Shandong Province250012, China
| | - Youjia Tian
- Department of Occupational Health and Occupational Medicine, School of Public Health, Shandong University, Jinan, Shandong Province250012, China
| | - Fengmei Zhang
- Department of Occupational Health and Occupational Medicine, School of Public Health, Shandong University, Jinan, Shandong Province250012, China
| | - Jianying Qu
- Qingdao Center for Disease Control and Prevention, Qingdao 266033, China
| | - David Lim
- Flinders Rural Health South Australia, Victor Harbor, South Australia 5211, Australia
| | - Zhihui Feng
- Department of Occupational Health and Occupational Medicine, School of Public Health, Shandong University, Jinan, Shandong Province250012, China
| |
Collapse
|
73
|
Mangels DR, Giri J, Hirshfeld J, Wilensky RL. Robotic-assisted percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 90:948-955. [DOI: 10.1002/ccd.27205] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/15/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel R. Mangels
- Department of Medicine; University of Pennsylvania, 3400 Spruce Street, 100 Centrex; Philadelphia Pennsylvania
| | - Jay Giri
- Division of Cardiovascular Medicine; University of Pennsylvania, 3400 Civic Center Blvd, 11th Floor, South Pavilion; Philadelphia Pennsylvania
| | - John Hirshfeld
- Division of Cardiovascular Medicine; University of Pennsylvania, 3400 Civic Center Blvd, 11th Floor, South Pavilion; Philadelphia Pennsylvania
| | - Robert L. Wilensky
- Division of Cardiovascular Medicine; University of Pennsylvania, 3400 Civic Center Blvd, 11th Floor, South Pavilion; Philadelphia Pennsylvania
| |
Collapse
|
74
|
Madder RD, VanOosterhout S, Mulder A, Elmore M, Campbell J, Borgman A, Parker J, Wohns D. Impact of robotics and a suspended lead suit on physician radiation exposure during percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:190-196. [DOI: 10.1016/j.carrev.2016.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/09/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
|
75
|
Alexandre D, Prieto M, Beaumont F, Taiar R, Polidori G. Wearing lead aprons in surgical operating rooms: ergonomic injuries evidenced by infrared thermography. J Surg Res 2017; 209:227-233. [DOI: 10.1016/j.jss.2016.10.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/28/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
|
76
|
Madder R, VanOosterhout S, Jacoby M, Collins JS, Borgman A, Mulder A, Elmore M, Campbell J, McNamara R, Wohns D. Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the patient: an early exploration into the feasibility of telestenting (the REMOTE-PCI study). EUROINTERVENTION 2017; 12:1569-1576. [DOI: 10.4244/eij-d-16-00363] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
77
|
Dixon RG, Khiatani V, Statler JD, Walser EM, Midia M, Miller DL, Bartal G, Collins JD, Gross KA, Stecker MS, Nikolic B. Society of Interventional Radiology: Occupational Back and Neck Pain and the Interventional Radiologist. J Vasc Interv Radiol 2016; 28:195-199. [PMID: 27993508 DOI: 10.1016/j.jvir.2016.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Robert G Dixon
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
| | - Vishal Khiatani
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - John D Statler
- Virginia Interventional and Vascular Associates, Fredericksburg, Virginia
| | - Eric M Walser
- Department of Radiology, University of Texas Medical Branch, Galveston, Texas
| | - Mehran Midia
- Department of Interventional Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Donald L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring
| | - Gabriel Bartal
- Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Kathleen A Gross
- Department of Interventional Radiology, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Michael S Stecker
- Division of Angiography Interventional Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
| | | |
Collapse
|
78
|
Andreassi MG, Piccaluga E, Guagliumi G, Del Greco M, Gaita F, Picano E. Occupational Health Risks in Cardiac Catheterization Laboratory Workers. Circ Cardiovasc Interv 2016; 9:e003273. [PMID: 27072525 DOI: 10.1161/circinterventions.115.003273] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Orthopedic strain and radiation exposure are recognized risk factors in personnel staff performing fluoroscopically guided cardiovascular procedures. However, the potential occupational health effects are still unclear. The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure. METHODS AND RESULTS We used a self-administered questionnaire to collect demographic information, work-related information, lifestyle-confounding factors, all current medications, and health status. A total number of 746 questionnaires were properly filled comprising 466 exposed staff (281 males; 44±9 years) and 280 unexposed subjects (179 males; 43±7years). Exposed personnel included 218 interventional cardiologists and electrophysiologists (168 males; 46±9 years); 191 nurses (76 males; 42±7 years), and 57 technicians (37 males; 40±12 years) working for a median of 10 years (quartiles: 5-24 years). Skin lesions (P=0.002), orthopedic illness (P<0.001), cataract (P=0.003), hypertension (P=0.02), and hypercholesterolemia (P<0.001) were all significantly higher in exposed versus nonexposed group, with a clear gradient unfavorable for physicians over technicians and nurses and for longer history of work (>16 years). In highly exposed physicians, adjusted odds ratio ranged from 1.7 for hypertension (95% confidence interval: 1-3; P=0.05), 2.9 for hypercholesterolemia (95% confidence interval: 1-5; P=0.004), 4.5 for cancer (95% confidence interval: 0.9-25; P=0.06), to 9 for cataract (95% confidence interval: 2-41; P=0.004). CONCLUSIONS Health problems are more frequently observed in workers performing fluoroscopically guided cardiovascular procedures than in unexposed controls, raising the need to spread the culture of safety in the cath laboratory.
Collapse
Affiliation(s)
- Maria Grazia Andreassi
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.).
| | - Emanuela Piccaluga
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Giulio Guagliumi
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Maurizio Del Greco
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Fiorenzo Gaita
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Eugenio Picano
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| |
Collapse
|
79
|
Aronow HD, Hyder ON. The Future of Endovascular Therapy: A View From the Cockpit. JACC Cardiovasc Interv 2016; 9:2065-2066. [PMID: 27639900 DOI: 10.1016/j.jcin.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Omar N Hyder
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
80
|
Feasibility and Safety of Robotic Peripheral Vascular Interventions. JACC Cardiovasc Interv 2016; 9:2058-2064. [DOI: 10.1016/j.jcin.2016.07.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/13/2016] [Accepted: 06/30/2016] [Indexed: 11/22/2022]
|
81
|
Orme NM, Geske JB, Pislaru SV, Askew JW, Lennon RJ, Lewis BR, Rihal CS, Pellikka PA, Singh M. Occupational musculoskeletal pain in cardiac sonographers compared to peer employees: a multisite cross-sectional study. Echocardiography 2016; 33:1642-1647. [DOI: 10.1111/echo.13344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nicholas M. Orme
- Division of Cardiovascular Disease; Mayo Clinic; Rochester Minnesota
| | - Jeffrey B. Geske
- Division of Cardiovascular Disease; Mayo Clinic; Rochester Minnesota
| | - Sorin V. Pislaru
- Division of Cardiovascular Disease; Mayo Clinic; Rochester Minnesota
| | - John Wells Askew
- Division of Cardiovascular Disease; Mayo Clinic; Rochester Minnesota
| | - Ryan J. Lennon
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Bradley R. Lewis
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | | | | | - Mandeep Singh
- Division of Cardiovascular Disease; Mayo Clinic; Rochester Minnesota
| |
Collapse
|
82
|
Ephrem G, Garikipati S, Hanson ID. The fluoro-less and contrast-less peripheral endovascular intervention: Halfway there. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:418-20. [PMID: 27318704 DOI: 10.1016/j.carrev.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Percutaneous endovascular revascularization requires the use of fluoroscopic guidance and radiopaque contrast. We present a successful intervention without the use of iodinated contrast. CASE A 92-year-old man with dry gangrene involving the second and fourth left toes had acute on chronic kidney injury. Arterial duplex showed severe stenosis in bilateral superficial femoral arteries (SFAs). Fluoroscopic and ultrasound guidance and intravascular imaging were used to avoid iodinated contrast. After right to left femoral crossover, the entire left SFA was imaged with ultrasound. The lesion was delineated with radiopaque measuring tapes then wired. Near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) imaging were performed. Points of interest were correlated with corresponding radiopaque markings on the ruler. Stenting and post-dilation resulted in complete stent expansion and no evidence of dissection by IVUS. The total procedure time was 113min and the total radiation dose 813mGy. The day after the procedure, there was a palpable dorsalis pedis pulse. He was discharged to inpatient rehabilitation on dual antiplatelet therapy. DISCUSSION Contrast and radiation continue to limit the feasibility of endovascular angiography and intervention. Carbon dioxide (CO2) digital subtraction angiography is an alternative for these patients but has several disadvantages. Previously proposed projects demonstrated the real potential of performing endovascular peripheral intervention without fluoroscopy or contrast. CONCLUSION This case is a clear demonstration of a successful use of a combination of fluoroscopy, ultrasonography and intravascular imaging to achieve a successful endovascular intervention to treat critical limb ischemia, without the use of iodinated contrast.
Collapse
Affiliation(s)
- Georges Ephrem
- Department of Cardiovascular Disease, Oakland University-William Beaumont School of Medicine at Beaumont Health System, Royal Oak, MI.
| | - Sireesha Garikipati
- Department of Cardiovascular Disease, Oakland University-William Beaumont School of Medicine at Beaumont Health System, Royal Oak, MI
| | - Ivan D Hanson
- Department of Cardiovascular Disease, Oakland University-William Beaumont School of Medicine at Beaumont Health System, Royal Oak, MI
| |
Collapse
|
83
|
Klein LW, Bazavan M. The Economic Imperatives Underlying the Occupational Health Hazards of the Cardiac Catheterization Laboratory. Circ Cardiovasc Interv 2016; 9:e003742. [DOI: 10.1161/circinterventions.116.003742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lloyd W. Klein
- From the Cardiology Department, Advocate Illinois Masonic Medical Center, and Rush Medical College, Chicago, IL
| | - Mugurel Bazavan
- From the Cardiology Department, Advocate Illinois Masonic Medical Center, and Rush Medical College, Chicago, IL
| |
Collapse
|
84
|
Clinical Importance of Transthoracic Echocardiography with Direct Input from Treating Physicians. J Am Soc Echocardiogr 2016; 29:195-204. [DOI: 10.1016/j.echo.2015.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Indexed: 11/22/2022]
|
85
|
|
86
|
Orme NM, Lennon RJ, Singh M. Reply. J Am Coll Cardiol 2015; 66:760. [DOI: 10.1016/j.jacc.2015.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/27/2022]
|
87
|
Fan G, He S, Chen Z. Musculoskeletal Pain and Cancer Risk of Staff Working With Fluoroscopically Guided Procedures. J Am Coll Cardiol 2015; 66:759-60. [PMID: 26249000 DOI: 10.1016/j.jacc.2015.04.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
|
88
|
Ephrem G, Lau JF, Meraj PM. The fluoro-less and contrast-less peripheral endovascular intervention: a concept for the future today. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:294-8. [DOI: 10.1016/j.carrev.2015.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/06/2015] [Accepted: 05/14/2015] [Indexed: 11/25/2022]
|
89
|
Goldstein JA. Orthopedic Afflictions in the Interventional Laboratory. J Am Coll Cardiol 2015; 65:827-829. [DOI: 10.1016/j.jacc.2014.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 11/25/2022]
|