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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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2
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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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3
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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 2024:10.1007/s11886-024-02056-z. [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] [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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Bernelli C, Di Fusco SA, Matteucci A, Zilio F, Nesti M, Barbero U, Maccagni D, Di Pasquale G, Oliva F, Colivicchi F, Maggioni AP. Working in interventional cardiology laboratories: The perceived impact of radiation exposure as a health and gender hazard. A NEXT generation ANMCO initiative. Int J Cardiol 2024; 401:131682. [PMID: 38176657 DOI: 10.1016/j.ijcard.2023.131682] [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: 11/09/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Gender-related discrepancies in personal and professional life have been reported among radio-exposed workers. We assessed this topic among cardiac catheterization workers in Italy, with a focus on gender and working position. METHODS Radio-exposed workers affiliated with the Italian Association of Hospital Cardiologists were invited to answer an online survey, which included 41 questions formatted as multiple choice. RESULTS Overall, 237 workers responded. The proportion of males was significantly higher than that of females in the population aged >50 years. A greater portion of females than males perceived female-gender discrimination regarding career advancement (77.2% vs 30.9%, p < 0.001) and work compensation (49.1% vs. 17.1%, p < 0.001). There was no difference in perceived gender- discrimination in terms of career advancement opportunities between physician and non-physicians. A larger portion of females than males experienced workplace discrimination (51.8% of females vs. 8.1% of males, p < 0.0001). Non-physician responders made up 38.8% of all respondents and reported a lower yearly radiation exposure than physicians. Non-physicians were more aware of the laws regulating lab access during pregnancy than physicians (93.5% vs. 48.3%, p < 0.0001). A greater percentage of female nurses than physicians communicate without hesitation the pregnancy status to their employers (45.6% vs 20%, p < 0.001). CONCLUSIONS Gender-based career disparities were perceived among physicians and non-physician staff of cardiology interventional laboratories. Strategies should be implemented to ensure gender equality in career opportunities and to increase knowledge of radioprotection and the laws regulating access to laboratories during pregnancy.
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Affiliation(s)
- Chiara Bernelli
- Cardiology Unit, Santa Corona Hospital, ASL2 Liguria, Pietra Ligure (SV), Italy.
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Andrea Matteucci
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy; Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Filippo Zilio
- Cardiology Unit, Santa Chiara Hospital, APSS, Trento, Italy
| | - Martina Nesti
- Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Davide Maccagni
- Interventional Cardiology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Di Pasquale
- ASL2 Liguria Cardiology Department, Ospedale Santa Corona, Via XXV Aprile 38 Pietra Ligure (SV), 17027, Italy
| | - Fabrizio Oliva
- Cardiology Unit, ASST Ca Grande, Niguarda Hospital, Milan, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Aldo Pietro Maggioni
- Centro Studi ANMCO - Fondazione "per il Tuo cuore" HCF ONLUS, Centro Studi ANMCO Via La Marmora, 34, 50121 Firenze, Italy
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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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Waksman R, Pahuja M, van Diepen S, Proudfoot AG, Morrow D, Spitzer E, Nichol G, Weisfeldt ML, Moscucci M, Lawler PR, Mebazaa A, Fan E, Dickert NW, Samsky M, Kormos R, Piña IL, Zuckerman B, Farb A, Sapirstein JS, Simonton C, West NEJ, Damluji AA, Gilchrist IC, Zeymer U, Thiele H, Cutlip DE, Krucoff M, Abraham WT. Standardized Definitions for Cardiogenic Shock Research and Mechanical Circulatory Support Devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC). Circulation 2023; 148:1113-1126. [PMID: 37782695 PMCID: PMC11025346 DOI: 10.1161/circulationaha.123.064527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023]
Abstract
The Shock Academic Research Consortium is a multi-stakeholder group, including representatives from the US Food and Drug Administration and other government agencies, industry, and payers, convened to develop pragmatic consensus definitions useful for the evaluation of clinical trials enrolling patients with cardiogenic shock, including trials evaluating mechanical circulatory support devices. Several in-person and virtual meetings were convened between 2020 and 2022 to discuss the need for developing the standardized definitions required for evaluation of mechanical circulatory support devices in clinical trials for cardiogenic shock patients. The expert panel identified key concepts and topics by performing literature reviews, including previous clinical trials, while recognizing current challenges and the need to advance evidence-based practice and statistical analysis to support future clinical trials. For each category, a lead (primary) author was assigned to perform a literature search and draft a proposed definition, which was presented to the subgroup. These definitions were further modified after feedback from the expert panel meetings until a consensus was reached. This manuscript summarizes the expert panel recommendations focused on outcome definitions, including efficacy and safety.
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Affiliation(s)
- Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC (R.W.)
| | - Mohit Pahuja
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City (M.P.)
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (S.v.D.)
| | - Alastair G Proudfoot
- Department of Perioperative Medicine, Barts Heart Centre, London, UK (A.G.P.)
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany (A.G.P.)
| | - David Morrow
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.M.)
| | - Ernest Spitzer
- Cardialysis, Rotterdam, The Netherlands (E.S.)
- Cardiology Department, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands (E.S.)
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington Harborview Center, Seattle (G.N.)
| | - Myron L Weisfeldt
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.L.W.)
| | - Mauro Moscucci
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, Canada (P.R.L.)
- McGill University Health Centre, Montreal, Canada (P.R.L.)
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (P.R.L.)
| | - Alexandre Mebazaa
- Université Paris Cité, Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisière, France (A.M.)
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (E.F.)
| | - Neal W Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.W.D.)
| | - Marc Samsky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (M.S.)
| | - Robert Kormos
- Global Medical Affairs Heart Failure, Abbott Laboratories, Austin, TX (R.K.)
| | - Ileana L Piña
- Division of Cardiology, Thomas Jefferson University, Philadelphia, PA (I.L.P.)
| | - Bram Zuckerman
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - Andrew Farb
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - John S Sapirstein
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | | | | | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D.)
| | - Ian C Gilchrist
- Department of Interventional Cardiology/Heart and Vascular Institute, Penn State Health/Hershey Medical Center (I.C.G.)
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Germany (H.T.)
- Leipzig Heart Science, Germany (H.T.)
| | - Donald E Cutlip
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA (D.E.C.)
| | - Mitchell Krucoff
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.K.)
| | - William T Abraham
- Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University College of Medicine/Ohio State University Wexner Medical Center, Columbus (W.T.A.)
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7
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Engström A, Isaksson M, Larsson PA, Lundh C, Båth M. Lead aprons and thyroid collars: to be, or not to be? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:031516. [PMID: 37678246 DOI: 10.1088/1361-6498/acf76f] [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: 05/25/2023] [Accepted: 09/07/2023] [Indexed: 09/09/2023]
Abstract
Wearing lead aprons and thyroid collars for long periods of time has a subjective component: to balance the effective dose reduction with the effort of carrying a heavy load. Occupational radiation exposure has decreased dramatically in the last century within the health care system. During the same period the use of lead aprons and thyroid collars has also gone up. Therefore, a question that may be raised is: how safe is safe enough? In order to promote stakeholder involvement, the aim of the present study was to investigate staff's experience of discomforts associated with wearing lead aprons and thyroid collars for long periods of time, and also to investigate staff's willingness to tolerate personal dose equivalent (expressed as radiation dose) and the corresponding increase in future cancer risk to avoid wearing these protective tools. A questionnaire was developed and given to staff working in operating or angiography rooms at Skaraborg Hospital in Sweden. The results from the 245 respondents showed that 51% experienced bothersome warmth, 36% experienced fatigue and 26% experienced ache or pain that they believed was associated with wearing lead aprons. One third of the respondents would tolerate a personal dose equivalent of 1 mSv per year to avoid wearing lead aprons, but only a fifth would tolerate the corresponding increase in future cancer risk (from 43% to 43.2%). In conclusion, discomforts associated with wearing lead aprons and thyroid collars for long periods of time are common for the staff using them. At the same time, only a minority of the staff would tolerate a small increase in future cancer risk to avoid wearing them. The present study gives an example of stakeholder involvement and points at the difficulties in making reasonable decisions about the use of these protective tools.
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Affiliation(s)
- Andreas Engström
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Radiology, Skaraborg Hospital, Region Västra Götaland, Skövde, SE-541 85, Sweden
| | - Mats Isaksson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
| | - Per-Anders Larsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Surgery, Skaraborg Hospital, Region Västra Götaland, Skövde, SE-541 85, Sweden
- Department of Research and Development, Skaraborg Hospital, Region Västra Götaland, SE-541 85 Skövde, Sweden
| | - Charlotta Lundh
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, SE-413 45, Sweden
| | - Magnus Båth
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, SE-413 45, Sweden
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8
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Jiang C, Ma C, Chen S, Chen S, Jiang C, Jiang R, Ju W, Long D, Li D, Li J, Liu Q, Ma W, Pu X, Wang R, Wang Y, Yi F, Zou C, Zhang J, Zhang X, Zhao Y, Zei PC, Biase LD, Chang D, Cai H, Chen L, Chen M, Fu G, Fu H, Fan J, Gui C, Jiang T, Liu S, Li X, Li Y, Shu M, Wang Y, Xu J, Xie R, Xia Y, Xue Y, Yang P, Yuan Y, Zhong J, Zhu W. Chinese expert consensus on the construction of the fluoroless cardiac electrophysiology laboratory and related techniques. Pacing Clin Electrophysiol 2023; 46:1035-1048. [PMID: 37573146 DOI: 10.1111/pace.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 08/14/2023]
Abstract
Transcatheter radiofrequency ablation has been widely introduced for the treatment of tachyarrhythmias. The demand for catheter ablation continues to grow rapidly as the level of recommendation for catheter ablation. Traditional catheter ablation is performed under the guidance of X-rays. X-rays can help display the heart contour and catheter position, but the radiobiological effects caused by ionizing radiation and the occupational injuries worn caused by medical staff wearing heavy protective equipment cannot be ignored. Three-dimensional mapping system and intracardiac echocardiography can provide detailed anatomical and electrical information during cardiac electrophysiological study and ablation procedure, and can also greatly reduce or avoid the use of X-rays. In recent years, fluoroless catheter ablation technique has been well demonstrated for most arrhythmic diseases. Several centers have reported performing procedures in a purposefully designed fluoroless electrophysiology catheterization laboratory (EP Lab) without fixed digital subtraction angiography equipment. In view of the lack of relevant standardized configurations and operating procedures, this expert task force has written this consensus statement in combination with relevant research and experience from China and abroad, with the aim of providing guidance for hospitals (institutions) and physicians intending to build a fluoroless cardiac EP Lab, implement relevant technologies, promote the standardized construction of the fluoroless cardiac EP Lab.
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Affiliation(s)
- Chenyang Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songwen Chen
- Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shiquan Chen
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenxi Jiang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruhong Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weizhu Ju
- Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Deyong Long
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ding Li
- Peking University People's Hospital, Beijing, China
| | - Jia Li
- The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qiang Liu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Ma
- Tianjin Chest Hospital, Tianjin, China
| | - Xiaobo Pu
- West China Hospital, Sichuan University, Chengdu, China
| | - Rui Wang
- First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuegang Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fu Yi
- Xijing Hospital, The First Affiliated Hospital of Air Force Medical University, Xian, China
| | - Cao Zou
- The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Jidong Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xi Zhang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Yujie Zhao
- The seventh People's Hospital of Zhenzhou, Zhengzhou, China
| | - Paul C Zei
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Dong Chang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Heng Cai
- Tianjin Medical University General Hospital, Tianjin, China
| | | | - Minglong Chen
- Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guosheng Fu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Fu
- West China Hospital, Sichuan University, Chengdu, China
| | - Jie Fan
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Chun Gui
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tingbo Jiang
- The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Shaowen Liu
- Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xuebin Li
- Peking University People's Hospital, Beijing, China
| | - Yigang Li
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Maoqin Shu
- Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yan Wang
- Tongji Hospital, Tongji Medical College of HUST, Wuhan, China
| | - Jian Xu
- The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, China
| | - Ruiqin Xie
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunlong Xia
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yumei Xue
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Pingzhen Yang
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yiqiang Yuan
- Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jingquan Zhong
- Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenqing Zhu
- Zhongshan Hospital, Fudan University, Shanghai, China
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9
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Piros K, Perge P, Salló Z, Herczeg S, Nagy VK, Osztheimer I, Merkely B, Gellér L, Szegedi N. Zero fluoroscopy ablation for atrioventricular nodal reentrant tachycardia and typical atrial flutter is equally safe and effective with EnSite NavX, Carto3, and Rhythmia mapping systems. Front Cardiovasc Med 2023; 10:1185187. [PMID: 37560116 PMCID: PMC10407085 DOI: 10.3389/fcvm.2023.1185187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Our purpose was to compare the procedural characteristics, success rate, and complication rate of the conventional fluoroscopic (CF) and the zero-fluoroscopic (ZF) approach in patients undergoing catheter ablation of AVNRT or typical atrial flutter (Aflu). METHODS 186 consecutive patients with an indication for AVNRT or Aflu ablation were enrolled. Based on the operator's preference, the patients were assigned to either CF or ZF group. In the ZF group EnSite NavX, Carto3, or Rhythmia EAMS were used for catheter guidance. RESULTS The median age was 56 (IQR = 42-68) years, 144 patients had AVNRT, and 42 had Aflu ablation. CF approach was chosen in 123 cases, while ZF in 63 cases. ZF approach was used more often in case of AVNRT patients [56 (39%) vs. 7 (17%), p = 0.006] and in the case of female patients [43 (68%) vs. 20 (32%), p = 0.008]. Acute procedural success was obtained in all cases. There was no difference in the complication rate (1 vs. 1, p > 0.99) between the two groups. No difference was found regarding the procedure time between the CF and ZF groups [CF: 55 (46-60) min, ZF 60 (47-65) min; p = 0.487] or in the procedure time for the different EAMS [EnSite NavX: 58 (50-63) min, Carto3: 60 (44.5-66.3) min, Rhythmia: 55 (35-69) min; p = 0.887]. A similar success rate was seen at the 3-month follow-up in the two groups [41 (100%) vs. 96 (97%); p = 0.55]. DISCUSSION The ZF approach demonstrated non-inferiority in safety and efficacy compared with CF for the AVNRT and Aflu ablations.
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Sommer P, Sciacca V, Anselmino M, Tilz R, Bourier F, Lehrmann H, Bulava A. Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review. Europace 2023; 25:euad191. [PMID: 37410906 PMCID: PMC10365833 DOI: 10.1093/europace/euad191] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is the main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.
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Affiliation(s)
- Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, ‘Citta della Salute e della Scienza di Torino’ Hospital, University of Turin, Torino, Italy
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center, Technical University, Munich, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology (Campus Bad Krozingen), University Hospital Freiburg, Bad Krozingen, Germany
| | - Alan Bulava
- Department of Cardiology, Ceske Budejovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
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11
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Hassanin A, Al-Azizi K, Uretsky BF. Occupational Safety in the Cardiac Catheterization Laboratory: Time for Better Ergonomics. JACC Cardiovasc Interv 2023; 16:1236-1238. [PMID: 37225296 DOI: 10.1016/j.jcin.2023.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Ahmed Hassanin
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Karim Al-Azizi
- Baylor Scott & White Health, The Heart Hospital Plano, Plano, Texas, USA
| | - Barry F Uretsky
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; Central Arkansas Veterans Health System, Little Rock, Arkansas, USA
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12
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Durand E, Sabatier R, Smits PC, Verheye S, Pereira B, Fajadet J. Evaluation of the R-One robotic system for percutaneous coronary intervention: the R-EVOLUTION study. EUROINTERVENTION 2023; 18:e1339-e1347. [PMID: 36602883 PMCID: PMC10068861 DOI: 10.4244/eij-d-22-00642] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND R-One is a robotic percutaneous coronary intervention (PCI) system (CE mark 2019) designed to reduce operator radiation exposure, improve ergonomics, and accurately navigate, position, and deliver guidewires/devices during PCI. AIMS We aimed to evaluate the safety and efficacy of the R-One system for PCI. METHODS The European multicentre prospective R-EVOLUTION study included patients with a de novo coronary artery stenosis (length <38 mm, reference diameter 2.5-4.0 mm) undergoing stent implantation. Patients with recent ST-segment elevation myocardial infarction, ostial or left main lesion, bifurcation, severe tortuosity, or calcification were excluded. Clinical success was defined as the absence of major intraprocedural complications. Technical success was defined as the successful advancement and retraction of all PCI devices (guidewires/balloon/stents) without total manual conversion. Radiation exposure to patients, to a simulated manual operator, and to robotic PCI operators was measured. RESULTS Sixty-two consecutive patients (B2/C lesions: 25.0% [16/64]) underwent robotic PCI. Radial access was used in 96.8% (60/62) of procedures. The mean robotic procedure duration was 19.9±9.6 min and the mean fluoroscopy time was 10.3±5.4 min. Clinical success was 100% with no complications at 30 days. Technical success was 95.2% (59/62). Total manual conversion was required in 4.8% (3/62) cases, with 1 case directly related to the robotic system. Operator radiation exposure was reduced by 84.5% under and 77.1% on top of the lead apron, compared to doses received on the patient table. CONCLUSIONS This study suggests that robotic PCI using R-One is safe and effective with markedly lower radiation exposure to the operator. Further studies are needed to evaluate R-One in larger patient populations with more complex lesions. (ClinicalTrials.gov: NCT04163393).
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Affiliation(s)
- Eric Durand
- Department of Cardiology, Normandie Université, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Remi Sabatier
- Department of Cardiology, Caen University Hospital, Caen, France
| | - Pieter C Smits
- Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Stefan Verheye
- Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
| | - Bruno Pereira
- Institut de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg
| | - Jean Fajadet
- Department of Cardiology, Clinique Pasteur, Toulouse, France
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Katsarou M, Zwiebel B, Vogler J, Shames ML, Thayer A, Chowdhurry RP, Money SR, Bismuth J. StemRad MD, An Exoskeleton-Based Radiation Protection System, Reduces Ergonomic Posture Risk Based on a Prospective Observational Study. J Endovasc Ther 2023:15266028231160661. [PMID: 36942629 DOI: 10.1177/15266028231160661] [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: 03/23/2023]
Abstract
OBJECTIVE Poor ergonomic posture during interventional procedures might lead to increased physical discomfort and work-related musculoskeletal disorders. Adjunctive equipment such as lead aprons (LAs) has been shown to increase ergonomic posture risk (EPR). The objective of this study was to evaluate the effectiveness of StemRad MD (StemRad Ltd., Tel Aviv, Israel), a weightless exoskeleton-based radiation protective ensemble, in reducing EPR on the operator using wearable inertial measurement unit (IMU) sensors. METHODS A prospective, observational study was conducted at an academic hospital. Inertial measurement unit sensors were affixed to the upper back of 9 interventionalists to assess ergonomic risk posture during endovascular procedures while wearing a traditional LA or the StemRad MD radiation protection system. Total fluoroscopy time, procedure type, and ergonomic risk postures were recorded and analyzed. RESULTS Twenty-one cases were performed with StemRad MD and 30 with LAs. Mean procedure time for the StemRad MD procedures was 48.4±23.3 minutes (range: 24-106 min), and for LA procedures, it was 34.66±25.83 minutes (range: 6-100 min) (p=.060). The operators assumed low-risk ergonomic positions in 96.1% of StemRad MD cases and in 62.9% of LA cases (p=.001), and high-risk ergonomic positions in 0% and 6.2%, respectively (p=.80). Mean EPR score for StemRad MD was 1.16, and for the LA, it was 1.49 (p=.001). CONCLUSIONS StemRad MD significantly reduces the EPR to the torso compared with a LA-based radiation protection system. CLINICAL IMPACT Poor ergonomic posture during interventional procedures might leas to work-related musculoskeletal disorders for healthcare workers. StemRad MD, a weightless, exoskeleton-based radiation protection system was shown to significantly reduce ergonomic posture risk to the torso compared to conventional lead aprons. This might lead to reduced physical discomfort for procedure-based specialists.
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Affiliation(s)
- Maria Katsarou
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruce Zwiebel
- Department of Interventional Radiology, Tampa General Hospital, Tampa, FL, USA
| | - James Vogler
- Department of Interventional Radiology, Tampa General Hospital, Tampa, FL, USA
| | - Murray L Shames
- Division of Vascular Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Angelyn Thayer
- Division of Vascular Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Samuel R Money
- Division of Vascular Surgery, Department of Surgery, Ochsner Health, New Orleans, LA, USA
| | - Jean Bismuth
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
- Division of Vascular Surgery, LSU School of Medicine, New Orleans, LA, USA
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Eder H. X-Ray Protective Aprons Re-Evaluated. ROFO-FORTSCHR RONTG 2023; 195:234-243. [PMID: 36796379 DOI: 10.1055/a-1994-7332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND The evaluation of the protective effect of X-ray protective clothing requires new criteria. The current concept assumes more or less uniform covering of the torso with protective material. The frequently worn heavy wrap-around aprons can weigh 7 to 8 kg. As relevant studies show, orthopedic damage can result from long-term activity. It should therefore be investigated whether the apron weight can be reduced by optimizing the material distribution. For a radiobiological evaluation of the protective effect, the "effective dose" should be used. METHODS Numerous laboratory measurements were performed with an Alderson Rando phantom as well as dose measurements on clinical personnel. The measurements were supplemented by Monte Carlo simulation of an interventional workplace in which a female ICRP reference phantom was used for the operator. The measured back doses on the Alderson phantom as well as the measured back doses at interventional workplaces were based on the personal equivalent dose Hp(10). Monte Carlo simulations were used to introduce protection factors for the protective clothing based on the "effective dose" introduced in radiation protection. RESULTS Back doses in clinical radiology personnel are largely negligible. Therefore, back protection can be much lower than currently used or can even be eliminated. The Monte Carlo simulations show that the protective effect of protective aprons worn on the body is higher than when the flat protective material is radiated through (3 D effect). About 80 % of the effective dose is attributed to the body region from the gonads to the chest. By additional shielding of this area, the effective dose can be lowered or, optionally, aprons with less weight can be produced. Attention must also be paid to the "radiation leaks" (upper arms, neck, skull), which can reduce the whole-body protective effect. CONCLUSION In the future, the evaluation of the protective effect of X-ray protective clothing should be based on the effective dose. For this purpose, effective dose-based protection factors could be introduced, while the lead equivalent should be used for measurement purposes only. If the results are implemented, protective aprons with approx. 40 % less weight can be produced with a comparable protective effect. KEY POINTS · The protective effect of X-ray protective clothing should be described by protection factors based on effective dose.. · The lead equivalent should only be used for measurement purposes.. · More than 80 % of the effective dose is attributed to the body region from the gonads to the chest.. · A reinforcing layer in this area increases the protective effect considerably.. · With optimized material distribution, protective aprons could be up to 40 % lighter.. CITATION FORMAT · Eder H. X-Ray Protective Aprons Re-Evaluated. Fortschr Röntgenstr 2023; 195: 234 - 243.
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Affiliation(s)
- Heinrich Eder
- Radiation Protection, Bavarian Environment Agency (formerly), Augsburg, Germany
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15
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Choi TW, Chung JW, Kwon Y. Modified design of x-ray protective clothing to enhance radiation protection for interventional radiologists. Med Phys 2023. [PMID: 36794321 DOI: 10.1002/mp.16309] [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: 06/13/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND In interventional radiology procedures, the operator typically stands on the right side of the patient's right thigh to manipulate devices through the femoral sheath. Because the standard x-ray protective clothing is designed as sleeveless and scatter radiations from the patient are mainly incident from the left-anterior direction to the operator, the arm hole of the clothing may be a significant unprotected area, contributing to an increase in the operator's organ doses and effective dose. PURPOSE This study aimed to compare the organ doses and effective dose received by the interventional radiologist when wearing the standard x-ray protective clothing and when wearing the modified clothing with an additional shoulder guard. METHODS The experimental setup aimed to simulate actual clinical practice in interventional radiology. The patient phantom was located at the beam center to generate scatter radiation. An adult female anthropomorphic phantom loaded with 126 nanoDots (Landauer Inc., Glenwood, IL) was used to measure organ and effective doses to the operator. The standard wrap-around type x-ray protective clothing offered 0.25-mm lead-equivalent protection, and the frontal overlap area offered 0.50-mm lead-equivalent protection. The shoulder guard was custom-made with a material providing x-ray protection equivalent to lead of 0.50 mm thickness. The organ and effective doses were compared between the operator wearing the standard protective clothing and the one wearing the modified clothing with a shoulder guard. RESULTS After adding the shoulder guard, doses to the lungs, bone marrow, and esophagus decreased by 81.9%, 58.6%, and 58.7%, respectively, and the effective dose to the operator decreased by 47.7%. CONCLUSIONS Widespread use of modified x-ray protective clothing with shoulder guards can significantly decrease the overall occupational radiation risk in interventional radiology.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Rabah M, Allen S, Abbas AE, Dixon S. A novel comprehensive radiation shielding system eliminates need for personal lead aprons in the catheterization laboratory. Catheter Cardiovasc Interv 2023; 101:79-86. [PMID: 36453459 DOI: 10.1002/ccd.30490] [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: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES This clinical study evaluated the efficacy of a novel radiation shielding system for the cardiac catheterization laboratory designed to provide comprehensive protection that obviates the need for personal lead aprons. BACKGROUND Invasive Cardiologists are exposed to occupational health hazards related directly to radiation exposure (RE) and indirectly to the orthopedic burden of wearing only partially protective lead aprons. Innovations to reduce these risks are warranted. A novel comprehensive shielding system (ProtegoTM , Image Diagnostics Inc, Fitchburg, Ma) has been validated in pre-clinical studies to provide excellent radiation protection, sufficient for the State of Michigan to certify it for use without need for personal lead aprons. METHODS This clinical analysis measured RE to a single Physician operator utilizing the ProtegoTM shield (and not wearing personal lead apron) during routine cardiac catheterization procedures (diagnostic and interventional). RE was measured at both thyroid and waist level with a real-time dosimetry system (RaysafeTM , Billdal, Sweden), calculated on a median per case basis (mrems). Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index. RESULTS In n=98 cases (25% diagnostic, 75% interventional including 22% chronic total occlusions), median/case RE was 0.4 mrems (thyroid) and 0.2 mrems (waist). RE=0 in 12 cases. In no case did radiation exposure exceed 3.2 mrems. CONCLUSION The ProtegoTM shield system provides excellent RE protection to the Physician operator, without the need for personal lead aprons and has the potential to reduce catheterization laboratory occupational health hazards.
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Affiliation(s)
- Maher Rabah
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Sorcha Allen
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
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17
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Lehar F, Szegedi N, Hejc J, Jez J, Soucek F, Kulik T, Siruckova A, Sallo Z, Nagy KV, Merkely B, Geller L, Starek Z. Randomized comparison of atrioventricular node re-entry tachycardia and atrial flutter catheter ablation with and without fluoroscopic guidance: ZeroFluoro study. Europace 2022; 24:1636-1644. [PMID: 35979596 DOI: 10.1093/europace/euac049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Abstract
AIMS Interventional cardiology procedures may expose patients and staff to considerable radiation doses. We aimed to assess whether exposure to ionizing radiation during catheter ablation of supraventricular tachycardia (SVT) can be completely avoided. METHODS AND RESULTS In this prospective randomized study, patients with SVT (atrioventricular re-entrant tachycardia n = 94, typical atrial flutter n = 29) were randomly assigned in a 1:1 ratio to catheter ablation with conventional fluoroscopic guidance (CF group) or with the EnSite Precision mapping system [zerofluoro (ZF) group]. Acute procedural parameters, increased stochastic risk of cancer incidence and 6-month follow-up data were assessed. Between May 2019 and August 2020, 123 patients were enrolled. Clinical parameters were comparable. Median procedural time was 60.0 and 58.0 min, median fluoroscopy time and estimated median effective dose were 240 s vs. 0 and 0.38 mSv vs. 0 and arrhythmia recurrence was 5% and 7.9% in the CF and ZF groups, respectively. The acute success rate was 98.4% in both groups. No procedure-related complications were reported. At an average age of 55.5 years and median radiation exposure of 0.38 mSv, the estimate of increased incidence was approximately 1 in 14 084. The estimated mortality rate was 1 per 17 857 exposed persons. CONCLUSIONS The procedural safety and efficacy of the zero-fluoroscopic approach are similar to those of conventional fluoroscopy-based ablation for atrioventricular nodal re-entrant tachycardia and atrial flutter. Under the assumption of low radiation dose, the excessive lifetime risk of malignancy in the CF group due to electrophysiology procedure is reasonably small, whilst totally reduced in zero fluoroscopy procedures.
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Affiliation(s)
- Frantisek Lehar
- International Clinical Research Center, Interventional Cardiac Electrophysiology Group, St. Anne's University Hospital Brno, Pekařská 53, 656 91 Brno, Czech Republic
- First Department of Internal Medicine/Cardioangiology, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic
| | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Jakub Hejc
- International Clinical Research Center, Interventional Cardiac Electrophysiology Group, St. Anne's University Hospital Brno, Pekařská 53, 656 91 Brno, Czech Republic
| | - Jiri Jez
- International Clinical Research Center, Interventional Cardiac Electrophysiology Group, St. Anne's University Hospital Brno, Pekařská 53, 656 91 Brno, Czech Republic
- First Department of Internal Medicine/Cardioangiology, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic
| | - Filip Soucek
- International Clinical Research Center, Interventional Cardiac Electrophysiology Group, St. Anne's University Hospital Brno, Pekařská 53, 656 91 Brno, Czech Republic
- First Department of Internal Medicine/Cardioangiology, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic
| | - Tomas Kulik
- International Clinical Research Center, Interventional Cardiac Electrophysiology Group, St. Anne's University Hospital Brno, Pekařská 53, 656 91 Brno, Czech Republic
- First Department of Internal Medicine/Cardioangiology, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic
| | - Anna Siruckova
- International Clinical Research Center, Interventional Cardiac Electrophysiology Group, St. Anne's University Hospital Brno, Pekařská 53, 656 91 Brno, Czech Republic
- First Department of Internal Medicine/Cardioangiology, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic
| | - Zoltan Sallo
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Klaudia Vivien Nagy
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - László Geller
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Zdeněk Starek
- International Clinical Research Center, Interventional Cardiac Electrophysiology Group, St. Anne's University Hospital Brno, Pekařská 53, 656 91 Brno, Czech Republic
- First Department of Internal Medicine/Cardioangiology, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic
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Kolz JM, Wagner SC, Vaccaro AR, Sebastian AS. Ergonomics in Spine Surgery. Clin Spine Surg 2022; 35:333-340. [PMID: 34321393 DOI: 10.1097/bsd.0000000000001238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.
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Affiliation(s)
- Joshua M Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Scott C Wagner
- Walter Reed National Military Medical Center, Bethesda, MD
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Scott H, Gallagher S, Abbott W, Talboys M. Assessment of occupational dose reduction with the use of a floor mounted mobile lead radiation protection shield. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:033501. [PMID: 35850100 DOI: 10.1088/1361-6498/ac8203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
With the increasing number and complexity of interventional cardiology procedures, there is the potential for higher occupational radiation doses to the interventionists. In order to reduce the radiation exposure to interventionists, a number of different radiation protection measures can be implemented; the most common of which being personal protective equipment in the form of a lead-equivalent apron. However, significant development has been achieved with mobile lead equivalent radiation protection devices, which provide enhanced radiation protection without the requirement of being directly worn by staff. The RAMPART M1128 radiation protection shield is one of these devices. The dose reduction provided to staff within a Cardiac Catheterisation Laboratory was assessed via the use of electronic personal dosimeters with the Philips live dosimetry system DoseAware (Philips DoseAware). A 60% dose reduction to the primary operator can be achieved with the Rampart device. Further dose reductions are possible for other individuals in the range of 65%-84%. Additionally, dose rate measurements were taken in a simulated clinical set-up using a phantom, which showed that the device provided a 65% dose reduction at eye level and a 90% dose reduction at chest level for the primary operator position. This significant dose reduction means that there is the potential for at least the primary operator to wear a lead apron of reduced lead equivalence specification when the Rampart device is in use, without increasing their occupational exposure and potentially reducing musculoskeletal pain due to the reduced weight.
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Affiliation(s)
| | - Sean Gallagher
- Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - William Abbott
- Cardiff and Vale University Health Board, Cardiff, United Kingdom
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Joseph T, VanOosterhout S, Negash A, VanLoo L, Redmond M, Parker JL, McNamara DA, Madder RD. Robotically performed diagnostic coronary angiography. Catheter Cardiovasc Interv 2022; 100:207-213. [PMID: 35621166 DOI: 10.1002/ccd.30250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study was performed to investigate the efficacy and safety of robotic diagnostic coronary angiography. BACKGROUND Robotic percutaneous coronary intervention is associated with marked reductions in physician radiation exposure. Development of robotic diagnostic coronary angiography might similarly impact occupational safety. METHODS Stable patients referred for coronary angiography were prospectively enrolled. After obtaining vascular access, diagnostic catheters were manually advanced over a wire to the ascending aorta. All subsequent catheter movements were performed robotically. The primary endpoint was procedural success, defined as robotic completion of coronary angiography without conversion to a manual procedure and the absence of procedural major adverse cardiovascular events (MACE-cardiac death, cardiac arrest, or stroke) and major angiographic complications (coronary/aortic dissection or embolization). The primary hypothesis was that the observed rate of the primary endpoint, evaluated at the completion of coronary angiography, would meet a pre-specified performance goal of 74.5%. RESULTS Among 46 consecutive patients (age 67 ± 12 years; 69.6% male), diagnostic coronary angiography was completed robotically in all cases without the need for manual conversion and without any MACE or major angiographic complications. Thus, procedural success was 100%, which was significantly higher than the pre-specified performance goal (p < 0.001). Robotic coronary angiography was completed using 2 [2, 3] catheters per case with a median procedural time of 15 [11, 20] minutes. CONCLUSIONS Robotic diagnostic coronary angiography was performed with 100% procedural success and no observed complications. These results support the performance of future studies to further explore robotic coronary angiography.
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Affiliation(s)
- Timothy Joseph
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Stacie VanOosterhout
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Araya Negash
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Lisa VanLoo
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Meaghan Redmond
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Jessica L Parker
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - David A McNamara
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Ryan D Madder
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
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Establishing a robotic-assisted PCI program: experiences at a large tertiary referral center. Heart Vessels 2022; 37:1669-1678. [PMID: 35487996 PMCID: PMC9399033 DOI: 10.1007/s00380-022-02078-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022]
Abstract
Robotic-assisted percutaneous coronary interventions (rPCI) have proven feasible and safe while reducing radiation exposure for the operator. Recently, rPCI systems have been refined to facilitate the treatment of complex lesions. The aim of the current study was to evaluate challenges and opportunities of establishing an rPCI program at a tertiary referral center. rPCI was performed using the CorPath GRX Vascular Robotic System (Corindus Inc., a Siemens Healthineers Company, Waltham, USA). Baseline, procedural, and in-hospital follow-up data were prospectively assessed. rPCI success was defined as completion of the PCI without or with partial manual assistance. The safety endpoint was the composite of missing angiographic success or procedure-related adverse events during hospital stay. Overall, 86 coronary lesions were treated in 71 patients (28.2% female) from January to April 2021. Median age was 71.0 years (IQR 60.3; 79.8). Indications for rPCI were stable angina pectoris (71.8%), unstable angina (12.7%) and non-ST elevation myocardial infarction (15.5%). Most lesions were complex (type B2/C: 88.4%) and included 7 cases of rPCI for chronic total occlusions. Angiographic and rPCI success were achieved in 100.0% and 94.2%, respectively. Partial manual assistance was used in 25.6%. Conversion to manual PCI was required in 5.8%. The safety endpoint occurred in 7.0% of patients. rPCI when applied as clinical routine for complex coronary lesions is effective with good immediate angiographic and clinical results. Future investigations should focus on the identification of patients that particularly benefit from robotic-assisted vs. manual PCI despite higher resource utilization.
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22
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Rubenstein DS, Holmes BB, Manfredi JA, McKillop MS, Netzler PC, Ward CC. Aegrescit medendo: orthopedic disability in electrophysiology - call for fluoroscopy elimination-review and commentary. J Interv Card Electrophysiol 2022; 64:239-253. [PMID: 35258751 PMCID: PMC9236987 DOI: 10.1007/s10840-022-01173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Donald S Rubenstein
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA.
| | - Benjamin B Holmes
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Joseph A Manfredi
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Matthew S McKillop
- Baptist Medical Center Jacksonville, 800 Prudential Dr., Jacksonville, FL, 32207, USA
| | - Peter C Netzler
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Chad C Ward
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
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Fluoroless left atrial access for radiofrequency and cryoballoon ablations using a novel radiofrequency transseptal wire. J Interv Card Electrophysiol 2022; 64:183-190. [PMID: 35194727 PMCID: PMC9236982 DOI: 10.1007/s10840-022-01157-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
Purpose Conventional catheter ablation for atrial fibrillation requires fluoroscopy, which has inherent risks of radiation exposure to patients and medical staff. Optimization of fluoroscopy parameters and use of three-dimensional electroanatomic mapping (EAM) and intracardiac echocardiography (ICE) have helped to reduce radiation exposure; however, despite growing evidence, there are still concerns about safety and added procedure time associated with fluoroless procedures, particularly in left-sided ablations, due to the potential risk of complications. Herein, we report our initial experience using a radiofrequency (RF) wire for completely fluoroless radiofrequency ablation (RFA) and cryoballoon ablation (CBA). Methods A retrospective analysis was conducted on ablation procedures for various cardiac arrhythmias performed non-fluoroscopically at two centers using the VersaCross RF wire transseptal system under EAM and ICE guidance. Results A total of 72 and 54 patients underwent RFA and CBA, respectively, successfully without any procedural complications. Transseptal access time for RFA was 14.5 ± 6.6 min from procedure start (including sheath and catheter placements ± right-sided ablation) or 2.8 ± 1.0 min from RF wire insertion into the femoral introducer. Transseptal access time for CBA was 19.2 ± 11.7 min from procedure start (including sheath and catheter placements ± right-sided ablation) or 3.5 ± 1.6 min from RF wire insertion into the femoral introducer. Average procedure time was 104.4 ± 38.0 min for RFA and 91.1 ± 22.1 min for CBA. Conclusions A RF wire can be used to achieve completely fluoroless transseptal puncture safely and effectively while improving procedural efficiency in both RFA and CBA.
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Kanake S, Chitturi K, Karuparthi PR, Hirai T. Totally robotic three-vessel percutaneous coronary intervention with total occlusion using robotic automation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40S:288-292. [PMID: 35115274 DOI: 10.1016/j.carrev.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
Robotic-assisted percutaneous coronary intervention (PCI) has emerged as an alternative to manual PCI to mitigate the risk of occupational hazards for operators, and to increase precision of device placement. Previous studies have reported the safety and efficacy of robotic-assisted PCI in simpler lesions, and recently the safety and efficacy of robotic-assisted chronic total occlusion PCI have been reported. Herein, we report two cases with three-vessel disease, including total occlusions, successfully treated robotically utilizing newer guidewire and device automation.
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Affiliation(s)
- Shubham Kanake
- University of Missouri, Columbia, MO, United States of America
| | - Kalyan Chitturi
- University of Missouri, Columbia, MO, United States of America
| | - Poorna R Karuparthi
- University of Missouri, Columbia, MO, United States of America; Truman VA Medical Center, Columbia, MO, United States of America
| | - Taishi Hirai
- University of Missouri, Columbia, MO, United States of America.
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JiangMD R, ChenMD M, LiuMS Q, FuMD G, XueMD Y, FuMD H, WuMD S, MaMD C, LongMD D, JiangMD C. Body pain - An unheeded personal health hazard in interventional cardiologists: A national online cross-sectional survey study in China. Int J Cardiol 2022; 350:27-32. [PMID: 34979148 DOI: 10.1016/j.ijcard.2021.12.052] [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: 09/28/2021] [Revised: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Interventional cardiology procedures (ICPs) have become the mainstay treatments in cardiology diseases and increased rapidly. This study aims to assess the occupational health hazards (OHHs) related to the long-time wearing of lead personal protective equipment and reveal health protection needs in interventional cardiologists. METHODS AND RESULTS We invited interventional and non-interventional cardiologists in tertiary hospitals in China to participate in an online cross-sectional survey on their health status, utilization of personal protective equipment (PPE), and personal health protection (PHP) needs. Propensity score methods were used for comparisons of OHHs between the matched interventional and non-interventional cardiologists. Totally, 642 interventional and 402 non-interventional cardiologists completed the survey. The interventional cardiologists had significantly higher incidence of body pain (56.6% vs. 24.2%, p < 0.001), bone and joint disease (21.7% vs. 8.6%, p = 0.001), cataract (3.5% vs. 0%, p = 0.039), and anxiety (8.1% vs. 2.5%, p = 0.029) than the matched non-interventional cardiologists. The risk of back pain was independently associated with female gender, performing percutaneous coronary intervention procedure or ≥ 2 types of ICP, and the personal annual volume of ICPs. Only 3.3% of interventional cardiologists were satisfied with PPE and 83.0% of them complained of physical toll caused by heavy PPE. 90.7% were willing to conduct ICP without radiation exposure. CONCLUSIONS Body pain was the main OHH in interventional cardiologists likely due to wearing heavy lead PPE for long working hours. Besides training more interventional cardiologists, the adoption of emerging technologies without heavy lead PPE will be a promising way to reduce the OHH burden.
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Affiliation(s)
- Ruhong JiangMD
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengmeng ChenMD
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiang LiuMS
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guosheng FuMD
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yumei XueMD
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hua FuMD
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shulin WuMD
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Changsheng MaMD
- Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Deyong LongMD
- Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Chenyang JiangMD
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Salcido-Rios J, McNamara DA, VanOosterhout S, VanLoo L, Redmond M, Parker JL, Madder RD. Suspended lead suit and physician radiation doses during coronary angiography. Catheter Cardiovasc Interv 2021; 99:981-988. [PMID: 34967086 DOI: 10.1002/ccd.30047] [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: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study was performed to evaluate physician radiation doses with the use of a suspended lead suit. BACKGROUND Interventional cardiologists face substantial occupational risks from chronic radiation exposure and wearing heavy lead aprons. METHODS Head-level physician radiation doses, collected using real-time dosimeters during consecutive coronary angiography procedures, were compared with the use of a suspended lead suit versus conventional lead aprons. Multiple linear regression analyses were completed using physician radiation doses as the response and testing patient variables (body mass index, age, sex), procedural variables (right heart catheterization, fractional flow reserve, percutaneous coronary intervention, radial access), and shielding variables (radiation-absorbing pad, accessory lead shield, suspended lead suit) as the predictors. RESULTS Among 1054 coronary angiography procedures, 691 (65.6%) were performed with a suspended lead suit and 363 (34.4%) with lead aprons. There was no significant difference in dose area product between groups (61.7 [41.0, 94.9] mGy·cm2 vs. 64.6 [42.9, 96.9] mGy·cm2 , p = 0.20). Median head-level physician radiation doses were 10.2 [3.2, 35.5] μSv with lead aprons and 0.2 [0.1, 0.9] μSv with a suspended lead suit (p < 0.001), representing a 98.0% reduced dose with suspended lead. In the fully adjusted regression model, the use of a suspended lead suit was independently associated with a 93.8% reduction (95% confidence interval: -95.0, -92.3; p < 0.001) in physician radiation dose. CONCLUSION Compared to conventional lead aprons, the use of a suspended lead suit during coronary angiography was associated with marked reductions in head-level physician radiation doses.
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Affiliation(s)
- Jose Salcido-Rios
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - David A McNamara
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Stacie VanOosterhout
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Lisa VanLoo
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Meaghan Redmond
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Jessica L Parker
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Ryan D Madder
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
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27
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Shimamoto K, Yamagata K, Wakamiya A, Ueda N, Kamakura T, Wada M, Inoue-Yamada Y, Miyamoto K, Nagase S, Kusano KF. Zero-fluoroscopy ablation in patients with cardiac electronic implantable devices. J Cardiovasc Electrophysiol 2021; 33:423-429. [PMID: 34921701 DOI: 10.1111/jce.15332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Utilizing a three-dimensional (3-D) mapping system and intracardiac echocardiography (ICE) has allowed ablation procedures with less or without fluoroscopy; however, there is limited data for patients with cardiac electronic implantable device (CIED) leads regarding the suspected risk of lead injury. Therefore, we sought to explore technics to perform safe trans-septal approach and catheter manipulation technique in patients with CIED leads. METHODS AND RESULTS This study comprised 49 consecutive patients (59% males, median 73 years old) with CIED who underwent catheter ablation for supraventricular tachycardia requiring the trans-septal approach, 15 without fluoroscopy (zero-fluoro group), and 34 with fluoroscopy (conventional-fluoro group), between July 2019 and April 2021. All procedures were performed under a 3-D mapping system and ICE guidance. We compared the differences in treatment and development of complications between the two groups. The procedures were for atrial fibrillation (82%) and atrial tachycardia (76%). Coronary sinus catheter insertion and the trans-septal procedure were successfully performed in all patients. The median time from venipuncture to trans-septal procedure (zero-fluoro vs. conventional-fluoro group: 28 [18-37] min vs. 24 [21-31] min, p = .70), total procedure time (231 [142-274] min vs. 175 [163-225] min, p = .63), and the acute procedural success rate (100% vs. 97%, p = 1.00) did not differ between both groups. No patient showed lead-related complications in both groups. CONCLUSION This is the first study to show zero-fluoro ablation for supraventricular arrhythmia using 3-D mapping and ICE in patients with CIED leads was feasible under careful catheter manipulation.
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Affiliation(s)
- Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuko Inoue-Yamada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kengo F Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Eder H, Schlattl H. Use of effective dose to assess x-ray protective clothing. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:R140-R151. [PMID: 34870616 DOI: 10.1088/1361-6498/ac191a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
This review article provides an overview on the results of studies conducted by the authors to improve the current personal protection concept in the clinical application of x-rays. With the aid of personal dose equivalent measurements during radiologically guided clinical interventions, laboratory tests using the Alderson-Rando phantom as well as Monte Carlo simulations various x-ray application scenarios were investigated. The organ doses and the effective doses of staff persons standing near the patient were determined. The 3D-attenuation properties of protective clothing under the scattered radiation emitted by the patient play a special role here. With regard to the minimisation of the quantity 'effective dose' the protection of the lower body from the gonads to the chest is of particular importance, since 80% of the effective dose is contributed by this region of the body. In contrast, protection of the back plays a subordinate role. Protective aprons optimised in terms of effective dose can be significantly lighter than conventional aprons, providing equal protection. The assessment of the attenuation properties of protective clothing should be based on the risk-related dose quantity, effective dose, rather than lead equivalent. In the future, the evaluation of radiation protective clothing could be based on the calculation of the effective dose assuming standardised irradiation conditions.
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Affiliation(s)
- Heinrich Eder
- Bavarian Environment Agency (formerly), priv. Am Stadtpark 43, 81243 München, Germany
| | - Helmut Schlattl
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstr. 1, 85764 Oberschleißheim, Germany
- Federal Office for Radiation Protection, Ingolstädter Landstr. 1, 85764 Oberschleißheim, Germany
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Barnard E, Sheaffer K, Hampton S, Measel ML, Farag A, Shaw C. Ergonomics and Work-Related Musculoskeletal Disorders: Characteristics Among Female Interventionists. Cureus 2021; 13:e18226. [PMID: 34722032 PMCID: PMC8544652 DOI: 10.7759/cureus.18226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/11/2022] Open
Abstract
Interventional radiology is a procedural specialty that performs minimally invasive operations under image guidance. Currently, there are inadequate ergonomic protocols for work-related musculoskeletal disorder (WMSD) prevention in interventional radiology (IR), and there is a paucity of information discerning gender differences in WMSDs. This article reviews current literature that addresses WMSDs in female physicians practicing interventional and fluoroscopic procedures, including interventional radiology, interventional cardiology, electrophysiology, vascular surgery, orthopedic surgery, neurosurgery, and gastroenterology. We searched PubMed and EBSCOhost databases for ergonomic studies that reported female physician WMSDs in the specialties listed above. After a thorough evaluation for inclusion based on eligibility criteria, 11 studies were included. From this search, there was poor female representation, averaging 25.7% of respondents. Several characteristics identified across the studies were that women were generally shorter, wore smaller glove sizes, and were younger than their male colleagues. Seventy-two percent of female proceduralists reported WMSDs versus 46.6% of their male colleagues. Additionally, women may experience more upper extremity pain than lumbar pain, which men commonly reported. Potential contributing factors to WMSDs are the size and design of procedural tools and the possible predisposition of female physicians to experience upper extremity WMSDs while performing the same operations as men. As more women enter medicine and pursue careers in procedural fields like interventional radiology, it is essential to address these discrepancies and develop ergonomically sound solutions for women.
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Affiliation(s)
- Emily Barnard
- Medicine, Mercer University School of Medicine, Savannah, USA
| | | | - Sarah Hampton
- Medicine, Mercer University School of Medicine, Savannah, USA
| | - Megan L Measel
- Biomedical Engineering, Georgia Institute of Technology, Atlanta, USA
| | - Ahmed Farag
- Interventional Radiology, Baylor University Medical Center, Dallas, USA
| | - Cathyrn Shaw
- Interventional Radiology, Baylor University Medical Center, Dallas, USA
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Habib H, Keller EJ. Disability in Interventional Radiology. Semin Intervent Radiol 2021; 38:500-503. [PMID: 34629721 DOI: 10.1055/s-0041-1735604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hasan Habib
- School of Osteopathic Medicine, Rowan University, Stratford, New Jersey
| | - Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
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Tripathi B, Sharma P, Arora S, Murtaza M, Singh A, Solanki D, Kapadia S, Sharma A, Pershad A. Safety and feasibility of robotic assisted percutaneous coronary intervention compared to standard percutaneous coronary intervention- a systematic review and meta-analysis. Indian Heart J 2021; 73:549-554. [PMID: 34627567 PMCID: PMC8514414 DOI: 10.1016/j.ihj.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/26/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
Objective Robotically assisted PCI offers a great alternative to S–PCI. This has gained even more relevance during the COVID-19 pandemic era however safety of R–PCI compared to S–PCI has not been studied well. This study explores the safety and efficacy of robotically assisted PCI (R–PCI) compared to standard PCI (S–PCI) for the treatment of coronary artery disease (CAD). Methods PubMed, Scopus, Ovid, and Google scholar databases were searched for studies comparing R–PCI to S–PCI. Outcomes included clinical success, procedure time, fluoroscopy time, contrast use and radiation exposure. Results Theauthors included 5 studies comprising 1555 patients in this meta-analysis. Clinical success was comparable in both arms (p = 0.91). Procedure time was significantly longer in R–PCI group (risk ratio: 5.52, 95% confidence interval: 1.85 to 9.91, p = 0.003). Compared to S–PCI, patients in R–PCI group had lower contrast use (meandifference: −19.88, 95% confidence interval: −21.43 to −18.33, p < 0.001), fluoroscopy time (mean difference:-1.82, 95% confidence interval: −3.64 to −0.00, p = 0.05) and radiation exposure (mean difference:-457.8, 95% confidence interval: −707.14 to −208.14, p < 0.001). Conclusion R–PCI can achieve similar success as S–PCI at the expense of longer procedural times. However, radiation exposure and contrast exposure were lower in the R–PCI arm.
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Affiliation(s)
| | - Purnima Sharma
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Shilpkumar Arora
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Malik Murtaza
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Aanandita Singh
- Sri Guru Ram Das Institute of Medical Sciences, Amritsar, Punjab, India
| | | | | | | | - Ashish Pershad
- University of Arizona College of Medicine, Phoenix, AZ, USA
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Caradu C, Stenson K, Houmaïda H, Le Ny J, Lalys F, Ducasse E, Gheysens B. EndoNaut two-dimensional fusion imaging with a mobile C-arm for endovascular treatment of occlusive peripheral arterial disease. J Vasc Surg 2021; 75:651-659.e1. [PMID: 34509588 DOI: 10.1016/j.jvs.2021.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular treatment has become the first-line strategy for peripheral arterial disease (PAD). Given the number of procedures required, any technology associated with a reduction in radiation exposure and contrast volume is highly relevant. In the present study, we evaluated whether two-dimensional (2D) fusion imaging could reduce the radiation exposure and contrast volume during endovascular treatment of occlusive PAD. METHODS Our consecutive, retrospective, single-center, nonrandomized comparative trial included patients with PAD at the femoral, popliteal, and/or tibial level, at any clinical stage, if they were candidates for endovascular revascularization. Patients were treated with or without the EndoNaut 2D fusion imaging system (Therenva, Rennes, France) in a nonhybrid room with the same Cios Alpha mobile C-arm (Siemens, Munich, Germany). The indirect dose-area product and contrast medium volume were recorded. RESULTS Between March 2018 and April 2020, 255 patients underwent endovascular femoropopliteal revascularization with (n = 124) or without (n = 131) 2D fusion imaging. The volume of injected contrast medium (34.7 ± 13.8 mL vs 51.3 ± 26.7 mL; P < .001) and dose-area product (8.9 ± 9.9 Gy/cm2 vs 13.5 ± 14.0 Gy/cm2; P = .003) were significantly lower for the 2D fusion imaging group than for the control group. A subgroup analysis of complex (TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease C/D) lesions showed similar results. Stratification of the fusion imaging group into three subgroups, according to the procedure dates, showed no effect of a potential learning curve on the operative parameters. CONCLUSIONS The results from the present study showed a significant reduction in the contrast volume and radiation dose for endovascular treatment of PAD when applying 2D fusion imaging technology. Overall, a reduction of >30% was observed for both operative parameters, without excessive training requirements, highlighting the potential benefits of using 2D fusion imaging when performing endovascular revascularization for PAD.
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Affiliation(s)
- Caroline Caradu
- Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France.
| | | | - Hassan Houmaïda
- Department of Vascular Surgery, Libourne Hospital, Libourne, France
| | - Julie Le Ny
- Department of Image-Guided Surgical Navigation in Endovascular Procedures, Therenva SAS, Rennes, France
| | - Florent Lalys
- Department of Image-Guided Surgical Navigation in Endovascular Procedures, Therenva SAS, Rennes, France
| | - Eric Ducasse
- Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Benoit Gheysens
- Department of Vascular Surgery, Libourne Hospital, Libourne, France
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Abstract
Despite more than 80% of interventional operators reporting one or more orthopedic injuries attributed to the X-ray laboratory, there has been limited adoption of various strategies and equipment to minimize these injuries. A comprehensive review of these methods to reduce musculoskeletal strain is lacking in the current literature, and is essential in order to ensure a long, healthy, and productive interventional career.
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Main ML, Mayer SA, Rahko PS, Rose GA. Interventional Transesophageal Echocardiography: Background and Coding Review: A Publication from the ASE Advocacy Committee. J Am Soc Echocardiogr 2021; 34:A14-A16. [PMID: 34362549 DOI: 10.1016/j.echo.2021.06.004] [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] [Indexed: 11/28/2022]
Affiliation(s)
- Michael L Main
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Susan A Mayer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Peter S Rahko
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Geoffrey A Rose
- Sanger Heart and Vascular Institute, Charlotte, North Carolina
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Malpani R, Petty CW, Bhatt N, Staib LH, Chapiro J. Use of Artificial Intelligence in Non-Oncologic Interventional Radiology: Current State and Future Directions. DIGESTIVE DISEASE INTERVENTIONS 2021; 5:331-337. [PMID: 35005333 PMCID: PMC8740955 DOI: 10.1055/s-0041-1726300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The future of radiology is disproportionately linked to the applications of artificial intelligence (AI). Recent exponential advancements in AI are already beginning to augment the clinical practice of radiology. Driven by a paucity of review articles in the area, this article aims to discuss applications of AI in non-oncologic IR across procedural planning, execution, and follow-up along with a discussion on the future directions of the field. Applications in vascular imaging, radiomics, touchless software interactions, robotics, natural language processing, post-procedural outcome prediction, device navigation, and image acquisition are included. Familiarity with AI study analysis will help open the current 'black box' of AI research and help bridge the gap between the research laboratory and clinical practice.
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Affiliation(s)
- Rohil Malpani
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Christopher W. Petty
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Neha Bhatt
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Lawrence H. Staib
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
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Krzowski B, Gawałko M, Peller M, Lodziński P, Grabowski M, De Potter T, Fiedler L, Ernst S, Duncker D, Chudzik M, Garcia R, Russo V, Yakushev A, Kosiuk J, Balsam P. Radiation Safety and Electrophysiologists: Radiation Protection Status - Go for Zero Fluoroscopy European Heart Rhythm Association Registry. Cardiology 2021; 146:600-606. [PMID: 34218228 DOI: 10.1159/000517000] [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: 05/15/2020] [Accepted: 05/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study was to analyze electrophysiologists' radiation-protective devices for occupational exposure across European countries. METHODS Data reported herein were gathered from the international, multicenter prospective Go for Zero Fluoroscopy registry performed in years 2018-2019. The registry encompassed 25 European electrophysiological centers from 14 countries and up to 5 operators from each center. RESULTS The analysis included 95 operators (median age: 39 years, 85% of male, median training time: 5 years). The most frequently used X-ray protection tools (used by ≥80% of the group) were lead aprons, thyroid shields, screens below the table, glass in the laboratory, and least often (<7%) protective gloves and cabin. No statistically significant differences regarding the number of procedures performed monthly, electrophysiologists' experience and gender, and radiation exposure dose or radiation protection tools were observed, except lead thyroid shields and eyeglasses, which were more often used in case of fewer electrophysiological procedures performed (<20 procedures per month). Operators who were protected by >4 X-ray protection tools were exposed to lower radiation levels than those who were protected by ≤4 X-ray protection tools (median radiation exposure: 0.6 [0.2-1.1] vs. 0.2 [0.1-0.2] mSv per month, p < 0.0001; 1.1 [0.1-12.0] vs. 0.5 [0.1-1.1] mSv per year, p < 0.0001), respectively. CONCLUSIONS Electrophysiologists' radiation-protective devices for occupational exposure are similar across European centers and in accordance with the applicable X-ray protection protocols, irrespective of the level of experience, number of monthly performed EP procedures, and gender.
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Affiliation(s)
- Bartosz Krzowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,1 Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Michał Peller
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Lodziński
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Lukas Fiedler
- Department of Internal Medicine II, General Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | | | - David Duncker
- Department of Cardiology and Angiology, Rhythmology and Electrophysiology, Hannover Medical School, Hannover, Germany
| | - Michał Chudzik
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | | | - Vincenzo Russo
- Department of Translational Medical Sciences, Chair of Cardiology, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Andriy Yakushev
- Amosov National institute of cardiovascular surgery, Kyiv, Ukraine
| | - Jedrzej Kosiuk
- Rhythmology Department, Helios Clinic Koethen, Koethen, Germany
| | - Paweł Balsam
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Günal A, Demirtürk F. Occupational hazards, sleep quality and musculoskeletal problems of pregnant workers. J OBSTET GYNAECOL 2021; 42:215-219. [PMID: 34027776 DOI: 10.1080/01443615.2021.1904221] [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: 09/30/2022]
Abstract
The aim of this study was to identify the relationship between musculoskeletal problems and sleep quality and exposure to occupational hazards in working pregnant women. The study included a total of 142 pregnant women working in various industries. The risk of experiencing musculoskeletal system problems was found to increase with impaired sleep quality (OR interval min =1.132 max =1.303). As the amount of work-related physical damage increased, musculoskeletal complaints increased (OR interval min = 1.228 max = 1.527). Environmental hazards and psychosocial hazards seemed to increase the risk of having musculoskeletal problems (OR interval min = 1.209 max = 1.465, and OR interval min = 1.326 max = 1.547, respectively). Physical, psychosocial and workplace environmental hazards seemed to increase the risk of musculoskeletal complaints in pregnancy. It was also seen that as sleep quality decreased, so musculoskeletal complaints increased.Impact StatementWhat is already known about this subject? Occupational hazards and poor sleep quality can be associated with adverse health outcomes. Pregnant women working in different industries in Turkey may also face work-related hazards. They may also experience pregnancy-related sleep problems. In this context, there is a need to identify occupational hazards and problems related to sleep and to provide protective strategies.What do the results of this study add? The most frequent physical hazard was determined to be a simultaneous bending and rolling movement, the most frequent work environment hazard was noise exposure and the most frequent psychosocial hazard was the lack of a reward system. Physical, work environment and psychosocial hazards were observed to increase the risk of musculoskeletal problems. Moreover, the risk of having musculoskeletal problems increased as sleep quality deteriorated.What are the implications of these findings for clinical practice and/or further research? Training should be planned for working women, including the idea of conception and work-related hazards and protective strategies. It may be possible to provide arrangements related to the workplace by including employers in this training.
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Affiliation(s)
- Ayla Günal
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Funda Demirtürk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpaşa University, Tokat, Turkey
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38
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Ergonomics in Interventional Radiology: Awareness Is Mandatory. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050500. [PMID: 34069174 PMCID: PMC8157181 DOI: 10.3390/medicina57050500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.
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39
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Desai VR, Lee JJ, Sample T, Kleiman NS, Lumsden A, Britz GW. First in Man Pilot Feasibility Study in Extracranial Carotid Robotic-Assisted Endovascular Intervention. Neurosurgery 2021; 88:506-514. [PMID: 33313923 DOI: 10.1093/neuros/nyaa461] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Robotic-assistance in endovascular intervention represents a nascent yet promising innovation. OBJECTIVE To present the first human experience utilizing robotic-assisted angiography in the extracranial carotid circulation. METHODS Between March 2019 and September 2019, patients with extracranial carotid circulation pathology presenting to Houston Methodist Hospital were enrolled. RESULTS A total of 6 patients met inclusion criteria: 5 underwent diagnostic angiography only with robotic-assisted catheter manipulation, while 1 underwent both diagnostic followed by delayed therapeutic intervention. Mean age was 51 +/- 17.5 yr. Mean anesthesia time was 158.7 +/- 37.9 min, mean fluoroscopic time was 22.0 +/- 7.3 min, and mean radiation dose was 815.0 +/- 517.0 mGy. There were no technical complications and no clinical deficits postprocedure. None of the cases required conversion to manual neurovascular intervention (NVI). CONCLUSION Incorporating robotic technology in NVI can enhance procedural technique and diminish occupational hazards. Its application in the coronary and peripheral vascular settings has established safety and efficacy, but in the neurovascular setting, this has yet to be demonstrated. This study presents the first in human feasibility experience of robotic-assisted NVI in the extracranial carotid circulation.
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Affiliation(s)
- Virendra R Desai
- Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Jonathan J Lee
- Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Trevis Sample
- Department of Endovascular Radiology, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Alan Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Gavin W Britz
- Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
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40
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Bartal G, Vano E, Paulo G. Get Protected! Recommendations for Staff in IR. Cardiovasc Intervent Radiol 2021; 44:871-876. [PMID: 33837456 PMCID: PMC8034513 DOI: 10.1007/s00270-021-02828-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
Purpose Evaluation and registration of patient and staff doses are mandatory under the current European legislation, and the occupational dose limits recommended by the ICRP have been adopted by most of the countries in the world. Methods Relevant documents and guidelines published by international organisations and interventional radiology societies are referred. Any potential reduction of patient and staff doses should be compatible with the clinical outcomes of the procedures. Results The review summarises the most common protective measures and the needed quality control for them, the criteria to select the appropriate protection devices, and how to avoid unnecessary occupational radiation exposures. Moreover, the current and future advancements in personnel radiation protection using medical simulation with virtual and augmented reality, robotics, and artificial intelligence (AI) are commented. A section on the personnel radiation protection in the era of COVID-19 is introduced, showing the expanding role of the interventional radiology during the pandemic. Conclusion The review is completed with a summary of the main factors to be considered in the selection of the appropriate radiation protection tools and practical advices to improve the protection of the staff.
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Affiliation(s)
| | - Eliseo Vano
- Radiology Department, Complutense University, Madrid, Spain
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, ESTESC - Coimbra Health School, Instituto Politécnico de Coimbra, Coimbra, Portugal
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41
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Stevenson A, Kirresh A, Ahmad M, Candilio L. Robotic-assisted PCI: The future of coronary intervention? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:161-168. [PMID: 33867293 DOI: 10.1016/j.carrev.2021.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/31/2022]
Abstract
Robotic percutaneous coronary intervention (R-PCI) is a novel approach to performing percutaneous coronary intervention (PCI) whereby the operator can utilise remotely controlled technology to manipulate guidewires and catheter devices. This enables the procedure to be undertaken from within a radiation-shielded cockpit. Success in early trials has led to the release of commercially available robotic platforms which have now received regulatory approval and are available for use in clinical practice. Recent trials evaluating R-PCI have demonstrated high technical success rates with low complication rates. Despite this, a significant number of cases, particularly those with complex anatomy, still require at least partial conversion to a manual procedure. Advantages of R-PCI include accurate stent placement, reduced operator radiation exposure and a presumed reduction in orthopedic injuries. Limitations include current incompatibility with certain intravascular imaging catheters and the inability to manipulate multiple guidewires and stents simultaneously. Patients presenting with ST-elevation myocardial infarction requiring primary-PCI have also largely been excluded from existing R-PCI studies. Given these caveats, R-PCI remains a novel technology and has yet to become commonplace in cardiac catheterisation laboratories, however with increasing safety and feasibility data emerging, it is possible that R-PCI may form part of standard practice in the future.
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Affiliation(s)
- Alexander Stevenson
- Department of Intensive Care, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland.
| | - Ali Kirresh
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Luciano Candilio
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
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42
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Peña CS, Tuncay V, Benenati JF, Powell A, Gandhi RT, Schiro BJ, van Alfen M, Katzen BT. Improving IR Ergonomics Using a Flexible C-Arm System. J Vasc Interv Radiol 2021; 32:220-225.e2. [PMID: 33461874 DOI: 10.1016/j.jvir.2020.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/10/2020] [Accepted: 08/16/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the impact of a versatile flexible ceiling-mounted C-arm on active table and gantry repositioning during interventions and its effect on operator discomfort, system usability, and patient safety compared with a traditional ceiling-mounted system. MATERIALS AND METHODS There were 100 IR procedures studied: 50 in a traditional IR system (standard group) and 50 with a novel multiaxis ceiling-mounted system (test group). FlexArm was capable of multiple gantry rotation points allowing increased access to the patient in addition to 236 cm of lateral x-ray detector travel. For each procedure, both the table and the gantry repositioning were measured. Patient safety, patient/equipment repositioning effort, and physical discomfort were evaluated through an operator survey. RESULTS Table repositioning was reduced from 42 to 16 instances per procedure (P < .001) in the test group compared with the standard group. The operators perceived less table and gantry repositioning effort (P < .0001) and decreased risks of equipment collisions, displacement of vascular access, and dislodgment of tubes/lines with the test group (P < .0001). Operator discomfort was reduced for all body areas in the test group over the standard group (P < .0001). CONCLUSIONS The FlexArm system geometry enhances operator ergonomics, as there was a decrease need to move the table, leading to a perceived decrease in patient risk and decrease operator physical discomfort when compared to a traditional imaging system.
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Affiliation(s)
- Constantino S Peña
- Miami Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176.
| | - Volkan Tuncay
- Philips Medical Systems Nederland B.V., Amsterdam, Netherlands
| | - James F Benenati
- Miami Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176
| | - Alex Powell
- Miami Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176
| | - Ripal T Gandhi
- Miami Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176
| | - Brian J Schiro
- Miami Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176
| | | | - Barry T Katzen
- Miami Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176
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AlShammari W, Alhussain H, Rizk NM. Risk Management Assessments and Recommendations Among Students, Staffs, and Health Care Workers in Educational Biomedical Laboratories. Risk Manag Healthc Policy 2021; 14:185-198. [PMID: 33488131 PMCID: PMC7816217 DOI: 10.2147/rmhp.s278162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Safety in laboratories is one of the most crucial topics for all educational institutes. All-hazards need to be identified, evaluated, and controlled whenever possible, following the risk management (RM) process. This study evaluates two academic laboratories' risks and safety in the Department of Biomedical Science (BMS) at Qatar University (QU). The goal is to eliminate or reduce any risks to the students, teaching assistants, laboratory technicians, faculties, and other related workers, following an RM process. METHODS A cross-sectional study was performed from January to March 2020 in the BMS at QU. The study sample comprised of microbiology and hematology laboratories. Checklists and data collection sheets were used for data collection. Hazard evaluation failure mode and effects analysis (FMEA) was used. The risk priority number (RPN) was calculated for all the identified hazards. For hazard control, the hierarchy of controls was followed. RESULTS The number of identified hazards was thirteen (n=13) in the hematology laboratory and sixteen (n=16) in the microbiology laboratory. Chemical and ergonomic hazards had the highest percentages in both laboratories, with 25% in the microbiology laboratory and 31% in the hematology laboratory. Both laboratories were free from radiation hazards. There is a significant difference between adopted and recommended control measures in each laboratory in terms of likelihood, severity, and risk priority number (RPN). CONCLUSION Both chemical and ergonomic hazards account for almost a quarter of the hazards in both laboratories. The recommended control measure can decrease the severity and likelihood of identified hazards.
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Affiliation(s)
- Wasaif AlShammari
- Biomedical Sciences Department, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
| | | | - Nasser M Rizk
- Biomedical Sciences Department, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
- Biomedical Research Center (BRC), Qatar University, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit, QU- Health, Qatar University, Doha, Qatar
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44
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Knuttinen MG, Zurcher KS, Wallace A, Doe C, Naidu SG, Money SR, Rochon PJ. Ergonomics in IR. J Vasc Interv Radiol 2020; 32:235-241. [PMID: 33358387 DOI: 10.1016/j.jvir.2020.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022] Open
Abstract
Ergonomic research in the field of interventional radiology remains limited. Existing literature suggests that operators are at increased risk for work-related musculoskeletal disorders related to the use of lead garments and incomplete knowledge of ergonomic principles. Data from existing surgical literature suggest that musculoskeletal disorders may contribute to physician burnout and female operators are at a higher risk of developing musculoskeletal disorders. This review article aims to summarize the existing ergonomic challenges faced by interventional radiologists, reiterate existing solutions to these challenges, and highlight the need for further ergonomic research in multiple areas, including burnout and gender.
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Affiliation(s)
| | - Kenneth S Zurcher
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona.
| | - Alex Wallace
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona
| | - Christopher Doe
- Department of Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sailendra G Naidu
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona
| | - Samuel R Money
- Department of Surgery, Ochsner Clinic, New Orleans, Louisiana
| | - Paul J Rochon
- Department of Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
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45
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Lurie A, Amit G, Divakaramenon S, Acosta JG, Healey JS, Wong JA. Outcomes and Safety of Fluoroless Catheter Ablation for Atrial Fibrillation. CJC Open 2020; 3:303-310. [PMID: 33778447 PMCID: PMC7984996 DOI: 10.1016/j.cjco.2020.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Intracardiac echocardiography and 3D mapping systems allow catheter ablation for atrial fibrillation (AF) to be conducted without fluoroscopy; however, the safety and effectiveness of fluoroless AF ablation are not well defined. Methods We examined consecutive radiofrequency AF catheter ablations at a large academic teaching hospital from November 2017 to July 2019. Outcomes for fluoroscopy-guided (N = 176) and fluoroless (N = 147) ablations were compared. Cases were designated as fluoroless at the outset of the procedure. Results Mean age was 59.5 ± 10 years, 66.9% were male, 71.8% had paroxysmal AF, and the mean CHA2DS2-VASc score was 1.7 ± 1.4. There were no differences in patient baseline characteristics. In the fluoroless group, minimal fluoroscopy was used in 17 patients (median, 3 seconds; interquartile range, 1.2-4.8). Mean procedure time, fluoroscopy time, and radiation dose (± standard deviation) were greater in the fluoroscopy group compared with the fluoroless group (194 ± 56 vs 176 ± 46 minutes, P = 0.0021; 10.7 ± 6.6 vs 0.008 ± 0.03 minutes, P < 0.0001; 2759.2 ± 1911 vs 5.4 ± 24 μGy m2, P < 0.0001). In multivariable linear regression models, fluoroless AF ablation was independently associated with reduced procedure times (ß = −16.5 minutes, P = 0.01). Acute procedural success (95.5% vs 98.6%, P = 0.1), complication rates (4.5% vs 2.0%, P = 0.24), and 1-year AF recurrence rates (28.7% vs 27.1%, log-rank P = 0.69) were similar between fluoroscopy and fluoroless groups. Excluding the 17 patients receiving fluoroscopy in the fluoroless group did not impact our results (P = 0.013). After exclusion of redo cases, fluoroless AF ablation was no longer associated with reduced procedure times (ß = −11.4 minutes, P = 0.106). Conclusions Fluoroless radiofrequency AF ablation had similar effectiveness and safety compared with conventional fluoroscopy-guided AF ablation.
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Affiliation(s)
- Antony Lurie
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Guy Amit
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - Syamkumar Divakaramenon
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - J Gabriel Acosta
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jorge A Wong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
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Patient Body Mass Index and Occupational Radiation Doses to Circulating Nurses During Coronary Angiography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:48-52. [PMID: 33168435 DOI: 10.1016/j.carrev.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patient BMI is associated with radiation doses received by interventional cardiologists, yet the association between patient BMI and nurse radiation doses is unknown. This study evaluated the association between patient body mass index (BMI) and nurse radiation doses during coronary angiography. METHODS Nurse radiation doses were collected by real-time dosimeters during consecutive coronary angiography procedures and are reported as the personal dose equivalent (Hp10). Patient radiation doses were estimated using dose area product (DAP). Patient BMI was categorized in kg/m2 as <25.0, 25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40. Multiple regression analysis determined procedural factors independently association with nurse radiation doses. RESULTS In 643 consecutive coronary angiography procedures, patient radiation doses increased significantly across increasing patient BMI categories (p < 0.001). Compared to a patient BMI <25, a patient BMI ≥40 was associated with a 2.3-fold increase in DAP (p < 0.001). Significant differences were also observed in nurse radiation doses across patient BMI categories (p = 0.036). Compared to a patient BMI <25, a patient BMI ≥40 was associated with a 4.0-fold increase in nurse radiation dose (BMI < 25: 0.3 [0.1, 1.3] μSv; BMI ≥ 40: 1.2 [0.2, 2.9] μSv; p = 0.003). By multiple regression analysis, each 1-unit kg/m2 increase in patient BMI was associated with a 3.3% increase in nurse radiation dose (p = 0.002). CONCLUSIONS Patient BMI was significantly associated with nurse radiation doses during coronary angiography. These observations may have important implications on nurse radiation safety, especially in the setting of the ongoing obesity epidemic.
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Mascia G, Giaccardi M. A New Era in Zero X-ray Ablation. Arrhythm Electrophysiol Rev 2020; 9:121-127. [PMID: 33240507 PMCID: PMC7675142 DOI: 10.15420/aer.2020.02] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022] Open
Abstract
In this article, the authors focus on the importance of the zero X-ray ablation approach in electrophysiology. Radiation exposure related to conventional transcatheter ablation carries small but non-negligible stochastic and deterministic effects on health. Non-fluoroscopic mapping systems can significantly reduce, or even completely avoid, radiological exposure. The zero X-ray approach determines potential clinical benefits in terms of reduction of ionising radiation exposure, as well as safe technical advantages. The use of this method can result in similar outcomes when compared to the conventional fluoroscopic technique. These results are achieved without altering the duration, or compromising the effectiveness and safety, of the procedure. The zero X-ray ablation approach is a feasible and safe alternative to fluoroscopy, which is often only used in selected cases for troubleshooting. The non-fluoroscopic approach is considered a milestone for cancer prevention in ablation procedures.
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Affiliation(s)
- Giuseppe Mascia
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Marzia Giaccardi
- Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
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48
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Legeza P, Britz GW, Loh T, Lumsden A. Current utilization and future directions of robotic-assisted endovascular surgery. Expert Rev Med Devices 2020; 17:919-927. [PMID: 32835546 DOI: 10.1080/17434440.2020.1814742] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Endovascular surgery has become the standard of care to treat most vascular diseases using a minimally invasive approach. The CorPath system further enhances the potential and enables surgeons to perform robotic-assisted endovascular procedures in interventional cardiology, peripheral vascular surgery, and neurovascular surgery. With the introduction of this technique, the operator can perform multiple steps of endovascular interventions outside of the radiation field with high precision movements even from long-geographical distances. AREAS COVERED The first and second-generation CorPath systems are currently the only commercially available robotic devices for endovascular surgery. This review article discusses the clinical experiences and outcomes with the robot, the advanced navigational features, and the results with recent hardware and software modifications, which enables the use of the system for neurovascular interventions, and long-distance interventional procedures. EXPERT OPINION A high procedural success was achieved with the CorPath robotic systems in coronary and peripheral interventions, and the device seems promising in neurovascular procedures. More experience is needed with robotic neurovascular interventions and with complex peripheral arterial cases. In the future, long-distance endovascular surgery can potentially transform the management and treatment of acute myocardial infarction and stroke, with making endovascular care more accessible for patients in remote areas.
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Affiliation(s)
- Peter Legeza
- Department of Cardiovascular Surgery, Houston Methodist Hospital , Houston, Texas, USA.,Department of Vascular Surgery, Semmelweis University , Budapest, Hungary
| | - Gavin W Britz
- Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital , Houston, Texas, USA
| | - Thomas Loh
- Department of Cardiovascular Surgery, Houston Methodist Hospital , Houston, Texas, USA
| | - Alan Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital , Houston, Texas, USA
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Scheidt S, Ossendorf R, Prangenberg C, Wirtz DC, Burger C, Kabir K, Welle K. The Impact of Lead Aprons on Posture of Orthopaedic Surgeons. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 160:56-63. [PMID: 32854126 DOI: 10.1055/a-1219-8453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgeons working in orthopedics and trauma surgery are frequently exposed to repetitive actions and non-ergonomic positions in their operative activities with the regular use of lead aprons. Musculoskeletal complaints of the neck and back among surgeons are reported in the literature as up to 80%. In this study, the effects of lead aprons on the posture of surgeons are examined using videorasterstereography, foot pressure measurement and questionnaires. METHODOLOGY All subjects (n = 31) were examined before and after exposure to wearing lead aprons during surgery using videorasterstereography and pedography. In addition, a survey with a separately created questionnaire and the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was carried out. RESULTS An average duration of lead apron use of 102.6 min showed an increase in forefoot load (p = 0.002) especially in the elderly subjects and thoracic kyphosis (p < 0.001) especially in the younger doctors with a significant lateral deviation (p = 0.006). In addition, the lateral deviation was shown to correlate with an increasing body size or a shorter period of employment (p = 0.008; r = 0.51/p = 0.026; r = - 0.44). Significantly fewer surgeons experienced back complaints on working days without lead apron use in the operating room compared to days in the OR (p = 0.011). CONCLUSION The impact of wearing front covered lead aprons during operations in the field of orthopaedics and trauma surgery leads to more frequent back complaints, even among young and healthy doctors. Under an average duration of surgery of 102 min a temporary postural deviation occurs that can be demonstrated by means of videorasterstereography and foot pressure measurement. The subjects showed a shifted weight distribution on the forefoot, a gain in thoracic kyphosis and an increase in lateral deviation, which also correlated with an increasing height and shorter length of employment.
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Affiliation(s)
- Sebastian Scheidt
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Robert Ossendorf
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | | | | | - Christof Burger
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Koroush Kabir
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Kristian Welle
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
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Monaco MGL, Carta A, Tamhid T, Porru S. Anti-X Apron Wearing and Musculoskeletal Problems Among Healthcare Workers: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165877. [PMID: 32823627 PMCID: PMC7459898 DOI: 10.3390/ijerph17165877] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
Interventional radiology activities and other medical practices using ionising radiation have become increasingly prevalent. In this context, the use of anti-X aprons, in association with awkward postures and non-ergonomic working conditions, might cause the onset of musculoskeletal disorders (MSDs). This research aims to evaluate the evidence about the correlation between wearing anti-X aprons and work-related MSDs. A systematic scoping review of articles published between 1990 and 2020 was conducted by searching the PubMed, Scopus, Embase, and Web of Science databases. Twelve cross-sectional studies, conducted among interventional physicians, nurses, and technicians, were finally included. Five studies primarily investigated the association between use of anti-X aprons and MSDs, showing that a higher prevalence of disorders was not always associated with the use of protective aprons. No studies investigated the impact of anti-X aprons on fitness for work assessment, particularly in subjects with MSDs. There is no complete agreement about the correlation between anti-X apron-wearing and the occurrence of MSDs, although the possible discomfort of workers using anti-X aprons appears more evident. Further studies are needed to objectify the role of these protective devices in the genesis of MSDs and to offer specific ergonomic solutions for healthcare workers.
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Affiliation(s)
- Maria Grazia Lourdes Monaco
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Correspondence: ; Tel.: +39-045-812-3946
| | - Angela Carta
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Health, University of Verona, 37134 Verona, Italy
| | - Tishad Tamhid
- Postgraduate School of Occupational Medicine, University of Verona, 37134 Verona, Italy;
| | - Stefano Porru
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Health, University of Verona, 37134 Verona, Italy
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