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Vallot D, Cavillon A, Lusque A, Izard P, Salvignol G, Delpuech B, Fuzier R. Radiation dose reduction during venous access port implantation: the importance of upgrading equipment and radiation-protection training. Ir J Med Sci 2024; 193:1461-1466. [PMID: 38349509 DOI: 10.1007/s11845-024-03623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/29/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Implantable central venous port systems are widely used in oncology. We upgraded our fluoroscopy machines, and all anesthetists completed two training courses focusing on the risks of ionizing radiation for patients and health workers. AIMS This study aimed to evaluate the impact of upgrading the machines and the radiation-protection training on ionizing radiation exposure during venous port system implantation. METHODS We retrospectively analyzed consecutive venous port implantations between 2019 and 2022. The older fluoroscopy machines were replaced by two new machines. A first training session about health worker radioprotection was organized. The medical staff completed a second training course focused on protecting patients from ionizing radiation. We defined four distinct time intervals (TI): venous port implantations performed with the old equipment, the new fluoroscopy machines, after the first training course, and after the second training course. The air kerma-area product (KAP) was compared between these four TI and fluoroscopy times and the number of exposures only with the new machines. RESULTS We analyzed 2587 procedures. A 93% decrease in the median KAP between the first and last TI was noted (median KAP = 323.0 mGy.cm2 vs. 24.0 mGy.cm2, p < 0.0001). A decrease in the KAP was observed for each of the 11 anesthetists. We also noted a significant decrease in the time of fluoroscopy and the number of exposures. CONCLUSIONS Upgrading the fluoroscopy equipment and completing two dedicated training courses allowed for a drastic decrease patient exposure to ionizing radiation during venous access port implantation by non-radiologist practitioners.
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Affiliation(s)
- Delphine Vallot
- Department of Medical Physics, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Ana Cavillon
- Department of Biostatistics and Health Data Science, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Amélie Lusque
- Department of Biostatistics and Health Data Science, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Philippe Izard
- Department of Anesthesiology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Geneviève Salvignol
- Department of Anesthesiology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Bertrand Delpuech
- Department of Radioprotection, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Régis Fuzier
- Department of Anesthesiology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France.
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Dalvi S, Roberts HM, Bellamy C, Rees M. The use of digital magnification to reduce radiation dose in the cardiac catheter laboratory. Br J Radiol 2022; 95:20210269. [PMID: 34889648 PMCID: PMC8722255 DOI: 10.1259/bjr.20210269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To audit whether using magnification of images by use of a large viewing screen using digital matrix magnification which enlarges the image by 33% without using the X-ray machine zoom magnification protocols on a Siemens Artis Zee X-ray machine in a cardiac catheter laboratory results in a reduction of kerma-area product (KAP) for both diagnostic and interventional procedures. This reduction was predicted in an in vitro study in our laboratory, which has previously shown a 20.4% reduction in KAP. METHODS A retrospective analysis was conducted of the radiation exposure to compare the measured KAP recorded during the period when conventional magnification with automatic brightness and dose control was used on a Siemens Artis Zee X-ray machine with a flat panel detector and when magnification settings were avoided by using a large screen to enlarge and project a non-magnified image by digital magnification. The analysis was carried out for patients having a diagnostic coronary angiogram and those having an interventional coronary procedure. RESULTS For diagnostic coronary angiograms the median KAP per procedure in the period using conventional magnification was 2124.5 µGy.m2 compared to 1401 µGy.m2 when image matrix magnification was used, a 34% reduction (p < 0.0001). For interventional coronary procedures, the median KAP per procedure in the period using conventional magnification was 3791 µGy.m2 compared to 2568.5 µGy.m2 when image matrix magnification was used, a 32% reduction (p < 0.0001). CONCLUSION Avoiding using conventional magnification in the cardiac catheter laboratory and using a large screen to magnify images was associated with a statistically significant greater than 30% reduction in KAP. ADVANCES IN KNOWLEDGE This paper is the proof in clinical practice of a theoretical conclusion that radiation dose (KAP) is reduced by use of Image matrix magnification using a large viewing screen without the need to use X-ray tube magnification without significant loss of image resolution in interventional cardiology. The same approach will be useful in interventional radiology.
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Subban V. Radiation doses during cardiac catheterisation procedures in India: a multicentre study: Radiation dose study. ASIAINTERVENTION 2020; 6:25-33. [PMID: 34912981 PMCID: PMC8525728 DOI: 10.4244/aij-d-18-00044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/04/2020] [Indexed: 10/25/2023]
Abstract
AIMS Established, evidence-based measures of radiation are required to minimise its hazards, while maintaining adequate image quality. The aim of this study is to evaluate radiation data and generate reference radiation levels for commonly performed coronary catheterisation procedures in India. METHODS AND RESULTS In this prospective, observational study, all procedures were performed in accordance with the established standards using Innova IGS 520/2100-IQ catheterisation laboratories. Demographic, procedural and radiation data were collected. Dose reference limits (DRL) were established as the 75th percentile of the total distribution. There were 2,906 coronary angiograms (CAG), 750 percutaneous coronary interventions (PCI) and 715 CAG+PCI. DRLs for dose area product were: 19.6 Gy·cm2 for CAG, 49.8 Gy·cm2 for PCI and 72.0 Gy·cm2 for CAG+PCI, respectively. Median cumulative air kerma levels were: 185 mGy for CAG, 533mGy for PCI, and 891 mGy for CAG+PCI. Male gender, higher BMI, combining CAG+PCI, fluoroscopy time, number of cine frames, and image acquisition settings were significant contributors to increased radiation dose. CONCLUSIONS This study established reference radiation dose levels for diagnostic and interventional coronary procedures in India, which were comparable to and in the lower range of international standards.
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Affiliation(s)
- Vijayakumar Subban
- Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
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Lopez JJ, Darki A. Radiation Dose Variability Across Institutions: A Wake-Up Call for Interventional Cardiology? JACC Cardiovasc Interv 2020; 13:857-859. [PMID: 32273097 DOI: 10.1016/j.jcin.2019.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/31/2019] [Indexed: 11/26/2022]
Affiliation(s)
- John J Lopez
- Division of Cardiology, Department of Medicine, Loyola University Medical Center and Loyola Stritch School of Medicine, Maywood, Illinois.
| | - Amir Darki
- Division of Cardiology, Department of Medicine, Loyola University Medical Center and Loyola Stritch School of Medicine, Maywood, Illinois
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Villecourt A, Faroux L, Blanpain T, Kinnel M, Mora C, Tassan-Mangina S, Heroguelle V, Nazeyrollas P, Metz D. Exposure to Ionizing Radiation in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:114-119. [PMID: 31699362 DOI: 10.1016/j.amjcard.2019.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is currently becoming an alternative to surgical valve replacement for patients at low risk, a population that is likely to experience an increase in the radiation-induced cancer risk following TAVI. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent transfemoral TAVI, including the procedure itself as well as the procedures performed in the preintervention work-up and the post-TAVI interventions. All patients who underwent transfemoral TAVI for symptomatic aortic stenosis in our center over a 26 months period were included. Dosimetric indicators from preprocedural coronary angiography and computed tomography (CT), the TAVI procedure, and any postprocedural interventions (electrophysiology study and/or pacemaker implantation) were collected and converted into an effective dose. A total of 119 transfemoral TAVI procedures were included. The mean cumulative effective dose (ED) was 37.3 mSv. Three irradiating procedures were necessary for 84 patients (71% of the population, i.e., coronary angiography, CT scan and the TAVI procedure itself), whereas 30 patients (25%) required a fourth procedure, and 5 required a fifth (4%). The majority of the dose was from the CT, while only 11% of the dose derived from the TAVI procedure itself. In conclusion, overall exposure to ionizing radiation for patients who underwent transfemoral TAVI seems acceptable, and the majority of the overall ED comes from the CT scan.
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Affiliation(s)
| | - Laurent Faroux
- Department of Cardiology, Reims University Hospital, Reims, France.
| | - Thierry Blanpain
- Department of Cardiology, Reims University Hospital, Reims, France; Department of Radiation Protection, Reims University Hospital, Reims, France
| | - Marine Kinnel
- Department of Cardiology, Reims University Hospital, Reims, France
| | - Caroline Mora
- Department of Radiology, Reims University Hospital, Reims, France
| | | | | | | | - Damien Metz
- Department of Cardiology, Reims University Hospital, Reims, France
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Multicenter Assessment of Radiation Exposure during Pediatric Cardiac Catheterizations Using a Novel Imaging System. J Interv Cardiol 2019; 2019:7639754. [PMID: 32089654 PMCID: PMC7012227 DOI: 10.1155/2019/7639754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/29/2019] [Accepted: 09/17/2019] [Indexed: 02/01/2023] Open
Abstract
Objectives To quantify radiation exposure during pediatric cardiac catheterizations performed by multiple operators on a new imaging platform, the Artis Q.zen (Siemens Healthcare, Forchheim, Germany), and to compare these data to contemporary benchmark values. Background The Artis Q.zen has been shown to achieve significant radiation reduction during select types of pediatric cardiac catheterizations in small single-center studies. No large multicenter study exists quantifying patient dose exposure for a broad spectrum of procedures. Methods Retrospective collection of Air Kerma (AK) and dose area product (DAP) for all pediatric cardiac catheterizations performed on this new imaging platform at four institutions over a two-year time period. Results A total of 1,127 pediatric cardiac catheterizations were analyzed. Compared to dose data from earlier generation Artis Zee imaging systems, this study demonstrates 70–80% dose reduction (AK and DAP) for similar patient and procedure types. Compared to contemporary benchmark data for common interventional procedures, this study demonstrates an average percent reduction in AK and DAP from the lowest dose saving per intervention of 39% for AK and 27% for DAP for transcatheter pulmonary valve implantation up to 77% reduction in AK and 70% reduction in DAP for atrial septal defect closure. Conclusion Use of next-generation imaging platforms for pediatric cardiac catheterizations can substantially decrease patient radiation exposure. This multicenter study defines new low-dose radiation measures achievable on a novel imaging system.
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Ison GR, Allahwala U, Weaver JC. Radiation Management in Coronary Angiography: Percutaneous Coronary Intervention for Chronic Total Occlusion at the Frontier. Heart Lung Circ 2019; 28:1501-1509. [DOI: 10.1016/j.hlc.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/10/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
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Faroux L, Daval C, Lesaffre F, Blanpain T, Chabert JP, Martin A, Guinot M, Luconi N, Espinosa M, Nazeyrollas P, Tourneux C, Metz D. Physicians' exposure to radiation during electrophysiology procedures. J Interv Card Electrophysiol 2019; 55:233-237. [PMID: 31177353 DOI: 10.1007/s10840-019-00568-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/19/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no study comparing the level of exposure of physicians during different electrophysiology procedures. We aimed to measure and compare cardiologists' exposure to radiation during different electrophysiology procedures. METHODS The study population comprised all electrophysiology procedures performed over a 6-month period in a large referral centre. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on the operator's left arm. RESULTS In total, 150 electrophysiology procedures were analyzed. Compared with electrophysiology studies (reference category), physician radiation exposure was 3-fold greater during ablation of atrial fibrillation, 9-fold greater during ablation of atrioventricular nodal reentrant tachycardia (AVNRT)/atrioventricular reentrant tachycardia (AVNT), and 10-fold greater during ablation of atrial flutter (p < 0.001). Physician exposure was mainly related to X-ray time (R2 = 0.28). CONCLUSIONS Our study showed significant differences in cardiologists' exposure to ionizing radiation depending on the type of electrophysiology procedure. Atrial flutter and AVNRT/AVNT ablations are the procedures in which operators are most exposed to ionizing radiation.
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Affiliation(s)
- Laurent Faroux
- Department of Cardiology, Reims University Hospital, Reims, France. .,Service Cardiologie, Hopital Robert Debré, CHU de Reims, Avenue du général Koenig, 51092, Reims, France.
| | - Charline Daval
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | - Thierry Blanpain
- Department of Cardiology, Reims University Hospital, Reims, France.,Department of Radiation Protection, Reims University Hospital, Reims, France
| | | | - Angeline Martin
- Department of Cardiology, Reims University Hospital, Reims, France
| | - Mathias Guinot
- Department of Cardiology, Reims University Hospital, Reims, France
| | - Nicolas Luconi
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | | | - Christophe Tourneux
- Department of Radiation Protection, Reims University Hospital, Reims, France
| | - Damien Metz
- Department of Cardiology, Reims University Hospital, Reims, France
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Bang VV, Levy MS. Radiation safety with dose reduction technology: The buck stops at zero dose. Catheter Cardiovasc Interv 2018; 91:1200-1201. [PMID: 29894585 DOI: 10.1002/ccd.27670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 11/08/2022]
Abstract
Exposure to ionizing radiation in cardiovascular imaging and its adverse impact on health is a growing concern. Cath lab imaging dose-reduction technology is an effective way to reduce patient and operator radiation dose. More clinical trials and studies such as this one are needed to assess the short-and long-term impact of this important technology.
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Affiliation(s)
- Vigyan V Bang
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Michael S Levy
- Lahey Hospital and Medical Center, Burlington, Massachusetts
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