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Reeg A, Braun Y, Sunderbrink D, Hakimi M. Lowest reported dose area product of 2.4 Gy∗cm 2 for ultra-low-dose endovascular aortic aneurysm repair of a standard infrarenal aortic aneurysm. J Vasc Surg Cases Innov Tech 2024; 10:101496. [PMID: 38764464 PMCID: PMC11099303 DOI: 10.1016/j.jvscit.2024.101496] [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: 01/10/2024] [Accepted: 03/21/2024] [Indexed: 05/21/2024] Open
Abstract
This is a report of successful treatment of an abdominal aortic aneurysm via standard endovascular aortic repair with an ultra-low dose (ULD) of 2.4 Gy∗cm2 using the latest imaging software in a hybrid operating room. To the best of our knowledge, no case has yet been reported achieving a successful outcome with such ULD values to date. The key factors to achieving an ULD regarding the dose area product comprise the right technology, procedural standardization, and team education and training. This case highlights the potential for reducing the radiation dose routinely for patients and staff alike, especially for operating room staff with daily radiation exposure.
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Affiliation(s)
- Alina Reeg
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Yvonne Braun
- Global Clinical Marketing Surgery, Siemens Healthineers, Forchheim, Germany
| | - Dirk Sunderbrink
- Global Clinical Marketing, Siemens Healthineers, Forchheim, Germany
| | - Maani Hakimi
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Patel AH, Patel V, Tang Y, Shah S, Tang G, Kern MJ. Implementing a 'Lead [Apron]-Free' Cardiac Catheterization: Current Status. Curr Cardiol Rep 2024:10.1007/s11886-024-02102-w. [PMID: 39052162 DOI: 10.1007/s11886-024-02102-w] [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] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW In this review, we discuss the status of novel radiation shielding and other methods to reduce radiation exposure and its associated health risks within the CCL. RECENT FINDINGS There are many devices on the market each with its unique advantages and inherent flaws. Several are available for widespread use with promising data, while others still in development. The field of percutaneous transcatheter interventions includes complex procedures often involving significant radiation exposure. Increased radiation exposes the proceduralist and CCL staff to potential harm from both direct effects of radiation but also from the ergonomic consequences of daily use of heavy personal protective equipment. Here we discuss several innovative efforts to reduce both radiation exposure and orthopedic injury within the CCL that are available, leading to a safer daily routine in a "lead [apron]-free" environment.
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Affiliation(s)
- Akash H Patel
- Division of Cardiology, University of California, Irvine, California, USA
| | - Vishal Patel
- Division of Cardiology, University of California, Irvine, California, USA
| | - Yicheng Tang
- Division of Cardiology, University of California, Irvine, California, USA
| | - Sai Shah
- Division of Internal Medicine, University of California, Irvine, California, USA
| | - George Tang
- Division of Cardiology, University of California, Irvine, California, USA
| | - Morton J Kern
- Division of Cardiology, University of California - Irvine and VA Long Beach, Long Beach, California, USA.
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Ramos-Avasola S, Ponce L, Leon K, Cuellar-Fritis C, Querales M. Efficacy of radiation attenuating caps in reducing radiation doses received at the cerebral level in interventional physicians: a systematic review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:031001. [PMID: 38959875 DOI: 10.1088/1361-6498/ad5e8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/03/2024] [Indexed: 07/05/2024]
Abstract
Background.Anecdotal reports are appearing in the scientific literature about cases of brain tumors in interventional physicians who are exposed to ionizing radiation. In response to this alarm, several designs of leaded caps have been made commercially available. However, the results reported on their efficacy are discordant.Objective.To synthesize, by means of a systematic review of the literature, the capacity of decreasing radiation levels conferred by radiation attenuating devices (RADs) at the cerebral level of interventional physicians.Methodology.A systematic review was performed including the following databases: MEDLINE, SCOPUS, EBSCO, Science Direct, Cochrane Controlled Trials Register (CENTRAL), WOS, WHO International Clinical Trials Register, Scielo and Google Scholar, considering original studies that evaluated the efficacy of RAD in experimental or clinical contexts from January 1990 to May 2023. Data selection and extraction were performed in triplicate, with a fourth author resolving discrepancies.Results.Twenty articles were included in the review from a total of 373 studies initially selected from the databases. From these, twelve studies were performed under clinical conditions encompassing 3801 fluoroscopically guided procedures, ten studies were performed under experimental conditions with phantoms, with a total of 88 procedures, four studies were performed using numerical calculations with a total of 63 procedures. The attenuation and effectiveness of provided by the caps analyzed in the present review varying from 12.3% to 99.9%, and 4.9% to 91% respectively.Conclusion.RAD were found to potentially provide radiation protection, but a high heterogeneity in the shielding afforded was found. This indicates the need for local assessment of cap efficiency according to the practice.
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Affiliation(s)
- Sergio Ramos-Avasola
- Universidad Viña del Mar, Viña del Mar, Chile, Facultad de Ciencias de La Salud, Escuela de Tecnología Médica, Agua Santa 7055, sector Rodelillo, Viña del Mar, Chile
| | - Lusin Ponce
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina Humana, Escuela Profesional de Tecnología Médica, Lima, Peru
| | - Karla Leon
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina Humana, Escuela Profesional de Tecnología Médica, Lima, Peru
| | | | - Marvin Querales
- Facultad de Medicina, Escuela de Tecnología Médica, Universidad de Valparaíso, Chile
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Malafosse C, Massiot N, Guimo F, Ben Abdallah I, Duprey A. Impact of the Endonaut® Angio-Navigation System on Radiation Exposure in Endovascular Aortic Repair Performed with Mobile C-Arms. Ann Vasc Surg 2024; 109:143-148. [PMID: 38986839 DOI: 10.1016/j.avsg.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Fusion imaging systems have proved to reduce radiation exposure mostly in hybrid rooms but reports with mobile C-arms are few. The aim of this study was to analyze the impact of the Endonaut navigation system on radiation exposure in endovascular aneurysm repair (EVAR) performed with mobile C-arms. METHODS All patients undergoing EVAR and/or iliac branched devices implantation between January 2016 and August 2022 were included. All procedures were performed with a mobile C-arm (Siemens Avantic or GE Elite until March 2018, Siemens Cios Alpha thereafter). The Endonaut navigation system has been used since January 2021. Two groups were, therefore, compared: before (control group [CGr]) and after the use of Endonaut. Radiation data including Dose Area Product (DAP) values, Air Kerma (AK) and fluoroscopy time (FT) were collected retrospectively. RESULTS Overall, 153 patients were included: CGr, n = 121; Endonaut group (EnGr), n = 32. No significant difference was found between the 2 groups regarding demographic data. DAP values were significantly lower in the EnGr (38 Gy cm2 ± 24) vs. the CGr (76 Gy cm2 ± 51) (P < 0.05) despite a significantly higher number of complex procedures such as iliac branched devices (P < 0.05). AK values were not significantly different between the EnGr and the CGr (196 mGy ±114 vs. 209 mGy ±138) as well as FT (33 minutes ±18 vs. 33 minutes ±16). Technical success was 97% (31/32) in the EnGr vs. 96% (116/121) in the CGr (P = 0.79). The volume of contrast media was significantly lower in the EnGr (94 cc ± 41) vs. the CGr (143 cc ± 66) (P < 0.05). CONCLUSIONS In this study, the use of the Endonaut angio-navigation system when performing EVAR with mobile C-arms led to a radiation dose reduction without compromising technical success or procedural time.
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Affiliation(s)
- Clémentine Malafosse
- Department of Vascular Surgery, Regional and University Hospital of Reims, Reims, France.
| | - Nicolas Massiot
- Department of Vascular Surgery, Regional and University Hospital of Reims, Reims, France
| | - François Guimo
- Department of Vascular Surgery, Regional and University Hospital of Reims, Reims, France
| | - Iannis Ben Abdallah
- Department of Vascular and Thoracic Surgery, Bichat Claude Bernard Hospital (AP-HP), Paris, France
| | - Ambroise Duprey
- Department of Vascular Surgery, Regional and University Hospital of Reims, Reims, France
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5
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Rizik DG, Gosselin KP, Burke RF, Goldstein JA. Comprehensive radiation shield minimizes operator radiation exposure in coronary and structural heart procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:70-75. [PMID: 38538447 DOI: 10.1016/j.carrev.2024.02.015] [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: 02/05/2024] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES This study evaluated the efficacy of a novel comprehensive shield designed to minimize radiation exposure (RE) to Physicians performing coronary and structural heart procedures. BACKGROUND The Protego™ radiation shielding system (Image Diagnostics Inc., Fitchburg, Ma) is designed to provide comprehensive protection from RE and has been State certified sufficient to allow operators to perform procedures without orthopedically burdensome lead aprons. METHODS This single center two-group cohort study assessed the efficacy of this shield in a large number of cardiac procedures (coronary and structural), comparing operator RE compared to standard protection methods (personal lead apparel and "drop down" shield). RESULTS The Protego™ system reduced operator RE by 99 % compared to Standard Protection. RE was significantly lower at both "Head" level by thyroid median dose 0.0 (0.0, 0,0) vs 5.7 (2.9, 8.2) μSv (p < 0.001), as well as waist dose 0.0 (0.0, 0.0) vs 10.0 (5.0, 16.6) μSv (p < 0.001). "Zero" Total RE was documented by Raysafe™ in 64 % (n = 32) of TAVR cases and 73.2 % (n = 183) of the coronary cases utilizing Protego™. In contrast, standard protection did not achieve "Zero" exposure in a single case. These dramatic differences in RE were achieved despite higher fluoroscopy times in the Protego™ arm (11.9 ± 8.6 vs 14.3 ± 12.5 min, p = 0.015). Per case procedural exposure measured by Dose Area Product was higher in the Protego™ group compared to standard protection (115.4 ± 139.2 vs 74.9 ± 69.3, p < 0.001). CONCLUSION The Protego™ shield provides total body RE protection for operators performing both coronary and structural heart procedures. This shield allows procedural performance without the need for personal lead aprons and has potential to reduce catheterization laboratory occupational health hazards.
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Affiliation(s)
- David G Rizik
- Honor Health, Scottsdale, AZ, United States of America.
| | - Kevin P Gosselin
- University of Texas at Tyler, AriTex LLC, Tyler, TX, United States of America
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Madder RD. Editorial: Denying the perils of radiation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:76-77. [PMID: 38553279 DOI: 10.1016/j.carrev.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Corewell Health West, Grand Rapids, MI, United States of America.
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Garcia-Sayan E, Jain R, Wessly P, Mackensen GB, Johnson B, Quader N. Radiation Exposure to the Interventional Echocardiographers and Sonographers: A Call to Action. J Am Soc Echocardiogr 2024; 37:698-705. [PMID: 38490315 DOI: 10.1016/j.echo.2024.03.002] [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] [Received: 12/18/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
Interventional echocardiography is a rapidly growing field within the disciplines of cardiology and anesthesiology, with the rise of advanced transcatheter procedures making skilled imagers more important than ever. However, these procedures also involve frequent manipulation of the transesophageal echocardiography probe, which means interventional echocardiographers (IEs) are at risk of long-term occupational radiation exposure. Studies have shown that radiation exposure is linked to various health issues, including cancer, cataracts, hypertension, hyperlipidemia, endothelial dysfunction, vascular aging, and early atherosclerosis. While there is increasing awareness of the occupational radiation dose limits and the need for better shielding methods, the importance of radiation safety for the IE is still not sufficiently prioritized in most cardiac catheterization laboratories/hybrid operating rooms. This is partly due to a paucity of studies looking at long-term radiation exposure to the IE, as this field is newer than that of interventional cardiologists.
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Affiliation(s)
- Enrique Garcia-Sayan
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Renuka Jain
- Aurora Cardiovascular Services, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Priscilla Wessly
- Aurora Cardiovascular Services, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Brianna Johnson
- Aurora Cardiovascular Services, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Nishath Quader
- Division of Cardiology, Washington University School of Medicine-St. Louis, St. Louis, Missouri.
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Lopes J, Baudin C, Rousseau F, Roy H, Lestaevel P, Caër-Lorho S, Bensefa-Colas L, Leuraud K, Bernier MO. Central nervous system tumours and occupational ionising radiation exposure: a nested case-control study among the ORICAMs cohort of healthcare workers in France. BMJ Open 2024; 14:e084285. [PMID: 38904132 PMCID: PMC11191795 DOI: 10.1136/bmjopen-2024-084285] [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] [Received: 01/14/2024] [Accepted: 06/06/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE This study aimed at investigating the relationship between occupational exposure to external ionising radiation and central nervous system (CNS) tumours mortality in healthcare workers working in France. DESIGN AND SETTING The Occupational Radiation-Induced Cancer in Medical staff (ORICAMs) nested case-control study was conducted based on the dosimetric records of the national register of occupational dosimetry (Système d'information de la surveillance de l'exposition aux rayonnements ionisants). PARTICIPANTS AND METHODS 33 CNS tumour deaths occurred between 2002 and 2012 among the ORICAMs cohort composed of 164 015 healthcare workers. Each case was matched to five controls alive at the time of the corresponding case's death, based on sex, year of birth, date of enrolment in the cohort and duration of follow-up. All participants were badge monitored for external radiation exposure, expressed in Hp(10). Conditional logistic regression was used to analyse the dose-response relationship between radiation dose and CNS mortality. RESULTS Cases were exposed to a mean cumulative career radiation dose of 5.8±13.7 (max: 54.3) millisievert (mSv) compared with 4.1±15.2 (142.2) mSv for controls. No statistically significant association was found between CNS tumour mortality and cumulative whole-body career dose (OR=1.00, 95% CI 0.98 to 1.03), duration of exposure (OR=1.03; 95% CI 0.95 to 1.12) or age at first exposure (OR=0.98; 95% CI 0.91 to 1.06). CONCLUSION We found no evidence of an association between external radiation exposure and CNS tumour risk in healthcare workers. Limitations of the study include low statistical power and short duration of follow-up.
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Affiliation(s)
- Julie Lopes
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, Île-de-France, France
| | - Clémence Baudin
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, Île-de-France, France
| | - Frédéric Rousseau
- PSE-SANTE/SER/BASEP, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, Île-de-France, France
| | - Hervé Roy
- PSE-SANTE/SER/BASEP, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, Île-de-France, France
| | - Philippe Lestaevel
- PSE-SANTE/SER/BASEP, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, Île-de-France, France
| | - Sylvaine Caër-Lorho
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, Île-de-France, France
| | | | - Klervi Leuraud
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, Île-de-France, France
| | - Marie-Odile Bernier
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, Île-de-France, France
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Mansour A, Gamal NM, Tohamy A, Abdeltawab A. A multicentre survey of knowledge and implementation of radiation protection techniques in cardiac cath-lab medical personnel. Egypt Heart J 2024; 76:69. [PMID: 38829551 PMCID: PMC11147976 DOI: 10.1186/s43044-024-00492-4] [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: 12/22/2023] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Awareness of radiation hazards and methods to reduce radiation dose is a sine qua non for all staff working in the cath-lab for their own safety and their patient's safety. RESULTS There were large variations in the implementation of radiation protection techniques with overall inadequate radiation risk knowledge. Some members of the cath-lab team are at higher risk of radiation-induced side effects, including the fellows, nurses, technicians, and anaesthesiologists because they spent longer time in the cath-lab and/or their position in relation to the source of radiation. About 10% of the participants have reported different health problems potentially induced by radiation exposure. CONCLUSIONS There is lack of radiation risks knowledge with inadequate radiation protection practice among cath-lab team. Some members such as fellows, nurse, technicians, and cardiac anaesthesiologist are at higher risks. They represent the forgotten members of the Cath-Lab team.
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Affiliation(s)
- Amr Mansour
- Cardiology Department, Ain Shams University Hospital, 62 Hegaz St, Abbassia, Heliopolis, Cairo, Egypt
| | - Noha M Gamal
- Cardiology Department, Assiut University, Asyut, Egypt
| | - Ali Tohamy
- Cardiology Department, Assiut University, Asyut, Egypt
| | - Adham Abdeltawab
- Cardiology Department, Ain Shams University Hospital, 62 Hegaz St, Abbassia, Heliopolis, Cairo, Egypt.
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Veillette JB, Carrier MA, Rinfret S, Mercier J, Arsenault J, Paradis JM. Occupational Risks of Radiation Exposure to Cardiologists. Curr Cardiol Rep 2024; 26:601-622. [PMID: 38625456 DOI: 10.1007/s11886-024-02056-z] [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] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE OF REVIEW Invasive cardiologists are exposed to large amounts of ionizing radiation. This review aims to summarize the main occupational risks in a radiation-exposed cardiology practice. RECENT FINDINGS We carried out a literature review on the subject. The studies reviewed allowed us to list six main health risk categories possibly associated with radiation exposure among cardiologists: deoxyribonucleic acid (DNA) and biochemical damages; cancers; ocular manifestations; olfaction, vascular, and neuropsychological alterations; musculoskeletal problems; and reproductive risks. Our descriptive analysis demonstrates higher risks of DNA damage and lens opacities among radiation-exposed cardiology staff. Surveys and questionnaires have demonstrated a higher risk of musculoskeletal disease in exposed workers. Studies reported no difference in cancer frequency between radiation-exposed workers and controls. Changes in olfactory performance, neuropsychological aspects, and vascular changes have also been reported. Limited literature supports the security of continuing radiation-exposed work during pregnancy. Therefore, there is an urgent need to increase knowledge of the occupational risks of radiation exposure and to adopt technologies to reduce them.
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Affiliation(s)
- Jean-Benoît Veillette
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Marc-Antoine Carrier
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Stéphane Rinfret
- Department of Interventional Cardiology, Georgia Heart Institute, Gainesville, GA, USA
| | - Julien Mercier
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jean Arsenault
- Department of Engineering, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Jean-Michel Paradis
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada.
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Hulthén M, Tsapaki V, Karambatsakidou A. Estimating brain and eye lens dose for the cardiologist in interventional cardiology-are the dose levels of concern? Br J Radiol 2024; 97:1191-1201. [PMID: 38711194 DOI: 10.1093/bjr/tqae089] [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: 11/07/2023] [Revised: 02/06/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To establish conversion coefficients (CCs), between mean absorbed dose to the brain and eye lens of the cardiologist and the air kerma-area product, PKA, for a set of projections in cardiac interventional procedures. Furthermore, by taking clinical data into account, a method to estimate the doses per procedure, or annual dose, is presented. METHODS Thermoluminescence dosimeters were used together with anthropomorphic phantoms, simulating a cardiologist performing an interventional cardiac procedure, to estimate the CCs for the brain and eye lens dose for nine standard projections, and change in patient size and x-ray spectrum. Additionally, a single CC has been estimated, accounting for each projections fraction of use in the clinic and associated PKA using clinical data from the dose monitoring system in our hospital. RESULTS The maximum CCs for the eye lens and segment of the brain, is 5.47 μGy/Gycm2 (left eye lens) and 1.71 μGy/Gycm2 (left brain segment). The corresponding weighted CCs: are 3.39 μGy/Gycm2 and 0.89 μGy/Gycm2, respectively. CONCLUSIONS Conversion coefficients have been established under actual scatter conditions, showing higher doses on the left side of the operator. Using modern interventional x-ray equipment, interventional cardiac procedures will not cause high radiation dose levels to the operator when a ceiling mounted shield is used, otherwise there is a risk that the threshold dose values for cataract will be reached. ADVANCE IN KNOWLEDGE In addition to the CCs for the different projections, methods for deriving a single CC per cardiac interventional procedure and dose per year were introduced.
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Affiliation(s)
- Markus Hulthén
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Virginia Tsapaki
- Dosimetry and Medical Radiation Physics Section, Human Health Division, IAEA, Vienna, Austria
| | - Angeliki Karambatsakidou
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
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Osorio J, Miranda-Arboleda AF, Velasco A, Varley AL, Rajendra A, Morales GX, Hoyos C, Matos C, Thorne C, D'Souza B, Silverstein JR, Metzl MD, Hebsur S, Costea AI, Kang S, Sellers M, Singh D, Salam T, Nazari J, Ro AS, Mazer S, Moretta A, Oza SR, Magnano AR, Sackett M, Dukes J, Patel P, Goyal SK, Senn T, Newton D, Romero JE, Zei PC. Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry. Heart Rhythm 2024:S1547-5271(24)02524-4. [PMID: 38768839 DOI: 10.1016/j.hrthm.2024.04.090] [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: 04/11/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed. OBJECTIVE The purpose of this study was to assess the contemporary real-world practice approach and short and long-term outcomes of RF CA for PAF through a prospective multicenter registry. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months. RESULTS A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation plus ablation approaches. The complication rate was 1.9%. CONCLUSION Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes.
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Affiliation(s)
- Jose Osorio
- HCA Electrophysiology, Mercy Hospital, Miami, Florida
| | | | - Alejandro Velasco
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama
| | | | | | - Carlos Matos
- Brigham and Women`s Hospital, Boston, Massachusetts
| | | | - Benjamin D'Souza
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | - Steven Kang
- Sutter Alta Bates Summit Medical Center, Oakland, California
| | | | | | - Tariq Salam
- Pulse Heart Institute/Multicare, Tacoma, Washington
| | | | | | - Sean Mazer
- New Mexico Heart Institute, Albuquerque, New Mexico
| | | | | | | | | | | | - Parin Patel
- Ascension Medical Group, Indianapolis, Indiana
| | | | | | | | | | - Paul C Zei
- Brigham and Women`s Hospital, Boston, Massachusetts.
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Vano E, Sanchez Casanueva RM, Fernandez Soto JM, Ten Moron JI. Alerts to improve occupational protection during Interventional Radiology. More attention is needed for simple but frequent procedures. Phys Med 2024; 121:103361. [PMID: 38669812 DOI: 10.1016/j.ejmp.2024.103361] [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] [Received: 05/15/2023] [Revised: 12/05/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Occupational protection could be improved in interventional radiology. The monthly personal dosimetry cannot alert on some occupational doses with anomalous values for certain procedures. Active electronic personal dosimeters linked wireless to a dose management system (DMS), allow for the measurement of occupational doses per procedure, integrating this information with patient dose indicators and with technical and geometrical conditions of the procedures. We analysed around 3100 occupational dose values for individual procedures collected during the last two years, in an interventional radiology laboratory of a University Hospital and two groups, with patient doses higher than 100 Gy.cm2, and lower than 30 Gy.cm2. An unshielded reference dosimeter located at the C-arm registers the ambient dose equivalent (ADE) per procedure to be compared with the personal dose equivalent (PDE) over the apron. The ratio between both values PDE/ADE is a good indication of occupational protection. Alerts for occupational protection optimisation are suggested. For the full sample, 8.4 % of occupational doses measured over the protective apron of the interventionists were higher than 100 µSv and 3.8 % higher than 200 µSv per procedure. Occupational protection for complex procedures (>100 Gy.cm2) had median values of 46 µSv for PDE and 3.3 % for PDE/ADE. However, for simple procedures, (<30 Gy.cm2) the median values were 10 µSv and 28.4 %. This last percentage is 9 times higher than the value for complex procedures. This lack of protection should be corrected and the need to reduce some occupational doses reinforced in radiation protection training programmes for interventionists.
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Affiliation(s)
- Eliseo Vano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Medical Physics Service, Madrid, Spain; Department of Radiology, Medical School. Complutense University, Madrid, Spain.
| | - Roberto M Sanchez Casanueva
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Medical Physics Service, Madrid, Spain; Department of Radiology, Medical School. Complutense University, Madrid, Spain
| | - Jose M Fernandez Soto
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Medical Physics Service, Madrid, Spain; Department of Radiology, Medical School. Complutense University, Madrid, Spain
| | - Jose I Ten Moron
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Medical Physics Service, Madrid, Spain
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Baudin C, Vacquier B, Thin G, Chenene L, Guersen J, Partarrieu I, Louet M, Ducou le Pointe H, Mora S, Verdun-Esquer C, Lestavel P, Rousseau F, Roy H, Bensefa-Colas L, Boyer L, Bernier MO. Radiation protection in a cohort of healthcare workers: knowledge, attitude, practices, feelings and IR-exposure in French hospitals. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021507. [PMID: 38569480 DOI: 10.1088/1361-6498/ad39f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/03/2024] [Indexed: 04/05/2024]
Abstract
The number of healthcare workers occupationally exposed to ionizing radiation (IR) is increasing every year. As health effects from exposure to low doses IR have been reported, radiation protection (RP) in the context of occupational activities is a major concern. This study aims to assess the compliance of healthcare workers with RP policies, according to their registered cumulative dose, profession, and perception of radiation self-exposure and associated risk. Every healthcare worker from one of the participating hospitals in France with at least one dosimetric record for each year 2009, 2014, and 2019 in the SISERI registry was included and invited to complete an online questionnaire including information on the worker's occupational exposure, perception of IR-exposure risk and RP general knowledge. Hp(10) doses were provided by the SISERI system. Multivariate logistic regressions were used. Dosimeter wearing and RP practices compliance were strongly associated with 'feeling of being IR-exposed' (OR = 3.69, CI95% 2.04-6.66; OR = 4.60, CI95% 2.28-9.30, respectively). However, none of these factors was associated with RP training courses attendance. The main reason given for non-compliance is unsuitability or insufficient numbers of RP devices. This study provided useful information for RP policies. Making exposed workers aware of their own IR-exposure seems to be a key element to address in RP training courses. This type of questionnaire should be introduced into larger epidemiological studies. Dosimeter wearing and RP practices compliance are associated to feeling being IR-exposed. RP training courses should reinforce workers' awareness of their exposure to IR.
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Affiliation(s)
- Clémence Baudin
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SESANE/LEPID, BP 17, F-92260 Fontenay-aux-Roses, France
| | | | - Guillemette Thin
- Service de médecine du travail, Hôpital Cochin, AP-HP, Paris, France
| | - Lamine Chenene
- Service central de santé au travail, AP-HP, Paris, France
| | - Joël Guersen
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Martine Louet
- Service de médecine du travail, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | | | - Stéphanie Mora
- Service de médecine du travail, CHU de Bordeaux, Bordeaux, France
| | | | - Philippe Lestavel
- Bureau d'Analyse et de Suivi des Expositions Professionnelles, Institut de radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Frédéric Rousseau
- Bureau d'Analyse et de Suivi des Expositions Professionnelles, Institut de radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Hervé Roy
- Bureau d'Analyse et de Suivi des Expositions Professionnelles, Institut de radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | | | - Louis Boyer
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Odile Bernier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SESANE/LEPID, BP 17, F-92260 Fontenay-aux-Roses, France
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15
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Elbahi A, Thomas O, Dungey M, Randall C, Menon DK. Factors associated with increased radiation exposure in the fixation of proximal femoral fractures. Ann R Coll Surg Engl 2024. [PMID: 38563063 DOI: 10.1308/rcsann.2023.0092] [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: 04/04/2024] Open
Abstract
INTRODUCTION When using radiation intraoperatively, a surgeon should aim to keep the radiation dose as low as is reasonably achievable to obtain the therapeutic goal. We aimed to investigate factors associated with increased radiation exposure in fixation of proximal femur fractures. METHODS We assessed 369 neck of femur fractures over a 1-year period in a district general hospital. All hip fracture subtypes that had undergone surgical fixation were included. We assessed the relationship between type of fracture, implants used and surgeon level of experience with the dose-area product (DAP; cGy/cm2) and screening time (dS). We also looked at the quality of reduction and fixation and its effect on the radiation exposure. RESULTS A total of 184 patients were included in our analysis; 185 patients who were treated with hip arthroplasty were excluded. There was a significant association between higher DAP and fracture subtype (p = 0.001), fracture complexity (p < 0.001), if an additional implant was used (p = 0.001), if fixation was satisfactory (p = 0.002) and operative time (p < 0.001). DAP was higher with a proximal femoral nail than with a dynamic hip screw, especially when a long nail was used. There was some evidence of an association between the surgeon's level of experience and DAP exposure, although this was not statistically significant (p = 0.069). CONCLUSIONS Increased radiation in proximal femur fractures is seen in the fixation of complex fractures, some subtypes, with certain types of implants used and if an additional implant was required. Surgeon seniority did not result in less radiation exposure, which is in contrast to other published studies.
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Affiliation(s)
- A Elbahi
- Dartford and Gravesham NHS Trust, UK
| | - O Thomas
- Kettering General Hospital NHS Foundation Trust, UK
| | - M Dungey
- Kettering General Hospital NHS Foundation Trust, UK
| | - C Randall
- University Hospitals of Leicester NHS Trust, UK
| | - D K Menon
- Kettering General Hospital NHS Foundation Trust, UK
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16
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Tamirisa KP, Alasnag M, Calvert P, Islam S, Bhardwaj A, Pakanati K, Zieroth S, Razminia M, Dalal AS, Mamas M, Russo AM, Kort S. Radiation Exposure, Training, and Safety in Cardiology. JACC. ADVANCES 2024; 3:100863. [PMID: 38939686 PMCID: PMC11198606 DOI: 10.1016/j.jacadv.2024.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 06/29/2024]
Abstract
Exposure to ionizing radiation is an inherent occupational health hazard in clinical cardiology. Health risks have been reported previously, including predilection to cancer. In addition, orthopedic injury due to prolonged wearing of heavy protective lead aprons, which are mandatory to reduce radiation risk, have been extensively documented. Cardiology as a specialty has grown with rising volumes of increasingly complex procedures. This includes electrophysiological, coronary, and structural intervention, advanced heart failure/transplant management, and diagnostic imaging. Both the operator as well imaging specialists are exposed to radiation, particularly in structural interventions where interventional cardiologists and structural imagers work closely. Increasingly, women interested in cardiology may deselect the field due to radiation concerns. This expert document highlights the risks of radiation exposure in cardiology, including practical tips within various subspecialty fields such as interventional/structural cardiology, electrophysiology, imaging, advanced heart failure, and pediatric cardiology.
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Affiliation(s)
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Sabrina Islam
- Section of Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Anju Bhardwaj
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas/McGovern Medical School, Texas Medical Center, Houston, Texas, USA
| | - Keerthana Pakanati
- Center for Cardiovascular Health, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Shelley Zieroth
- Department of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | | | - Aarti S. Dalal
- Division of Cardiology, Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
| | - Andrea M. Russo
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
| | - Smadar Kort
- Department of Cardiology, Stony Brook Heart Institute, Stony Brook, New York, USA
| | - ACC Women in Cardiology Advocacy Work Group
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Section of Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas/McGovern Medical School, Texas Medical Center, Houston, Texas, USA
- Center for Cardiovascular Health, Virginia Mason Franciscan Health, Seattle, Washington, USA
- Department of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
- Amita St. Joseph Hospital, Elgin, Illinois, USA
- Division of Cardiology, Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
- Department of Cardiology, Stony Brook Heart Institute, Stony Brook, New York, USA
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17
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Sadri S, Loeb GJ, Grinshpoon A, Elvezio C, Sun SH, Ng VG, Khalique O, Moses JW, Einstein AJ, Patel AJ, George I, Hahn RT, Nazif TM, Leon MB, Kirtane AJ, Kodali SK, Feiner SK, Vahl TP. First Experience With Augmented Reality Guidance for Cerebral Embolic Protection During TAVR. JACC. ADVANCES 2024; 3:100839. [PMID: 38938839 PMCID: PMC11198681 DOI: 10.1016/j.jacadv.2024.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/18/2023] [Accepted: 10/23/2023] [Indexed: 06/29/2024]
Abstract
Background Augmented reality (AR) guidance holds potential to improve transcatheter interventions by enabling visualization of and interaction with patient-specific 3-dimensional virtual content. Positioning of cerebral embolic protection devices (CEP) during transcatheter aortic valve replacement (TAVR) increases patient exposure to radiation and iodinated contrast, and increases procedure time. AR may enhance procedural guidance and facilitate a safer intervention. Objectives The purpose of this study was to develop and test a novel AR guidance system with a custom user interface that displays virtual, patient-specific 3-dimensional anatomic models, and assess its intraprocedural impact during CEP placement in TAVR. Methods Patients undergoing CEP during TAVR were prospectively enrolled and assigned to either AR guidance or control groups. Primary endpoints were contrast volume used prior to filter placement, times to filter placement, and fluoroscopy time. Postprocedure questionnaires were administered to assess intraprocedural physician experience with AR guidance. Results A total of 24 patients presenting for TAVR were enrolled in the study (12 with AR guidance and 12 controls). AR guidance eliminated the need for aortic arch angiograms prior to device placement thus reducing contrast volume (0 mL vs 15 mL, P < 0.0001). There was no significant difference in the time required for filter placement or fluoroscopy time. Postprocedure questionnaires indicated that AR guidance increased confidence in wiring of the aortic arch and facilitated easier device placement. Conclusions We developed a novel AR guidance system that eliminated the need for additional intraprocedural angiograms prior to device placement without any significant difference in time to intervention and offered a subjective improvement in performance of the intervention.
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Affiliation(s)
- Shirin Sadri
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Gabrielle J. Loeb
- Department of Radiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Alon Grinshpoon
- Department of Computer Science, Columbia University, New York, New York, USA
| | - Carmine Elvezio
- Department of Computer Science, Columbia University, New York, New York, USA
| | - Shawn H. Sun
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Vivian G. Ng
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Omar Khalique
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey W. Moses
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew J. Einstein
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Amisha J. Patel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Isaac George
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T. Hahn
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Tamim M. Nazif
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B. Leon
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Susheel K. Kodali
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Steven K. Feiner
- Department of Computer Science, Columbia University, New York, New York, USA
| | - Torsten P. Vahl
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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18
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Gentry V, Farkouh A, Chen N, Amasyali AS, Lee J, Srikureja N, Keheila M, Okhunov Z, Baldwin DD. Do Flat Panel Detector C-Arms Decrease Radiation Exposure Compared to Conventional Image Intensifiers? Urology 2024; 185:150-156. [PMID: 38350550 DOI: 10.1016/j.urology.2024.01.015] [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: 12/04/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To compare the radiation dose and image quality between flat panel detector (FPD) and traditional image intensifier (II) C-arms at their lowest radiation settings. METHODS In a ureteroscopy simulation using a cadaver model, the radiation exposure was compared between FPD and II at 4 pulses-per-second (pps) using both low dose and automatic exposure control (AEC) settings. Additionally, the lowest dose settings for each machine were compared (4 pps with low dose in the FPD and 1 pps with low dose in the II). Five trials of 5 minutes were conducted for each setting. Four new optically stimulated luminescent dosimeters were used in each trial to record radiation exposure. Ten blinded urologists completed a survey rating image quality for each setting. RESULTS When comparing the FPD and II at their lowest possible settings, the FPD produced significantly more radiation (P <.05). Using both machines at 4 pps in low dose mode resulted in no significant difference between C-arms (P >.05). Conversely, operating the C-arms at 4 pps and AEC resulted in significantly higher radiation exposure from the FPD compared to the II (P <.05). There was no significant difference in image quality at each setting. CONCLUSION FPDs produce significantly more radiation at the lowest settings compared to IIs. Surgeons should employ IIs when reducing radiation exposure as low as possible is imperative, such as when operating on pediatric and pregnant patients.
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Affiliation(s)
- Vance Gentry
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Ala'a Farkouh
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Natalie Chen
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Jenna Lee
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | | | - Mohamed Keheila
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Zhamshid Okhunov
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, CA.
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Larsson MEV, Jonasson PI, Apell PS, Kearney PP, Lundh CJ. Evaluation of novel radiation protection devices during radiologically guided interventions. CVIR Endovasc 2024; 7:18. [PMID: 38353904 PMCID: PMC10866844 DOI: 10.1186/s42155-024-00430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND In radiologically guided interventions, medical practitioners are subjected to radiation exposure, which may lead to radiation-induced diseases. In this study, novel radiation shields for the head and neck were evaluated for their potential to reduce radiation exposure. METHOD An anthropomorphic phantom was exposed on its left side to scattered radiation from beneath to simulate the exposure of an operator in a x-ray operating room. Thermoluminescent dosimeters (TLDs) were positioned at different depths in five slices in the phantom, measuring personal dose equivalent. Two different set up situations were evaluated: a head protector designed to reduce radiation in the upper section of the head; and a novel thyroid protector prototype extended in the front and on both sides, designed to reduce radiation in the lower and middle sections of the head. A standard thyroid collar prototype and a ceiling mounted lead glass shield were used as comparisons. Furthermore, the head protector was evaluated in a clinical study in which TLDs were positioned to measure scattered radiation exposure to the heads of operators during endovascular interventions. RESULTS The extended thyroid protector reduced the scattered radiation in the throat, chin, and ear slices. Some shielding effect was seen in the brain and skull slices. The head protector showed a shielding effect in the skull slice up to two cm depth where it covered the phantom head. As expected, the ceiling mounted lead glass shield reduced the scattered radiation in all measuring points. CONCLUSIONS A ceiling mounted lead glass shield is an effective radiation protection for the head, but in clinical practice, optimal positioning of a ceiling mounted lead shield may not always be possible, particularly during complex cases when radiation protection may be most relevant. Added protection using these novel guards may compliment the shielding effect of the ceiling mounted lead shield. The head protector stand-alone did not provide sufficient protection of the head. The extended thyroid protector stand-alone provided sufficient protection in the lower and middle sections of the head and neck.
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Affiliation(s)
- Maria E V Larsson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Pernilla I Jonasson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Petra S Apell
- Texray AB, Gothenburg, Sweden
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Peter P Kearney
- Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Charlotta J Lundh
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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20
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Maeda T, Hayashi H, Ando M, Kobayashi D, Nishigami R, Asahara T, Goto S, Lee C, Yamashita K, Higashino K, Konishi T, Murakami S, Maki M. Performance of elastic x-ray shield made by embedding Bi 2 O 3 particles in porous polyurethane. Med Phys 2024; 51:1061-1073. [PMID: 38103261 DOI: 10.1002/mp.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Many healthcare institutions have guidelines concerning the usage of protective procedures, and various x-ray shields have been used to reduce unwanted radiation exposure to medical staff and patients when using x-rays. Most x-ray shields are in the form of sheets and lack elasticity, which limits their effectiveness in shielding areas with movement, such as the thyroid. To overcome this limitation, we have developed an innovative elastic x-ray shield. PURPOSE The purpose of this study is to explain the methodology for developing and evaluating a novel elastic x-ray shield with sufficient x-ray shielding ability. Furthermore, valuable knowledge and evaluation indices are derived to assess our shield's performance. METHODS Our x-ray shield was developed through a process of embedding Bi2 O3 particles into porous polyurethane. Porous polyurethane with a thickness of 10 mm was dipped into a solution of water, metal particles, and chemical agents. Then, it was air-dried to fix the metal particles in the porous polyurethane. Thirteen investigational x-ray shields were fabricated, in which Bi2 O3 particles at various mass thicknesses (ranging from 585 to 2493 g/m2 ) were embedded. To determine the performance of the shielding material, three criteria were evaluated: (1) Dose Reduction Factor (D R F $DRF$ ), measured using inverse broad beam geometry; (2) uniformity, evaluated from the standard deviation (S D $SD$ ) of the x-ray image obtained using a clinical x-ray imaging detector; and (3) elasticity, evaluated by a compression test. RESULTS The elastic shield with small pores, containing 1200 g/m2 of the metal element (Bi), exhibited a well-balanced performance. TheD R F $DRF$ was approximately 80% for 70 kV diagnostic x-rays. This shield's elasticity was -0.62 N/mm, a loss of only 30% when compared to porous polyurethane without metal. Although the non-uniformity of the x-ray shield leads to poor shielding ability, it was found that the decrease in the shielding ability can be limited to a maximum of 6% when the shield is manufactured so that theS D $SD$ of the x-ray image of the shield is less than 10%. CONCLUSIONS It was verified that an elastic x-ray shield that offers an appropriate reduction in radiation exposure can be produced by embedding Bi2 O3 particles into porous polyurethane. Our findings can lead to the development of novel x-ray shielding products that can reduce the physical and mental stress on users.
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Affiliation(s)
- Tatsuya Maeda
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroaki Hayashi
- College of Medical, Pharmaceutical and Health Sciences, Kanazawa, Ishikawa, Japan
| | - Miku Ando
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daiki Kobayashi
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Rina Nishigami
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takashi Asahara
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Okayama University Hospital, Kitaku, Okayama, Japan
| | - Sota Goto
- Faculty of Health Sciences, Kobe Tokiwa University, Kobe, Hyogo, Japan
| | - Cheonghae Lee
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, School of Medicine, Tokushima University, Tokushima, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopedics and Rehabilitation, Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
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21
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Moschovaki-Zeiger O, Arkoudis NA, Spiliopoulos S. Safety and feasibility study of a novel robotic system in an in vivo porcine vascular model. CVIR Endovasc 2024; 7:14. [PMID: 38279977 PMCID: PMC10821852 DOI: 10.1186/s42155-024-00425-x] [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: 10/18/2023] [Accepted: 12/31/2023] [Indexed: 01/29/2024] Open
Abstract
PURPOSE The goal of this preclinical study is to assess the functionality, technical feasibility, and safety of a new vascular robotic LIBERTYR 3 System, in the microcatheterization of vascular targets using a range of guidewires and microcatheters. MATERIAL AND METHODS An anesthetized pig served as an arterial model for the robotic device (LIBERTYR3; Microbot Medical Ltd, Yoqneam, IL). The primary efficacy endpoint was the evaluation of its capability to selectively catheterize predetermined distal arterial branches in the liver, kidneys, and mesenteric arteries (technical success), under fluoroscopy guidance. The primary safety endpoint was the occurrence of angiographic acute catheterization-related complications (dissection, thrombosis, embolism, perforation). The catheterizations were conducted by two interventional radiologists that present different work experience in endovascular procedures (18 and 2 years respectively), using a variety of microcatheters and wires. Various procedural parameters such as functionality, practicality, ease of use, and time required for selective catheterization, were evaluated, and recorded. RESULTS All pre-determined arteries were successfully selectively catheterized (100% technical success), by both operators. No angiographic acute complications occurred. The microcatheters and wires were manipulated using the remote portable console in an effortless manner that maintained a high level of accuracy. Mean time for selective catheterization was 131 ± 82 s. The robot's conversion function to manual operation was successfully demonstrated. CONCLUSION Robotic navigation and catheterization of selected target arteries were accomplished without observable vascular damage, suggesting that the LIBERTYR 3 robotic system is a reliable and safe tool for robotic-assisted endovascular navigation. Further experimental studies are required to evaluate safety and efficacy prior to introduction into clinical practice.
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Affiliation(s)
- Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, Attikon" University General Hospital, 1st Rimini St, Chaidari, 12461, Athens, GR, Greece
| | - Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, Attikon" University General Hospital, 1st Rimini St, Chaidari, 12461, Athens, GR, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, Attikon" University General Hospital, 1st Rimini St, Chaidari, 12461, Athens, GR, Greece.
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22
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Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, Paolucci M, Mazzone P, Guarracini F. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics (Basel) 2024; 14:182. [PMID: 38248058 PMCID: PMC10814721 DOI: 10.3390/diagnostics14020182] [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: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Eleonora Bonvicini
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Elena Coradello
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Carbonaro
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Giulia Colombo
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Paolucci
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
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23
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Parikh MJ, Refahiyat L, Joseph TA, McNamara D, Madder RD. Radiation Doses to the Entire Catheterization Laboratory Team With a Novel Radiation Protection Device. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101109. [PMID: 39131980 PMCID: PMC11307758 DOI: 10.1016/j.jscai.2023.101109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 08/13/2024]
Abstract
Background A novel radiation protection system has recently been shown to shield the primary operator from scatter radiation, but whether it shields other members of the catheterization laboratory team remains unknown. Methods Radiation exposure data were collected prospectively in 50 coronary angiography cases, in which 25 were completed using standard radiation protection and 25 with a novel system consisting of a series of rigid shields and flexible radiation-resistant drapes. Radiation doses, measured with real-time dosimeters, were compared between the 2 groups. Results There were no significant differences between groups with respect to patient or procedural characteristics, including air kerma (P = .97) and dose area product (P = .17). The primary operator received a median head-level radiation dose of 0.0 [0.0, 0.0] μSv with the novel radiation protection system and 2.1 [0.7, 3.3] μSv with standard radiation protection (P < .001). Scrub technologists had a median head-level radiation dose of 0.0 [0.0, 0.0] μSv with the novel radiation protection system and 0.3 [0.1, 0.4] μSv with standard radiation protection (P < .001). The median head-level radiation dose among circulating nurses was 0.0 [0.0, 0.0] μSv with the novel radiation protection system and was 0.1 [0.0, 0.2] μSv with standard radiation protection (P < .001). Conclusions Compared to standard radiation protection with lead aprons, use of a novel radiation protection system during coronary angiography was associated with significantly lower head-level radiation doses among all members of the catheterization laboratory team.
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Affiliation(s)
- Malav J. Parikh
- Frederik Meijer Heart & Vascular Institute, Corewell Health, Grand Rapids, Michigan
| | - Lahdan Refahiyat
- Frederik Meijer Heart & Vascular Institute, Corewell Health, Grand Rapids, Michigan
| | - Timothy A. Joseph
- Frederik Meijer Heart & Vascular Institute, Corewell Health, Grand Rapids, Michigan
| | - David McNamara
- Frederik Meijer Heart & Vascular Institute, Corewell Health, Grand Rapids, Michigan
| | - Ryan D. Madder
- Frederik Meijer Heart & Vascular Institute, Corewell Health, Grand Rapids, Michigan
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24
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Lisko JC, Shekiladze N, Chamoun J, Sheikh N, Rainer K, Wei J, Binongo J, Raj L, Byku I, Rinfret S, Devireddy C, Jaber WA, Greenbaum AB, Babaliaros V, Steuterman S, Sandesara P, Nicholson WJ. Radiation Exposure Using Rampart vs Standard Lead Aprons and Shields During Invasive Cardiovascular Procedures. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101184. [PMID: 39131978 PMCID: PMC11308832 DOI: 10.1016/j.jscai.2023.101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 08/13/2024]
Abstract
Background Radiation exposure during invasive cardiovascular procedures remains an important health care issue. Lead aprons and shields (LAS) are used to decrease radiation exposure but leave large portions of the body unshielded. The Rampart IC M1128 is a portable radiation shielding system that may significantly attenuate radiation exposure. Methods Catheterization laboratory teams were randomized in a 1:1 fashion to perform elective invasive cardiovascular procedures utilizing either traditional LAS or the Rampart IC M1128. Radiation exposure was measured using real-time dosimetry monitoring in prespecified anatomic locations on 3 operators (position 1: first operator/fellow; position 2: second operator/attending; and position 3: catheterization laboratory nurse/technologist). Radiation exposure was measured on a per-case basis. Results In total, 100 consecutive cases were randomized in this study (47 Rampart; 53 LAS). There was no difference in fluoroscopy time (12.3 minutes for Rampart vs 15.4 minutes for LAS; P = .52), dose area product (288 Gy⋅cm2 for Rampart vs 376.5 Gy⋅cm2 for LAS; P = .52), or scatter radiation (38.8 mRem for Rampart vs 46.8 mRem for LAS; P = .61) between the groups. There was significantly lower total body radiation (in milliroentgen equivalent man) exposure using the Rampart than that using LAS for each team member: position 1-0.1 mRem for Rampart vs 2.2 mRem for LAS; P < .001; position 2-0.1 mRem Rampart vs 3.2 mRem LAS; P < .001; and position 3-0.0 mRem for Rampart vs 0.8 mRem for LAS; P < .001. Conclusions During routine clinical procedures, the Rampart system significantly decreases total body radiation exposure compared with traditional LAS.
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Affiliation(s)
- John C. Lisko
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Nikoloz Shekiladze
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Joseph Chamoun
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Noah Sheikh
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Katharine Rainer
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jane Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Leah Raj
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Isida Byku
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Stephane Rinfret
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Chandan Devireddy
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Wissam A. Jaber
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Adam B. Greenbaum
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis Babaliaros
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | | | - Pratik Sandesara
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - William J. Nicholson
- Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia
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25
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Yalin K, Soysal AU, Aksu T, Onder SE, Ozturk S, Yalman H, Mutlu D, Ercan OT, Ikitimur B, Cimci M, Durmaz E, Karadag B, Bilge AK, Huang H, Karpuz H. Safety and efficacy of coronary angiographic image integration tool-guided ablation of left sided outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2024; 67:31-34. [PMID: 37578671 DOI: 10.1007/s10840-023-01619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Kivanc Yalin
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ali Ugur Soysal
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, 34100, Turkey.
| | | | - Sila Ozturk
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hakan Yalman
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Mutlu
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Talha Ercan
- Johnson and Johnson, Biosense Webster-Turkey Office, Istanbul, Turkey
| | - Baris Ikitimur
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Cimci
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eser Durmaz
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bilgehan Karadag
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Istanbul Faculty of Medicine, Department of Cardiology, Istanbul University, Istanbul, Turkey
| | - Henry Huang
- Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL, 60612, USA
| | - Hakan Karpuz
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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26
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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.
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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
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27
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Rizik DG, Rizik MB. Zero Radiation in the Cardiac Catheterization Laboratory: An Aspirational Goal or Moral Imperative? JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101131. [PMID: 39131981 PMCID: PMC11307473 DOI: 10.1016/j.jscai.2023.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2024]
Affiliation(s)
- David G. Rizik
- Department of Cardiovascular Medicine, HonorHealth, Scottsdale, Arizona
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Alvandi M, Javid RN, Shaghaghi Z, Farzipour S, Nosrati S. An In-depth Analysis of the Adverse Effects of Ionizing Radiation Exposure on Cardiac Catheterization Staffs. Curr Radiopharm 2024; 17:219-228. [PMID: 38314600 DOI: 10.2174/0118744710283181231229112417] [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: 09/19/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
Diagnostic and interventional angiograms are instrumental in the multidisciplinary approach to CAD management, enabling accurate diagnosis and effective targeted treatments that significantly enhance patient care and cardiovascular outcomes. However, cath lab staff, including interventional cardiologists, is consistently exposed to ionizing radiation, which poses inherent health risks. Radiation exposure in the cath lab primarily results from the use of fluoroscopy and cineangiography during diagnostic and interventional procedures. Understanding these risks and implementing effective radiation protection measurements are imperative to ensure the well-being of healthcare professionals while delivering high-quality cardiac care. Prolonged and repeated exposure can lead to both deterministic and stochastic effects. Deterministic effects, such as skin erythema and tissue damage, are more likely to occur at high radiation doses. Interventional cardiologists and staff may experience these effects when safety measures are not rigorously followed. In fact, while ionizing radiation is essential in the practice of radiation cardiology ward, cath lab staff faces inherent risks from radiation exposure. Stochastic effects, on the other hand, are characterized by a probabilistic relationship between radiation exposure and the likelihood of harm. These effects include the increased risk of cancer, particularly for those with long-term exposure. Interventional cardiologists, due to their frequent presence in the cath lab, face a higher lifetime cumulative radiation dose, potentially elevating their cancer risk. Protective measures, including the use of lead aprons, thyroid shields, and radiation monitoring devices, play a crucial role in reducing radiation exposure for cath lab personnel. Adherence to strict dose optimization protocols, such as minimizing fluoroscopy time and maximizing distance from the radiation source, is also essential in mitigating these risks. Ongoing research and advancements in radiation safety technology are essential in further for minimizing the adverse effects of ionizing radiation in the cath lab.
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Affiliation(s)
- Maryam Alvandi
- Cardiovascular Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Zahra Shaghaghi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Soghra Farzipour
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Sahar Nosrati
- Institute of Nuclear Chemistry and Technology, Dorodna 16 Str, 03-195, Warsaw, Poland
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29
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Soether C, Boehmer AA, Dobre BC, Kaess BM, Ehrlich JR. Zero-fluoro atrioventricular-nodal reentrant tachycardia ablation. Herzschrittmacherther Elektrophysiol 2023; 34:305-310. [PMID: 37950109 DOI: 10.1007/s00399-023-00977-w] [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: 07/27/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Atrioventricular-nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia, particularly in younger patients. The treatment of choice is radiofrequency catheter ablation (RFCA), traditionally necessitating ionizing radiation for catheter guidance. OBJECTIVE The authors aimed to demonstrate the feasibility and safety of zero-fluoroscopy RFCA of AVNRT using EnSite™ NavX™ as a three-dimensional (3D) electroanatomical mapping system (EAM). METHODS The authors retrospectively analyzed 68 patients that underwent AVNRT-RFCA. One group was a priori allocated to conventional fluoroscopy mapping (convFluoro, n = 30). In 38 cases, the electrophysiologist chose to use 3D-EAM for ablation. Of these patients, 20 could be ablated without fluoroscopy use (zeroFluoro). In 18 cases that were initially intended as 3D-EAM, additional fluoroscopy use was necessary due to difficult anatomic conditions (convertedFluoro). Procedure duration, fluoroscopy duration and dose, as well as complications were analyzed. RESULTS Procedure duration was similar for the convFluoro and zeroFluoro groups (74 ± 24 min vs. 80 ± 26 min, p = ns). The convertedFluoro group showed longer procedure duration compared to the convFluoro group (94 ± 30 min vs. 74 ± 24 min, p < 0.05). The use of 3D-EAM significantly reduced fluoroscopy duration comparing the convFluoro with the convertedFluoro group (12 ± 9 min vs. 7 ± 6 min, p < 0.05). The difference in fluoroscopy dose between convFluoro and convertedFluoro did not reach significance (169 ± 166 cGycm2 vs. 134 ± 137 cGycm2, p = ns). In zeroFluoro cases, no radiation was used at all. 3D-EAM-guided RFCA was primarily successful in all patients. Overall, there were only few minor complications in the different groups. No major complications occurred. CONCLUSION Zero-fluoro RFCA in patients with AVNRT is feasible and safe. 3D-EAM can reduce radiation exposure in the majority of patients without prolonging procedure duration or increasing complications.
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Affiliation(s)
- Christina Soether
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Andreas A Boehmer
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Bianca C Dobre
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Bernhard M Kaess
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany.
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30
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Sulieman A, Mahgoub O, Salah H, Tamam N, Taha A, Dawood S, Bradley DA. Assessment of patient and occupational exposure and radiation risk from cath-lab procedure. Appl Radiat Isot 2023; 202:111071. [PMID: 37871398 DOI: 10.1016/j.apradiso.2023.111071] [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: 02/28/2023] [Revised: 09/22/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
Due to the extended localized fluoroscopy, many radiographic exposures, and multiple procedures that might result in tissue reaction, patients and personnel received a significant radiation dose during interventional cardiology (IR) procedures. This study aims to calculate the radiation risk and assess patient and staff effective doses during IC procedures. Thirty-two patients underwent a Cath lab treatment in total. Ten Cath lab personnel, including six nurses, two cardiologists, and two X-ray technologists. Optical stimulating-luminescent dosimeters (OSL) (Al2O3:C) calibrated for this purpose were used to monitor both occupational and ambient doses. Using an automated OSL reader, these badges were scanned. The Air Kerma (mGy) and Kerma Area Products (KAP, mGy.cm2) have a mean and standard deviation (SD) of 371 ± 132 and 26052, respectively. The average personal dose equivalent (mSv) and its range for cardiologists, nurses and X ray technologists were 1.11 ± 0.21 (0.96-1.26), 0.84 ± 0.11 (0.68-1.16), and 0.68 ± 0.014 (0.12-0.13), respectively. The current study findings showed that the annual effective dose for cardiologists, nurses, and X-ray technologists was lesser than the yearly occupational dose limit of 20 mSv recommended by national and international guidelines. The patients' doses are comparable with some previously published studies and below the tissue reaction limits.
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Affiliation(s)
- Abdelmoneim Sulieman
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Alkharj, Saudi Arabia.
| | - Omer Mahgoub
- College of Medical Radiologic Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - H Salah
- College of Medical Radiologic Science, Sudan University of Science and Technology, Khartoum, Sudan; INAYA Medical Collage, Nuclear Medicine Department, Riyadh, Saudi Arabia
| | - Nissren Tamam
- Department of Physics, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428 Riyadh 1167, Saudi Arabia
| | - Afaf Taha
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Alkharj, Saudi Arabia
| | - Sali Dawood
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Alkharj, Saudi Arabia
| | - D A Bradley
- Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, Bandar Sunway, 47500, Selangor, Malaysia; Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, UK
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31
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Batnyam U, Zei PC, Romero JE, Kapur S, Steiger N, Tadros T, Sharma E, Tedrow U, Koplan BA, Sauer WH. Reduction and elimination of operator exposure to radiation during endocardial ventricular arrhythmia ablation procedures over time. Heart Rhythm O2 2023; 4:733-737. [PMID: 38034893 PMCID: PMC10685160 DOI: 10.1016/j.hroo.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
- Uyanga Batnyam
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C. Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge E. Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas Tadros
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Esseim Sharma
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bruce A. Koplan
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William H. Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Jiang Y, Luo F, Bu H. Percutaneous closure of simple congenital heart diseases under echocardiographic guidance. Eur J Med Res 2023; 28:408. [PMID: 37805534 PMCID: PMC10559656 DOI: 10.1186/s40001-023-01398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
Congenital heart disease (CHD), birth defect with the highest incidence rates worldwide, and is mainly characterized by the abnormal internal structure of the heart or/and the anatomical structure of great vessels. In the past few decades, CHD repair surgery through standard median sternotomy incision combined with cardiopulmonary bypass (CPB) technology has been considered the gold standard for surgical correction of heart and great vessels. With the promotion and clinical application of interventional catheterization technology, transcatheter closure of CHD under radioactive radiation has gradually been recognized and applied. However, its radiation exposure and potential complications related to arteriovenous vessels still face challenges. In recent years, an increasing number of surgeons have explored new surgical procedures, for the safe and effective treatment of CHD, as far as possible to reduce surgical trauma, avoid radiation exposure, and improve the cosmetic effect. Therefore, on the premise of satisfactory exposure or guidance, how to integrate ultrasound and percutaneous interventional technology remained the focus of the exploration. This mini-review highlights and summarizes the signs of progress of ultrasound intervention in the last decade that have proven the effectiveness and operability of a well-established procedure for percutaneous closure of congenital heart diseases under echocardiographic guidance only. We discuss potential diseases that will benefit from this emerging procedure based on this progress. Owing to the crucial advantages played by this strategy in the treatment of CHD, better understanding and promotion of this less exploited field may contribute to the development of therapeutics targeting CHD, improve medical utilization rate, promote the optimization of medical resources, and ultimately achieve precise and efficient medical treatment.
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Affiliation(s)
- Ying Jiang
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Fanyan Luo
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Haisong Bu
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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Hu X, Zhang Y, Li Y. Trans-jugular transcutaneous closure of atrial septal defects with an adjustable curved sheath under echocardiography guidance. Echocardiography 2023; 40:1088-1093. [PMID: 37641803 DOI: 10.1111/echo.15682] [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: 05/16/2023] [Revised: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Traditional transcatheter closure of atrial septal defect (ASD) via the femoral vein carries risk of radiation damage. Transcutaneous closure of ASD under echocardiography guidance avoids radiation exposure and can be gradually applied. An alternative is to transcutaneous closure of ASD trans-jugular with an adjustable curved sheath under echocardiography guidance. METHODS We retrospectively studied all cases of trans-jugular transcutaneous closure of ASD with an adjustable curved sheath under echocardiography guidance in the Heart Center of Henan Province People's Hospital between 2016 and December 2022. RESULTS A total of 156 patients were included, 74 males and 82 females. Mean age was 6.9 ± 7.4 years and weight 23.7 ± 14.6 kg. Mean sizes of the ASD and occluder were (9.7 ± 4.7) mm and (14.1 ± 5.7) mm. The mean operation time was (49.6 ± 29.2) min. No complications such as atrioventricular block, reoperation, or pericardial effusion occurred. There are 3 patients had a residual shunt. All patients were followed-up for (38.7 ± 11.0) months. The three patients with residual shunt had self-closed at the 3-6-12 months follow-up. There was no complication at follow-up. CONCLUSION Trans-jugular transcutaneous closure of ASD with adjustable curved sheath under echocardiography guidance is safe, effective and minimally invasive.
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Affiliation(s)
- Xiaosong Hu
- Department of Structural Heart Disease, Fuwai Central China Cardiovascular Hospital, Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Yanwei Zhang
- Department of Structural Heart Disease, Fuwai Central China Cardiovascular Hospital, Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Yanan Li
- Department of Cardiovascular Ultrasound, Fuwai Central China Cardiovascular Hospital, Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
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Koulaouzidis G, Charisopoulou D, Bomba P, Stachura J, Gasior P, Harpula J, Zarifis J, Marlicz W, Hudziak D, Jadczyk T. Robotic-Assisted Solutions for Invasive Cardiology, Cardiac Surgery and Routine On-Ward Tasks: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:399. [PMID: 37754828 PMCID: PMC10532157 DOI: 10.3390/jcdd10090399] [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: 06/28/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive cardiac electrophysiology procedures as well as surgical operations including minimally invasive aortic and mitral valve repair, coronary artery bypass procedures, and structural heart diseases. Furthermore, machines are used as staff-assisting tools to support nurses with repetitive clinical duties i.e., food delivery. High precision and resolution allow for excellent maneuverability, enabling the performance of medical procedures in challenging anatomies that are difficult or impossible using conventional approaches. Moreover, robot-assisted techniques protect operators from occupational hazards, reducing exposure to ionizing radiation, and limiting risk of orthopedic injuries. Novel automatic systems provide advantages for patients, ensuring device stability with optimized utilization of fluoroscopy. The acceptance of robotic technology among healthcare providers as well as patients paves the way for widespread clinical application in the field of cardiovascular medicine. However, incorporation of robotic systems is associated with some disadvantages including high costs of installation and expensive disposable instrumentations, the need for large operating room space, and the necessity of dedicated training for operators due to the challenging learning curve of robotic-assisted interventional systems.
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Affiliation(s)
- George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Dafni Charisopoulou
- Pediatric Cardiology Department, Great Ormond Street Hospital, London WC1N 3JH, UK;
| | | | | | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - Jan Harpula
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - John Zarifis
- Cardiology Department, George Papanikolaou General Hospital, 570 10 Thessaloniki, Greece;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 71-455 Szczecin, Poland;
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland;
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, 602 00 Brno, Czech Republic
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Crowhurst JA, Tse J, Mirjalili N, Savage ML, Raffel OC, Gaikwad N, Walters DL, Dautov R. Trial of a Novel Radiation Shielding Device to Protect Staff in the Cardiac Catheter Laboratory. Am J Cardiol 2023; 203:429-435. [PMID: 37536045 DOI: 10.1016/j.amjcard.2023.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/18/2023] [Accepted: 07/08/2023] [Indexed: 08/05/2023]
Abstract
Continuous exposure to low-level scattered radiation to staff performing cardiac angiography and intervention is of concern. A novel shielding solution (NSS) (Rampart IC M1128) has the potential to provide greater shielding for staff present at the table-side. This study aimed to investigate the effectiveness of the NSS compared with a traditional shielding solution (TSS) in a randomized controlled trial that enrolled 100 patients who underwent cardiac angiography and/or intervention which were randomized to the NSS or TSS. Baseline patient characteristics and radiation dose data were collected. Staff who were scrubbed at the table-side wore 5 real-time dosimeters on the head, collar, waist, ankle, and under the apron. The median primary operator radiation dose was significantly lower (p <0.001) for all dosimeter locations with the NSS when compared with the TSS, being reduced by 86%, 80.0%, 100%, and 50.0% for the head, collar, waist, and leg respectively. Median under-apron dose was 0.0 µSv for both NSS and TSS. Median second operator dose was reduced by 100%, 100%, and 100% for the head, collar, and waist respectively (p <0.001). Median NSS and TSS dose at the ankle and under apron was 0.0 µSv. Median scrub nurse dose was reduced by 50% and 100% for the head and collar respectively (p <0.001). Median NSS and TSS dose at the waist, ankle, and under apron was 0.0 µSv. In conclusion, the NSS tested in this study demonstrates a significant decrease in radiation dose to operators and scrub nurses when compared with traditional radiation protection measures.
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Affiliation(s)
- James A Crowhurst
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Jason Tse
- Biomedical Technical Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Negar Mirjalili
- Biomedical Technical Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Michael L Savage
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Owen C Raffel
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Niranjan Gaikwad
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Darren L Walters
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Rustem Dautov
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia
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Patel S, Jenkins P, Zhong J, Liu W, Harborne K, Modi S, Joy C, Williams R, Haslam P. Better safe than so ray: national survey of radiation protection amongst interventional radiology trainees in the United Kingdom. Br J Radiol 2023; 96:20230071. [PMID: 37493155 PMCID: PMC10461283 DOI: 10.1259/bjr.20230071] [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: 01/12/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To establish the provision and use of radiation personal protective equipment (PPE) and dosimetry amongst UK interventional radiology (IR) trainees and highlight areas of improvement in order to enhance the radiation safety. METHODS A survey questionnaire was designed by members of the British Society of Interventional Radiology (BSIR) trainee committee via survey monkey and distributed to UK IR trainees via the BSIR membership mailing list, local representatives and Twitter. The survey was open from 04/01/2021 to 20/02/2021. Only IR trainees in years ST4 and above were included. RESULTS Of the 73 respondents, 62 qualified for analysis. Respondents (81% male) spent a median of 5.5 sessions (half day list) per week in the angiography suite and 58% (n=36) had difficulty finding appropriately sized lead aprons at least once a week. Overall 53% (n=33) had concerns about their radiation PPE. Furthermore 56% of trainees (n=35) experienced back pain among other symptoms attributed to wearing the lead aprons available to them. 77% (n=48) regularly wore lead glasses. For trainees requiring prescription glasses (n=22) overfit goggles were provided however 17 (77%) of these trainees felt the goggles compromised their ability to perform the procedure. Eye and finger dosimeters were used by 50% and 52% of respondents respectively. Compliance with body dosimetry was 99%. CONCLUSION Provision of radiation PPE and dose monitoring for IR trainees is suboptimal, particularly access to adequate eye protection or suitably fitting leads. Based on the findings of this survey, recommendations have been made to promote the safety and radiation awareness of IR trainees. ADVANCES IN KNOWLEDGE Radiation protection practices for IR trainees nationally are poor. Provision of suitable eye protection and well fitting lead body protection is low.
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Affiliation(s)
| | | | | | - W Liu
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - K Harborne
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - C Joy
- University Hospital Southampton, Southampton, United Kingdom
| | - R Williams
- Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation, London, United Kingdom
| | - P Haslam
- Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation, London, United Kingdom
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Ha BJ, Lee JM, Yoon SJ, Kim BK, Lee J, Lee S, Ryu S, Cha Y, Hwang S, Woo D, Lee CK, Shin DA, Ha Y, Kuh SU, Kim KN, Son D, Yi S. Three-Dimensional Quantitative Assessment of Pedicle Screw Accuracy in Clinical Utilization of a New Robotic System in Spine Surgery: A Multicenter Study. Neurospine 2023; 20:1028-1039. [PMID: 37798995 PMCID: PMC10562248 DOI: 10.14245/ns.2346552.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/22/2023] [Accepted: 07/09/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the accuracy of pedicle screw placement in patients undergoing percutaneous pedicle screw fixation with robotic guidance, using a newly developed 3-dimensional quantitative measurement system. The study also aimed to assess the clinical feasibility of the robotic system in the field of spinal surgery. METHODS A total of 113 patients underwent pedicle screw insertion using the CUVIS-spine pedicle screw guide system (CUREXO Inc.). Intraoperative O-arm images were obtained, and screw insertion pathways were planned accordingly. Image registration was performed using paired-point registration and iterative closest point methods. The accuracy of the robotic-guided pedicle screw insertion was assessed using 3-dimensional offset calculation and the Gertzbein-Robbins system (GRS). RESULTS A total of 448 screws were inserted in the 113 patients. The image registration success rate was 95.16%. The average error of entry offset was 2.86 mm, target offset was 2.48 mm, depth offset was 1.99 mm, and angular offset was 3.07°. According to the GRS grading system, 88.39% of the screws were classified as grade A, 9.60% as grade B, 1.56% as grade C, 0.22% as grade D, and 0.22% as grade E. Clinically acceptable screws (GRS grade A or B) accounted for 97.54% of the total, with no reported neurologic complications. CONCLUSION Our study demonstrated that pedicle screw insertion using the novel robot-assisted navigation method is both accurate and safe. Further prospective studies are necessary to explore the potential benefits of this robot-assisted technique in comparison to conventional approaches.
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Affiliation(s)
- Byeong-Jin Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jong-Min Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- Saeroun Hospital, Seoul, Korea
| | - Seon-Jin Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Kwan Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- Daejeon Woori Hospital, Daejeon, Korea
| | - Junseok Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Suhun Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | | | | | | | | | - Chang Kyu Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dongwuk Son
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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Bocz B, Debreceni D, Janosi KF, Turcsan M, Simor T, Kupo P. Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial. J Clin Med 2023; 12:5577. [PMID: 37685645 PMCID: PMC10488800 DOI: 10.3390/jcm12175577] [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: 06/18/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective study, we aimed to compare the effectiveness of an electroanatomical mapping system (EAMS)-guided approach with an ICE-guided approach for SP ablation. Eighty patients undergoing SP ablation for AVNRT were randomly assigned to either the ICE-guided or EAMS-guided group. If the procedural endpoint was not achieved after 8 RF applications; patients were allowed to crossover to the ICE-guided group. The ICE-guided approach reduced the total procedure time (61.0 (56.0; 66.8) min vs. 71.5 (61.0; 80.8) min, p < 0.01). However, the total fluoroscopy time was shorter (0 (0-0) s vs. 83.5 (58.5-133.25) s, p < 0.001) and the radiation dose was lower (0 (0-0) mGy vs. 3.3 (2.0-4.7) mGy, p < 0.001) with EAMS-guidance. The ICE-guided group had a lower number of RF applications (4 (3-5) vs. 5 (3.0-7.8), p = 0.03) and total ablation time (98.5 (66.8-186) s vs. 136.5 (100.5-215.8) s, p = 0.02). Nine out of 40 patients (22.5%) in the EAMS-guided group crossed over to the ICE-guided group, and they were successfully treated with similar RF applications in terms of number, time, and energy compared to the ICE-guided group. There were no recurrences during the follow-up period. In conclusion, the utilization of ICE guidance during SP ablation has demonstrated notable reductions in procedural time and RF delivery when compared to procedures guided by EAMS. In challenging cases, an early switch to ICE-guided ablation may be the optimal choice for achieving successful treatment.
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Affiliation(s)
| | | | | | | | | | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Ifjusag Utja 13, H-7624 Pécs, Hungary; (B.B.); (D.D.); (K.-F.J.); (M.T.); (T.S.)
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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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Ternacle J, Salaun E, Ruf T, Lafitte S, von Bardeleben RS, Modine T, Leroux L, Rodes-Cabau J, Kodali S, Leon M, Pibarot P, Hahn RT. Radioprotection for the imaging specialist during structural heart interventions: Not an option! Arch Cardiovasc Dis 2023; 116:352-356. [PMID: 37391341 DOI: 10.1016/j.acvd.2023.03.004] [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] [Received: 02/27/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 07/02/2023]
Abstract
Structural heart interventions are steadily increasing, and the majority requires echocardiographic guidance. As a result, imaging specialists are exposed to the harmful effects of scattered ionizing radiation. This X-ray exposure must be quantified, its potential consequences should be monitored by occupational medicine and the "as low as reasonably achievable" principles of radioprotection should be optimized (including increasing the distance, decreasing the duration, using shielding radiation and providing safety training for the imaging specialist). The spatial organization of and shielding provision in the procedural rooms should be designed to optimize radioprotection for all team members.
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Affiliation(s)
- Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec Heart and Lung Institute, Laval University, Québec, QC G1V 4G5, Canada; Haut-Leveque Cardiology Hospital, Bordeaux University, 33600 Pessac, France.
| | - Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec Heart and Lung Institute, Laval University, Québec, QC G1V 4G5, Canada
| | - Tobias Ruf
- Structural Heart Disease Interventions and the Heart Valve Centre, 55131 Mainz, Germany
| | - Stéphane Lafitte
- Haut-Leveque Cardiology Hospital, Bordeaux University, 33600 Pessac, France
| | | | - Thomas Modine
- Haut-Leveque Cardiology Hospital, Bordeaux University, 33600 Pessac, France
| | - Lionel Leroux
- Haut-Leveque Cardiology Hospital, Bordeaux University, 33600 Pessac, France
| | - Josep Rodes-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec Heart and Lung Institute, Laval University, Québec, QC G1V 4G5, Canada
| | - Susheel Kodali
- Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY 10032, USA
| | - Martin Leon
- Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY 10032, USA; Cardiovascular Research Foundation, New York, NY 10019, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec Heart and Lung Institute, Laval University, Québec, QC G1V 4G5, Canada
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY 10032, USA; Cardiovascular Research Foundation, New York, NY 10019, USA
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Cui L, Tian Q, Feng Z, Ma Y. What happened when medical staff in Beijing, China wore over-apron dosemeters? RADIATION PROTECTION DOSIMETRY 2023:7185476. [PMID: 37247844 DOI: 10.1093/rpd/ncad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
The wearing method of personal dosemeters for medical staff changed from under to outside the operator's protective apron in April 2020. We measured the radiation dose Hp(10) for medical staff in Beijing from September 2020 to October 2021. The study population consisted of 3291 medical staff. All participants were divided into three groups. After excluding unusually low doses, the collected data higher than the detection limit involved 811 (7.8%) of 10 395 readings from 479 (14.6%) of 3291 staff. The mean equivalent dose was 1.4 mSv/3 months, with an SD of 2.3 mSv. The calculated average annual effective doses of radiation workers in the three groups after the interventional procedures from September 2020 to October 2021 ranged from 0.47 to 0.63 mSv/year, with median values of 0.32, 0.23 and 0.26 mSv/year, respectively.
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Affiliation(s)
- Limeng Cui
- Department of Radiation Protection, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Qingxiang Tian
- Department of Radiation Protection, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Zechen Feng
- Department of Radiation Protection, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yongzhong Ma
- Department of Radiation Protection, Beijing Center for Disease Prevention and Control, Beijing, China
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Sattar Y, Sengodan PM, Cheema MS, Javed N, Ashraf S, Fakhra S, Alharbi A, Syed M, Alam M, Elgendy IY, Haleem A, Kawsara A, Alraies MC, Daggubati R. Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory? Interv Cardiol 2023; 18:e18. [PMID: 37435603 PMCID: PMC10331561 DOI: 10.15420/icr.2023.10] [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: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 07/13/2023] Open
Abstract
Background: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health consequences. Personal protective equipment, including lead jackets and glasses, is common, but the use of radiation protective lead caps is inconsistent. Methods: A systematic review qualitative assessment of five observational studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines protocol was performed. Results: It was concluded that lead caps significantly reduce radiation exposure to the head, even when a ceiling-mounted lead shield was present. Conclusion: Although newer protective systems are being studied and introduced, tools, such as lead caps, need to be strongly considered and employed in the catheterisation laboratory as mainstay personal protective equipment.
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Affiliation(s)
- Yasar Sattar
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | | | - Mustafa Sajjad Cheema
- Department of Medicine, CMH Lahore Medical College and Institute of DentistryLahore, Punjab, Pakistan
| | - Nismat Javed
- Department of Internal Medicine, BronxCare Health SystemNew York, NY, US
| | - Shoaib Ashraf
- Department of Cardiology, Hackensack University Medical CentreNJ, US
| | - Sadaf Fakhra
- Department of Internal Medicine, University of Nevada, Kirk Kerkorian School of MedicineLas Vegas, NV, US
| | - Anas Alharbi
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - Moinuddin Syed
- Department of Cardiology, Boston UniversityBoston, MA, US
| | - Mahboob Alam
- Department of Cardiology, Baylor College of MedicineHouston, TX, US
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of KentuckyLexington, KT, US
| | - Affan Haleem
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - Akram Kawsara
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - M Chadi Alraies
- Detroit Medical Centre, Wayne State UniversityDetroit, MI, US
| | - Ramesh Daggubati
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
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Rainford L, Tcacenco A, Potocnik J, Brophy C, Lunney A, Kearney D, O'Connor M. Student perceptions of the use of three-dimensional (3-D) virtual reality (VR) simulation in the delivery of radiation protection training for radiography and medical students. Radiography (Lond) 2023; 29:777-785. [PMID: 37244141 DOI: 10.1016/j.radi.2023.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND VR simulation-based learning is increasingly used in healthcare education to prepare students for clinical practice. This study investigates healthcare students' experience of learning radiation safety in a simulated interventional radiology (IR) suite. METHOD Radiography students (n = 35) and medical students (n = 100) were introduced to 3D VR radiation dosimetry software designed to improve the learners' understanding of radiation safety in IR. Radiography students underwent formal VR training and assessment, which was complemented with clinical placement. Medical students practiced similar 3D VR activities informally without assessment. An online questionnaire containing Likert questions and open-ended questions was used to gather student feedback on the perceived value of VR-based radiation safety education. Descriptive statistics and Mann-Whitney U tests were used to analyse Likert-questions. Open-ended question responses were thematically analysed. RESULTS A survey response rate of 49% (n = 49) and 77% (n = 27) was obtained from radiography and medical students respectively. Most respondents (80%) enjoyed their 3D VR learning experience, favouring the in-person VR experience to online VR. 73% felt that VR learning enhanced their confidence across all relevant learning outcomes. Whilst confidence was enhanced across both cohorts, VR learning had a greater impact on confidence levels amongst medical students with respect to their understanding of radiation safety matters (U = 375.5, p < 0.01). 3D VR was deemed a valuable assessment tool. CONCLUSION Radiation dosimetry simulation-based learning in the 3D VR IR suite is perceived to be a valuable pedagogical tool by radiography and medical students and enhances curricula content.
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Affiliation(s)
- L Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - A Tcacenco
- School of Medicine, University College Dublin, Ireland.
| | - J Potocnik
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - C Brophy
- Radiology Department, Blackrock Clinic, Dublin, Ireland.
| | - A Lunney
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - D Kearney
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - M O'Connor
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland. michelle.o'
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Weyland CS, Jesser J, Bourgart I, Hilgenfeld T, Breckwoldt MO, Vollherbst D, Schmitt N, Seker F, Bendszus M, Möhlenbruch MA. Occupational radiation exposure of neurointerventionalists during endovascular stroke treatment. Eur J Radiol 2023; 164:110882. [PMID: 37201247 DOI: 10.1016/j.ejrad.2023.110882] [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: 02/13/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Radiological neuro-interventions, especially endovascular stroke treatment (EST), are increasing in case numbers worldwide with increasing occupational radiation exposure. Aim of this study was to define the radiation exposure of neurointerventionalists (NI) during EST and to compare the accumulated dose reaching the left arm with the left temple. METHODS This is a prospective observational study in a tertiary stroke center conducted between 11/2021 and 07/2022. Radiation exposure was measured using real time dosimetry with dosimeters being carried by the NI during EST simultaneously at the left temple and left arm. The effective dose [µSV] per dose area product (DAP) and potential influencing factors were compared in univariate analysis between the two dosimeter positions. RESULTS In total, 82 ESTs were analyzed with a median DAP of 6179 µGy*m2 (IQR 3271 µGy*m2-11720 µGy*m2). The accumulated dose at the left arm and left temple correlated with the DAP and fluoroscopy time of the EST (DAP and arm: p = 0.01, DAP and temple: p = 0.006). The radiation exposure (RE) showed a wide range and did not differ between the two dosimeter positions (median, IQR arm 7 µSV, IQR 3.1-16.9 µSV, min. 0.3 µSV max. 64.5 µSV) vs. head 7 µSv, IQR 3.2-17.4 µSV, min. 0.38 µSV, max. 48.6 µSV, p = 0.94). Occupational RE depends on the number of thrombectomy attempts, but not the target vessel occlusion location or the NI's body height. CONCLUSION Neurointerventionalists experience a generally low but very variable radiation exposure during EST, which depends on the intervention's fluoroscopy time and dose area product as well as thrombectomy attempts but does not differ between left temple and left arm.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Neuroradiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52076 Aachen, Germany.
| | - Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Isabella Bourgart
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Michael O Breckwoldt
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Dominik Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Niclas Schmitt
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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45
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Fiorilli PN, Goldsweig AM. Occupationally Exposed: It Is Time to Protect Ourselves! JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100610. [PMID: 39130721 PMCID: PMC11307579 DOI: 10.1016/j.jscai.2023.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 08/13/2024]
Affiliation(s)
- Paul N. Fiorilli
- Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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46
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Rizik DG, Riley RD, Burke RF, Klassen SR, Nigoghosian AM, Gosselin KP, Goldstein JA. Comprehensive Radiation Shield Minimizes Operator Radiation Exposure and Obviates Need for Lead Aprons. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100603. [PMID: 39130703 PMCID: PMC11307751 DOI: 10.1016/j.jscai.2023.100603] [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: 10/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 08/13/2024]
Abstract
Background The catheterization laboratory predisposes to occupational health hazards. Chronic radiation exposure (RE) direct injuries include a predilection to cataracts and concerns for cancers. Indirectly adverse effects underly the prevalence of orthopedic maladies in interventionists, linked to the burden of mandatory protective lead aprons. A novel comprehensive shielding system (Protego, Image Diagnostics Inc) has been validated in early studies to provide excellent radiation protection. The system is designed to reduce operator RE sufficient to eliminate the need for personal lead aprons. Recent system refinements offer potentially even greater degrees of protection. This clinical study evaluated the efficacy of this system. Methods This single-center 2-group cohort study compared physician operator RE utilizing the latest iteration of the Protego shield (n = 25 cases) or standard protection (personal leaded apparel and drop-down shield, n = 25 cases) during routine cardiac catheterization procedures. RE at both thyroid and waist levels were measured with a real-time dosimetry system (Raysafe) and calculated on a mean per case basis at both thyroid and waist levels. Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index. Between-group comparisons were conducted to evaluate RE by group and measurement sites. Results Protection with Protego was superior to standard methods. Protego showed markedly lower RE at both the thyroid level (0.36 ± 0.86 vs 58.5 ± 50.2 μSv; P < .001) and the waist level (0.84 ± 2.99 vs 121.4 ± 171.2 μSv; P < .001. "Zero" total RE was documented in 68% (n = 17) of Protego cases; in contrast, standard protection did not achieve "zero" exposure in a single case. Conclusions The Protego shield system provides excellent RE protection to the physician operator, achieving "zero" RE in two-thirds of cases. RE was superior to standard protection methods. The magnitude of protection achieves state regulatory standards sufficient to allow operators to perform procedures without orthopedically burdensome lead aprons. This shield system has the potential to reduce occupational health hazards.
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Affiliation(s)
- David G. Rizik
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Robert D. Riley
- 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
| | | | - Kevin P. Gosselin
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
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Sótonyi P, Berczeli M, Gyánó M, Legeza P, Mihály Z, Csobay-Novák C, Pataki Á, Juhász V, Góg I, Szigeti K, Osváth S, Kiss JP, Nemes B. Radiation Exposure Reduction by Digital Variance Angiography in Lower Limb Angiography: A Randomized Controlled Trial. J Cardiovasc Dev Dis 2023; 10:jcdd10050198. [PMID: 37233165 DOI: 10.3390/jcdd10050198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND digital variance angiography (DVA) provides higher image quality than digital subtraction angiography (DSA). This study investigates whether the quality reserve of DVA allows for radiation dose reduction during lower limb angiography (LLA), and compares the performance of two DVA algorithms. METHODS this prospective block-randomized controlled study enrolled 114 peripheral arterial disease patients undergoing LLA into normal dose (ND, 1.2 µGy/frame, n = 57) or low-dose (LD, 0.36 µGy/frame, n = 57) groups. DSA images were generated in both groups, DVA1 and DVA2 images were generated in the LD group. Total and DSA-related radiation dose area product (DAP) were analyzed. Image quality was assessed on a 5-grade Likert scale by six readers. RESULTS the total and DSA-related DAP were reduced by 38% and 61% in the LD group. The overall visual evaluation scores (median (IQR)) of LD-DSA (3.50 (1.17)) were significantly lower than the ND-DSA scores (3.83 (1.00), p < 0.001). There was no difference between ND-DSA and LD-DVA1 (3.83 (1.17)), but the LD-DVA2 scores were significantly higher (4.00 (0.83), p < 0.01). The difference between LD-DVA2 and LD-DVA1 was also significant (p < 0.001). CONCLUSIONS DVA significantly reduced the total and DSA-related radiation dose in LLA, without affecting the image quality. LD-DVA2 images outperformed LD-DVA1, therefore DVA2 might be especially beneficial in lower limb interventions.
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Affiliation(s)
- Péter Sótonyi
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - Márton Berczeli
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
| | - Marcell Gyánó
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - Péter Legeza
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
| | - Csaba Csobay-Novák
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - Ákos Pataki
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - Viktória Juhász
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - István Góg
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Vascular Surgery, Hungarian Defence Forces Medical Centre, Róbert Károly körút 44, 1134 Budapest, Hungary
| | - Krisztián Szigeti
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Tűzoltó u. 37-47, 1094 Budapest, Hungary
| | - Szabolcs Osváth
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Tűzoltó u. 37-47, 1094 Budapest, Hungary
| | - János P Kiss
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Tűzoltó u. 37-47, 1094 Budapest, Hungary
| | - Balázs Nemes
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
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Foroughi P, Demir A, Hossbach M, Rajan P, Yarmolenko P, Vellody R, Cleary K, Sharma K. In situ guidance for MRI interventions using projected feedback. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02897-z. [PMID: 37072658 DOI: 10.1007/s11548-023-02897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To develop and evaluate an augmented reality instrument guidance system for MRI-guided needle placement procedures such as musculoskeletal biopsy and arthrography. Our system guides the physician to insert a needle toward a target while looking at the insertion site without requiring special headgear. METHODS The system is comprised of a pair of stereo cameras, a projector, and a computational unit with a touch screen. All components are designed to be used within the MRI suite (Zone 4). Multi-modality fiducial markers called VisiMARKERs, detectable in both MRI and camera images, facilitate automatic registration after the initial scan. The navigation feedback is projected directly onto the intervention site allowing the interventionalist to keep their focus on the insertion site instead of a secondary monitor which is often not in front of them. RESULTS We evaluated the feasibility and accuracy of this system on custom-built shoulder phantoms. Two radiologists used the system to select targets and entry points on initial MRIs of these phantoms over three sessions. They performed 80 needle insertions following the projected guidance. The system targeting error was 1.09 mm, and the overall error was 2.29 mm. CONCLUSION We demonstrated both feasibility and accuracy of this MRI navigation system. The system operated without any problems inside the MRI suite close to the MRI bore. The two radiologists were able to easily follow the guidance and place the needle close to the target without any intermediate imaging.
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Affiliation(s)
| | - Alican Demir
- Clear Guide Medical Inc., Baltimore, MD, 21211, USA
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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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50
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Costa M, Tataryn Z, Alobaid A, Pierre C, Basamh M, Somji M, Loh Y, Patel A, Monteith S. Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature. Interv Neuroradiol 2023; 29:201-210. [PMID: 35296166 PMCID: PMC10152820 DOI: 10.1177/15910199221082475] [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: 11/23/2021] [Revised: 01/21/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Robotics could expand treatment of rapidly progressive pathologies such as acute ischemic stroke, with the potential to provide populations in need prompt access to neuro-endovascular procedures. METHODS Robotically-assisted (RA) neuro-endovascular procedures (RANPs) performed at our institution were retrospectively examined (RA-group, RG). A control group of manual neuro-endovascular procedures was selected (manual group, MG). Total operating room (OR) time, procedural time, contrast media use, fluoroscopy time, conversion from RA to manual control, procedural success, and complication rates were compared. A learning curve was identified. RESULTS Forty-one (41) RANPs were analyzed. Ages ranged from 20-82 y.o. Indications included diagnostic cerebral angiography (37), extracranial carotid artery stenting (3), and transverse sinus stent (1). Total OR time was longer in RG (median 86 vs. 71 min, p < 0.01). Procedural time (median 56 vs. 45 min, p = 0.12), fluoroscopy time (median 12 vs. 12 min, p = 0.69) and contrast media usage (82 vs. 92 ml, p = 0.54) were not significantly different. Patient radiation exposure was similar, considering similar fluoroscopy times. Radiation exposure and lead apron use were virtually absent for the main surgeon in RG. Procedural success was 83% and conversion from RA to manual control was 17% in RG. No treatment-related complications occurred. A learning curve showed that, after the fifth procedure, procedural times reduced and stabilized. CONCLUSIONS This series may contribute to further demonstrating the safety and feasibility of RANPs. RANPs can potentially reduce radiation exposure and physical burden for health personnel, expand acute cerebrovascular treatment to underserved areas, and enhance telementoring. Prospective studies are necessary for results to be generalized.
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Affiliation(s)
- Matias Costa
- Swedish Neuroscience
Institute, Seattle, WA, USA
| | | | - Abdullah Alobaid
- National Neurosciences Institute, King
Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | | | - Yince Loh
- Swedish Neuroscience
Institute, Seattle, WA, USA
| | - Akshal Patel
- Swedish Neuroscience
Institute, Seattle, WA, USA
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