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Tamirisa KP, Alasnag M, Calvert P, Islam S, Bhardwaj A, Pakanati K, Zieroth S, Razminia M, Dalal AS, Mamas M, Russo AM, Kort S. Radiation Exposure, Training, and Safety in Cardiology. JACC. ADVANCES 2024; 3:100863. [PMID: 38939686 PMCID: PMC11198606 DOI: 10.1016/j.jacadv.2024.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 06/29/2024]
Abstract
Exposure to ionizing radiation is an inherent occupational health hazard in clinical cardiology. Health risks have been reported previously, including predilection to cancer. In addition, orthopedic injury due to prolonged wearing of heavy protective lead aprons, which are mandatory to reduce radiation risk, have been extensively documented. Cardiology as a specialty has grown with rising volumes of increasingly complex procedures. This includes electrophysiological, coronary, and structural intervention, advanced heart failure/transplant management, and diagnostic imaging. Both the operator as well imaging specialists are exposed to radiation, particularly in structural interventions where interventional cardiologists and structural imagers work closely. Increasingly, women interested in cardiology may deselect the field due to radiation concerns. This expert document highlights the risks of radiation exposure in cardiology, including practical tips within various subspecialty fields such as interventional/structural cardiology, electrophysiology, imaging, advanced heart failure, and pediatric cardiology.
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Affiliation(s)
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Sabrina Islam
- Section of Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Anju Bhardwaj
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas/McGovern Medical School, Texas Medical Center, Houston, Texas, USA
| | - Keerthana Pakanati
- Center for Cardiovascular Health, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Shelley Zieroth
- Department of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | | | - Aarti S. Dalal
- Division of Cardiology, Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
| | - Andrea M. Russo
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
| | - Smadar Kort
- Department of Cardiology, Stony Brook Heart Institute, Stony Brook, New York, USA
| | - ACC Women in Cardiology Advocacy Work Group
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Section of Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas/McGovern Medical School, Texas Medical Center, Houston, Texas, USA
- Center for Cardiovascular Health, Virginia Mason Franciscan Health, Seattle, Washington, USA
- Department of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
- Amita St. Joseph Hospital, Elgin, Illinois, USA
- Division of Cardiology, Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
- Department of Cardiology, Stony Brook Heart Institute, Stony Brook, New York, USA
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Madder RD, Seth M, Frazier K, Dixon S, Karve M, Collins J, Miller RV, Pielsticker E, Sharma M, Sukul D, Gurm HS. Statewide Initiative to Reduce Patient Radiation Doses During Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2024; 17:e013502. [PMID: 38348649 DOI: 10.1161/circinterventions.123.013502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/06/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Improved radiation safety practices are needed across hospitals performing percutaneous coronary intervention (PCI). This study was performed to assess the temporal trend in PCI radiation doses concurrent with the conduct of a statewide radiation safety initiative. METHODS A statewide initiative to reduce PCI radiation doses was conducted in Michigan between 2017 and 2021 and included focused radiation safety education, reporting of institutional radiation doses, and implementation of radiation performance metrics for hospitals. Using data from a large statewide registry, PCI discharges between July 1, 2016, and July 1, 2022, having a procedural air kerma (AK) recorded were analyzed for temporal trends. A multivariable regression analysis was performed to determine whether declines in procedural AK over time were attributable to changes in known predictors of radiation doses. RESULTS Among 131 619 PCI procedures performed during the study period, a reduction in procedural AK was observed over time, from a median dose of 1.46 (0.86-2.37) Gy in the first year of the study to 0.97 (0.56-1.64) Gy in the last year of the study (P<0.001). The proportion of cases with an AK ≥5 Gy declined from 4.24% to 0.86% over the same time period (P<0.0001). After adjusting for variables known to impact radiation doses, a 1-year increase in the date of PCI was associated with a 7.61% (95% CI, 7.38%-7.84%) reduction in procedural AK (P<0.0001). CONCLUSIONS Concurrent with the conduct of a statewide initiative to reduce procedural radiation doses, a progressive and significant decline in procedural radiation doses was observed among patients undergoing PCI in the state of Michigan.
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Affiliation(s)
- Ryan D Madder
- Frederik Meijer Heart and Vascular Institute, Division of Cardiovascular Medicine, Corewell Health West, Grand Rapids, MI (R.D.M.)
| | - Milan Seth
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.S., K.F., D.S., H.S.G.)
| | - Kathleen Frazier
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.S., K.F., D.S., H.S.G.)
| | - Simon Dixon
- Department of Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI (S.D.)
| | | | - John Collins
- Ascension St. Mary's Hospital, Saginaw, MI (J.C.)
| | | | | | | | - Devraj Sukul
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.S., K.F., D.S., H.S.G.)
| | - Hitinder S Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.S., K.F., D.S., H.S.G.)
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Colello SS, Fiorilli PN, Hirshfeld JW. Old Dogs Can Learn New Tricks: Reducing Radiation Exposure in the Cardiac Catheterization Laboratory. Circ Cardiovasc Interv 2024; 17:e013846. [PMID: 38348664 DOI: 10.1161/circinterventions.123.013846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Stephanie S Colello
- Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Paul N Fiorilli
- Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - John W Hirshfeld
- Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, Paolucci M, Mazzone P, Guarracini F. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics (Basel) 2024; 14:182. [PMID: 38248058 PMCID: PMC10814721 DOI: 10.3390/diagnostics14020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Eleonora Bonvicini
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Elena Coradello
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Carbonaro
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Giulia Colombo
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Paolucci
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101181. [PMID: 39131968 PMCID: PMC11307799 DOI: 10.1016/j.jscai.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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7
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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: 10] [Impact Index Per Article: 10.0] [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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8
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Fiorilli PN, Goldsweig AM. Occupationally Exposed: It Is Time to Protect Ourselves! JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100610. [PMID: 39130721 PMCID: PMC11307579 DOI: 10.1016/j.jscai.2023.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 08/13/2024]
Affiliation(s)
- Paul N. Fiorilli
- Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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10
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Huang H, Chen L, Liu J, Wang W, Cao Y, Yuan B, Tao E, Fang Q, Tang L, Wang F, Wan L. Clinical application of percutaneous left atrial appendage occlusion guided only by transesophageal echocardiography without fluoroscopy and angiography in the patients with nonvalvular atrial fibrillation. J Card Surg 2022; 37:1479-1485. [PMID: 35355334 DOI: 10.1111/jocs.16463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/05/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The objective of this study was to understand the clinical efficacy and application of the percutaneous left atrial appendage occlusion (PLAAO) guided only by the transesophageal echocardiography (TEE) in patients with nonvalvular atrial fibrillation (NVAF), without using the fluoroscopy and angiography. METHODS During the time period of this study from June 2020 to June 2021, 32 patients underwent PLAAO and all underwent a TEE guided approach. The anatomical features of the left atrial appendage (LAA) were evaluated and observed by TEE before and during the procedure. LAA occluder device was selected for the appropriate size. Intraoperative TEE guided and monitored the process of PLAAO in real-time, and also evaluated the stability and tightness of the occluder device, following monitored postoperative complications. RESULTS The PLAAO procedure was successful in all the patients. No serious complications like dislocation of the occluder and embolism were seen. Postoperative TEE demonstrated that the PLAAO occluder devices were in a good position without residual shunting. CONCLUSIONS PLAAO only guided by TEE may become a safe and reliable surgical procedure, which can protect surgeons and patients from radiation, and can gradually become a novel surgical method of PLAAO with the practical application value.
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Affiliation(s)
- Huang Huang
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Li Chen
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Ultrasound Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jichun Liu
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wenjun Wang
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuanping Cao
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Yuan
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ende Tao
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qiao Fang
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Liang Tang
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Fudong Wang
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Li Wan
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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11
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Conventional fluoroscopy-guided versus zero-fluoroscopy catheter ablation of supraventricular tachycardias. BMC Cardiovasc Disord 2022; 22:98. [PMID: 35282836 PMCID: PMC8919640 DOI: 10.1186/s12872-022-02544-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/02/2022] [Indexed: 12/26/2022] Open
Abstract
Abstract
Purpose
The aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy (ZF) catheter ablation (CA) for supraventricular tachycardias (SVT).
Methods
584 consecutive patients referred to our institution for CA of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. The ZF group was further divided into two subgroups (adults and paediatric). Patient characteristics, procedural information, and follow-up data were compared.
Results
The ZF group had a higher proportion of paediatric patients (42.2% vs 0.0%; p < 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p < 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p < 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4%; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p = 0.004). The difference can be partially explained by the operators' preferences.
Conclusion
The safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.
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12
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Dalvi S, Roberts HM, Bellamy C, Rees M. The use of digital magnification to reduce radiation dose in the cardiac catheter laboratory. Br J Radiol 2022; 95:20210269. [PMID: 34889648 PMCID: PMC8722255 DOI: 10.1259/bjr.20210269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To audit whether using magnification of images by use of a large viewing screen using digital matrix magnification which enlarges the image by 33% without using the X-ray machine zoom magnification protocols on a Siemens Artis Zee X-ray machine in a cardiac catheter laboratory results in a reduction of kerma-area product (KAP) for both diagnostic and interventional procedures. This reduction was predicted in an in vitro study in our laboratory, which has previously shown a 20.4% reduction in KAP. METHODS A retrospective analysis was conducted of the radiation exposure to compare the measured KAP recorded during the period when conventional magnification with automatic brightness and dose control was used on a Siemens Artis Zee X-ray machine with a flat panel detector and when magnification settings were avoided by using a large screen to enlarge and project a non-magnified image by digital magnification. The analysis was carried out for patients having a diagnostic coronary angiogram and those having an interventional coronary procedure. RESULTS For diagnostic coronary angiograms the median KAP per procedure in the period using conventional magnification was 2124.5 µGy.m2 compared to 1401 µGy.m2 when image matrix magnification was used, a 34% reduction (p < 0.0001). For interventional coronary procedures, the median KAP per procedure in the period using conventional magnification was 3791 µGy.m2 compared to 2568.5 µGy.m2 when image matrix magnification was used, a 32% reduction (p < 0.0001). CONCLUSION Avoiding using conventional magnification in the cardiac catheter laboratory and using a large screen to magnify images was associated with a statistically significant greater than 30% reduction in KAP. ADVANCES IN KNOWLEDGE This paper is the proof in clinical practice of a theoretical conclusion that radiation dose (KAP) is reduced by use of Image matrix magnification using a large viewing screen without the need to use X-ray tube magnification without significant loss of image resolution in interventional cardiology. The same approach will be useful in interventional radiology.
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13
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Zagrodzky J, Bailey S, Shah S, Kulstad E. Impact of Active Esophageal Cooling on Fluoroscopy Usage During Left Atrial Ablation. J Innov Card Rhythm Manag 2021; 12:4749-4755. [PMID: 34676132 PMCID: PMC8519316 DOI: 10.19102/icrm.2021.121101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022] Open
Abstract
Risks to collateral structures exist with radiofrequency (RF) ablation of the left atrium to obtain pulmonary vein isolation (PVI) for the treatment of atrial fibrillation. Passive luminal esophageal temperature (LET) monitoring is commonly utilized, but increasing data suggest limited benefits with LET monitoring. In contrast, active cooling of the esophagus has been shown to significantly reduce esophageal injury. Active cooling of the esophagus also avoids the need for stopping and repositioning an LET probe during use, which may reduce the need for fluoroscopy use. This study aimed to measure the impact on fluoroscopy use during RF ablation with esophageal cooling using a dedicated cooling device in a low-fluoroscopy practice. All patients who underwent PVI over a one-year timeframe by a single provider were analyzed. Patients undergoing PVI prior to the incorporation of an esophageal cooling protocol into standard ablation practice were treated with traditional LET monitoring. Patients treated after this point received active esophageal cooling, in which no LET monitoring is utilized. A total of 280 patients were treated; 91 patients were treated using LET monitoring, and 189 patients were treated with esophageal cooling. The mean total fluoroscopy time before the implementation of the esophageal cooling protocol in 91 patients was 194 seconds [standard deviation (SD): 182 seconds] per case, with a median of 144 seconds. The mean total fluoroscopy time after implementation in 189 patients was 126 seconds (SD: 120 seconds) per case with a median of 96 seconds, representing a reduction of 35% per case (p < 0.0001, Mann-Whitney U test). In this largest study to date of active esophageal cooling during PVI, a 35% reduction in fluoroscopy time compared with patients who received LET monitoring was found. This reduction was seen despite an already low fluoroscopy usage rate in place.
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Affiliation(s)
- Jason Zagrodzky
- Department of Electrophysiology, St. David’s South Austin Medical Center, Austin, TX, USA
| | - Shane Bailey
- Department of Electrophysiology, St. David’s South Austin Medical Center, Austin, TX, USA
| | | | - Erik Kulstad
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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14
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Giaccardi M, Anselmino M, Del Greco M, Mascia G, Paoletti Perini A, Mascia P, De Ferrari GM, Picano E. Radiation awareness in an Italian multispecialist sample assessed with a web-based survey. Acta Cardiol 2021; 76:307-311. [PMID: 32228163 DOI: 10.1080/00015385.2020.1733303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The awareness of radiation doses and risks, also during interventional cardiology procedures, is essential today in order to apply the risk-benefit assessment and to reinforce the principles of justification and optimisation in clinical practice. METHODS A voluntary survey with 10 questions and multiple-choice answers was run on a popular cardiology website (www.cardiolink.it) independently by a scientific publisher, in order to evaluate the contemporary level of radiation awareness in a multi-speciality sample of physicians in Italy. RESULTS One thousand eight hundred and sixty-one physicians completed the test. The survey showed good results since both prescribers and practitioners (mostly cardiologists) working in Italy are largely aware of the cancer and non-cancer risks of medical radiation use, regardless of their subspecialty background. CONCLUSION Physicians are largely aware of the cancer and non-cancer risks of medical radiation use, regardless of their subspecialty background. However, there is still broad space for improvement; in the future, the awareness of radiation risk is a prerequisite to create a culture of respect for radiation hazard and a commitment to minimise exposure and maximise protection.
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Affiliation(s)
- Marzia Giaccardi
- Department of Internal Medicine, Cardiology and Electrophysiology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Matteo Anselmino
- Department of Medical Sciences, Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | | | - Giuseppe Mascia
- Department of Internal Medicine (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Paoletti Perini
- Department of Internal Medicine, Cardiology and Electrophysiology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Paola Mascia
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Gaetano Maria De Ferrari
- Department of Medical Sciences, Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
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15
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Jin L, Gao Y, Jiang A, Li Z, Wang P, Li M. Can the Coronary Artery Calcium Score Scan Reduce the Radiation Dose in Coronary Computed Tomography Angiography? Acad Radiol 2021; 28:364-369. [PMID: 32209277 DOI: 10.1016/j.acra.2020.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVES Radiation exposure from coronary computed tomography angiography (CCTA) remains a cause for concern. The objective of this study was to investigate whether using the coronary artery calcium score scan (CACS) would reduce the radiation dose for CCTA scanning and the overall radiation exposure (ORE). MATERIALS AND METHODS In total, 256 patients were examined with a third-generation dual-source CT (n = 200) or 256-row CT (n = 56), among whom 105 (Group A) and 28 patients (Group B), respectively, underwent CCTA with CACS for field of view planning. The remaining patients, with the scout view for field of view planning, constituted Group A1 and B1. The scanning parameter settings were standardized between groups. RESULTS Shorter scan lengths were observed in Group A (9.98 ± 0.79 cm) compared to Group A1 (13.64 ± 1.79 cm; p < 0.001), which also resulted in a lower dose-length product (DLP) in Group A (115.04 ± 64.13) relative to Group A1 (138.67 ± 68.87; p < 0.05). Similarly, shorter scan lengths were found in Group B (14.92 ± 1.17 cm) compared to Group B1 (15.79 ± 0.63 cm; p = 0.001); this resulted in a lower DLP (322.07 ± 45.39) compared to Group B1 (354.34 ± 65.27; p = 0.036). The CACS resulted in an increase in ORE in both groups. CONCLUSION CACS may have a critical role in the reduction of radiation dose in CCTA scanning, but the potential effectiveness of CACS in reducing ORE is weak.
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Affiliation(s)
- Liang Jin
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - Yiyi Gao
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - An'qi Jiang
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - Zhenlin Li
- Radiology Department, West China Hospital, Affiliated to SiChuan University, Chengdu, China
| | - Peijun Wang
- Radiology Department, Tongji Hospital, Affiliated to Tongji University, Shanghai, China
| | - Ming Li
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
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16
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Agricola E, Ancona F, Brochet E, Donal E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Ribeiro J, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Edvardsen T, Bertrand P, Delgado V, Gerber B, Stankovic I. The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2021; 22:471-479. [DOI: 10.1093/ehjci/jeab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of ‘Interventional Imaging’ for SHD interventions and a new dedicated professional figure, the ‘Interventional Imager’ with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, San Raffaele Hospital, IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, San Raffaele Hospital, Milan, Italy
| | - Eric Brochet
- Cardiology Department, Hôpital BICHAT Paris, France
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, Rennes, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Francesco Faletra
- Director of cardiac imaging service, . Cardiocentro Ticino Switzerland
| | - Patrizio Lancellotti
- Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Hani Mahmoud-Elsayed
- Consultant Cardiologist, Director of Echocardiography Lab, Al-Nas Hospital, Cairo, Egypt
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | | | - Mark Monaghan
- Director of Non-Invasive Cardiology, King’s College Hospital, London, UK
| | - José Ribeiro
- Thorax and Circulation Unit Director, Gaia Hospital Center, Oporto, Portugal
| | - Leyla Elif Sade
- University of Baskent, Department of Cardiology, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St.Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy ‘Carol Davila’ - Euroecolab, Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’, Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Thor Edvardsen
- Dept of Cardiology, Oslo University Hospital, Pb 4950 Nydalen, 0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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17
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McCutcheon K, Vanhaverbeke M, Pauwels R, Dabin J, Schoonjans W, Bennett J, Adriaenssens T, Dubois C, Sinnaeve P, Desmet W. Efficacy of MAVIG X-Ray Protective Drapes in Reducing Operator Radiation Dose in the Cardiac Catheterization Laboratory: A Randomized Controlled Trial. Circ Cardiovasc Interv 2020; 13:e009627. [PMID: 33092401 DOI: 10.1161/circinterventions.120.009627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interventional cardiologists are occupationally exposed to high doses of ionizing radiation. The MAVIG X-ray protective drape (MXPD) is a commercially available light weight, lead-free shield placed over the pelvic area of patients to minimize operator radiation dose. The aim of this study was to examine the efficacy of the MXPD during routine cardiac catheterization, including percutaneous coronary interventions. METHODS We performed a prospective, randomized controlled study comparing operator radiation dose during cardiac catheterization and percutaneous coronary intervention (n=632) with or without pelvic MXPD. We measured operator radiation dose at 4 sites: left eye, chest, left ring finger, and right ring finger. The primary outcomes were the difference in first operator radiation dose (µSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the 2 groups. RESULTS The use of the MXPD was associated with a 50% reduction in operator radiation dose (median dose 30.5 [interquartile range, 23.0-39.7] µSv in no drape group versus 15.3 [interquartile range, 11.1-20.0] µSv in the drape group; P<0.001) and a 57% reduction in relative operator dose (P<0.001). The largest absolute reduction in dose was observed at the left finger (median left finger dose for the no drape group was 104.9 [75.7-137.4] µSv versus 41.9 [32.6-70.6] µSv in the drape group; P<0.001). CONCLUSIONS The pelvic MXPD significantly reduces first operator radiation dose during routine cardiac catheterization and percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04285944.
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Affiliation(s)
- Keir McCutcheon
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Maarten Vanhaverbeke
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Ruben Pauwels
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.)
| | - Jérémie Dabin
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Werner Schoonjans
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Johan Bennett
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Christophe Dubois
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Peter Sinnaeve
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Walter Desmet
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
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18
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Catto V, Stronati G, Porro B, Fiorelli S, Ricci V, Vavassori C, Russo E, Guerra F, Gasperetti A, Ribatti V, Sicuso R, Dello Russo A, Veglia F, Tondo C, Cavalca V, Colombo GI, Tremoli E, Casella M. Cardiac arrhythmia catheter ablation procedures guided by x-ray imaging: N-acetylcysteine protection against radiation-induced cellular damage (CARAPACE study): study design. J Interv Card Electrophysiol 2020; 61:577-582. [PMID: 32833109 DOI: 10.1007/s10840-020-00853-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Catheter ablation (CA) procedures are characterized by exposure to ionizing radiations (IR). IR can cause DNA damage and may lead to carcinogenesis if not efficiently repaired. The primary endpoint of this study is to investigate whether intravenous administration of N-acetylcysteine prior to CA procedure may prevent systemic oxidative stress and genomic DNA damage induced by exposure to IR. METHODS The "Cardiac Arrhythmia catheter ablation procedures guided by x-Ray imaging: N-Acetylcysteine Protection Against radiation induced Cellular damagE" (CARAPACE) study is a prospective, randomized, single-blinded, parallel-arm monocenter study enrolling 550 consecutive patients undergoing CA at the Arrhythmology Unit of Centro Cardiologico Monzino (CCM). Inclusion criteria are age ≥ 18, indication for CA procedure guided by IR imaging, and written informed consent. IR levels will be measured via fluoroscopy time, effective dose, and dose area product. Glutathione and glutathione disulfide concentrations will be measured, and urinary levels of 8-iso-prostaglandin-F2α and 8-hydroxy-2-deoxyguanosine will be quantified. The enrolled patients will be randomized 1:1 to the N-acetylcysteine group or to the control group. RESULTS We expect that pre-operative administration of N-acetylcysteine will prevent IR-induced systemic oxidative stress. The study will provide data on oxidative DNA damage assessed by urinary 8-hydroxy-2-deoxyguanosine levels and direct evidence of genomic DNA damage in blood cells by comet assay. CONCLUSION Catheter ablation procedures can lead to IR exposure and subsequent DNA damage. N-acetylcysteine administration prior to the procedure may prevent them and therefore lead to less possible complications. TRIAL REGISTRATION www.clinicaltrials.gov (NCT04154982).
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Affiliation(s)
- Valentina Catto
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Torrette (AN), 60126, Ancona, Italy.
| | - Benedetta Porro
- Unit of Metabolomics and Cellular Biochemistry of Atherothrombosis, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Susanna Fiorelli
- Unit of Metabolomics and Cellular Biochemistry of Atherothrombosis, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Veronica Ricci
- Unit of Immunology and Functional Genomics, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Chiara Vavassori
- Unit of Immunology and Functional Genomics, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eleonora Russo
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Torrette (AN), 60126, Ancona, Italy
| | | | - Valentina Ribatti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Rita Sicuso
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Torrette (AN), 60126, Ancona, Italy
| | - Fabrizio Veglia
- Unit of Biostatistics, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Viviana Cavalca
- Unit of Metabolomics and Cellular Biochemistry of Atherothrombosis, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gualtiero I Colombo
- Unit of Immunology and Functional Genomics, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino IRCCS, 20138, Milan, Italy
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy
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19
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Cardiac catheterization real-time dynamic radiation dose measurement to estimate lifetime attributable risk of cancer. PLoS One 2020; 15:e0234461. [PMID: 32544209 PMCID: PMC7297332 DOI: 10.1371/journal.pone.0234461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/27/2020] [Indexed: 11/24/2022] Open
Abstract
Cardiac catheterization procedure is the gold standard to diagnose and treat cardiovascular disease. However, radiation safety and cancer risk remain major concerns. This study aimed to real-time dynamic radiation dose measurement to estimate lifetime attributable risk (LAR) of cancer incidence and mortality in operators. Coronary angiography (CA) with percutaneous coronary intervention (PCI), CA, and others (radiofrequency ablation, pacemaker and defibrillator implantation) procedures with different beam directions, were undertaken on x-ray angiography system. A real-time electronic personal dosimeter (EPD) system was used to measure the radiation dose of staff during all procedures. We followed the Biological Effects of Ionizing Radiation (BEIR) VII report to estimate the LAR of all cancer incidence and mortality. Primary operators received radiation dose in CA with PCI, CA, and others procedures were 59.33 ± 95.03 μSv, 39.81 ± 103.85 μSv, and 21.92 ± 37.04 μSv, respectively. As to the assistant operators were 30.03 ± 55.67 μSv, 14.67 ± 14.88 μSv, and 4 μSv, respectively. LAR of all cancer incidences for staffs aged from 18 to 65 are varied from 0.40% for males to 1.50% for females. LAR of all cancer mortality for staffs aged from 18 to 65 are varied from 0.22% for males to 0.83% for females. Our study provided an easy, real-time and dynamic radiation dose measurement to estimate LAR of cancer for staff during the cardiac catheterization procedures. The LAR for all cancer incidence is about twice that for cancer mortality. Although the radiation doses of staff are lower during each procedure, the increased years of service leads to greater radiation risk to the staff.
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Kubicki R, Hummel J, Höhn R, Müller K, Stiller B, Grohmann J. Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access. Open Heart 2020; 7:e001267. [PMID: 32595140 PMCID: PMC7322512 DOI: 10.1136/openhrt-2020-001267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To assess the potential occupational radiation reduction and technical feasibility in patients rotated 180° (upside-down) when requiring neck access for transcervical or trans-subclavian catheterisation. METHODS Upside-down positioning is defined as rotating patients in supine position by 180°, so that the feet come to rest where the head would otherwise be. We retrospectively evaluated all these procedures performed between March 2016 and May 2019. Furthermore, two different phantoms (paediatric and adult) were used prospectively to quantify the occupational dose between conventional or upside-down positioning. In this context, ambient dose equivalents were measured using real-time dosimeters. Three different projection angles were applied. RESULTS 44 patients with median age and body weight of 1.0 year (range 0-56) and 9.5 kg (range 1.3-74.3) underwent 63 procedures positioned upside-down. This position proved advantageous for practical reasons, since the length of the examination table could be optimally used. Additionally, it resulted in a significantly lower overall ambient dose equivalent for the primary operator (PO) of 94.8% (mean: 2569±807 vs 135±23 nSv; p<0.01) in the adult, and of 65.5% (mean: 351±104 vs 121±56 nSv; p<0.01) in the paediatric phantom, respectively. CONCLUSION Upside-down positioning facilitates handling in a straightforward manner when access from the neck is required. Moreover, it significantly reduces local radiation exposure for the PO in the paediatric and, most impressively, in the adult phantom.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Johanna Hummel
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - René Höhn
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Kevin Müller
- Department of Occupational Safety, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
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Mortimer-Roberts H, Rees MR. The difference in dose and image quality between magnification methods used after the introduction of larger 60-inch operator screens. BJR Open 2020; 2:20190044. [PMID: 33178965 PMCID: PMC7594884 DOI: 10.1259/bjro.20190044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine whether the use of display matrix magnification on larger operator screens without the use of conventional magnification can reduce radiation dose to the patient, and what effect it would have on image quality. METHODS The kerma-area product (KAP) resulting from standard projections in cardiac angiography were measured when an anthropomorphic phantom was imaged using conventional magnification method and display matrix magnification. The image quality was also evaluated by three observers using a TOR 18FG test tool for both magnification method. RESULTS The mean radiation KAP for the seven views with conventional magnification was 36.65 µGy m-2 whilst a reduction in KAP of 20.4% is possible using display matrix magnification (p < 0.05). The image resolution during acquisition was identical between both methods and only slightly reduced for the display matrix (1.6 LP mm-1) compared to conventional magnification (1.8 LP mm-1) when images were stored and retrieved on a Picture Archiving and Communication Systems (PACS) system. Both methods retained the same low-contrast detectability to PACS, with only a slight increase in detectability of 18 for display matrix magnification compared to 17 for conventional. CONCLUSION Using display matrix magnification instead of conventional equipment magnification significantly reduces radiation does in all standard cardiac views without reducing image quality for the operator. This reduction in radiation dose is significant (p < 0.05) for the patients. The resolution did not change during acquisition, but contrast improved slightly (0.9% threshold contrast), but lost resolution of 0.2 LP mm-1 when archived to PACS. ADVANCES IN KNOWLEDGE This is a new method of reducing significant dose to the patient during cardiology examinations and may encourage further studies in other fluoroscopy lead examination to see if it could work for them.
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Affiliation(s)
- Hywel Mortimer-Roberts
- North Wales Cardiac Centre, Betsi Cadwaladr University Health Board, Sarn Lan, United Kingdom
| | - Michael R Rees
- North Wales Cardiac Centre, Betsi Cadwaladr University Health Board, Sarn Lan, United Kingdom
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22
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Madder RD, Dixon SR, Seth M, Lee D, Earl T, Hill T, Shah I, Gurm HS. Institutional Variability in Patient Radiation Doses ≥5 Gy During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2020; 13:846-856. [DOI: 10.1016/j.jcin.2019.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022]
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23
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Doyen B, Vlerick P, Soenens G, Vermassen F, Van Herzeele I. Team perception of the radiation safety climate in the hybrid angiography suite: A cross-sectional study. Int J Surg 2020; 77:48-56. [PMID: 32200059 DOI: 10.1016/j.ijsu.2020.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/09/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Good radiation safety practice in the angiosuite is essential to protect patients and healthcare workers. Most strategies aim to advance radiation safety through technological upgrades and educational initiatives. However, safety literature suggests that additional ways to improve radiation safety in the angiosuite do exist. The safety climate reflects the way team members perceive various key characteristics of their work environment and is closely related to relevant safety outcomes. A specific 'radiation safety climate' has not been described nor studied in the hybrid angiosuite. This study explores the radiation safety climate in the hybrid angiosuite and its relation to team members' radiation safety behavior, knowledge and motivation. MATERIALS AND METHODS Vascular surgeons, fellows/trainees and operating room nurses active in the angiosuite at five hospitals were invited to complete an online self-report questionnaire assessing the radiation safety climate (28 items); radiation safety behavior; radiation safety knowledge and radiation safety motivation. Relations between climate scores and behavior were investigated using Pearson correlations. Mediation was analyzed using the Baron and Kenny analysis. P-Values < 0.05 were considered statistically significant. RESULTS No major differences were identified in total radiation safety climate scores between centers or team member functions. Scale reliability for radiation safety climate was good to excellent (α > 0.663). Total radiation safety climate scores were positively related to the radiation safety behavior score (r = 0.403; p = 0.015). This relation was partially mediated by radiation safety knowledge (β = 0.1730; 95% CI: [0.0475; 0.3512]), while radiation safety motivation did not act as a mediator: (β = 0.010; 95% CI: [-0.0561; 0.0998]). CONCLUSION A well-developed radiation safety climate in the hybrid angiosuite fosters positive radiation safety behaviors, which may partially be explained through improved radiation safety knowledge transfer. Further research on (radiation) safety climate and its impact on radiation safety-related outcome measures for patients is recommended.
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Affiliation(s)
- Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Peter Vlerick
- Department of Work, Organisation and Society, Ghent University, Ghent, Belgium
| | - Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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24
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Aristizábal JM. Riesgo cardiovascular relacionado con la radiación ionizante. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Baykaner T, Quadros KK, Thosani A, Yasmeh B, Mitra R, Liu E, Belden W, Liu Z, Costea A, Brodt CR, Zei PC. Safety and efficacy of zero fluoroscopy transseptal puncture with different approaches. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 43:12-18. [PMID: 31736095 DOI: 10.1111/pace.13841] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation requires access to the left atrium (LA) via transseptal puncture (TP). TP is traditionally performed with fluoroscopic guidance. Use of intracardiac echocardiography (ICE) and three-dimensional mapping allows for zero fluoroscopy TP. OBJECTIVE To demonstrate safety and efficacy of zero fluoroscopy TP using multiple procedural approaches. METHODS Patients undergoing AF ablation between January 2015 and November 2017 at five institutions were included. ICE and three-dimensional mapping were used for sheath positioning and TP. Variable technical approaches were used across centers including placement of J wire in the superior vena cava with ICE guidance followed by dragging down the transseptal sheath into the interatrial septum, or guiding the transseptal sheath directly to the interatrial septum by localizing the ablation catheter with three-dimensional mapping and replacing it with the transseptal needle once in position. In patients with pacemaker/implantable cardiac defibrillator leads, pre-/poststudy device interrogation was performed. RESULTS A total of 747 TPs were performed (646 patients, age 63.1 ± 13.1, 67.5% male, LA volume index 34.5 ± 15.8 mL/m2 , ejection fraction 57.7 ± 10.9%) with 100% success. No punctures required fluoroscopy. Two pericardial effusions, two pericardial tamponades requiring pericardiocentesis, and one transient ischemic attack were observed during the overall ablation procedure, with a total complication rate of 0.7%. There were no other periprocedural complications related to TP, including intrathoracic bleeding, stroke, or death both immediately following TP and within 30 days of the procedure. In patients with intracardiac devices, no device-related complications were observed. CONCLUSION TP can be safely and effectively performed without the need for fluoroscopy.
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Affiliation(s)
- Tina Baykaner
- Department of Medicine, Stanford University, Stanford, California
| | - Kenneth K Quadros
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amit Thosani
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Babak Yasmeh
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Raman Mitra
- Department of Medicine, Beacon Health System, South Bend, Indiana
| | - Emerson Liu
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - William Belden
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Zhigang Liu
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alex Costea
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Chad R Brodt
- Department of Medicine, Stanford University, Stanford, California
| | - Paul C Zei
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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26
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Fiorilli PN, Kobayashi T, Giri J, Hirshfeld JW. Strategies for radiation exposure‐sparing in fluoroscopically guided invasive cardiovascular procedures. Catheter Cardiovasc Interv 2019; 95:118-127. [DOI: 10.1002/ccd.28281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/29/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Paul N. Fiorilli
- Cardiovascular Medicine DivisionHospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (CAVOQER) Philadelphia Pennsylvania
- Corporal Michael J Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania
| | - Taisei Kobayashi
- Cardiovascular Medicine DivisionHospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (CAVOQER) Philadelphia Pennsylvania
- Corporal Michael J Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania
| | - Jay Giri
- Cardiovascular Medicine DivisionHospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (CAVOQER) Philadelphia Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Philadelphia Pennsylvania
- Corporal Michael J Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania
| | - John W. Hirshfeld
- Cardiovascular Medicine DivisionHospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Corporal Michael J Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania
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27
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Patient effective doses and radiation risks in cardiac catheterization procedures. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2018.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Thompson RC, Soman P. Striking a balance in the discussion of the benefits of imaging tests and risks of radiation exposure. J Nucl Cardiol 2019; 26:136-137. [PMID: 30030785 DOI: 10.1007/s12350-018-1372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Randall C Thompson
- St. Luke's Mid America Heart Institute, University of Missouri - Kansas City, 4330 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA.
| | - Prem Soman
- University of Pittsburg Medical Center, Pittsburgh, PA, USA
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29
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Cavalcante JL, Wang DD. Structural Heart Interventional Imagers - The New Face of Cardiac Imaging. Arq Bras Cardiol 2018; 111:645-647. [PMID: 30484504 PMCID: PMC6248239 DOI: 10.5935/abc.20180232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis - Minnesota - USA.,Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota - USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit - Michigan - USA
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30
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Wunderle KA, Chung MK, Rayadurgam S, Miller MA, Obuchowski NA, Lindsay BD. Occupational and patient radiation doses in a modern cardiac electrophysiology laboratory. J Interv Card Electrophysiol 2018; 56:183-190. [PMID: 30280302 DOI: 10.1007/s10840-018-0462-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/25/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Technological advancements have greatly expanded the field of cardiac electrophysiology, requiring greater demands on imaging systems and potentially delivering higher radiation doses to patients and operators. With little contemporary research on occupational and patient radiation risk in the electrophysiology laboratory, the aim of this study was to analyze radiation doses, including occupational fetal doses, over approximately the last decade. We benchmarked the occupational data to our patient radiation dose data to allow for comparison and to put into perspective the associated radiation risks. METHODS Occupational radiation dosimetry analyzed included data from an 11-year period for physicians, a 7-year period for nurses, and a 9-year period for fetal doses. Patient-related dose metrics over an 8-year period were also analyzed. RESULTS In the physician and nursing groups, there was a nearly 70% decrease in the average occupational radiation doses over the given periods. Within the electrophysiology department, the average fetal occupational doses were very low, close to 0 μSv. The average reference point air kerma per patient for all electrophysiology procedures decreased from nearly 600 mGy/procedure in 2010 to just over 100 mGy/procedure in 2017. CONCLUSIONS Patient and occupational radiation doses in our laboratories significantly decreased over the periods analyzed as a result of clinical and technical staff efforts as well as advances in imaging technology. The radiation-related risk to individuals working in our electrophysiology laboratories, including pregnant women, is very low. Data reported herein could be used by other institutions to evaluate their occupational and patient radiation safety practices.
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Affiliation(s)
- Kevin A Wunderle
- Department of Radiology, Cleveland Clinic, 25900 Science Park Dr., AC211, Beachwood, OH, 44122, USA.
| | - Mina K Chung
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mark A Miller
- Department of Radiation Safety, Cleveland Clinic, Cleveland, OH, USA
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce D Lindsay
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Picano E, Ciampi Q, Wierzbowska-Drabik K, Urluescu ML, Morrone D, Carpeggiani C. The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol. Cardiovasc Ultrasound 2018; 16:22. [PMID: 30285774 PMCID: PMC6167852 DOI: 10.1186/s12947-018-0141-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/24/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The detection of regional wall motion abnormalities is the cornerstone of stress echocardiography. Today, stress echo shows increasing trends of utilization due to growing concerns for radiation risk, higher cost and stronger environmental impact of competing techniques. However, it has also limitations: underused ability to identify factors of clinical vulnerability outside coronary artery stenosis; operator-dependence; low positivity rate in contemporary populations; intermediate risk associated with a negative test; limited value of wall motion beyond coronary artery disease. Nevertheless, stress echo has potential to adapt to a changing environment and overcome its current limitations. INTEGRATED-QUADRUPLE STRESS-ECHO Four parameters now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-stress echo. They are: 1- regional wall motion abnormalities; 2-B-lines measured by lung ultrasound; 3-left ventricular contractile reserve assessed as the stress/rest ratio of force (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D); 4- coronary flow velocity reserve on left anterior descending coronary artery (with color-Doppler guided pulsed wave Doppler). IQ-Stress echo allows a synoptic functional assessment of epicardial coronary artery stenosis (wall motion), lung water (B-lines), myocardial function (left ventricular contractile reserve) and coronary small vessels (coronary flow velocity reserve in mid or distal left anterior descending artery). In "ABCD" protocol, A stands for Asynergy (ischemic vs non-ischemic heart); B for B-lines (wet vs dry lung); C for Contractile reserve (weak vs strong heart); D for Doppler flowmetry (warm vs cold heart, since the hyperemic blood flow increases the local temperature of the myocardium). From the technical (acquisition/analysis) viewpoint and required training, B-lines are the kindergarten, left ventricular contractile reserve the primary (for acquisition) and secondary (for analysis) school, wall motion the university, and coronary flow velocity reserve the PhD program of stress echo. CONCLUSION Stress echo is changing. As an old landline telephone with only one function, yesterday stress echo used one sign (regional wall motion abnormalities) for one patient with coronary artery disease. As a versatile smart-phone with multiple applications, stress echo today uses many signs for different pathophysiological and clinical targets. Large scale effectiveness studies are now in progress in the Stress Echo2020 project with the omnivorous "ABCD" protocol.
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Affiliation(s)
- Eugenio Picano
- Institute of Clinical Physiology, National Council Research, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Quirino Ciampi
- Fatebenefratelli Hospital of Benevento, Viale Principe di Napoli, 12, 82100 Benevento, Italy
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Ul Kniaziewicza 1/5, 91-347 Lodz, Poland
| | | | - Doralisa Morrone
- Cardiothoracic department, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Clara Carpeggiani
- Institute of Clinical Physiology, National Council Research, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
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Schnur M, Wannagat S, Loehr L, Lask S, Mügge A, Wutzler A. [Radiation reduction in interventional electrophysiology : Results from operators with different levels of experience]. Herzschrittmacherther Elektrophysiol 2018; 29:406-410. [PMID: 30155562 DOI: 10.1007/s00399-018-0589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiation exposure in the catherization laboratory is associated with significant health risks. It is unclear whether a reduction of radiation exposure with the use of "near-zero fluoroscopy" protocols is possible when applied by less experienced operators. METHODS Consecutive ablation procedures with the use of a 3D mapping system were analyzed. Three time periods were analyzed. During the first period (standard), no specific radiation-reduction protocol was used. During the second period (initial phase of radiation reduction) a near "near-zero fluoroscopy" protocol was implemented; however, the majority of procedures were performed by an expert. During the third period (routine use of radiation reduction), less experienced operators (fellow and beginner) performed a growing number of procedures with the "near-zero fluoroscopy" protocol. RESULTS In all, 290 procedures were analyzed. After implementation of a radiation-reduced protocol, a significant reduction of radiation exposure was observed (standard 850 ± 831.7 vs. initial phase 197.2 ± 481.8 μGy/m2, p < 0.001, and vs. routine use 283 ± 493.8 μGy/m2, p < 0.001). No significant difference was observed between the initial phase and routine phase (p = 1). Over the three periods, the proportion of procedures performed by less experienced operators grew significantly for complex (fellow: 0% vs. 10% vs. 30%; p < 0.001) and noncomplex procedures (fellow: 30% vs. 39% vs. 49%; beginner: 15% vs. 38% vs. 34%; p = 0.002). Complication rates were not significantly different. CONCLUSIONS Implementation of a radiation-reduced protocol leads to a significant reduction of radiation exposure even in less experienced operators during training.
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Affiliation(s)
- Miriam Schnur
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Severin Wannagat
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Lena Loehr
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Sebastian Lask
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Andreas Mügge
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Alexander Wutzler
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
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