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Serna Santos J, Kaasalainen T, Laukontaus S, Björkman P, Heinola I, Laine M, Vikatmaa P, Pekkarinen A, Venermo M, Aho P. The Effect of a Suspended Radiation Protection System on Occupational Radiation Doses During Infrarenal EVAR Procedures: A Randomised Controlled Study. Eur J Vasc Endovasc Surg 2024; 67:435-443. [PMID: 37611731 DOI: 10.1016/j.ejvs.2023.08.039] [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: 11/11/2022] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To compare the protective effect of Zero Gravity (ZG) with conventional radiation protection during endovascular aneurysm repair (EVAR). Secondly, user experience was surveyed with a questionnaire on ergonomics. METHODS This was a single centre, prospective, randomised, two arm trial where 71 consecutive elective infrarenal EVAR procedures were randomised into two groups: (1) operator using ZG and assistant using conventional protection (n = 36), and (2) operator and assistant using conventional radiation protection (n = 35). A movable floor unit ZG system consists of a lead shield (1.0 mm Pb equivalent) for the front of the body and 0.5 mm Pb equivalent acrylic shielding for the head and neck. The ZG also includes arm flaps of 0.5 mm Pb equivalent covering the arm up to the elbow. Deep dose equivalent values, Hp(10) were measured with direct ion storage dosimeters (DIS) placed on various anatomical regions of the operator (axilla, chest, abdomen, and lower leg). Personal dose equivalent values, Hp(3) to eye lenses were measured in the operating and assisting surgeon using thermoluminescence dosimeters. The study was registered at the US National Institute of Health #NCT04078165. RESULTS Protection with the standard protection was superior in chest (0.0 vs. 0.1 μSv), abdomen (0.0 vs. 0.6 μSv), and lower leg (0.4 vs. 2.2 μSv) (p < .001). On the other hand, the ZG system yielded better shielding for the axilla (1.5 vs. 0.0 μSv) and eyes (6.3 vs. 1.1 μSv) of the operator. The use of ZG hampered the deployment of ancillary shields, which is particularly relevant for protection of the assisting surgeon. Users found ZG more cumbersome than conventional garments, it also impaired communication and reduced field of view. CONCLUSION Both ZG and conventional radiation protection reduced radiation exposure. Conventional protection allows better manoeuvrability at the price of wider exposure of the upper arm and axilla. ZG indirectly impaired protection of the assistant.
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Affiliation(s)
- Juan Serna Santos
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland.
| | - Touko Kaasalainen
- HUS Diagnostic Centre, Radiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Sani Laukontaus
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Patrick Björkman
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Ivika Heinola
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Matti Laine
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Pirkka Vikatmaa
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Antti Pekkarinen
- Radiation Practices Regulation, Radiation and Nuclear Safety Authority (STUK), Helsinki, Finland; Department of Medical Physics, Kymsote, Kymenlaakso Central Hospital
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Pekka Aho
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
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Bork FT, Boehmer AA, Zezyk C, Kaess BM, Ehrlich JR. Frame-rate reduction to reduce radiation dose for cardiac device implantation is safe. Heart Rhythm O2 2023; 4:427-432. [PMID: 37520019 PMCID: PMC10373156 DOI: 10.1016/j.hroo.2023.05.003] [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: 08/01/2023] Open
Abstract
Background Radiation exposure to patient and surgeon during cardiac implantable electrical device (CIED) procedures remains a substantial health hazard to date. Advanced technical options for radiation dose reduction often pose considerable financial hurdles. We propose a near-zero cost, low-effort modification to a clinical x-ray system significantly reducing radiation dose during CIED implantation. Objective We aim to evaluate a reduced frame rate protocol in CIED implantation for complication rates and reduction in radiation exposure. Methods Starting May 2019, the frame rate during CIED implantations at our hospital was halved from 7.5 frames/s to 3.8 frames/s, and no further technical changes were made. During the following year, 264 patients were operated using this protocol and retrospectively compared with 231 cases implanted in the year before the protocol change, totaling 495 cases. Of these, 17%, 63%, and 19% were single-chamber, dual-chamber, or resynchronization devices, respectively. Incidence of complication prior to hospital discharge was considered the primary endpoint of the analysis. Radiation dose and procedural parameters were secondary endpoints. Results There was no increase in complications with the reduced frame rate protocol. Regression analysis further supported that the reduced frame rate radiation protocol was not associated with complication rates. Radiation exposure measured as dose area product was significantly reduced by ∼62% (median 369 [interquartile range 154-1207] cGy·cm2 via the reduced frame rate protocol vs median 970 [interquartile range 400-1906] cGy·cm2 with the standard frame rate; P < 0.01). Conclusion A reduction of frame rate during CIED implantation is safe in terms of complication incidence and effective in terms of reducing radiation exposure.
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Affiliation(s)
| | | | | | | | - Joachim R. Ehrlich
- Address reprint requests and correspondence: Dr Joachim R. Ehrlich, Department of Cardiology, St. Josefs-Hospital, Beethovenstraße 20, 65189 Wiesbaden, Germany.
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Huet C, Dabin J, Domienik-Andrzejewska J, Hebre A, Honorio da Silva E, Lombardo P, Tamborino G, Vanhavere F. Effectiveness of staff radiation protection devices for interventional cardiology procedures. Phys Med 2023; 107:102543. [PMID: 36780792 DOI: 10.1016/j.ejmp.2023.102543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/13/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of currently available radioprotective (RP) devices in reducing the dose to interventional cardiology staff, especially to the eye lens and brain. METHODS The performances of five RP devices (masks, caps, patient drapes, staff lead and lead-free aprons and Zero-Gravity (ZG) suspended radiation protection system) were assessed by means of Monte Carlo (MC) simulations. A geometry representative of an interventional cardiology setup was modelled and several configurations, including beam projections and staff distance from the source, were investigated. In addition, measurements on phantoms were performed for masks and drapes. RESULTS An average dose reduction of 65% and 25% to the eyes and the brain respectively was obtained for the masks by MC simulations but a strong influence of the design was observed. The cap effectiveness for the brain ranges on average between 13% and 37%. Nevertheless, it was shown that only some upper parts of the brain were protected. There was no significant difference between the effectiveness of lead and lead-free aprons. Of all the devices, the ZG system offered the highest protection to the brain and eye lens and a protection level comparable to the apron for the organs normally covered. CONCLUSION All investigated devices showed potential for dose reduction to specific organs. However, for masks, caps and drapes, it strongly depends on the design, exposure conditions and staff position. Therefore, for a clinical use, it is recommended to evaluate their effectiveness in the planned conditions of use.
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Affiliation(s)
- Christelle Huet
- Institut de radioprotection et de sûreté nucléaire, Pôle santé et environnement, Service de recherche en dosimétrie, Fontenay-aux-Roses, France.
| | - Jérémie Dabin
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium
| | | | - Alexandre Hebre
- Institut de radioprotection et de sûreté nucléaire, Pôle santé et environnement, Service de recherche en dosimétrie, Fontenay-aux-Roses, France
| | | | - Pasquale Lombardo
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium
| | - Giulia Tamborino
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium
| | - Filip Vanhavere
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium
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Fukuda A, Ichikawa N, Hayashi T, Lin PJP, Matsubara K. Reducing stray radiation with a novel detachable lead arm support in percutaneous coronary intervention. J Appl Clin Med Phys 2022; 23:e13763. [PMID: 36001385 PMCID: PMC9588269 DOI: 10.1002/acm2.13763] [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: 11/08/2021] [Revised: 07/29/2022] [Accepted: 08/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background Placing radioprotective devices near patients reduces stray radiation during percutaneous coronary intervention (PCI), a promising technique for treating coronary artery disease. Therefore, lead arm support may effectively reduce occupational radiation dose to cardiologists. Purpose We aimed to estimate the reduction of stray radiation using a novel detachable lead arm support (DLAS) in PCI. Materials and methods A dedicated cardiovascular angiography system was equipped with the conventional 0.5‐mm lead curtain suspended from the table side rail. The DLAS was developed using an L‐shaped acrylic board and detachable water‐resistant covers encasing the 0.5‐, 0.75‐, or 1.0‐mm lead. The DLAS was placed adjacent to a female anthropomorphic phantom lying on the examination tabletop at the patient entrance reference point. An ionization chamber survey meter was placed 100 cm away from the isocenter to emulate the cardiologist's position. Dose reduction using the L‐shaped acrylic board, DLAS, lead curtain, and their combination each was measured at five heights (80–160 cm in 20‐cm increments) when acquiring cardiac images of the patient phantom with 10 gantry angulations, typical for PCI. Results Median dose reductions of stray radiation using the L‐shaped acrylic board were 9.0%, 8.8%, 12.4%, 12.3%, and 6.4% at 80‐, 100‐, 120‐, 140‐, and 160‐cm heights, respectively. Dose reduction using DLAS with a 0.5‐mm lead was almost identical to that using DLAS with 0.75‐ and 1.0‐mm leads; mean dose reductions using these three DLASs increased to 16.2%, 45.1%, 66.0%, 64.2%, and 43.0%, respectively. Similarly, dose reductions using the conventional lead curtain were 95.9%, 95.5%, 83.7%, 26.0%, and 19.6%, respectively. The combination of DLAS with 0.5‐mm lead and lead curtain could increase dose reductions to 96.0%, 95.8%, 93.8%, 71.1%, and 47.1%, respectively. Conclusions DLAS reduces stray radiation at 120‐, 140‐, and 160‐cm heights, where the conventional lead curtain provides insufficient protection.
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Affiliation(s)
- Atsushi Fukuda
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Nao Ichikawa
- Department of Radiological Technology, Faculty of Health Science, Kobe Tokiwa University, Kobe, Hyogo, Japan
| | - Takuma Hayashi
- Department of Radiation Oncology, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Pei-Jan P Lin
- Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Budošová D, Horváthová M, Bárdyová Z, Balázs T. CURRENT TRENDS OF RADIATION PROTECTION EQUIPMENT IN INTERVENTIONAL RADIOLOGY. RADIATION PROTECTION DOSIMETRY 2022; 198:554-559. [PMID: 36005965 DOI: 10.1093/rpd/ncac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/11/2022] [Accepted: 05/22/2020] [Indexed: 06/15/2023]
Abstract
Interventional radiology represents subspecialty of radiology, which does not use imaging modalities only for diagnostics, but mostly for therapeutic purposes. Realisation of interventional procedures is done through X-rays, which replaces direct visual control done by interventional radiologist or cardiologist. For the targeted reduction of the radiation exposure, the interventional radiology staff use personal protective equipment. Usually, aprons with lead-equivalent are used, which provide protection for 75% of the radiosensitive organs. As the eye lens and thyroid gland belong to the radiosensitive organs, lead eyeglasses and thyroid collar are commonly used for their protection. Cap and gloves with lead-equivalent can be utilised as an additional personal protective equipment, that is commercially available. Innovative protection systems, such as mobile radiation protection cabin and suspended radiation protection, have been designed to ensure better radiation protection and safety. These systems provide the comfort for the interventional radiologists at work, while offering better protection against ionising radiation.
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Affiliation(s)
- Darina Budošová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Martina Horváthová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Zuzana Bárdyová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Tibor Balázs
- CINRE s.r.o., Center for Interventional Neuroradiology and Endovascular Treatment, Tematínska 5/a, Bratislava 851 05, Slovakia
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Domienik-Andrzejewska J, Mirowski M, Jastrzębski M, Górnik T, Masiarek K, Warchoł I, Grabowicz W. Occupational exposure to physicians working with a Zero-Gravity™ protection system in haemodynamic and electrophysiology labs and the assessment of its performance against a standard ceiling suspended shield. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:293-300. [PMID: 35218403 PMCID: PMC8881893 DOI: 10.1007/s00411-022-00968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
A two centre clinical study was performed to analyse exposure levels of cardiac physicians performing electrophysiology and haemodynamic procedures with the use of state of the art Zero-Gravity™ radiation protective system (ZG). The effectiveness of ZG was compared against the commonly used ceiling suspended lead shield (CSS) in a haemodynamic lab. The operator's exposure was assessed using thermoluminescent dosimeters (TLDs) during both ablation (radiofrequency ablation (RFA) and cryoablation (CRYA)) and angiography and angioplasty procedures (CA/PCI). The dosimeters were placed in multiple body regions: near the left eye, on the left side of the neck, waist and chest, on both hands and ankles during each measurement performed with the use of ZG. In total 29 measurements were performed during 105 procedures. To compare the effectiveness of ZG against CSS an extra 80 measurements were performed with the standard lead apron, thyroid collar and ceiling suspended lead shield during CA/PCI procedures. For ZG, the upper values for the average eye lens and whole body doses per procedure were 4 µSv and 16 µSv for the left eye lens in electrophysiology lab (with additionally used CSS) and haemodynamic lab (without CSS), respectively, and about 10 µSv for the remaining body parts (neck, chest and waist) in both labs. The skin doses to hands and ankles non-protected by the ZG were 5 µSv for the most exposed left finger and left ankle in electrophysiology lab, while in haemodynamic lab 150 µSv and 17 µSv, respectively. The ZG performance was 3 times (p < 0.05) and at least 15 times (p < 0.05) higher for the eye lenses and thoracic region, respectively, compared to CSS (with dosimeters on the apron/collar). However, when only ZG was used slightly higher normalised doses were observed for the left finger compared to CSS (5.88e - 2 Sv/Gym2 vs. 4.31 e - 2 Sv/Gym2, p = 0.016). The study results indicate that ZG performance is superior to CSS. It can be simultaneously used with the ceiling suspended lead shield to ensure the protection to the hands as long as this is not obstructive for the work.
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Affiliation(s)
| | - Mateusz Mirowski
- Radiation Protection Department, Nofer Institute of Occupational Medicine in Lodz, Łódź, Poland
| | - Marek Jastrzębski
- Medical College, 1St Department of Cardiology, Jagiellonian University, Interventional Electrocardiology and Hypertension, Kraków, Poland
| | - Tomasz Górnik
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Łódź, Poland
| | - Konrad Masiarek
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Łódź, Poland
| | - Izabela Warchoł
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Łódź, Poland
| | - Włodzimierz Grabowicz
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Łódź, Poland
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Koenig A, Akgöl A, Verbe J, Aigner R, Fiebich M, Thomas R, Mahnken A. Joint replacement increases radiation exposure to the staff in angiography: a phantom study. Eur J Radiol 2022; 151:110270. [DOI: 10.1016/j.ejrad.2022.110270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
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Olschewski M, Ullrich H, Brandt M, Steven S, Ahoopai M, Blessing R, Petrescu A, Wenzel P, Munzel T, Gori T. Effectiveness of a Real-Time X-ray Dosimetry Monitor in Reducing Radiation Exposure in Coronary Procedures: The ESPRESSO-Raysafe Randomized Trial. J Clin Med 2021; 10:jcm10225350. [PMID: 34830632 PMCID: PMC8621135 DOI: 10.3390/jcm10225350] [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: 10/27/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background—Several methods to reduce radiation exposure in the setting of coronary procedures are available on the market, and we previously showed that additional radiation shields reduce operator exposure during radial interventions. We set out to examine the efficacy of real-time personal dosimetry monitoring in a real-world setting of radial artery catheterization. Methods and Results—In an all-comer prospective, parallel study, consecutive coronary diagnostic and intervention procedures were performed with the use of standard radiation shield alone (control group) or with the addition of a real-time dosimetry monitoring system (Raysafe, Billdal, Sweden, monitoring group). The primary outcome was the difference in exposure of the primary operator among groups. Additional endpoints included patient, nurse, second operator exposure and fluoroscopy time. A total of 700 procedures were included in the analysis (n = 369 in the monitoring group). There were no differences among groups in patients’ body mass index (p = 0.232), type of procedure (intervention vs. diagnostic, p = 0.172), and patient sex (p = 0.784). Fluoroscopy time was shorter in the monitoring group (5.6 (5.1–6.2) min vs. 7.0 (6.1–7.7) min, p = 0.023). Radiation exposure was significantly lower in the monitoring group for the patient (135 (115–151) µSv vs. 208 (176–245) µSv, p < 0.0001) but not for the first operator (9 (7–11) µSv vs. 10 (8–11), p = 0.70) and the assistant (2 (1–2) µSv vs. 2 (1–2) µSv, p = 0.121). Conclusions—In clinical daily practice, the use of a real-time dosimetry monitoring device reduces patient radiation exposure and fluoroscopy time without an effect on operator radiation exposure.
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