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Ferrari P, Venturi G, Campani L, Mariotti F, Becker F, Jansen J, Jovanović Z, Krstić D, Teles P. Medical staff monitoring in interventional cardiology: over apron dosemeter placement based on measurements and simulations. RADIATION PROTECTION DOSIMETRY 2024; 200:802-807. [PMID: 38773775 DOI: 10.1093/rpd/ncae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024]
Abstract
Interventional cardiology is characterized by high radiation exposure for both the patient and the operator. Adequate shielding and monitoring of the operator are fundamental to comply with radiation protection principles. In a previous work, the effect on the dose of the dosemeter position on the chest was studied. In this paper, the investigation has been completed, employing an anthropomorphic thorax phantom, equipped with arms. Although there are differences between the Monte Carlo simulations and the measurements, similar trends are observed, showing that the reduction in dose, due to the arms, is between 20 and 60%, compared with the situation without arms. For that reason, considering a dosemeter placed on the chest, the upper position, which is the least affected by the arms, should be preferred while the extreme lateral position, near the armpit, should be avoided.
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Affiliation(s)
- Paolo Ferrari
- ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, IRP-Radiation Protection Institute, Bologna 40129, Italy
| | | | - Lorenzo Campani
- ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, IRP-Radiation Protection Institute, Bologna 40129, Italy
| | - Francesca Mariotti
- ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, IRP-Radiation Protection Institute, Bologna 40129, Italy
| | - Frank Becker
- KIT-Karlsruhe Institute of Technology, Institute for Nuclear Waste Disposal, Eggenstein-Leopoldshafen 76344, Germany
| | - Jan Jansen
- UK Health Security Agency, Oxon OX11 0RQ, United Kingdom
| | - Zoran Jovanović
- Faculty of Science, University of Kragujevac, Kragujevac 34000, Serbia
| | - Dragana Krstić
- Faculty of Science, University of Kragujevac, Kragujevac 34000, Serbia
| | - Pedro Teles
- Faculty of Science, University of Porto and CI-IPOP (Porto Cancer Institute Research Centre), Porto 4169-007, Portugal
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Koch A, Gruber-Rouh T, Zangos S, Eichler K, Vogl T, Basten L. Radiation protection in CT-guided interventions: does real-time dose visualisation lead to a reduction in radiation dose to participating radiologists? A single-centre evaluation. Clin Radiol 2024; 79:e785-e790. [PMID: 38388255 DOI: 10.1016/j.crad.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024]
Abstract
AIM To evaluate if real-time dose visualisation during computed tomography (CT)-guided interventions leads to a reduction in radiation dose to participating radiologists. MATERIALS AND METHODS The individual radiation dose radiologists are exposed to during CT interventions was measured using dedicated dosimeters (RaySafe i2-system, Unfors RaySafe GmbH, Billdal, Sweden) worn over the usual radiation protective apron. Initially, only the total radiation dose was measured, without visualisation (control group). In the following study period, the radiation dose was shown to participants on a live screen in real-time (experimental group). In both groups, the dose was recorded in 1-second intervals. The results collected were evaluated by comparison using descriptive statistics and mixed-effect models. In particular, the variables experience, gender, role, and position during the intervention were analysed. RESULTS In total, 517 measurements of 304 interventions (n=249 with and n=268 without live screen) performed by 29 radiologists acting as interventionalists or assistants were analysed. All CT-guided interventions were performed percutaneously, the majority of which (n=280) were microwave ablations (MWA). Radiation doses in the group without visualisation were comparable with usual dose rates for the corresponding intervention type. The mean total radiation dose was reduced by 58.1% (11.6 versus 4.86 μSv) in the experimental group (p=0.034). The highest reduction of 78.5% (15.55 versus 3.35 μSv) was observed in radiologists with the role of assistant (p=0.002). Sub-analysis showed significant dose reduction (p<0.0001) for the use of live screen in general; considering all variables, the role "assistant" alone had a statistically significant influence (p=0.002). CONCLUSION The real-time visualisation of active radiation dose during CT interventions leads to a relevant reduction in radiation dose to participating radiologists.
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Affiliation(s)
- A Koch
- Department of Diagnostic and Interventional Radiology, Frankfurt-University Hospital, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - T Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Frankfurt-University Hospital, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - S Zangos
- Department of Diagnostic and Interventional Radiology, Frankfurt-University Hospital, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - K Eichler
- Department of Diagnostic and Interventional Radiology, Frankfurt-University Hospital, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - T Vogl
- Department of Diagnostic and Interventional Radiology, Frankfurt-University Hospital, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - L Basten
- Department of Diagnostic and Interventional Radiology, Frankfurt-University Hospital, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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Altin SE, Kwong M, Hamburg NM, Creager MA, Banerjee S, Oladini L, Schneider MD, Ruddy JM. Addressing Barriers to Entry and Retention of Women in Interventional Vascular Specialties With Proposed Solutions: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e986-e995. [PMID: 38375663 DOI: 10.1161/cir.0000000000001210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Representation of women in interventional vascular fields (interventional cardiology, interventional radiology, and vascular surgery) lags behind that in other specialties. With women representing half of all medical school graduates, encouraging parity of women in these fields needs to start in medical school. Barriers to pursuing careers in vascular intervention include insufficient exposure during core clerkships, early mentorship, visibility of women in the field, length of training, lifestyle considerations, work culture and environment, and concerns about radiation exposure. This scientific statement highlights potential solutions for both the real and perceived barriers that women may face in pursuing careers in vascular intervention, including streamlining of training (as both interventional radiology and vascular surgery have done with a resultant increase in percentage of women trainees), standardization of institutional promotion of women in leadership, and professional and industry partnerships for the retention and advancement of women.
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Cecconi A, Li CHP, Pombar Camean M, Cruz-Gonzalez I, Martínez Monzonís A. Radiation protection in interventional echocardiography. Recommendations of the SEC-Cardiovascular Imaging Association/SEC-Interventional Cardiology Association. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:956-960. [PMID: 37572774 DOI: 10.1016/j.rec.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Alberto Cecconi
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Chi-Hion Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain.
| | - Miguel Pombar Camean
- Servicio de Radiofísica e Protección Radiológica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Ignacio Cruz-Gonzalez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Amparo Martínez Monzonís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Szegedi N, Kroptkin E, Traykoc V, Abdrakhmanov A, Lorgat F, Sapelnikov O, Simons S, Amin M. Routine use of a 3D mapping system in the ablation of supraventricular arrhythmias with as low as reasonably achievable X-ray exposure (AALARA): protocol for a prospective, observational, multicentre, multinational, open-label registry study. BMJ Open 2023; 13:e072181. [PMID: 37541748 PMCID: PMC10407390 DOI: 10.1136/bmjopen-2023-072181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming standard of care in many parts of the world. While observational studies in the USA and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real-world data for this technique and generalisability of outcome in other economic regions. METHODS AND ANALYSIS The arrhythmias with as low as reasonably achievable X-ray exposure study is a prospective, observational, multicentre and multinational open-label registry study. Up to 700 patients undergoing catheter ablation for right-sided supraventricular arrhythmias (according to national guidelines) will be enrolled for the routine use of the EnSite Precision 3D mapping system. Participating sites are distributed in 13 countries from Central Eastern Europe, North and South Africa, the Middle East and the CIS (Commonwealth of Independent States), with different levels of expertise using minimal fluoroscopic exposure techniques. After electrophysiological procedure, patients will be followed up for 6 months either in-clinic or via telephone interview. Patients will be asked to complete a study questionnaire at enrolment and 6 months after the invasive procedure to assess quality of life changes secondary to the procedure. The study's primary objective is to describe ionising radiation exposure during catheter ablation when the EnSite Precision 3D mapping system is used in supraventricular tachycardia ablation. The study's secondary objective is to assess the safety and efficacy of this method. Furthermore, fluoroscopy timing, total procedure time, success rate and complications will be reported. ETHICS AND DISSEMINATION The study was approved by the ethics committee at Mohammed Bin Khalifa Specialist Cardiac Centre (BDF/R&REC/2020-504) and the medical ethics committees of all participating sites. Participants will be required to provide informed consent before enrolment in the study. The study results will be published and presented at conferences. TRIAL REGISTRATION NUMBER NCT04716270.
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Affiliation(s)
- Nandor Szegedi
- Semmelweis University Heart and Vascular Centre, Budapest, Hungary
| | - Evgeniy Kroptkin
- Federal Center for Cardiovascular Surgery, Krasnoyarsk region, Russian Federation
| | - Vassil Traykoc
- Federal Center for Cardiovascular Surgery, Krasnoyarsk region, Russian Federation
| | | | - Faizel Lorgat
- Christian Barnard Memorial Hospital, Cape Town, South Africa
| | - Oleg Sapelnikov
- Institute of Clinical Cardiology, Moscow, Russian Federation
| | | | - Mohammad Amin
- Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
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Roguin A, Wu P, Cohoon T, Gul F, Nasr G, Premyodhin N, Kern MJ. Update on Radiation Safety in the Cath Lab - Moving Toward a "Lead-Free" Environment. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101040. [PMID: 39131633 PMCID: PMC11307637 DOI: 10.1016/j.jscai.2023.101040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 08/13/2024]
Abstract
Radiation exposure in the cardiac catheterization laboratory (CCL) is an occupational hazard that predisposes health care workers to the development of adverse health effects such as cataracts, cancer, and orthopedic injury. To mitigate radiation exposure, personal protective shielding as well as permanently installed shields reduces these adverse effects. Yet, heavy protective lead aprons and poor ergonomics required for positioning movable shields remain barriers to a safer environment. Recent innovations to enhance personal protective equipment and revolutionize fixed shielding systems will permit the CCL team to work in a personal "lead-free" environment, markedly reducing occupational hazards. The purpose of this review is to update the status and future of radiation protection in the CCL.
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Affiliation(s)
- Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion - Israel Institute of Technology, Israel
| | - Perry Wu
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Travis Cohoon
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Fahad Gul
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - George Nasr
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Ned Premyodhin
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Morton J. Kern
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
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Pierce KV, Scansen BA, Rao S. Radiation dose during interventional cardiology procedures: portable C-arm vs. a new generation fluoroscopy system. J Vet Cardiol 2023; 47:30-40. [PMID: 37150018 DOI: 10.1016/j.jvc.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Occupational exposure to ionizing radiation poses health risks for veterinary interventionalists. There are limited veterinary studies evaluating radiation dose in the cardiac catheterization laboratory. The purpose of this study was to report direct radiation dose exposure to patients during common interventional cardiology procedures and compare these doses between two fluoroscopy units. ANIMALS One hundred and fifty-four client-owned dogs. MATERIALS AND METHODS Patient dose during procedures using a portable C-arm were retrospectively analyzed and compared to those performed in a contemporary interventional suite. Fluoroscopy equipment, procedure type, operator, patient weight, fluoroscopy time, dose area product, and air kerma were recorded and statistically modeled using univariable and multivariable linear regression to evaluate the effect of each factor. RESULTS Patient dose population (154 dogs), comprised 61 patent ductus arteriosus occlusions, 60 balloon pulmonary valvuloplasties, and 33 pacemaker implantations. Patient dose was significantly lower in the group utilizing a newer generation fluoroscopy unit vs. the group utilizing an older portable C-arm, positively correlated with patient weight, and highest during balloon pulmonary valvuloplasties compared to patent ductus arteriosus occlusions or pacemaker implantations (all p<0.010). DISCUSSION Newer fluoroscopy systems can be equipped with technologies that improve image quality while reducing patient dose and radiation exposure to interventional personnel. CONCLUSIONS We documented a significant reduction in patient radiation dose using a newer fluoroscopy system as compared to an older portable C-arm for interventional cardiology procedures in animals. Improved knowledge of patient radiation dose factors may promote better radiation safety protocols in veterinary interventional cardiology.
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Affiliation(s)
- K V Pierce
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - B A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - S Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
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Ramanan B, Pizano A, Timaran CH, Siah M, Baig S, Shih M, Guild J, Kirkwood ML. Operator Lower Leg Radiation Dose during Fluoroscopically Guided Interventions is Effectively Reduced by Wearing Lead-Equivalent Leg Wraps. Ann Vasc Surg 2023; 89:161-165. [PMID: 36162628 DOI: 10.1016/j.avsg.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The intensity of radiation scatter that emanates from the X-ray beam during fluoroscopically guided interventions is greater below the fluoroscopy table than above. Yet interventionalists' lower legs are typically unshielded and table skirts are often positioned incorrectly. We sought to characterize the efficacy of the leg protector wraps (Leg Wraps, Burlington Medical Inc.) in reducing the radiation dose to the operator's lower leg during fenestrated and branched endovascular aneurysm repair (F-BEVAR). METHODS A prospective cohort study was performed evaluating the lower leg radiation dose reduction of one vascular surgeon during F/BEVAR using antimony/bismuth Enviro-Lite leg wraps (0.35 mm lead equivalency, 99.7% attenuation at 50 kVp; Burlington Medical, Hampton Roads, Virginia). Optically Stimulated Luminescence nanoDot detectors (microSTARii System, LANDAUER, Inc., Glenwood, Illinois) were placed over and under the left leg wrap at the anterior tibial tuberosity position to compare operator leg dose with and without this additional protection. The table-mounted lead skirt was used consistently in all cases. The nanoDot detectors were cross-calibrated with a survey meter (RaySafe X2 survey sensor, Fluke Biomedical, Cleveland, Ohio) by measuring scattered radiation at a position equivalent to an operator's mid-tibia while performing digital acquisitions of a 25-cm thick, 30 cm × 30 cm acrylic phantom with a Philips FD20 fluoroscope (Philips Healthcare, Best, The Netherlands) with the table skirt removed. The measured radiation doses were converted to a Hp (0.07) skin dose, assuming an RQR6 beam spectrum (IEC-61267). Paired Wilcoxon test was performed to identify significant attenuation of radiation exposure. RESULTS Leg dose measurements from 40 F-BEVARs were analyzed. The patients had a median (interquartile range) body mass index of 27 (24-32) kg/m2. Median procedure reference air kerma was 1,100 (728-1,601) mGy, kerma-area product was 127 (73-184) Gycm2, and fluoroscopy time was 69 (54-86) min. The median skin dose Hp (0.07) over the leg wraps (n = 40) was 54.2 (24-100) μSv and under the leg wraps (n = 40) was 2.7 μSv (1.0-5.8). The leg wraps attenuated the radiation dose by 95% (89-98%) (P < 0.001). The unprotected, Hp (0.07) per kerma-area product was determined to be 0.38 (0.30-0.55) μSv/Gycm2. CONCLUSIONS The 0.35-mm lead-equivalent leg wraps significantly decreased scattered radiation to the lower leg during F-BEVAR. Protective leg wraps should be recommended to operators performing complex fluoroscopically guided procedures.
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Affiliation(s)
- Bala Ramanan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Guild
- Division of Medical Physics, Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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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: 41] [Impact Index Per Article: 41.0] [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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ICRP PUBLICATION 153 Approved by the Commission in September 2022. Ann ICRP 2022; 51:9-95. [PMID: 36942865 DOI: 10.1177/01466453221142702] [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] [Indexed: 03/23/2023]
Abstract
Veterinary use of radiation in the diagnosis, management, and treatment of disease has expanded and diversified, as have the corresponding radiological protection concerns. Radiological exposure of personnel involved in veterinary procedures and, where applicable, members of the public providing assistance (e.g. owners or handlers) has always been included within the system of radiological protection. Veterinary practice is now addressed explicitly as the modern complexities associated with this practice warrant dedicated consideration, and there is a need to clarify and strengthen the application of radiological protection principles in this area. The Commission recommends that the system of radiological protection should be applied in veterinary practice principally for the protection of humans, but with explicit attention to the protection of exposed animals. Additionally, consideration should be given to the risk of potential contamination of the environment associated with applications of nuclear medicine in veterinary practice. This publication focuses primarily on justification and optimisation in veterinary practice, and sets the scene for more detailed guidance to follow in future Recommendations. It is intended for a wide-ranging audience, including radiological protection professionals, veterinary staff, students, education and training providers, and members of the public, as an introduction to radiological protection in veterinary practice.© 2022 ICRP. Published by SAGE.
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Kowatari M, Nagamoto K, Nakagami K, Yoshitomi H, Moritake T, Kunugita N. DOSE MEASUREMENT PRECISION OF AN RPLD-BASED EYE LENS DOSEMETER APPLICABLE TO THE MEDICAL SECTOR. RADIATION PROTECTION DOSIMETRY 2022; 198:1303-1312. [PMID: 35909091 DOI: 10.1093/rpd/ncac167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/23/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
We demonstrate a practical calibration method and its applicability for a commercially available radiophotoluminescence dosemeter (RPLD), i.e. the GD-352M (AGC Techno Glass, Shizuoka, Japan) to eye lens dose monitoring, by performing the calibration according to the ISO recommendations. The calibration was then verified through a series of experiments. For verification of the derived calibration factor (1.21 ± 0.04, k = 1) of the RPLD, we performed standard irradiations in the ISO narrow series X-ray reference fields and the simulation measurements in the actual radiation fields in a hospital. The TLD-based commercially available dosemeters, DOSIRIS™ was also put on the ISO cylinder phantom and the RANDO phantom together with the GD-352M in the verification experiments. The personal dose equivalents Hp(3) obtained from the GD-352M and those obtained from the DOSIRIS™ were in good agreement with each other. Our results demonstrate the proper calibration of a commercially available RPLD that is applicable to the additional monitoring of the lens of the eyes for medical staff.
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Affiliation(s)
- Munehiko Kowatari
- National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555 Japan
| | - Keisuke Nagamoto
- University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
| | - Koichi Nakagami
- University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
| | - Hiroshi Yoshitomi
- Nuclear Science Research Institute, Japan Atomic Energy Agency, 2-4, Shirakata, Tokai, Naka, Ibaraki, 319-1195, Japan
| | - Takashi Moritake
- National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555 Japan
- University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
| | - Naoki Kunugita
- University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
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Rose A, Rae WI, Sweetlove MA, Ngetu L, Benadjaoud MA, Marais W. Radiation induced cataracts in interventionalists occupationally exposed to ionising radiation. SA J Radiol 2022; 26:2495. [PMID: 36262829 PMCID: PMC9575381 DOI: 10.4102/sajr.v26i1.2495] [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: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Occupational exposure to ionising radiation may have detrimental health effects. Longer and more complex fluoroscopic procedures have placed interventionalists at increased occupational health risks especially for developing cataracts in the radiosensitive lenses of the eyes. OBJECTIVES This study aimed to determine the prevalence of occupational related cataracts and describe the risk factors for cataracts in occupationally exposed interventionalists compared with unexposed doctors. METHOD A cross-sectional study using multiple methods. A survey was conducted. The radiation workload was determined based on a self-administered questionnaire and dose area product values determined in previous studies. Both groups had slit lamp examinations. The data were analysed analytically using R software version 9.3. RESULTS The study included 98 interventionalists. The combined prevalence of posterior sub-capsular (PSC) and cortical cataracts was 18.8% in the exposed and 13.9% in the unexposed group. The prevalence of PSC cataracts in the exposed group was 5.9% and 2.8% in the unexposed group, with an odds ratio (OR) of 2.2 (95% confidence interval [CI]: 0.58; 8.61). Posterior sub-capsular cataracts were more common in the left eye. The increase in cataracts was not statistically significant in the exposed group but is of clinical significance. CONCLUSION The findings are important as they highlight the need for greater vigilance for protecting the radiation healthcare workforce in a developing country setting. CONTRIBUTION The research is the first of its kind in South Africa and Africa and contributes to determining the prevalence in this highly skilled and occupationally vulnerable group.
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Affiliation(s)
- André Rose
- Center for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - William I.D. Rae
- Prince of Wales Hospital, Faculty of Medical Imaging, University of Sydney, Sydney, Australia
| | - Margaret A. Sweetlove
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Lumko Ngetu
- Department of Ophthalmology, Faculty of Health, University of the Free State, Bloemfontein, South Africa
| | - Mohamed A. Benadjaoud
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France,Department of Radiobiology and Regenerative Medicine (SERAMED), Fontenay-aux-Roses, France
| | - Wayne Marais
- Department of Ophthalmology, Faculty of Health, University of the Free State, Bloemfontein, South Africa
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Balter S, Patel A. Radiation Management in Interventional Cardiology. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Lemos PA, Franken M, Mariani J, Caixeta A, Almeida BO, Pitta FG, Prado GFA, Garzon S, Ramalho F, Albuquerque G, Gomes IM, de Oliveira IS, Valle L, Galastri L, Affonso BB, Nasser F, Garcia RG. Safety and effectiveness of introducing a robotic-assisted percutaneous coronary intervention program in a tertiary center: a prospective study. Cardiovasc Diagn Ther 2022; 12:67-76. [PMID: 35282671 PMCID: PMC8898692 DOI: 10.21037/cdt-21-442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/29/2021] [Indexed: 01/03/2024]
Abstract
BACKGROUND Robotic-assisted percutaneous coronary intervention (PCI) is a novel technology that permits remote operation of interventional devices. However, little is known about the safety and effectiveness of introducing a robotic PCI program in a hospital already experienced in traditional coronary angioplasty. METHODS Prospective single-arm survey to assess the safety and effectiveness of robotic-assisted PCI in comparison to pre-defined performance goals. The study cohort comprised all consecutive cases treated with robotic PCI since its introduction. The safety primary endpoint was a composite of (I) overall death or (II) non-fatal adverse events related to target vessel complications (stent thrombosis, myocardial infarction, vessel perforation or cardiac tamponade, or repeat invasive treatment) during the index hospitalization. The efficacy primary endpoint was robotic-assisted procedural success, a composite of (I) successful dilatation of the target lesion and (II) successful robotic assistance, defined as absent non-planned manual conversion. RESULTS A total of 83 patients and 112 lesions were prospectively enrolled. The rate of angiographic success was 99.1%. From these, 97 lesions (86.6%) were treated with only robotic PCI or with hybrid according to the pre-interventional plan. The rates of efficacy and safety primary endpoints were 85.7% and 2.4% respectively (P<0.01 for non-inferior to the pre-defined performance threshold). CONCLUSIONS Introduction of robotic-assisted PCI in a tertiary center was associated with safe and effective results, comparable to pre-defined goals of optimal performance.
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Affiliation(s)
| | | | | | | | | | - Fabio G. Pitta
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Felipe Ramalho
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Gabriel Albuquerque
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Ivanise M. Gomes
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | | | - Breno B. Affonso
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Felipe Nasser
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Cewe P, Vorbau R, Omar A, Elmi-Terander A, Edström E. Radiation distribution in a hybrid operating room, utilizing different X-ray imaging systems: investigations to minimize occupational exposure. J Neurointerv Surg 2021; 14:1139-1144. [PMID: 34750111 PMCID: PMC9606514 DOI: 10.1136/neurintsurg-2021-018220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/31/2021] [Indexed: 01/10/2023]
Abstract
Objectives To reduce occupational radiation exposure in a hybrid operating room (OR) used for three-dimensional (3D) image guided spine procedures. The effects of staff positioning, different X-ray imaging systems, and freestanding radiation protection shields (RPSs) were considered. Methods An anthropomorphic phantom was imaged with a robotic ceiling mounted hybrid OR C-arm cone beam CT (hCBCT), a mobile O-arm CBCT (oCBCT), and a mobile two-dimensional C-arm fluoroscopy system. The resulting scatter doses were measured at different positions in the hybrid OR using active personal dosimeters and an ionization chamber. Two types of RPSs were evaluated. Results Using the hCBCT system instead of the oCBCT system reduced the occupational radiation dose on average by 22%. At 200 cm from the phantom, scatter doses from the hCBCT were 27% lower compared with the oCBCT. One rotational acquisition with hCBCT or oCBCT corresponded to 12 or 16 min of fluoroscopy with the C-arm, respectively. The scatter dose decreased by more than 90% behind an RPS. However, the protection was slightly less effective at 60 cm behind the RPS, due to tertiary scatter from the surroundings. Conclusions For 3D image guided spine procedures in the hybrid OR, occupational radiation exposure is lowered by using hCBCT rather than oCBCT. Radiation exposure can also be decreased by optimal staff positioning in the OR, considering distance to the source and positioning relative to the walls, ceiling, and RPS. In this setting and workflow, staff can use RPSs instead of heavy aprons during intraoperative CBCT imaging, to achieve effective whole body dose reduction with improved comfort.
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Affiliation(s)
- Paulina Cewe
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .,Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Vorbau
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Artur Omar
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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16
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Mourtada F, Clement CH, Dauer LT, Baureus Koch C, Cosset JM, Doruff M, Damato A, Guedea F, Scalliet P, Thomadsen B, Pinillos-Ashton L, Small W. Occupational Radiological Protection in Brachytherapy. Ann ICRP 2021; 50:5-75. [PMID: 34503342 DOI: 10.1177/01466453211013514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Firas Mourtada
- Chief of Clinical Physics, ChristianaCare, Newark, Delaware.,President, American Brachytherapy Society
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17
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Roh Y, Kim J, Park H, Kim J, Ryu D, Chun K, Seo J, Lee B, Cho B, Yoon Y. Effect of Exposure Angulation on the Occupational Radiation Exposure during Cardiac Angiography: Simulation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8097. [PMID: 34360390 PMCID: PMC8345727 DOI: 10.3390/ijerph18158097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
Cardiac angiography to visualize the cardiac coronary artery for lesions causes a lot of radiation exposure dose to the interventional cardiologist. We evaluated the occupational radiation exposure to the interventional cardiologist based on changes to the angle of the X-ray tube used in cardiac angiography and calculated the conversion factor for effective dose in this study. To evaluate the occupational radiation exposure resulting from scattered radiation to interventional cardiologists, organ doses for eyeball, thyroid, and heart were calculated using Monte Carlo simulation with korean typical man(KTMAN) phantom at the left anterior oblique (LAO)30/cranial (CRAN)30, CRAN40, right anterior oblique (RAO)30/CRAN30, RAO30/caudal(CAUD)20, CAUD39, LAO40/CAUD35, and LAO40 positions in the femoral and the radial artery puncture. In this study, analysis of the different angles showed the highest radiation exposure on LAO30/CRAN30 and CRAN40 position, which were 150.65% and 135.3%, respectively, compared to AP angles. Therefore, to reduce occupational dose for interventional cardiologists, it is recommended that radiation protection, such as using radiation shield and personal protective equipment (PPE), be used at LAO30/CRAN30 and CRAN40 angulation, and the conversion factor for calculating the organ dose received by the interventional cardiologists based on patient dose can be applied for improved occupational dose management.
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Affiliation(s)
- Younghoon Roh
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Jungsu Kim
- Department of Radiologic-Technology, Daegu Health College, 15, Yeongsong-ro, Buk-gu, Daegu 41453, Korea;
| | - Hyemin Park
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Jungmin Kim
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Dongryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Kwangjin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Jeonghun Seo
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Bongki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Byungryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Yongsu Yoon
- Department of Radiological Science, Dongseo University, 47 Jurye-ro, Sasang-gu, Busan 47011, Korea
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Bartal G, Vano E, Paulo G. Get Protected! Recommendations for Staff in IR. Cardiovasc Intervent Radiol 2021; 44:871-876. [PMID: 33837456 PMCID: PMC8034513 DOI: 10.1007/s00270-021-02828-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
Purpose Evaluation and registration of patient and staff doses are mandatory under the current European legislation, and the occupational dose limits recommended by the ICRP have been adopted by most of the countries in the world. Methods Relevant documents and guidelines published by international organisations and interventional radiology societies are referred. Any potential reduction of patient and staff doses should be compatible with the clinical outcomes of the procedures. Results The review summarises the most common protective measures and the needed quality control for them, the criteria to select the appropriate protection devices, and how to avoid unnecessary occupational radiation exposures. Moreover, the current and future advancements in personnel radiation protection using medical simulation with virtual and augmented reality, robotics, and artificial intelligence (AI) are commented. A section on the personnel radiation protection in the era of COVID-19 is introduced, showing the expanding role of the interventional radiology during the pandemic. Conclusion The review is completed with a summary of the main factors to be considered in the selection of the appropriate radiation protection tools and practical advices to improve the protection of the staff.
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Affiliation(s)
| | - Eliseo Vano
- Radiology Department, Complutense University, Madrid, Spain
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, ESTESC - Coimbra Health School, Instituto Politécnico de Coimbra, Coimbra, Portugal
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19
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Hammami R, Jmaa AB, Bahloul A, Charfeddine S, Ellouze T, Mallek S, Mrad IB, Abid L, Kammoun S, Jdidi J. [Assessment of the practices and knowledge among cardiologists regarding radiation protection in Tunisia]. Pan Afr Med J 2021; 38:300. [PMID: 34178219 PMCID: PMC8197064 DOI: 10.11604/pamj.2021.38.300.24254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction les procédures de cardiologie interventionnelle sont devenues complexes et chronophages avec un sur-risque d´exposition aux rayonnements ionisants. L’objectif de notre étude était d’évaluer le niveau des connaissances et des pratiques en radioprotection des cardiologues Tunisiens exposés au rayon X. Méthodes notre étude est descriptive analytique réalisée en octobre 2019, organisée sous forme de questionnaire anonyme des connaissances et pratiques en radioprotection et envoyé à tous les Cardiologues Tunisiens exposés aux rayons X. Résultats parmi 126 cardiologues exposés aux rayons X et ayant reçu le questionnaire, 58 médecins ont répondu au questionnaire (48%), avec une prédominance masculine (72%, n=42). Trente-huit médecins (65%) exerçaient dans le secteur public. L´expérience professionnelle était en moyenne de 12,02 ans (ET 6,88 ans). La moitié des médecins avaient un score de connaissances inférieur à 50%. La moyenne du score des pratiques était de 43,83 (ET 13,95%). Le port du tablier en plomb, de la cache thyroïde, du dosimètre, des lunettes en plomb, du calot en plomb était respectivement de 100% (n=58), 86,2% (n=50), 30,7% (n=18), 12,1% (n=7) et 1,7% (n=1). Il n´y avait pas de corrélation entre les scores et l´âge du médecin ainsi que la durée de l´expérience professionnelle. Les scores de connaissances ne différaient pas statistiquement entre les 2 sexes (p=0,06) ni entre le secteur public et le secteur privé (p=0,9). Le score de pratique était significativement plus élevé chez les hommes (0.007) et les cardiologues interventionnels comparés aux rythmologues et cardiopédiatres (p<0.001). Conclusion le niveau des connaissances et des pratiques des cardiologues Tunisiens en radioprotection est globalement insuffisant. Ce qui interpelle les autorités sanitaires à organiser un plan de formation régulier pour cette population.
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Affiliation(s)
- Rania Hammami
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Abdelhamid Ben Jmaa
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Amine Bahloul
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Selma Charfeddine
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Tarek Ellouze
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Souad Mallek
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | | | - Leila Abid
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Jihen Jdidi
- Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie.,Service de Médecine Préventive, Hôpital Hedi Chaker, Sfax, Tunisie
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20
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Inoue T, Okada S, Hamamoto S, Fujisawa M. Retrograde intrarenal surgery: Past, present, and future. Investig Clin Urol 2021; 62:121-135. [PMID: 33660439 PMCID: PMC7940851 DOI: 10.4111/icu.20200526] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022] Open
Abstract
With the recent technological advancements in endourology, retrograde intrarenal surgery has become a more popular procedure for treatment of urolithiasis. Furthermore, since the introduction of new laser systems and advanced flexible ureteroscopy with miniaturized ureteroscopes, the treatment indications for retrograde intrarenal surgery have expanded to include not only larger renal stones of >2 cm but also upper urinary tract urothelial carcinoma, ureteral stricture, and idiopathic renal hematuria. Clinicians must keep up with these trends and make good use of these technologies in the rapidly changing field of endourology. Simultaneously, we must consider the risk of various complications including thermal injury due to laser use, ureteral injury caused by the ureteral access sheath, and radiation exposure during retrograde intrarenal surgery with fluoroscopic guidance. This review focuses on the past, present, and future of retrograde intrarenal surgery and provides many topics and clinical options for urologists to consider.
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Affiliation(s)
- Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Hyogo, Japan.,Department of Urology, Kobe University, Kobe, Hyogo, Japan.
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan
| | - Shuzo Hamamoto
- Department of Urology, Medical School, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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21
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Desai M, Kahaly O, Aslam A, Saifa-Bonsu J, Usmani M, Okabe T, Afzal MR, Houmsse M. Comprehensive strategies to minimize radiation exposure during Interventional electrophysiology procedures: state-of-the-art review. Expert Rev Med Devices 2020; 17:1183-1192. [PMID: 32885677 DOI: 10.1080/17434440.2020.1819789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cardiac electrophysiology (EP) procedures are frequently performed in patients with cardiac arrhythmias, chronic heart failure, and sudden cardiac death. Most EP procedures involve fluoroscopy, which results in radiation exposure to physicians, patients, and EP lab staff. Accumulated radiation exposure is a known health detriment to patients and physicians. AREA COVERED This review will summarize radiation exposure, dose metrics, complications of radiation exposure, factors affecting radiation exposure, minimizing radiation exposure, zero or near-zero fluoroscopy strategies, and up-to-date research in the area of reducing radiation exposure and best practices. EXPERT COMMENTARY Comprehensive strategies should be implemented in EP laboratories to minimize radiation exposure with standard fluoroscopy. There are routine techniques that can mitigate significant amounts of radiation exposure using standard equipment within the EP lab. The operators need to emphasize that EP practices routinely incorporate non-ionizing radiation sources for cardiac imaging (e.g. magnetic resonance imaging, advanced electroanatomical mapping systems, intracardiac ultrasonography) in addition to other novel technologies to mitigate radiation exposure to patients and physicians.
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Affiliation(s)
| | - Omar Kahaly
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Adil Aslam
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Jonnie Saifa-Bonsu
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Maham Usmani
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
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22
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Martinez NE, Van Bladel L. Radiation protection challenges in applications of ionising radiation on animals in veterinary practice. Ann ICRP 2020; 49:158-168. [PMID: 32700551 DOI: 10.1177/0146645320931973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As we work towards a holistic approach to radiation protection, we begin to consider and integrate protection beyond humans to include, among other things, non-human biota. Non-human biota not only includes environmental flora and fauna, but also livestock, companion animals, working animals, etc. Although under consideration, there is currently little guidance in terms of protection strategies for types of non-human biota beyond wildlife. For example, in recent years, veterinary procedures that make use of ionising radiation have increased in number and have diversified considerably, which has made radiation protection in veterinary applications of ionising radiation more challenging, both for humans and the animal patients. In fact, the common belief that doses to professionals and members of the public from these applications will be very low to negligible, and doses to the animals will not be acutely harmful nor even affect their lifetime probability of developing cancer, needs to be revisited in the light of higher dose diagnostic and interventional techniques, and certainly in the case of therapeutic applications. This paper provides a brief overview of the initiatives of the International Commission on Radiological Protection concerning radiation protection aspects of veterinary practice, and poses a variety of perspectives for consideration and further discussion.
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Affiliation(s)
- N E Martinez
- Department of Environmental Engineering and Earth Sciences, Clemson University, 342 Computer Ct, Anderson, SC 29625, USA; e-mail:
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Saad EB, Slater C, Inácio LAO, Santos GVD, Dias LC, Camanho LEM. Catheter Ablation for Treatment of Atrial Fibrillation and Supraventricular Arrhythmias Without Fluoroscopy Use: Acute Efficacy and Safety. Arq Bras Cardiol 2020; 114:1015-1026. [PMID: 32638895 PMCID: PMC8416121 DOI: 10.36660/abc.20200096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/08/2020] [Indexed: 01/01/2023] Open
Abstract
Fundamento O uso da radiação ionizante em procedimentos médicos está associado a riscos significativos à saúde dos pacientes e da equipe de saúde. Objetivos Avaliar a segurança e a eficácia aguda da ablação por cateter para tratamento da fibrilação atrial (FA) e arritmias supraventriculares (SVTs), utilizando uma abordagem exclusivamente não fluoroscópica, guiada por eco intracardíaco (ICE) e mapeamento 3D. Métodos 95 pts (idade média 60 ± 18 anos, 61% do sexo masculino) programados para ablação de FA (69 pts, 45 FA paroxística e 24 FA persistente) ou SVTs (26 pts – 14 reentrada nodal, 6 Wolf-Parkinson-White [WPW], 5 flutter atrial direito [AD], 1 taquicardia atrial). Nove pacientes (9,5%) tinham marcapasso definitivo ou dispositivos de ressincronização com desfibrilador. Dois sistemas de mapeamento eletroanatômico foram utilizados – CARTO (65%) e NAVx (35%), bem como cateteres de ICE disponíveis – Acunav e ViewFlex. Resultados O isolamento das veias pulmonares (VPs), bem como todos os outros alvos que precisavam de ablação em ambos os átrios, foram alcançados e adequadamente visualizados. Não foram observados derrames pericárdicos, complicações trombóticas ou outras intercorrências nesta série. Punções transseptais difíceis (19 pacientes – 20%) foram realizadas sem fluoroscopia em todos os casos. Não foi utilizada fluoroscopia de backup, e nenhum vestuário de chumbo foi necessário. Avaliações detalhadas dos marcapassos após o procedimento não mostraram nenhum dano aos eletrodos, deslocamentos ou mudanças de limiar. Conclusões Uma estratégia de ablação por cateter sem uso de radiação para FA e outras arritmias atriais é segura e eficaz quando guiada pela utilização adequada do ICE e do mapeamento 3D. Diversos sítios em ambos os átrios podem ser alcançados e adequadamente ablacionados sem a necessidade de fluoroscopia de backup. Não foram observadas complicações. (Arq Bras Cardiol. 2020; 114(6):1015-1026)
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Affiliation(s)
- Eduardo B Saad
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | - Charles Slater
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | | | - Gustavo Vignoli Dos Santos
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | - Lucas Carvalho Dias
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
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Kubicki R, Hummel J, Höhn R, Müller K, Stiller B, Grohmann J. Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access. Open Heart 2020; 7:e001267. [PMID: 32595140 PMCID: PMC7322512 DOI: 10.1136/openhrt-2020-001267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To assess the potential occupational radiation reduction and technical feasibility in patients rotated 180° (upside-down) when requiring neck access for transcervical or trans-subclavian catheterisation. METHODS Upside-down positioning is defined as rotating patients in supine position by 180°, so that the feet come to rest where the head would otherwise be. We retrospectively evaluated all these procedures performed between March 2016 and May 2019. Furthermore, two different phantoms (paediatric and adult) were used prospectively to quantify the occupational dose between conventional or upside-down positioning. In this context, ambient dose equivalents were measured using real-time dosimeters. Three different projection angles were applied. RESULTS 44 patients with median age and body weight of 1.0 year (range 0-56) and 9.5 kg (range 1.3-74.3) underwent 63 procedures positioned upside-down. This position proved advantageous for practical reasons, since the length of the examination table could be optimally used. Additionally, it resulted in a significantly lower overall ambient dose equivalent for the primary operator (PO) of 94.8% (mean: 2569±807 vs 135±23 nSv; p<0.01) in the adult, and of 65.5% (mean: 351±104 vs 121±56 nSv; p<0.01) in the paediatric phantom, respectively. CONCLUSION Upside-down positioning facilitates handling in a straightforward manner when access from the neck is required. Moreover, it significantly reduces local radiation exposure for the PO in the paediatric and, most impressively, in the adult phantom.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Johanna Hummel
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - René Höhn
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Kevin Müller
- Department of Occupational Safety, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
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Kijima K, Krisanachinda A, Tamura M, Monzen H, Nishimura Y. Reduction of Occupational Exposure Using a Novel Tungsten-Containing Rubber Shield in Interventional Radiology. HEALTH PHYSICS 2020; 118:609-614. [PMID: 31855596 DOI: 10.1097/hp.0000000000001177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study investigates whether a novel tungsten-containing rubber shield could be used as substitute shielding material in interventional radiology to reduce the occupational exposure of operators to scattered radiation from a patient. The tungsten-containing rubber is a lead-free radiation-shielding material that contains as much as 90% tungsten powder by weight. Air kerma rates of scattered radiation from solid-plate phantoms, simulating a patient, were measured with a semiconductor dosimeter at the height of the operator's eye (1,600 mm from the floor), chest (1,300 mm), waist (1,000 mm), and knee (600 mm) with and without tungsten-containing rubber shielding (1-5 mm thickness). The tungsten-containing rubber and a commercial shielding material (RADPAD) were affixed onto the phantom on the operator's side, and reductions in air kerma rates were compared. Reduction rates for tungsten-containing rubber shielding with thicknesses of 1, 2, 3, 4, and 5 mm at each height level were as follows: 70.37 ± 0.40%, 72.17 ± 0.29%, 72.95 ± 0.31%, 72.58 ± 0.35%, and 73.63 ± 0.63% at eye level; 76.36 ± 0.19%, 77.13 ± 0.10%, 77.36 ± 0.14%, 77.62 ± 0.25%, and 77.66 ± 0.14% at chest level; 67.78 ± 0.31%, 68.12 ± 0.19%, 68.88 ± 0.28%, 68.97 ± 0.14%, and 68.85 ± 0.45% at waist level; and 0.14 ± 0.94%, 0.72 ± 0.56%, 1.08 ± 0.74%, 1.77 ± 0.80%, and 1.79 ± 1.82% at knee level, respectively. Reduction rates with RADPAD were 61.80 ± 0.67%, 60.33 ± 0.61%, 64.70 ± 0.25%, and 0.14 ± 0.66% at eye, chest, waist, and knee levels, respectively. The shielding ability of the 1 mm tungsten-containing rubber was superior to that of RADPAD. The tungsten-containing rubber could be employed to minimize an operator's radiation exposure instead of the commercial shielding material in interventional radiology.
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Affiliation(s)
- Kenta Kijima
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Anchali Krisanachinda
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
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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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Durán A, Mila R. Prólogo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hernández C, Durán A, Cortés MC. Lesiones oculares y radiación ionizante. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Shankar S, Padmanabhan D, Chandrashekharaiah A, Deshpande S. Strategies to Reduce Radiation Exposure in Electrophysiology and Interventional Cardiology. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2019.21.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinical diagnosis sometimes involves the use of medical instruments that employ ionizing radiation. However, ionizing radiation exposure is a workplace hazard that goes undetected and is detrimental to patients and staff in the catheterization laboratory. Every possible effort should be made to reduce the amount of radiation, including scattered radiation. Implementing radiation dose feedback may have a role in reducing exposure. In medicine, it is important to estimate the potential biologic effects on, and the risk to, an individual. In general, implantation of cardiac resynchronization devices is associated with one of the highest operator exposure doses due to the proximity of the operator to the radiation source. All physicians should work on the principle of as low as reasonably achievable. Methods for reducing radiation exposure must be implemented in the catheterization laboratory. In this article, we review the available tools to lower the radiation exposure dose to the operator during diagnostic, interventional, and electrophysiological cardiac procedures.
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Affiliation(s)
- Sandeep Shankar
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | | | - Saurabh Deshpande
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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Chen G, Wang Y, Proietti R, Wang X, Ouyang F, Ma CS, Yu RH, Zhao C, Ma K, Qiu J, Liu Q, Wang DW. Zero-fluoroscopy approach for ablation of supraventricular tachycardia using the Ensite NavX system: a multicenter experience. BMC Cardiovasc Disord 2020; 20:48. [PMID: 32013865 PMCID: PMC6996189 DOI: 10.1186/s12872-020-01344-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional electroanatomic mapping systems have demonstrated a significant reduction in radiation exposure during radiofrequency catheter ablation procedures. We aimed to investigate the safety, feasibility and efficacy of a completely zero-fluoroscopy approach for catheter ablation of supraventricular tachycardia using the Ensite NavX navigation system compared with a conventional fluoroscopy approach. METHODS A multicenter prospective non-randomized registry study was performed in seven centers from January 2013 to February 2018. Consecutive patients referred for catheter ablation of supraventricular tachycardia were assigned either to a completely zero-fluoroscopic approach (ZF) or conventional fluoroscopy approach (CF) according to the operator's preference. Patients with atrial tachycardia were excluded. RESULTS Totally, 1020 patients were enrolled in ZF group; 2040 patients ablated by CF approach were selected for controls. There was no significant difference between the zero-fluoroscopy group and conventional fluoroscopy group as to procedure time (60.3 ± 20.3 vs. 59.7 ± 22.6 min, P = 0.90), immediate success rate of procedure (98.8% vs. 99.2%, P = 0.22), arrhythmia recurrence (0.4% vs. 0.5%, P = 0.85), total success rate of procedure (98.4% vs. 98.8%, P = 0.39) or complications (1.1% vs. 1.5%, P = 0.41). Compared with the conventional fluoroscopy approach, the zero-fluoroscopy approach provided similar outcomes without compromising the safety or efficacy of the procedure. CONCLUSION The completely zero-fluoroscopy approach demonstrated safety and efficacy comparable to a conventional fluoroscopy approach for catheter ablation of supraventricular tachycardia, and mitigated radiation exposure to both patients and operators. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03042078; first registered February 3, 2017; retrospectively registered.
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Affiliation(s)
- Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences, via Giustiniani 2, 35121, Padua, Italy
| | - Xunzhang Wang
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Chang Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Rong Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Kezhong Ma
- Department of Cardiology, Xiangyang Central Hospital, Xiangyang, 441021, People's Republic of China
| | - Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qigong Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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Aristizábal J. WITHDRAWN: Otra faceta de la evaluación del riesgo: la importancia de conocer el nuestro. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Park SH, Ko MJ, Park YS, Yun J, Byun H, Park SW. A New Shielding Curtain for Protection of Intraoperative Radiation During Minimally Invasive Spine Surgery. Neurospine 2019; 17:288-293. [PMID: 31614404 PMCID: PMC7136108 DOI: 10.14245/ns.1938282.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/02/2019] [Indexed: 11/26/2022] Open
Abstract
Objective Gradually increasing number of minimally invasive spine surgery (MISS), there is an increasing risk of radiation exposure to medical personnel during the surgery. We measured the radiation exposure of the operating room personnel during MISS, tried to find the riskiest person, and checked the effectiveness of a new lead-composite shielding curtain.
Methods Radiation exposure of medical staffs (operator, first assistant, anesthesiologist, and scrub nurse) involved in MISS procedures of 35 patients without shielding curtain (nonshield group) and 35 patients with shielding curtain (shield group). The shielding curtain had 0.25-mm nominal lead equivalent and was mounted on 2 frame bars fixed on the operating table.
Results In the nonshield group, radiation exposure was significantly higher in the order of operator > first assistant > scrub nurse > anesthesiologist (p < 0.001) during both anteroposterior (AP) and lateral views. In the shield group, the radiation exposure of the operator and the scrub nurse decreased significantly by 94.1% and 76.4% in AP view (p < 0.001), and by 96.3% and 73.9% in lateral view (p < 0.001), respectively.
Conclusion Since the radiation dose of the operator was highest in a C-arm-guided MISS, there is a high priority need to protect the operator from the radiation exposure. The shielding curtain could most effectively reduce the radiation exposure of the operator.
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Affiliation(s)
- Se Hoon Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Yong Sook Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jaehan Yun
- Department of Chemical Engineering, Keimyung University, Daegu, Korea
| | - Hongsik Byun
- Department of Chemical Engineering, Keimyung University, Daegu, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
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Lee B, Kim MS, Eum D, Min KT. The radiation environment of anaesthesiologists in the endoscopic retrograde cholangiopancreatography room. Sci Rep 2019; 9:9124. [PMID: 31235744 PMCID: PMC6591287 DOI: 10.1038/s41598-019-45610-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022] Open
Abstract
Anaesthesiologists are increasingly involved in nonoperating room anaesthesia (NORA) for fluoroscopic procedures. However, the radiation exposure of medical staff differs among NORA settings. Therefore, we aimed to investigate the radiation environment generated by fluoroscopic endoscopic retrograde cholangiopancreatography (ERCP) and the radiation exposure of anaesthesiologists. The dose area product (DAP), radiation entrance dose (RED), and fluoroscopy time (FT) according to the procedures and monthly cumulative radiation exposure were analysed at two sites (neck and wrist) from 363 procedures in 316 patients performed within 3 months. The total RED and DAP were 43643.1 mGy and 13681.1 Gy cm2, respectively. DAP and RED (r = 0.924) were strongly correlated and DAP and FT (r = 0.701) and RED and FT (r = 0.749) were moderately correlated. The radiation environment per procedure varied widely, DAP and RED per FT were the highest during stent insertion with esophagogastroduodenoscopy. Monthly cumulative deep dose equivalents at the wrist and neck ranged between 0.31-1.27 mSv and 0.33-0.59 mSv, respectively, but they were related to jaw thrust manipulation (r = 0.997, P = 0.047) and not to the radiation environment. The anaesthesiologists may be exposed to high dose of radiation in the ERCP room, which depends on the volume of procedures performed and perhaps the anaesthesiologists' practice patterns.
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Affiliation(s)
- Bora Lee
- Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Min-Soo Kim
- Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Darhae Eum
- Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyeong Tae Min
- Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Mayr NP, Wiesner G, Kretschmer A, Brönner J, Hoedlmoser H, Husser O, Kasel AM, Lange R, Tassani-Prell P. Assessing the level of radiation experienced by anesthesiologists during transfemoral Transcatheter Aortic Valve Implantation and protection by a lead cap. PLoS One 2019; 14:e0210872. [PMID: 30699164 PMCID: PMC6353158 DOI: 10.1371/journal.pone.0210872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/16/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Transfemoral Transcatheter Aortic Valve Implantation (TAVI) has become a standard therapy for patients with aortic valve stenosis. Fluoroscopic imaging is essential for TAVI with the anesthesiologist's workplace close to patient's head side. While the use of lead-caps has been shown to be useful for interventional cardiologists, data are lacking for anesthesiologists. METHODS A protective cap with a 0.35 lead-equivalent was worn on 15 working days by one anesthesiologist. Six detectors (three outside, three inside) were analyzed to determine the reduction of radiation. Literature search was conducted between April and October 2018. RESULTS In the observational period, 32 TAVI procedures were conducted. A maximum radiation dose of 0.55 mSv was detected by the dosimeters at the outside of the cap. The dosimeters inside the cap, in contrast, displayed a constant radiation dose of 0.08 mSv. CONCLUSION The anesthesiologist's head is exposed to significant radiation during TAVI and it can be protected by wearing a lead-cap.
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Affiliation(s)
- N. Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Gunther Wiesner
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Angela Kretschmer
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Johannes Brönner
- Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Herbert Hoedlmoser
- Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Oliver Husser
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Albert M. Kasel
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Rüdiger Lange
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Peter Tassani-Prell
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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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
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Corrigan FE, Hall MJ, Iturbe JM, Condado JF, Kamioka N, Howell S, Thourani VH, Clements SD, Babaliaros VC, Lerakis S. Radioprotective strategies for interventional echocardiographers during structural heart interventions. Catheter Cardiovasc Interv 2018; 93:356-361. [PMID: 30196578 DOI: 10.1002/ccd.27843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/28/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We investigated radioprotective strategies for the interventional echocardiographer (IE) during structural heart interventions in comparison with the interventional cardiologist (IC). BACKGROUND Structural heart interventions are expanding in complexity with increased reliance on IE. Recent reports have demonstrated concerning exposure and higher radiation to the IE. METHODS We monitored 32 structural interventions - 19 transcatheter aortic valve replacements (TAVR), 6 transcatheter mitral valve repairs, 5 paravalvular leak closures, and 2 atrial septal defect closures. Seventeen utilized transesophageal echocardiography (TEE) while 15 used transthoracic echocardiography (TTE). Members of the IC and IE teams wore multiple dosimeters on different sites of the body to measure radiation dose to the total body, lens of the eye, and hand. During each case, IE utilized dedicated radiation shielding. RESULTS Mean doses were higher for the primary IC than the primary IE: IC#1-99, 222, 378; IE#1-48, 52, 416 (body, lens, and hand doses in μSv). IE radioprotective strategies were able to reduce body and lens doses compared to IC during both TTE and TEE-guided procedures. Hand equivalent dose remained higher for the IE driven by exposure during TEE-guided procedures (IC#1 294 vs. IE#1 676 μSv). In a subgroup using radioprotective drapes during TTE-guided TAVR, IC dose was reduced without effect on the IE. CONCLUSIONS Radiation exposure during structural heart interventions is concerning. With dedicated shielding, IE received lower doses to the body and lens than IC. Further optimization of structural suite design and shielding is needed.
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Affiliation(s)
- Frank E Corrigan
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.,Cardiovascular Medicine, Wellstar Health System, Marietta, GA, USA
| | - Michael J Hall
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jose Miguel Iturbe
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jose F Condado
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Norihiko Kamioka
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sharon Howell
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vinod H Thourani
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Stephen D Clements
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis C Babaliaros
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Stamatios Lerakis
- Divisions of Cardiology and Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Ge L, Zhong X, Ma J, Fan B, Lu H, Qian J, Ge J. Safety and feasibility of a low frame rate protocol for percutaneous coronary intervention to chronic total occlusions: preliminary experience. EUROINTERVENTION 2018; 14:e538-e545. [PMID: 29104180 DOI: 10.4244/eij-d-17-00515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The present study aimed to evaluate the safety and feasibility of a low frame rate protocol for chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). METHODS AND RESULTS A total of 192 consecutive patients who underwent CTO-PCI following the low frame rate protocol were analysed. The low frame rate protocol adopted reduced frame rates and the addition of copper and aluminium filters. Procedural outcomes, radiation dose and in-hospital outcomes were ascertained. Meanwhile, a phantom experiment was designed to measure the radiation dose reduction. Overall technical and procedural success rates were 91.1% (175) and 90.6% (174), respectively. The retrograde approach was attempted in 56 (29.2%) lesions. The mean air kerma (AK) radiation exposure, fluoroscopy time and contrast volume were 2.6±2.0 Gy, 50.3±34.3 min and 294.1±131.8 ml, respectively. In-hospital major adverse events occurred in one patient (0.5%) and procedural complications occurred in six patients (3.1%). In the phantom experiment, a remarkable radiation dose reduction could be achieved for AK, dose area product (DAP), simulated first and second operator radiation exposure (reduction of 72.5%, 69.8%, 60.9% and 59.6%, respectively) in cineangiography from this protocol. CONCLUSIONS Our results provide the primary evidence that it appears to be safe and feasible to carry out the low frame rate protocol for CTO-PCI.
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Affiliation(s)
- Lei Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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Affiliation(s)
- Edward T Carreras
- From the Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David O Williams
- From the Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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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: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Rose A, Uebel KE, Rae WI. Interventionalists' perceptions on a culture of radiation protection. SA J Radiol 2018; 22:1285. [PMID: 31754493 PMCID: PMC6837825 DOI: 10.4102/sajr.v22i1.1285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/21/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Occupational exposure to ionising radiation poses potential health risks to radiation workers unless adequate protection is in place. The catheterisation laboratory is a highly contextualised workplace with a distinctive organisational and workplace culture. OBJECTIVE This study was conducted to understand the culture of radiation protection (CRP). METHODS This study was a qualitative study and data were collected through 30 in-depth and 6 group interviews with 54 purposively selected South African interventionalists (interventional radiologists and cardiologists). The participants included a diversity of interventionalists who varied in sex, geographic location and years of experience with fluoroscopy. The transcribed data were analysed thematically using a deductive and inductive approach. RESULTS 'Culture of radiation protection' emerged as a complex theme that intersected with other themes: 'knowledge and awareness of radiation', 'radiation safety practice', 'personal protective equipment (PPE) utilisation' and 'education and training'. CONCLUSION Establishing and sustaining a CRP provides an opportunity to mitigate the potentially detrimental health effects of occupational radiation exposure. Education and training are pivotal to establishing a CRP. The time to establish a culture of radiation in the catheterisation laboratory is now.
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Affiliation(s)
- André Rose
- Department of Community Health, University of the Free State, South Africa
| | - Kerry E. Uebel
- Department of Internal Medicine, University of the Free State, South Africa
| | - William I. Rae
- Department of Medical Physics, University of the Free State, South Africa
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Thibault B, Macle L, Mondésert B, Dubuc M, Shohoudi A, Dyrda K, Guerra PG, Rivard L, Roy D, Talajic M, Khairy P. Reducing radiation exposure during procedures performed in the electrophysiology laboratory. J Cardiovasc Electrophysiol 2017; 29:308-315. [PMID: 29064134 DOI: 10.1111/jce.13373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/22/2017] [Accepted: 10/16/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Expert societies recently published strong recommendations to reduce the exposure of patients and staff to ionizing radiation (IR) during interventional and electrophysiology (EP) procedures. However, adherence to these guidelines remains difficult and the impact of implementing such recommendations is poorly characterized. METHODS AND RESULTS We conducted a single-center cohort study to quantify radiation exposure over time in three EP laboratories at the Montreal Heart Institute during 5,546 consecutive procedures from 2012 to 2015 by 11 primary operators. Overall, 2,618 (47.2%) procedures were catheter-based and 2,928 (52.8%) were device interventions. Interventions to reduce radiation exposure included educational initiatives to raise awareness (i.e., limiting cine acquisition, patient position, table height), slower frame rate, lower radiation dose per pulse, collimation, and integration with 3-D mapping systems and/or MediGuide technology. An 85% reduction in IR exposure was observed from 2012 to 2015, with the mean dose-area-product (DAP) decreasing from 7.65 ± 0.05 Gy·cm2 to 1.15 ± 0.04 Gy·cm2 (P < 0.001). This was true for catheter-based procedures (mean DAP 16.99 ± 0.08 to 2.00 ± 0.06 Gy·cm2 , P < 0.001) and device interventions (mean DAP 4.18 ± 0.06 to 0.64 ± 0.05 Gy·cm2 , P < 0.001). The median effective dose of IR recorded per quarter by 282 cervical dosimeters on EP staff decreased from 0.57 (IQR 0.18, 1.03) mSv in 2012 to 0.00 (IQR 0.00, 0.19) mSv in 2015, P < 0.001. CONCLUSION Enforcing good clinical practices with simple measures and low-dose fluoroscopy settings are highly effective in reducing IR exposure in the EP lab. These promising results should encourage other EP labs to adopt similar protective measures.
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Affiliation(s)
- Bernard Thibault
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Marc Dubuc
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Azadeh Shohoudi
- Montreal Health Innovations Coordinating Center, Montreal Heart Innovations Coordinating Center, Montrel Heart Institute, Université de Montréal, Montréal, Canada
| | - Katia Dyrda
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Peter G Guerra
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Léna Rivard
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Denis Roy
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Mario Talajic
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Paul Khairy
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
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Inoue T, Komemushi A, Murota T, Yoshida T, Taguchi M, Kinoshita H, Matsuda T. Effect of Protective Lead Curtains on Scattered Radiation Exposure to the Operator During Ureteroscopy for Stone Disease: A Controlled Trial. Urology 2017; 109:60-66. [DOI: 10.1016/j.urology.2017.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/18/2017] [Accepted: 07/28/2017] [Indexed: 11/25/2022]
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Morishima Y, Chida K, Muroya Y, Utsumi Y. Effectiveness of a New Lead-Shielding Device and Additional Filter for Reducing Staff and Patient Radiation Exposure During Videofluoroscopic Swallowing Study Using a Human Phantom. Dysphagia 2017; 33:109-114. [PMID: 28921404 DOI: 10.1007/s00455-017-9839-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/12/2017] [Indexed: 12/19/2022]
Abstract
Interventional radiology procedures often involve lengthy exposure to fluoroscopy-derived radiation. We therefore devised a videofluoroscopic swallowing study (VFSS) procedure using a human phantom that proved to protect the patient and physician by reducing the radiation dose. We evaluated a new lead-shielding device and separately attached additional filters (1.0-, 2.0-, and 3.0-mm Al filters and a 0.5-mm Cu filter) during VFSS to reduce the patient's entrance skin dose (ESD). A monitor attached to the human phantom's neck measured the ESD. We also developed another lead shield (VFSS Shielding Box, 1.0-mm Pb equivalent) and tested its efficacy using the human phantom and an ionization chamber radiation survey meter with and without protection from scattered radiation at the physician's position on the phantom. We then measured the scattered radiation (at 90 and 150 cm above the floor) after combining the filters with the VFSS Shielding Box. With the additional filters, the ESD was reduced by 15.4-55.1%. With the VFSS Shielding Box alone, the scattered radiation was reduced by about 10% compared with the dose without additional shielding. With the VFSS Shielding Box and filters combined, the scattered radiation dose was reduced by a maximum of about 44% at the physician's position. Thus, the additional lead-shielding device effectively provided protection from scattered radiation during fluoroscopy. These results indicate that the combined VFSS Shielding Box and filters can effectively reduce the physician's and patient's radiation doses.
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Affiliation(s)
- Yoshiaki Morishima
- Department of Radiology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan. .,Department of Radiological Technology, Tohoku University School of Health Sciences, Sendai, 980-8575, Japan.
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University School of Health Sciences, Sendai, 980-8575, Japan
| | - Yoshikazu Muroya
- Rehabilitation Center, Tohoku Medical and Pharmaceutical University Hospital, Sendai, 983-8512, Japan
| | - Yoshiya Utsumi
- Rehabilitation Center, Tohoku Medical and Pharmaceutical University Hospital, Sendai, 983-8512, Japan
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Ordiales JM, Vano E, Nogales JM, Ramos J, López-Mínguez JR, Martínez G, Cerrato P, Álvarez FJ. Optimisation of imaging protocols in interventional cardiology: impact on patient doses. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:684-696. [PMID: 28677594 DOI: 10.1088/1361-6498/aa7dae] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this work is to evaluate the impact of the imaging protocol as part of the optimisation of patient doses in interventional cardiology. This paper reports the results of an initial study to refine the existing fluoroscopy and cine settings, evaluates a new imaging protocol by measuring the image quality and phantom entrance air kerma values, and tests the clinical implementation of the new protocol in terms of the reduction in patient doses and the impact on clinical images. The initial study developed a new fluoroscopy mode using 7.5 frames s-1 (instead of the previous 15 frames s-1) with a similar dose/frame and a reduction of approximately 26% in dose/frame for the existing standard cine mode. For the new imaging protocol, the reduction in entrance air kerma was characterised for water depths of 16, 20, and 24 cm and the image quality was evaluated using a Leeds test object. A reduction in dose of around 50% was observed for the low fluoroscopy mode and an 18%-38% reduction was measured for cine. The image quality was unchanged in fluoroscopy mode and did not suffer noticeable alterations in cine mode. In the clinical implementation, cardiologists evaluated the new imaging protocol in clinical practice and cooperated with medical physicists to ensure full optimisation. The image quality criteria evaluated the ability to visualise the standard coronary arteries and small vessels (<2 mm), and the proper visualisation of the heart and diaphragm. A total of 1635 interventional cardiac procedures were assessed. The median kerma-area product exhibited a reduction of 37% for CA and 43% for PTCA examinations, and the quality of the clinical images was considered sufficient for standard clinical practice.
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Affiliation(s)
- J M Ordiales
- Medical Physics Department, Hospital de Mérida, Mérida, Spain
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Rodríguez-González E, Castanedo-Álvarez M, León-Aliz E, Benitez-Peyrat J, Oteo JF, Hernández-Hernández M, Montes-Uruén A, Gorigolzarri-Artaza J, Restrepo-Córdoba MA, Pifarré-Martínez X, Goicolea J, García-Touchard A. Right lateral versus left lateral view for forearm coronary angiography. An operator radiation exposure and image quality study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:450-458. [PMID: 28586317 DOI: 10.1088/1361-6498/aa6b76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the operator radiation exposure (ORE) and the image quality in a coronary angiography (CA) of the standard left lateral view (LLV) and compare it with an alternative right lateral view (RLV). BACKGROUND Interventional cardiologists are exposed to high doses of scatter radiation, especially in angulated projections. METHODS We prospectively included consecutive patients who underwent diagnostic CA. A standard +90° LLV and an alternative RLV (-90°) were done in each patient with the same protocol. The operator effective dose rate (mSv/h) was determined for each projection with digital dosimeters located in the collar, waist and knee. The image quality of both the LLV and RLV was analyzed and compared to a standard projection. RESULTS 116 patients were enrolled; left coronary artery (LCA) was assessed in 52 patients and right coronary artery (RCA) in 64 patients. The ORE was significantly lower with the RLV compared to the conventional LLV with a maximum ORE reduction of 91.5% in the operator waist (LLV: 6.84 mSv h-1 versus RLV: 0.58 mSv h-1, p < 0.001). No significant differences in image quality were observed for the RCA in both projections. For the LCA, a slight loss of quality was observed with the RLV. CONCLUSIONS -90° RLV is associated with a significant decrease in ORE compared to the conventional +90° LLV without losing image resolution for the RCA and resulting in a slight quality loss for the LCA evaluation. The RLV should be the first choice for RCA evaluation. For the LCA, the RLV loss of resolution should be balanced with the benefit of minimizing ORE, mainly in cases with long fluoroscopy times, such as complex percutaneous coronary interventional procedures.
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Rose A, Rae WID, Chikobvu P, Marais W. A multiple methods approach: radiation associated cataracts and occupational radiation safety practices in interventionalists in South Africa. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:329-339. [PMID: 28253201 DOI: 10.1088/1361-6498/aa5eee] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ionising radiation is a modality used in diagnostic and therapeutic medicine. The technology has improved and resulted in lower dose exposure but there has been an escalation in the quantity of procedures, their duration and complexity. These factors have meant increased occupational radiation exposure for interventionalists. Ionising radiation exposure can have detrimental health effects and includes radiation skin burns, various carcinomas, genetic and chromosomal aberrations and cataractogenesis of the lenses of the eye. The lenses of the eye are of the most radiosensitive organs and the risk of cataracts is high despite low radiation dose exposures. The use of personal protective equipment (PPE) is a method that can be used to mitigate the risk for developing lens opacifications. The consistent and effective utilisation of PPE is marred by availability, proper fit and ease of use when performing procedures. Radiation safety training is imperative to enforce a culture of radiation safety among interventionalists. The aim of this study was to quantify and describe cataracts among South African interventionalists and to understand their radiation safety practices. For this purpose, a cross sectional study was designed using multiple methods. A survey was conducted to determine the demographics and the risk factors of doctors exposed to radiation to doctors not exposed. The radiation workload and radiation safety practices of interventionalists were explored. Both groups had slit lamp examinations. The data were analysed analytically and a regression model developed looking at the outcomes and the risk factors. Qualitative in-depth interviews and group interviews were conducted to explore the perceptions of interventionalists regarding radiation safety. Deductive and inductive thematic analysis was done. Interdisciplinary research is challenging but offers tremendous opportunity for exploring and tackling complex issues related to securing a safe radiation work environment.
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Affiliation(s)
- A Rose
- Department of Community Health, University of the Free State, South Africa
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Grootendorst MR, Cariati M, Pinder SE, Kothari A, Douek M, Kovacs T, Hamed H, Pawa A, Nimmo F, Owen J, Ramalingam V, Sethi S, Mistry S, Vyas K, Tuch DS, Britten A, Van Hemelrijck M, Cook GJ, Sibley-Allen C, Allen S, Purushotham A. Intraoperative Assessment of Tumor Resection Margins in Breast-Conserving Surgery Using 18F-FDG Cerenkov Luminescence Imaging: A First-in-Human Feasibility Study. J Nucl Med 2017; 58:891-898. [PMID: 27932562 DOI: 10.2967/jnumed.116.181032] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/26/2016] [Indexed: 01/27/2023] Open
Abstract
In early-stage breast cancer, the primary treatment option for most women is breast-conserving surgery (BCS). There is a clear need for more accurate techniques to assess resection margins intraoperatively, because on average 20% of patients require further surgery to achieve clear margins. Cerenkov luminescence imaging (CLI) combines optical and molecular imaging by detecting light emitted by 18F-FDG. Its high-resolution and small size imaging equipment make CLI a promising technology for intraoperative margin assessment. A first-in-human study was conducted to evaluate the feasibility of 18F-FDG CLI for intraoperative assessment of tumor margins in BCS. Methods: Twenty-two patients with invasive breast cancer received 18F-FDG (5 MBq/kg) 45-60 min before surgery. Sentinel lymph node biopsy was performed using an increased 99mTc-nanocolloid activity of 150 MBq to facilitate nodal detection against the γ-probe background signal (cross-talk) from 18F-FDG. The cross-talk and 99mTc dose required was evaluated in 2 lead-in studies. Immediately after excision, specimens were imaged intraoperatively in an investigational CLI system. The first 10 patients were used to optimize the imaging protocol; the remaining 12 patients were included in the analysis dataset. Cerenkov luminescence images from incised BCS specimens were analyzed postoperatively by 2 surgeons blinded to the histopathology results, and mean radiance and margin distance were measured. The agreement between margin distance on CLI and histopathology was assessed. Radiation doses to staff were measured. Results: Ten of the 12 patients had an elevated tumor radiance on CLI. Mean radiance and tumor-to-background ratio were 560 ± 160 photons/s/cm2/sr and 2.41 ± 0.54, respectively. All 15 assessable margins were clear on CLI and histopathology. The agreement in margin distance and interrater agreement was good (κ = 0.81 and 0.912, respectively). Sentinel lymph nodes were successfully detected in all patients. The radiation dose to staff was low; surgeons received a mean dose of 34 ± 15 μSv per procedure. Conclusion: Intraoperative 18F-FDG CLI is a promising, low-risk technique for intraoperative assessment of tumor margins in BCS. A randomized controlled trial will evaluate the impact of this technique on reexcision rates.
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Affiliation(s)
- Maarten R Grootendorst
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Massimiliano Cariati
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sarah E Pinder
- Division of Cancer Studies, King's College London, London, United Kingdom
| | - Ashutosh Kothari
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael Douek
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tibor Kovacs
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hisham Hamed
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amit Pawa
- Anesthetic Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fiona Nimmo
- Day Surgery Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Julie Owen
- Division of Cancer Studies, King's College London, London, United Kingdom
| | - Vernie Ramalingam
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sweta Sethi
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sanjay Mistry
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kunal Vyas
- Sagentia Ltd., Cambridge, United Kingdom
| | - David S Tuch
- Lightpoint Medical Ltd., Chesham, United Kingdom
| | - Alan Britten
- Medical Physics Department, St George's Hospital, London, United Kingdom
| | | | - Gary J Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; and
| | - Chris Sibley-Allen
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sarah Allen
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Arnie Purushotham
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Zeinali-Rafsanjani B, Rasekhi A, Saeedi-Moghadam M, Zarei F, Jalli R, Sefidbakht S, Pishdad P. A Useful Gadget to Reduce the Radiation Dose of Interventionist's Hands. HEALTH PHYSICS 2017; 112:494-497. [PMID: 28350707 DOI: 10.1097/hp.0000000000000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Increased demand for interventional radiology techniques has interventionists performing a large number of these procedures. Measurements and calculations have shown that the radiation doses received by these specialists can exceed the threshold of radiation-induced deterministic effects unless radiation protection procedures and devices are used. Proper usage of radiation protection devices can protect them from radiation-induced effects, even with a high workload. Occupational radiation protection entails proper training of interventionists to increase their awareness about available appropriate protection tools and equipment, and devices that can be used to minimize exposure, such as needle holders, tubing extensions, and injectors. This study introduces a device that can be used to fix the catheter to prevent the physician from holding the catheter by hand. The authors, also, discuss the importance of radiation protection training along with the training on new medical equipment, which can be applied to reduce the radiation dose.
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Radiation safety in the cardiac catheterization lab: A time series quality improvement initiative. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:S22-S26. [PMID: 28483588 DOI: 10.1016/j.carrev.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/10/2017] [Accepted: 04/19/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interventional cardiologists have one of the highest annual radiation exposures yet systems of care that promote radiation safety in cardiac catheterization labs are lacking. This study sought to reduce the frequency of radiation exposure, for PCI procedures, above 1.5Gy in labs utilizing a Phillips system at our local institution by 40%, over a 12-month period. METHODS We performed a time series study to assess the impact of different interventions on the frequency of radiation exposure above 1.5Gy. Process measures were percent of procedures where collimation and magnification were used and percent of completion of online educational modules. Balancing measures were the mean number of cases performed and mean fluoroscopy time. INTERVENTIONS Information sessions, online modules, policies and posters were implemented followed by the introduction of a new lab with a novel software (AlluraClarity©) to reduce radiation dose. RESULTS There was a significant reduction (91%, p<0.05) in the frequency of radiation exposure above 1.5Gy after utilizing a novel software (AlluraClarity©) in a new Phillips lab. Process measures of use of collimation (95.0% to 98.0%), use of magnification (20.0% to 14.0%) and completion of online modules (62%) helped track implementation. The mean number of cases performed and mean fluoroscopy time did not change significantly. CONCLUSION While educational strategies had limited impact on reducing radiation exposure, implementing a novel software system provided the most effective means of reducing radiation exposure.
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