1
|
Rizik DG, Burke RF, Klassen SR, Nigoghosian AM, Riley RD, Gosselin KP, Goldstein JA. Comprehensive Shielding System Enhances Radiation Protection for Structural Heart Procedures. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101110. [PMID: 39131971 PMCID: PMC11307704 DOI: 10.1016/j.jscai.2023.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2024]
Abstract
Background This study of radiation exposure (RE) to physicians performing structural heart procedures evaluated the efficacy of a novel comprehensive radiation shield compared to those of traditional shielding methods. A novel comprehensive shielding system (Protego, Image Diagnostics Inc) has been documented to provide superior RE protection during coronary procedures compared to that provided by a standard "drop down" shield. The purpose of this study was to assess the efficacy of this shield in transcatheter aortic valve replacement (TAVR) procedures, which are associated with disproportionate RE to operators. Methods This single-center, 2-group cohort, observational analysis compared RE to the primary physician operator performing TAVR using the Protego shield (n = 25) with that using a standard drop-down shield with personal leaded apparel (n = 25). RE was measured at both thyroid and waist levels with a real-time dosimetry system (RaySafe i3, RaySafe) and was calculated on a mean per case basis. Data were collected on additional procedural parameters, including access site(s) for device implantation, per case fluoroscopy time, air kerma, and patient factors, including body mass index. Between-group comparisons were conducted to evaluate RE by group and measurement sites. Results The Protego system reduced operator RE by 99% compared to that using standard protection. RE was significantly lower at both the thyroid level (0.08 ± 0.27 vs 79.2 ± 62.4 μSv; P < .001) and the waist level (0.70 ± 1.50 vs 162.0 ± 91.0 μSv, P < .001). "Zero" total RE was documented by RaySafe in 60% (n = 15) of TAVR cases using Protego. In contrast, standard protection did not achieve zero exposure in a single case. Conclusions The Protego shield system provides superior operator RE protection during TAVR procedures. This shield allows operators to work without the need for personal lead aprons and has potential to reduce catheterization laboratory occupational health hazards.
Collapse
Affiliation(s)
- David G. Rizik
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Robert F. Burke
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Sabrina R. Klassen
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | | | - Robert D. Riley
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Kevin P. Gosselin
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - James A. Goldstein
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| |
Collapse
|
2
|
Asgar AW. Editorial: Ionizing Radiation-The Unseen Enemy of Structural Heart Disease Interventions. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100007. [PMID: 37273479 PMCID: PMC10236860 DOI: 10.1016/j.shj.2022.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 06/06/2023]
Affiliation(s)
- Anita W. Asgar
- Address correspondence to: Anita W. Asgar, MD, MSc, Montreal Heart Institute, Universite de Montreal, 5000 rue Belanger, Montreal, QC H1T 1C8
| |
Collapse
|
3
|
Nocum DJ, Robinson J, Halaki M, Liang E, Thompson N, Moscova M, Reed W. Identifying predictors of patient radiation dose during uterine artery embolisation. J Med Radiat Sci 2021; 68:131-138. [PMID: 33185033 PMCID: PMC8168071 DOI: 10.1002/jmrs.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Uterine artery embolisation (UAE) is regarded as a safe and effective treatment for symptomatic uterine fibroids and/or adenomyosis. Dose reduction during UAE is critical for this reproductive-age patient population to minimise the risks of radiation-induced effects. The aim of this study was to identify the predictors of radiation dose which can be controlled and optimised for patients during UAE. METHODS A total of 150 patients between June 2018 and August 2019 were included in this study. Demographic and clinical information such as age, body mass index (BMI), total number of fibroids, total fibroid volume, total uterus volume and dosimetric measurements on Dose Area Product (DAP), Air Kerma (AK) and fluoroscopy time were recorded. Total digital subtraction angiography (DSA), total conventional roadmap (CRM), total last-image hold (LIH) and total fluoroscopy were calculated from the dose report. Multiple linear regression analysis was used to identify the independent predictor variables of total dose (DAP) using a regression model. RESULTS Total DSA, total CRM and total LIH were identified as the determinants of dose for UAE (P < 0.05) and together accounted for 95.2% of the variance. CONCLUSIONS This study identified the key imaging predictors of dose for UAE. Total DSA, total CRM and total LIH were shown to have a greater impact on the outcome DAP compared to other demographic or dosimetric measurements. Optimisation of these predictors during future UAE procedures can facilitate radiation dose reduction to the pelvis and reproductive organs.
Collapse
Affiliation(s)
- Don J. Nocum
- San Radiology & Nuclear MedicineSydney Adventist HospitalWahroongaNew South WalesAustralia
- Discipline of Medical Imaging ScienceSchool of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - John Robinson
- Discipline of Medical Imaging ScienceSchool of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Mark Halaki
- Discipline of Exercise and Sports ScienceSchool of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Eisen Liang
- Department of RadiologySydney Adventist Hospital Clinical SchoolUniversity of SydneyWahroongaNew South WalesAustralia
| | - Nadine Thompson
- San Radiology & Nuclear MedicineSydney Adventist HospitalWahroongaNew South WalesAustralia
- Department of RadiologySydney Adventist Hospital Clinical SchoolUniversity of SydneyWahroongaNew South WalesAustralia
| | - Michelle Moscova
- Faculty of MedicineSchool of Medical SciencesUniversity of New South WalesNew South WalesAustralia
| | - Warren Reed
- Discipline of Medical Imaging ScienceSchool of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Järvinen J, Sierpowska J, Siiskonen T, Järvinen H, Kiviniemi T, Rissanen TT, Matikka H, Niskanen E, Hurme S, Larjava HRS, Mäkelä TJ, Strengell S, Eskola M, Parviainen T, Hallinen E, Pirinen M, Kivelä A, Teräs M. CONTEMPORARY RADIATION DOSES IN INTERVENTIONAL CARDIOLOGY: A NATIONWIDE STUDY OF PATIENT DOSES IN FINLAND. RADIATION PROTECTION DOSIMETRY 2019; 185:483-493. [PMID: 30989216 DOI: 10.1093/rpd/ncz041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/01/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
The amount of interventional procedures such as percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI), pacemaker implantation (PI) and ablations has increased within the previous decade. Simultaneously, novel fluoroscopy mainframes enable lower radiation doses for patients and operators. Therefore, there is a need to update the existing diagnostic reference levels (DRLs) and propose new ones for common or recently introduced procedures. We sought to assess patient radiation doses in interventional cardiology in a large sample from seven hospitals across Finland between 2014 and 2016. Data were used to set updated national DRLs for coronary angiographies (kerma-air product (KAP) 30 Gycm2) and PCIs (KAP 75 cm2), and novel levels for PIs (KAP 3.5 Gycm2), atrial fibrillation ablation procedures (KAP 25 Gycm2) and TAVI (KAP 90 Gycm2). Tentative KAP values were set for implantations of cardiac resynchronization therapy devices (CRT, KAP 22 Gycm2), electrophysiological treatment of atrioventricular nodal re-entry tachycardia (6 Gycm2) and atrial flutter procedures (KAP 16 Gycm2). The values for TAVI and CRT device implantation are published for the first time on national level. Dose from image acquisition (cine) constitutes the major part of the total dose in coronary and atrial fibrillation ablation procedures. For TAVI, patient weight is a good predictor of patient dose.
Collapse
Affiliation(s)
- Jukka Järvinen
- Department of Cardiology, Turku Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Radiology, The Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Joanna Sierpowska
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, Finland
| | | | - Hannu Järvinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Tuomas Kiviniemi
- Department of Cardiology, Turku Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas T Rissanen
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, Finland
| | - Hanna Matikka
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Eini Niskanen
- Department of Radiology, Vaasa Central Hospital, Vaasa, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku
| | - Heli R S Larjava
- Department of Medical Imaging, Central Finland Health Care District, Jyväskylä, Finland
| | - Timo J Mäkelä
- Department of Internal Medicine, Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Satu Strengell
- Department of Cardiology, Cardiology Division, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Markku Eskola
- Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere, Finland and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | | | - Elina Hallinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Markku Pirinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Antti Kivelä
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Mika Teräs
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Department of Biomedicine, Institute of Biomedicine, University of Turku, Turku, Finland
| |
Collapse
|
7
|
Balter S, Moses JW. Caution: Predictors ahead. Catheter Cardiovasc Interv 2018; 92:775-776. [PMID: 30341821 DOI: 10.1002/ccd.27883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 11/06/2022]
Abstract
Radiation dose data can be used as a starting point to establish local TAVR reference levels. Cancer risk is of concern but is very low in the context of TAVR patients. Improvements in clinical radiation management will reduce both patient and staff risk for all procedures.
Collapse
Affiliation(s)
- Stephen Balter
- Departments of Radiology and Medicine, Columbia University Medical Center, New York
| | - Jeffrey W Moses
- Departments of Radiology and Medicine, Columbia University Medical Center, New York
| |
Collapse
|