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Johnson A, Cupp G, Armour N, Warren K, Stone C, Lee D, Gilbert N, Hammond C, Moore J, Kang YA. An Inexpensive Cardiovascular Flow Simulator for Cardiac Catheterization Procedure Using a Pulmonary Artery Catheter. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:764007. [PMID: 35047963 PMCID: PMC8757711 DOI: 10.3389/fmedt.2021.764007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
Abstract
Cardiac catheterization associated with central vein cannulation can involve potential thrombotic and infectious complications due to multiple cannulation trials or improper placement. To minimize the risks, medical simulators are used for training. Simulators are also employed to test medical devices such as catheters before performing animal tests because they are more cost-effective and still reveal necessary improvements. However, commercial simulators are expensive, simplified for their purpose, and provide limited access sites. Inexpensive and anatomical cardiovascular simulators with central venous access for cannulation are sparse. Here, we developed an anatomically and physiologically accurate cardiovascular flow simulator to help train medical professionals and test medical devices. Our simulator includes an anatomical right atrium/ventricle, femoral and radial access sites, and considers the variability of arm position. It simulates physiological pulsatile blood flow with a setting for constant flow from 3 to 6 L/min and mimics physiological temperature (37°C). We demonstrated simulation by inserting a catheter into the system at radial/femoral access sites, passing it through the vasculature, and advancing it into the heart. We expect that our simulator can be used as an educational tool for cardiac catheterization as well as a testing tool that will allow for design iteration before moving to animal trials.
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Affiliation(s)
- Annika Johnson
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Grace Cupp
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Nicholas Armour
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Kyle Warren
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Christopher Stone
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Davin Lee
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Nicholas Gilbert
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | | | - John Moore
- TZ Medical Inc, Portland, OR, United States
| | - Youngbok Abraham Kang
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
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Abstract
Despite more than 80% of interventional operators reporting one or more orthopedic injuries attributed to the X-ray laboratory, there has been limited adoption of various strategies and equipment to minimize these injuries. A comprehensive review of these methods to reduce musculoskeletal strain is lacking in the current literature, and is essential in order to ensure a long, healthy, and productive interventional career.
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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]
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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
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Chinnadurai P, Bismuth J. Intraoperative Imaging and Image Fusion for Venous Interventions. Methodist Debakey Cardiovasc J 2018; 14:200-207. [PMID: 30410650 DOI: 10.14797/mdcj-14-3-200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Advanced imaging for intraoperative evaluation of venous pathologies has played an increasingly significant role in this era of evolving minimally invasive surgical and interventional therapies. The evolution of dedicated venous stents and other novel interventional devices has mandated the need for advanced imaging tools to optimize safe and accurate device deployment. Most venous interventions are typically performed using a combination of standard 2-dimensional (2D) fluoroscopy, digital-subtraction angiography, and intravascular ultrasound imaging techniques. Latest generation computer tomography (CT) and magnetic resonance imaging (MRI) scanners have been shown to provide high-resolution 3D and 4D information about venous vasculature. In addition to morphological imaging, novel MRI techniques such as 3D time-resolved MR venography and 4D flow sequences can provide quantitative information and help visualize intricate flow patterns to better understand complex venous pathologies. Moreover, the high-fidelity information from multiple imaging techniques can be integrated using image fusion to overcome the limitations of current intraoperative imaging techniques. For example, the limitations of standard 2D fluoroscopy and luminal angiography can be compensated for by perivascular and soft-tissue information from MRI during complex venous interventions using image fusion techniques. Intraoperative dynamic evaluation of devices such as venous stents and real-time understanding of changes in flow patterns during venous interventions may be routinely available in future interventional suites with integrated multimodality CT or MR imaging capabilities. The purpose of this review is to discuss the outlook for intraoperative imaging and multimodality image fusion techniques and highlight their value during complex venous interventions.
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Affiliation(s)
| | - Jean Bismuth
- METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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Schwein A, Kramer B, Chinnadurai P, Virmani N, Walker S, O'Malley M, Lumsden AB, Bismuth J. Electromagnetic tracking of flexible robotic catheters enables “assisted navigation” and brings automation to endovascular navigation in an in vitro study. J Vasc Surg 2018; 67:1274-1281. [DOI: 10.1016/j.jvs.2017.01.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/29/2017] [Indexed: 11/28/2022]
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Lotfi AS, Klein LW. The Metamorphosis of ST-Segment Elevation Myocardial Infarction Programs. JACC Cardiovasc Interv 2017; 10:2574-2576. [DOI: 10.1016/j.jcin.2017.06.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 10/18/2022]
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8
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Balter S, Chambers CE. Radiation Management in Interventional Cardiology. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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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
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Cheng I, Shen R, Moreau R, Brizzi V, Rossol N, Basu A. An augmented reality framework for optimization of computer assisted navigation in endovascular surgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:5647-50. [PMID: 25571276 DOI: 10.1109/embc.2014.6944908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Endovascular surgery is performed by placing a catheter through blood vessels. Due to the fragility of arteries and the difficulty in controlling a long elastic wire to reach the target region, training plays an extremely important role in helping a surgeon acquire the required complex skills. Virtual reality simulators and augmented reality systems have proven to be effective in minimally invasive surgical training. These systems, however, often employ pre-captured or computer-generated medical images. We have developed an augmented reality system for ultrasound-guided endovascular surgical training, where real ultrasound images captured during the procedure are registered with a pre-scanned phantom model to give the operator a realistic experience. Our goal is to extend the planning and training environment to deliver a system for computer assisted remote endovascular surgery where the navigation of a catheter can be controlled through a robotic device based on the guidance provided by an endovascular surgeon.
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Christopoulos G, Christakopoulos GE, Rangan BV, Layne R, Grabarkewitz R, Haagen D, Latif F, Abu-Fadel M, Banerjee S, Brilakis ES. Comparison of radiation dose between different fluoroscopy systems in the modern catheterization laboratory: Results from bench testing using an anthropomorphic phantom. Catheter Cardiovasc Interv 2015; 86:927-32. [DOI: 10.1002/ccd.26007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/03/2015] [Accepted: 04/11/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Georgios Christopoulos
- Division of Cardiovascular Diseases; VA North Texas Health Care System and UT Southwestern Medical Center; Dallas Texas
| | - Georgios E. Christakopoulos
- Division of Cardiovascular Diseases; VA North Texas Health Care System and UT Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- Division of Cardiovascular Diseases; VA North Texas Health Care System and UT Southwestern Medical Center; Dallas Texas
| | - Ronald Layne
- Division of Cardiovascular Diseases; VA North Texas Health Care System and UT Southwestern Medical Center; Dallas Texas
| | - Rebecca Grabarkewitz
- Division of Cardiovascular Diseases; VA North Texas Health Care System and UT Southwestern Medical Center; Dallas Texas
| | - Donald Haagen
- Division of Cardiovascular Diseases; VA North Texas Health Care System and UT Southwestern Medical Center; Dallas Texas
| | - Faisal Latif
- Division of Cardiovascular Diseases; University of Oklahoma; Norman Oklahoma
| | - Mazen Abu-Fadel
- Division of Cardiovascular Diseases; University of Oklahoma; Norman Oklahoma
| | - Subhash Banerjee
- Division of Cardiovascular Diseases; VA North Texas Health Care System and UT Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- Division of Cardiovascular Diseases; VA North Texas Health Care System and UT Southwestern Medical Center; Dallas Texas
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Vano E. Occupational radiation protection of health workers in imaging. RADIATION PROTECTION DOSIMETRY 2015; 164:126-129. [PMID: 25480840 DOI: 10.1093/rpd/ncu354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Occupational radiological protection (RP) is still a challenge in several clinical practices. ICRP has included specific recommendations and advice for occupational protection in most of the documents published in recent years and its current programme of work includes the preparation of documents with specific contents on Occupational Protection. Different professional groups and different medical specialists need dedicated training, supervision and advice to optimise their practices. Many medical specialties outside the imaging departments are still using fluoroscopically guided procedures in surgical theatres without the appropriate RP tools. In addition to the stochastic radiation risks, the new thresholds for tissue reactions proposed by ICRP, and especially the ones for the lens of the eyes and the cerebrovascular system, are a matter of concern for some groups of health workers. More support from medical physics and radiation protection experts regarding occupational issues in the medical field will be needed in the coming years.
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Affiliation(s)
- E Vano
- Radiology Department, Medicine Faculty, Complutense University and IdISSC San Carlos Hospital, Madrid 28040, Spain
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Klein LW, Tra Y, Garratt KN, Powell W, Lopez-Cruz G, Chambers C, Goldstein JA. Occupational health hazards of interventional cardiologists in the current decade: Results of the 2014 SCAI membership survey. Catheter Cardiovasc Interv 2015; 86:913-24. [PMID: 25810341 DOI: 10.1002/ccd.25927] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/08/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Interventional cardiologists and staff are subject to unique physical demands that predispose them to distinct occupational health hazards not seen in other medical disciplines. METHODS To characterize the prevalence of these occupational health problems, The Society for Cardiovascular Angiography and Interventions (SCAI) surveyed its members by email. Inquiries included age, years of invasive practice, and diagnostic and interventional cases per year. Questions focused on orthopedic (spine, hips, knees, and ankles) and radiation-associated problems (cataracts and cancers). RESULTS There were 314 responses. Responders were on average busy and experienced, performing a mean of 380±249 diagnostic and 200±129 interventional cases annually. Of the responders, 6.9% of operators have had to limit their caseload because of radiation exposure and 9.3% have had a health-related period of absence. Furthermore, 153 (49.4%) operators reported at least one orthopedic injury: 24.7% cervical spine disease, 34.4% lumbar spine problems, and 19.6% hip, knee or ankle joint problems. Age was most significantly correlated with orthopedic illnesses: cervical injuries (χ2=150.7, P<0.0001); hip/knee or ankle injuries (χ2=80.9, P<0.0001); lumbar injuries (χ2=147.0, P<0.0001); and any orthopedic illness (χ2= 241.2, P<0.0001). Annual total caseload was also associated: the estimated change in the odds of orthopedic illness for each additional total caseload quintile is 1.0013 (1.0001, 1.0026). There is a small but substantial incidence of cancer. CONCLUSIONS These findings are consistent with, and extend the findings, of a prior 2004 SCAI survey, in documenting a substantial prevalence of orthopedic complications among active interventional cardiologists, which persists despite increased awareness.
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Affiliation(s)
- Lloyd W Klein
- Department of Cardiology, Advocate Illinois Medical Center, Chicago, Illinois
| | - Yolande Tra
- Maryland Poison Center, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Kirk N Garratt
- Department of Cardiology, Lenox Hill Hospital, New York, New York
| | | | | | - Charles Chambers
- Department of Cardiology, Penn State University, Hershey, Pennsylvania
| | - James A Goldstein
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
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Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol 2013; 111:1368-72. [PMID: 23419190 DOI: 10.1016/j.amjcard.2012.12.060] [Citation(s) in RCA: 359] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 12/26/2012] [Accepted: 12/26/2012] [Indexed: 11/24/2022]
Abstract
Physicians performing interventional procedures are chronically exposed to ionizing radiation, which is known to pose increased cancer risks. We recently reported 9 cases of brain cancer in interventional cardiologists. Subsequently, we received 22 additional cases from around the world, comprising an expanded 31 case cohort. Data were transmitted to us during the past few months. For all cases, where possible, we endeavored to obtain the baseline data, including age, gender, tumor type, and side involved, specialty (cardiologist vs radiologist), and number of years in practice. These data were obtained from the medical records, interviews with patients, when possible, or with family members and/or colleagues. The present report documented brain and neck tumors occurring in 31 physicians: 23 interventional cardiologists, 2 electrophysiologists, and 6 interventional radiologists. All physicians had worked for prolonged periods (latency period 12 to 32 years, mean 23.5 ± 5.9) in active interventional practice with exposure to ionizing radiation in the catheterization laboratory. The tumors included 17 cases (55%) of glioblastoma multiforme (GBM), 2 astrocytomas (7%), and 5 meningiomas (16%). In 26 of 31 cases, data were available regarding the side of the brain involved. The malignancy was left sided in 22 (85%), midline in 1, and right sided in 3 operators. In conclusion, these results raise additional concerns regarding brain cancer developing in physicians performing interventional procedures. Given that the brain is relatively unprotected and the left side of the head is known to be more exposed to radiation than the right, these findings of disproportionate reports of left-sided tumors suggest the possibility of a causal relation to occupational radiation exposure.
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Reduction of Exposure of Patients and Staff to Radiation During Fluoroscopically Guided Interventional Procedures. CURRENT RADIOLOGY REPORTS 2012. [DOI: 10.1007/s40134-012-0001-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Maroney J, Khan S, Powell W, Klein LW. Current operator volumes of invasive coronary procedures in medicare patients: Implications for future manpower needs in the catheterization laboratory. Catheter Cardiovasc Interv 2012; 81:34-9. [DOI: 10.1002/ccd.24366] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 02/13/2012] [Indexed: 11/09/2022]
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Roguin A, Goldstein J, Bar O. Brain tumours among interventional cardiologists: a cause for alarm? Report of four new cases from two cities and a review of the literature. EUROINTERVENTION 2012; 7:1081-6. [DOI: 10.4244/eijv7i9a172] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Klein LW, Maroney J. Optimizing Operator Protection by Proper Radiation Shield Positioning in the Interventional Cardiology Suite⁎⁎Editorials published in JACC: Cardiovascular Interventions reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Interventions or the American College of Cardiology. JACC Cardiovasc Interv 2011; 4:1140-1. [DOI: 10.1016/j.jcin.2011.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 11/30/2022]
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