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Nasr B, Villa M, Benoit D, Visvikis D, Bert J. Monte Carlo Dosimetry Validation for X-Ray Guided Endovascular Procedures. Ann Vasc Surg 2024; 99:186-192. [PMID: 37717818 DOI: 10.1016/j.avsg.2023.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Endovascular treatment is continuously gaining ground in vascular surgery procedures. However, current patient radiation dose estimation does not take into account the exact patient morphology and organs' composition. Monte Carlo (MC) simulation can accurately estimate the dose by recreating the irradiation process generated during X-ray-guided interventions. This study aimed to validate the MC simulation models by comparing simulated and measured dose distributions in endovascular aortic aneurysm repair (EVAR) procedures. METHODS We conducted a clinical study in patients treated for EVAR. Patient dose measurements were taken with passive dosimeters using Optically Stimulated Luminescence technology in 4 specific anatomical points on the skin: xiphoid process, pubic symphysis, right and left iliac crest. Dose measurements were compared to the corresponding simulated doses with the Geant4 Application for Emission Tomography (GATE) and GPU Geant4-based Monte Carlo Simulations (GGEMS) MC simulations softwares. The MC simulation took as input the computed tomography scan of the patient and the parameters of the imaging system (orientation angles, tube voltage, and aluminum filtration) and gives as output the three-dimensional (3D) dose map for each patient and angulation. RESULTS A good agreement with real doses was found for doses simulated by the MC GATE method (P < 0.0001; r = 0.97; 95% confidence interval [CI] [0.96-0.98]), as well as for doses simulated by the GGEMS method (P < 0.0001; r = 0.96; 95% CI [0.94-0.97]). The mean relative error for all measurements was 5 ± 5% in the MC GATE group and 6 ± 5% in the GGEMS group. Process execution on GGEMS (6 sec) was faster than the GATE MC simulation (5 hr). CONCLUSION Considering the current imaging settings, this study shows the potential of using the GATE and GGEMS MC simulations platforms to model the 3D dose distributions during EVAR procedures.
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Affiliation(s)
- Bahaa Nasr
- Univ Brest, INSERM, IMT-Atlantique, UMR 1011 LaTIM, Brest, France; CHU Cavale Blanche Brest, Vascular and Endovascular Surgery Department, Brest, France.
| | - Mateo Villa
- Univ Brest, INSERM, IMT-Atlantique, UMR 1011 LaTIM, Brest, France
| | - Didier Benoit
- Univ Brest, INSERM, IMT-Atlantique, UMR 1011 LaTIM, Brest, France
| | | | - Julien Bert
- Univ Brest, INSERM, IMT-Atlantique, UMR 1011 LaTIM, Brest, France
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2
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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: 9] [Impact Index Per Article: 9.0] [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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3
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Goula A, Chatzis A, Stamouli MA, Kelesi M, Kaba E, Brilakis E. Assessment of Health Professionals' Attitudes on Radiation Protection Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413380. [PMID: 34948989 PMCID: PMC8708066 DOI: 10.3390/ijerph182413380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Health professionals' knowledge, beliefs and perceptions concerning radiation protection may affect their behaviour during surgery and consequently influence the quality of health services. This study highlights the health professionals' average knowledge level and captures the beliefs, perceptions, and behaviours in a large public Greek hospital. (2) Materials and Methods: A cross-sectional study was carried out, including health professionals working in operating rooms. One hundred thirty-two staff members participated by responding to an original questionnaire. The sample consisted of nurses, radiographers and medical doctors of various specialties involved daily in surgical procedures where ionizing radiation is required. The survey was conducted from March to June 2021, and the response rate was 97%. (3) Results: The level of overall knowledge of health professionals regarding radiation protection safety was not satisfactory. Females and employees with a lower level of education had more misconceptions about radiation and radiation protection. Employees of younger ages and with less previous experience were more likely to have negative emotions towards radiation exposure. Finally, employees with fewer children tended to express physical complaints caused by their negative emotions due to radiation exposure. (4) Conclusions: Health professionals' lack of basic and specialized knowledge concerning radiation protection safety had a negative impact on the provision of health services. The continuing training of the staff seemed to be the only solution to reverse this trend. The training should highlight how radiation exposure can be minimized, safeguarding health professionals' trust and sense of security by significantly improving their working environment.
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Affiliation(s)
- Aspasia Goula
- Master of Health and Social Care Management, Department of Business Administration, School of Administrative, Economics and Social Sciences, University of West Attica, 12243 Athens, Greece; (A.C.); (M.-A.S.)
- Correspondence:
| | - Athanasios Chatzis
- Master of Health and Social Care Management, Department of Business Administration, School of Administrative, Economics and Social Sciences, University of West Attica, 12243 Athens, Greece; (A.C.); (M.-A.S.)
| | - Maria-Aggeliki Stamouli
- Master of Health and Social Care Management, Department of Business Administration, School of Administrative, Economics and Social Sciences, University of West Attica, 12243 Athens, Greece; (A.C.); (M.-A.S.)
| | - Martha Kelesi
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.K.); (E.K.)
| | - Evridiki Kaba
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.K.); (E.K.)
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4
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Ayoub EM, Bourgi A, Alsouki J, Merhej S, Conort P. Fluoroless endourological surgery for high burden renal and proximal ureteric stones: A safe technique for experienced surgeons. Arab J Urol 2021; 19:438-444. [PMID: 34881057 PMCID: PMC8648002 DOI: 10.1080/2090598x.2021.1901357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: To describe the feasibility of treating proximal ureteric and renal stones using flexible ureteroscopy (fURS) or a double approach (mini-percutaneous nephrolithotomy [PCNL] + fURS) without any use of radiation. Patients and methods: We retrospectively reviewed the data of all patients operated by one surgeon for retrograde endoscopic removal of renal and ureteric lithiasis performed between June 2015 and January 2019 in our institution. Patients with anatomical complexities, high-burden stone disease (diameter >20 mm), and medical comorbidities (anti-platelet drug administration) were included in our study. Outcomes analysed included complication rate, stone-free rate (SFR, defined as no residual stone >1 mm), and repeat procedure rate. Results: In all, 183 consecutive URS for proximal ureteric and renal lithiasis were conducted. C-arm fluoroscope guidance was not required, not even in the complex cases. Simultaneous ultrasonography and fURS guidance was used in patients where the mini-PCNL approach was indicated. Lead aprons were not needed by the operating room staff in any of the operations. The SFR was 91.8% after the first procedure, with no Clavien–Dindo Grade III or IV complications. Conclusion: Our present series shows clearly that the fURS and mini-PCNL approach under fURS control is a feasible and safe technique for experienced surgeons. Patients had a high SFR and no technique-related complications, with no additional risk of X-ray exposure. However, a prospective study is required to test the reproducibility of this technique. Abbreviations: GMSV: Galdakao-modified supine Valdivia; ICRP: International Commission on Radiological Protection; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; OR: operating room; PCNL: percutaneous nephrolithotomy; SFR: stone-free rate; UAS: ureteric access sheath; (f)URS: (flexible) ureteroscopy; US: ultrasonography
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Affiliation(s)
- Elias M Ayoub
- Department of Urology, Hôpital Français Du Levant, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ali Bourgi
- Department of Urology, Hôpital Français Du Levant, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Josee Alsouki
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Urology, Hôtel-Dieu De France, Beirut, Lebanon
| | - Sleiman Merhej
- Department of Urology, Hôpital Français Du Levant, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Urology, Hôtel-Dieu De France, Beirut, Lebanon
| | - Pierre Conort
- Department of Urology, Pitié Salpêtrière, Assistance Publique - Hôpitaux De Paris, Paris, France
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5
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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: 3] [Impact Index Per Article: 1.0] [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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Cheng W, Yao M, Zhai B, Wang P. Contact force sensors in minimally invasive catheters: current and future applications. Expert Rev Med Devices 2021; 18:445-455. [PMID: 33886427 DOI: 10.1080/17434440.2021.1917372] [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: 10/21/2022]
Abstract
INTRODUCTION Advances in catheter design for minimally invasive surgery have brought about the incorporation of contact force (CF) sensors in catheters. Two main approaches to achieve CF sensing at the catheter end-effector consist of fiber optic or magnetic solutions. CF sensing feedback can be used to assist in ablation procedures, mapping cardiac regions, identifying tissue characteristics, and enhancing robotic catheter control. AREAS COVERED This review covers the technological and clinical aspects of CFS in catheters. Contact force and force-time integral thresholds for ablation procedures, procedural complications, and electroanatomical mapping strategies are discussed. Future applications of improving catheter control, minimizing complications, and enhancing mapping techniques through CF are examined. EXPERT OPINION Fiber optic CF catheters may be more desirable compared to magnetic modalities due to the lower cost, compactness, and higher accuracy. In ablation procedures, complications due to higher ablation duration, power, contact force, and force time can be reduced through practical experience and informed training for catheter operators. Future prospects consist of the incorporation of CF sensors with remote catheter systems to assist in catheter control. We propose that CF can also be used in machine learning decision-making algorithms to prevent complications or improve tissue characterization.
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Affiliation(s)
- Weyland Cheng
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China.,Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Manye Yao
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Bo Zhai
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Penggao Wang
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
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7
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Roh Y, Nam S, Lee BK, Ryu DR, Chun K, Lee KS, Cho N, Yoon Y, Park H, Cho BR, Kim JS. Radiation exposure of interventional cardiologists during coronary angiography: evaluation by phantom measurement and computer simulation. Phys Eng Sci Med 2020; 43:1279-1287. [DOI: 10.1007/s13246-020-00931-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
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8
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Morrison JJ, Jiao A, Robinson S, Jahangiri Y, Kaufman JA. Prevalence of Musculoskeletal Symptoms in Interventional Radiologists. J Vasc Interv Radiol 2020; 31:1308-1314. [PMID: 32674871 DOI: 10.1016/j.jvir.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the prevalence of musculoskeletal symptoms, defined as aches, pains, discomfort, or numbness, by using a validated assessment tool among interventional radiologists. MATERIALS AND METHODS A Web-based survey using the Nordic Musculoskeletal Questionnaire was disseminated to interventional radiologist members by email in November 2015. Musculoskeletal symptoms were evaluated in 9 body areas. Information regarding participant demographics, practice details, use of radio-protective equipment, and exercise routines was also gathered. Univariate and multivariate analyses were performed to determine risk factors associated with more severe symptoms. RESULTS Of 4,096 SIR members at the time of the survey, 640 completed the questionnaire in its entirety (16% response rate). Respondents consisted of 69 females (11%) and 571 males (89%), with a mean age of 47.5 ± 10.2 years old, a mean body mass index of 25.5 ± 3.9 kg/m2, and a mean practice length of 17.1 ± 9.8 years. Prevalence of musculoskeletal symptoms was 88% in the 12 months preceding the survey. For those reporting musculoskeletal issues, 58% attributed the symptoms to work-related activities. Lower back (61%), neck (56%), and shoulder complaints (46%) were the most common. Symptoms prevented 21.2% of respondents from being able to work over the same time period. Multivariate analysis identified female gender, above-normal body mass index, and a practice length of 10 years or more as factors associated with a higher risk of moderate-to-severe symptoms. CONCLUSIONS Musculoskeletal symptoms are prevalent among interventional radiologists, the majority of which are attributed to work-related causes.
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Affiliation(s)
- James J Morrison
- Advanced Radiology Services, 3264 North Evergreen Drive, Grand Rapids, MI 49525; Michigan State University College of Human Medicine, Grand Rapids, MI.
| | - Albert Jiao
- Advanced Radiology Services, 3264 North Evergreen Drive, Grand Rapids, MI 49525
| | - Sean Robinson
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Younes Jahangiri
- Department of Interventional Radiology, Oregon Health and Science University, Portland, OR
| | - John A Kaufman
- Department of Interventional Radiology, Oregon Health and Science University, Portland, OR
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9
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Andreassi MG, Borghini A, Vecoli C, Piccaluga E, Guagliumi G, Del Greco M, Gaita F, Picano E. Reproductive outcomes and Y chromosome instability in radiation-exposed male workers in cardiac catheterization laboratory. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2020; 61:361-368. [PMID: 31605552 DOI: 10.1002/em.22341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/10/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
Occupational radiation exposure may impact the reproductive outcome of male workers in the cardiac catheterization laboratory (cath Lab) who receive a dose of ~1-10 mSv/year. An increased copy number variation (CNV) in azoospermia factor region c (AZFc) of the Y chromosome is a marker of spermatogenic failure, previously associated with radiation exposure. This study sought to investigate the association between paternal exposure in the Cath Lab and adverse reproductive outcomes as well as to assess the induction of CNV in the AZFc region. In a case-control study, we enrolled 193 catheterization lab workers (Group I) and 164 age-matched unexposed controls (Group II). Reproductive outcomes were assessed through a structured questionnaire. Two sequence-tagged sites (SY1197 and SY579) in AZFc region were evaluated by qRT-PCR in 83 exposed and 47 unexposed subjects. Exposed workers had a higher prevalence of low birth weight in offspring (Group I = 13% vs. II = 5.3%, P = 0.02; ORadjusted = 2.7; 95% CI: 1.1-6.3; P = 0.02). The mean of CNV (microdeletion and microduplication) for SY1197 was significantly higher in the exposed workers (Group I = 1.53 ± 0.85 vs. Group II = 1.02 ± 0.41; P = 0.0005). Despite the study design limitations, our findings show that chronic occupational radiation exposure of male workers is correlated with higher prevalence of low birth weight in offspring and instability in the Y chromosome AZFc region. Environ. Mol. Mutagen. 61:361-368, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | - Giulio Guagliumi
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Science, University of Turin, Turin, Italy
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10
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Arrivi A, Pucci G, Vaudo G, Bier N, Bock C, Casavecchia M, Bazzucchi M, Dominici M. Operators' radiation exposure reduction during cardiac catheterization using a removable shield. Cardiovasc Interv Ther 2020; 35:379-384. [PMID: 32034690 DOI: 10.1007/s12928-020-00646-6] [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: 11/11/2019] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
Abstract
Cardiac catheterization through radial access is associated with significant ionizing radiation exposure for the operator. We aimed at evaluating whether a removable shield placed upon the patient could impact favorably on annual radiation exposure for the operator. We designed a pre-post study comparing radiation exposure in a total of five operators under standard protection procedures (first period) and after applying a removable shield (second period). Each period included all the procedures performed in 1 year. Radiation exposure was measured through three dosimeters on each operator. A total of 1610 procedures were performed during the first period, and 1670 during the second period. For each operator, Fluoroscopy Time (FT) per exam did not differ between the two periods (13.1 ± 1 vs 12.9 ± 2 min/exam, p = 0.73), whereas Dose-Area Product (DAP) per procedure was slightly higher in the second period (5.247 ± 651 vs 6.374 ± 967 mGy/cm2, p < 0.01). The use of a removable shield significantly reduced operators' radiation dose at the left bracelet (64.3 ± 13.3 μSv/exam vs 23.8 ± 6.0 μSv/exam, p = 0.003). This remained significant even after adjustment for DAP per procedure (p = 0.015) and number of operators participating to each procedure (p = 0.013), whereas no significant difference was observed for card (5.6 ± 10.5 μSv/exam vs 0.9 ± 0.3 μSv/exam, p = 0.36) and neck bands (3.3 ± 4.5 μSv/exam vs 2.0 ± 2.0 μSv/exam, p = 0.36) dosimeters. The use of a removable shield during cardiac catheterization reduces radiation exposure at the level of the operator's upper limb, whereas no difference was found for other body parts. This may help in reducing radiation exposure of operator's hand. DAP increase merits further investigation.
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Affiliation(s)
- Alessio Arrivi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - G Pucci
- Unit of Internal Medicine, "Santa Maria" University Hospital, Terni, Italy.,Department of Medicine, University of Perugia, Perugia, Italy
| | - G Vaudo
- Unit of Internal Medicine, "Santa Maria" University Hospital, Terni, Italy.,Department of Medicine, University of Perugia, Perugia, Italy
| | - N Bier
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - C Bock
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - M Casavecchia
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - M Bazzucchi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - M Dominici
- Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy.,Department of Medicine, University of Perugia, Perugia, Italy
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11
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Loganovsky KN, Fedirko PA, Kuts KV, Marazziti D, Antypchuk KY, Perchuk IV, Babenko TF, Loganovska TK, Kolosynska OO, Kreinis GY, Gresko MV, Masiuk SV, Zdorenko LL, Zdanevich NA, Garkava NA, Dorichevska RY, Vasilenko ZL, Kravchenko VI, Drosdova NV, Yefimova YV. BRAIN AND EYE AS POTENTIAL TARGETS FOR IONIZING RADIATION IMPACT. Part І. THE CONSEQUENCES OF IRRADIATION OF THE PARTICIPANTS OF THE LIQUIDATION OF THE CHORNOBYL ACCIDENT. PROBLEMY RADIAT︠S︡IĬNOÏ MEDYT︠S︡YNY TA RADIOBIOLOHIÏ 2020; 25:90-129. [PMID: 33361831 DOI: 10.33145/2304-8336-2020-25-90-129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exposure to ionizing radiation could affect the brain and eyes leading to cognitive and vision impairment, behavior disorders and performance decrement during professional irradiation at medical radiology, includinginterventional radiological procedures, long-term space flights, and radiation accidents. OBJECTIVE The objective was to analyze the current experimental, epidemiological, and clinical data on the radiation cerebro-ophthalmic effects. MATERIALS AND METHODS In our analytical review peer-reviewed publications via the bibliographic and scientometric bases PubMed / MEDLINE, Scopus, Web of Science, and selected papers from the library catalog of NRCRM - theleading institution in the field of studying the medical effects of ionizing radiation - were used. RESULTS The probable radiation-induced cerebro-ophthalmic effects in human adults comprise radiation cataracts,radiation glaucoma, radiation-induced optic neuropathy, retinopathies, angiopathies as well as specific neurocognitive deficit in the various neuropsychiatric pathology including cerebrovascular pathology and neurodegenerativediseases. Specific attention is paid to the likely stochastic nature of many of those effects. Those prenatally and inchildhood exposed are a particular target group with a higher risk for possible radiation effects and neurodegenerative diseases. CONCLUSIONS The experimental, clinical, epidemiological, anatomical and pathophysiological rationale for visualsystem and central nervous system (CNS) radiosensitivity is given. The necessity for further international studieswith adequate dosimetric support and the follow-up medical and biophysical monitoring of high radiation riskcohorts is justified. The first part of the study currently being published presents the results of the study of theeffects of irradiation in the participants of emergency works at the Chornobyl Nuclear Power Plant (ChNPP).
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Affiliation(s)
- K N Loganovsky
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - P A Fedirko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - K V Kuts
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - D Marazziti
- Dipartimento di Medicina Clinica e Sperimentale Section of Psychiatry, University of Pisa, Via Roma, 67, I 56100, Pisa, Italy
| | - K Yu Antypchuk
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - I V Perchuk
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - T F Babenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - T K Loganovska
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - O O Kolosynska
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - G Yu Kreinis
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - M V Gresko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - S V Masiuk
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - L L Zdorenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - N A Zdanevich
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - N A Garkava
- State Institution «Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine», 9 Vernadsky Street, Dnipro, 49044, Ukraine
| | - R Yu Dorichevska
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - Z L Vasilenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - V I Kravchenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - N V Drosdova
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
| | - Yu V Yefimova
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Illyenko Street, Kyiv, 04050, Ukraine
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Abstract
PURPOSE OF REVIEW To review the contemporary evidence for robotic-assisted percutaneous coronary and vascular interventions, discussing its current capabilities, limitations, and potential future applications. RECENT FINDINGS Robotic-assisted cardiovascular interventions significantly reduce radiation exposure and orthopedic strains for interventionalists, while maintaining high rates of device and clinical success. The PRECISE and CORA-PCI studies demonstrated the safety and efficacy of robotic-assisted percutaneous coronary intervention (PCI) in increasingly complex coronary lesions. The RAPID study demonstrated similar findings in peripheral vascular interventions (PVI). Subsequent studies have demonstrated the safety and efficacy of second-generation devices, with automations mimicking manual PCI techniques. While innovations such as telestenting continue to bring excitement to the field, major limitations remain-particularly the lack of randomized trials comparing robotic-assisted PCI with manual PCI. Robotic technology has successfully been applied to multiple cardiovascular procedures. There are limited data to evaluate outcomes with robotic-assisted PCI and other robotic-assisted cardiovascular procedures, but existing data show some promise of improving the precision of PCI while decreasing occupational hazards associated with radiation exposure.
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Affiliation(s)
- Zachary K Wegermann
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA. .,Duke Clinical Research Institute, Durham, NC, USA.
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Sunil V Rao
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
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13
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Whitney GM, Thomas JJ, Austin TM, Fanfan J, Yaster M. Radiation Safety Perceptions and Practices Among Pediatric Anesthesiologists: A Survey of the Physician Membership of the Society for Pediatric Anesthesia. Anesth Analg 2019; 128:1242-1248. [PMID: 31094794 DOI: 10.1213/ane.0000000000003773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric anesthesiologists are exposed to ionizing radiation from x-rays on an almost daily basis. Our goal was to determine the culture of safety in which they work and how they adhere to preventative strategies that minimize exposure risk in their daily practice. METHODS After Institutional Review Board waiver and approval of the Society for Pediatric Anesthesia's research and quality and safety committees, an electronic e-mail questionnaire was sent to the Society's physician, nontrainee members and consisted of questions specific to provider use of protective lead shielding, the routine use of dosimeters, and demographic information. Univariate analyses were performed using the Wilcoxon rank sum test for ordinal variables, the Fisher exact test for categorical variables, and the Spearman test to analyze correlation between 2 ordinal variables, while a proportional odds logistic regression was used for a multivariable ordinal outcome analysis. P values of <.05 were considered statistically significant. RESULTS Twenty-one percent (674/3151) of the surveyed anesthesiologists completed the online questionnaire. Radiation exposure is ubiquitous (98.7%), and regardless of sex, most respondents were either concerned or very concerned about radiation exposure (76.8%); however, women were significantly more concerned than men (proportional odds ratio, 1.66 [95% confidence interval, 1.20-2.31]; P = .002). Despite this and independent of sex, level of concern was not associated with use of a radiation dosimeter (P = .85), lead glasses (odds ratio, 1.07 [95% confidence interval, 0.52-2.39]; P = 1.0), or a thyroid shield (P = .12). Dosimeters were rarely (13%) or never used (52%) and were mandated in only 28.5% of institutions. Virtually none of the respondents had ever taken a radiation safety course, received a personal radiation dose report, notification of their radiation exposure, or knew how many millirem/y was considered safe. Half of the respondents were female, and while pregnant, 73% (151/206) tried to avoid radiation exposure by requesting not to be assigned to cases requiring x-rays. These requests were honored 78% (160/206) of the time. DISCUSSION Despite universal exposure to ionizing radiation from x-rays, pediatric anesthesiologists do not routinely adhere to strategies designed to limit the intensity of this exposure and rarely work in institutions in which a culture of radiation safety exists. Our study highlights the need to improve radiation safety education, the need to change the safety culture within the operating rooms and imaging suites, and the need to more fully investigate the utility of dosimeters, lead shielding, and eye safety measures in pediatric anesthesia practice.
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Affiliation(s)
- Gina M Whitney
- From the Department of Anesthesiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | - James J Thomas
- From the Department of Anesthesiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | - Thomas M Austin
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jemel Fanfan
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Myron Yaster
- From the Department of Anesthesiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
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14
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McCormick ZL, Mattie R, Ebrahimi A, Lee DT, Marcolina A, Press J, Kennedy DJ, Smuck M, Walega DR, Cushman D. Is There a Relationship Between Body Mass Index and Fluoroscopy Time During Cervical Interlaminar Epidural Steroid Injections? PAIN MEDICINE 2018; 18:1326-1333. [PMID: 28034968 DOI: 10.1093/pm/pnw264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background The challenge of obtaining medical imaging in individuals with higher body mass index (BMI) is described, but there is minimal data regarding the relationship between BMI and fluoroscopy time during cervical interlaminar epidural steroid injection (CIESI). Objective To determine the relationship between BMI and fluoroscopy time during CIESI. Methods Retrospective cohort study of patients who underwent fluoroscopically guided CIESI between January 2014 and February 2015 at an academic pain medicine center. Fluoroscopy time data were collected. Comparisons based on analysis of variance were made between patients with normal (<25.0 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), and obese (≥30.0 kg/m 2 ) BMI. Results Of 399 procedure encounters, 366 had documented BMI and fluoroscopy time data and were included for analysis. Mean age (± SD) in this cohort was 53 ± 13 years, including 189 females (52%) and 205 first-time injections. Mean fluoroscopy time for all injections was 18 ± 10 seconds. Separated by categorical BMI class, the mean fluoroscopy time was 18 ± 9 seconds for normal weight patients, 17 ± 10 seconds for overweight patients, and 20 ± 11 seconds for obese patients, respectively. Post hoc analysis showed that fluoroscopy time was significantly longer only in obese compared with overweight patients ( P = 0.02). Trainee involvement and first-time vs repeat injection did not significantly alter fluoroscopy time ( P = 0.17 and P = 0.12, respectively). Conclusions The findings of this study indicate that BMI does not appear to have a clinically significant impact on fluoroscopy time during cervical interlaminar epidural steroid injection procedures. Future study is needed to directly quantify radiation exposure in patients and practitioners, as well as the associated health risk.
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Affiliation(s)
- Zachary L McCormick
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Ryan Mattie
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Ali Ebrahimi
- Department of Anesthesia, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - David T Lee
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Joel Press
- Department of Physical Medicine and Rehabilitation, the Rehabilitation Institute of Chicago, Chicago, Illinois
| | - D J Kennedy
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - David R Walega
- Department of Anesthesia, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Cushman
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
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15
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Lo N, Gutierrez JA, Swaminathan RV. Robotic-Assisted Percutaneous Coronary Intervention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:14. [DOI: 10.1007/s11936-018-0608-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Tarighatnia A, Mohammadalian A, Ghojazade M, Pourafkari L, Farajollahi A. Beam projections and radiation exposure in transradial and transfemoral approaches during coronary angiography. Anatol J Cardiol 2017; 18:298-303. [PMID: 28777096 PMCID: PMC5731527 DOI: 10.14744/anatoljcardiol.2017.7724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We aimed to compare the operator and patient radiation exposure in standard projections during elective diagnostic coronary angiography procedures via transradial (TRA) versus transfemoral (TFA) approaches. METHODS In this analytical cross-sectional study, a total of 202 consecutive patients who were candidates for diagnostic coronary angiography were randomized to undergo the procedure via TFA or TRA approaches (101 in each group). Patients with abnormal Allen test and history of coronary artery bypass surgery, valvular heart disease, and unsuccessful coronary angiography were excluded from the study. A single operator performed all of the procedures using a single angiography system. Patient and operator radiation exposure were measured using diamentor and an electronic personal dosimeter, respectively. Each procedure comprised a standardized sequence of projections including four standard views for the left coronary system and two standard views for the right coronary system. RESULTS Left anterior oblique (LAO) caudal (50°/30°) and right anterior oblique RAO (30°) projections were associated with the highest and lowest patient radiation exposure, respectively. The operator received a significantly higher radiation exposure in the TRA approach for LAO cranial (for both left and right coronary systems) and LAO caudal (for left coronary system) projections during coronary angiography compared with the TFA approach. CONCLUSION Though a similar amount of patient radiation exposure in each projection was observed among TFA and TRA groups; LAO cranial and LAO caudal projections were associated with a significantly higher operator radiation exposure in the TRA group. These findings need to be considered when choosing the optimal arterial approach for patients scheduled for coronary angiography.
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Affiliation(s)
| | | | | | | | - Alireza Farajollahi
- Department of Medical Physics, Faculty of Medicine Tabriz University of Medical Sciences, Tabriz-Iran. ,
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17
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Wang Y, Chen GZ, Yao Y, Bai Y, Chu HM, Ma KZ, Liew R, Liu H, Zhong GQ, Xue YM, Wu SL, Li YF, Zhao CX, Liu QG, Lin L, Wang L, Wang DW. Ablation of idiopathic ventricular arrhythmia using zero-fluoroscopy approach with equivalent efficacy and less fatigue: A multicenter comparative study. Medicine (Baltimore) 2017; 96:e6080. [PMID: 28178165 PMCID: PMC5313022 DOI: 10.1097/md.0000000000006080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The efficacy of a completely zero-fluoroscopy (ZF) approach for the catheter ablation of idiopathic ventricular arrhythmias (VAs) and whether it has advantages over the conventional fluoroscopy (F) approach are still unknown. The aim of this study was to compare the safety and efficacy of a completely ZF approach with those of the conventional F approach in the ablation of idiopathic VAs.We conducted a prospective study involving 7 centers in China. Consecutive patients (n = 489, mean age 45.3 ± 15.3 years, 44.8% male) with idiopathic VAs were recruited. Eligible participants were assigned to either a ZF (n = 163) or F (n = 326) approach at a ratio of 1:2. The completely ZF approach was successful in 163 (100%) patients for electrophysiological study, and in 151 patients (94.4%) for arrhythmia ablation with 9 cases having to switch to the F approach due to the need for coronary angiography. There was no significant difference between the ZF approach and F approach in procedural success rate (84.1% vs 85.4%, respectively), arrhythmia recurrence (1.9% vs 2.2%), or severe complications (0.6% vs 0.9%). The medical staffs using the ZF approach did not wear heavy protective apparels, thus experienced significantly less fatigue compared with those using the F approach (2.1 ± 0.7 vs 3.9 ± 1.6, P < 0.05).The completely ZF approach is as safe and efficient as the conventional F approach for the electrophysiological study and the ablation of idiopathic VAs. The medical staffs using ZF approach felt less fatigue and received less exposure to radiation.
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Affiliation(s)
- Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Guang Zhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Yan Yao
- Clinical EP Laboratory and Arrhythmia Center, Fuwai Hospital and Cardiovascular Institute, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
| | - Yang Bai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Hui Min Chu
- Department of Cardiology, First Hospital of Ningbo City, Ningbo
| | - Ke Zhong Ma
- Department of Cardiology, Xiangyang Central Hospital, Xiangyang, P.R. China
| | | | - Hao Liu
- Cardiovascular Department, First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Guo Qiang Zhong
- Cardiovascular Department, First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Yu Mei Xue
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou
| | - Shu Lin Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou
| | - Yi Fu Li
- Sun Yat-sen Cardiovascular Hospital, Shenzhen, P.R. China
| | - Chun Xia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Qi Gong Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Li Lin
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Lin Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
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18
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McCormick ZL, Choxi SC, Lee DT, Marcolina A, Press J, Kennedy DJ, Smuck M, Walega DR, Cushman DM. The Impact of Body Mass Index on Fluoroscopy Time During Lumbar Epidural Steroid Injection; A Multicenter Cohort Study. PAIN MEDICINE 2017; 18:25-35. [PMID: 27084415 DOI: 10.1093/pm/pnw050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective This study aimed to assess the relationship between BMI and fluoroscopy time during lumbar epidural steroid injections (LESIs) performed for lumbosacral radicular pain. Design Multicenter retrospective cohort study. Setting Three academic, outpatient pain treatment centers. Subjects Patients who underwent fluoroscopically guided LESI. Methods Mean and standard deviation (SD) fluoroscopy time were compared between patients with normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2) BMI. Statistical significance was set at P=0.01 due to multiple comparisons. Results A total of 2,930 procedure encounters were included, consisting of 598 interlaminar LESIs and 2,332 transforaminal LESIs. Fluoroscopy time was significantly longer in the obese patients compared to normal and overweight patients during interlaminar LESI (P < 0.01). Fluoroscopy time was significantly longer with each increasing BMI category in during transforaminal LESI (P < 0.01). These relationships remained when a trainee was involved (P < 0.01; P<0.01), during repeat injections (P < 0.01; P < 0.01), and during bilateral transforaminal LESIs (P < 0.01). While longer fluoroscopy times were required in high BMI categories during L5-S1 transforaminal LESI (P < 0.01), there was no relationship between fluoroscopy time and BMI during L4-L5 and S1 transforaminal LESI (P = 0.02; P = 0.13). Fluoroscopy time during interlaminar LESI compared to transforaminal LESI was significantly lower within all BMI categories (all P<0.01). Conclusions The findings of this study indicate that fluoroscopy time is increased during interlaminar LESIs and during L5-S1 transforaminal LESIs in patients who are obese. These relationships are not affected by injection number, performance of bilateral injections, or trainee involvement. Further study is needed to determine if this increase in fluoroscopy time is indicative of a clinically significant associated increase in radiation dose.
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Affiliation(s)
- Zachary L McCormick
- Department of Physical Medicine & Rehabilitation/Department of Anesthesia, Northwestern Feinberg School of Medicine/the Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | - Sarah C Choxi
- Department of Anesthesia, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - David T Lee
- Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Austin Marcolina
- Midwestern University, School of Medicine, Downers Grove, Illinois, USA
| | - Joel Press
- Department of Physical Medicine & Rehabilitation, the Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | - D J Kennedy
- Department of Orthopaedics, Stanford University, Palo Alto, California, USA
| | - Matthew Smuck
- Department of Orthopaedics, Stanford University, Palo Alto, California, USA
| | - David R Walega
- Department of Anesthesia, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel M Cushman
- Department of PM&R, University of Utah, Salt Lake City, Utah, USA
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19
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Dixon RG, Khiatani V, Statler JD, Walser EM, Midia M, Miller DL, Bartal G, Collins JD, Gross KA, Stecker MS, Nikolic B. Society of Interventional Radiology: Occupational Back and Neck Pain and the Interventional Radiologist. J Vasc Interv Radiol 2016; 28:195-199. [PMID: 27993508 DOI: 10.1016/j.jvir.2016.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Robert G Dixon
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
| | - Vishal Khiatani
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - John D Statler
- Virginia Interventional and Vascular Associates, Fredericksburg, Virginia
| | - Eric M Walser
- Department of Radiology, University of Texas Medical Branch, Galveston, Texas
| | - Mehran Midia
- Department of Interventional Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Donald L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring
| | - Gabriel Bartal
- Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Kathleen A Gross
- Department of Interventional Radiology, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Michael S Stecker
- Division of Angiography Interventional Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
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20
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Andreassi MG, Piccaluga E, Guagliumi G, Del Greco M, Gaita F, Picano E. Occupational Health Risks in Cardiac Catheterization Laboratory Workers. Circ Cardiovasc Interv 2016; 9:e003273. [PMID: 27072525 DOI: 10.1161/circinterventions.115.003273] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Orthopedic strain and radiation exposure are recognized risk factors in personnel staff performing fluoroscopically guided cardiovascular procedures. However, the potential occupational health effects are still unclear. The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure. METHODS AND RESULTS We used a self-administered questionnaire to collect demographic information, work-related information, lifestyle-confounding factors, all current medications, and health status. A total number of 746 questionnaires were properly filled comprising 466 exposed staff (281 males; 44±9 years) and 280 unexposed subjects (179 males; 43±7years). Exposed personnel included 218 interventional cardiologists and electrophysiologists (168 males; 46±9 years); 191 nurses (76 males; 42±7 years), and 57 technicians (37 males; 40±12 years) working for a median of 10 years (quartiles: 5-24 years). Skin lesions (P=0.002), orthopedic illness (P<0.001), cataract (P=0.003), hypertension (P=0.02), and hypercholesterolemia (P<0.001) were all significantly higher in exposed versus nonexposed group, with a clear gradient unfavorable for physicians over technicians and nurses and for longer history of work (>16 years). In highly exposed physicians, adjusted odds ratio ranged from 1.7 for hypertension (95% confidence interval: 1-3; P=0.05), 2.9 for hypercholesterolemia (95% confidence interval: 1-5; P=0.004), 4.5 for cancer (95% confidence interval: 0.9-25; P=0.06), to 9 for cataract (95% confidence interval: 2-41; P=0.004). CONCLUSIONS Health problems are more frequently observed in workers performing fluoroscopically guided cardiovascular procedures than in unexposed controls, raising the need to spread the culture of safety in the cath laboratory.
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Affiliation(s)
- Maria Grazia Andreassi
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.).
| | - Emanuela Piccaluga
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Giulio Guagliumi
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Maurizio Del Greco
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Fiorenzo Gaita
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Eugenio Picano
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
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Andreassi MG, Piccaluga E, Gargani L, Sabatino L, Borghini A, Faita F, Bruno RM, Padovani R, Guagliumi G, Picano E. Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff. JACC Cardiovasc Interv 2016; 8:616-27. [PMID: 25907089 DOI: 10.1016/j.jcin.2014.12.233] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/02/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to assess the association between long-term radiation exposure in the catheterization laboratory (cath lab) and early signs of subclinical atherosclerosis. BACKGROUND There is growing evidence of an excess risk of cardiovascular disease at low-dose levels of ionizing radiation exposure. METHODS Left and right carotid intima-media thickness (CIMT) was measured in 223 cath lab personnel (141 male; age, 45 ± 8 years) and 222 unexposed subjects (113 male; age, 44±10 years). Leukocyte telomere length (LTL) was evaluated by quantitative reverse transcriptase polymerase chain reaction. The DNA repair gene XRCC3 Thr241Met polymorphism was also analyzed to explore the possible interaction with radiation exposure. The occupational radiological risk score (ORRS) was computed for each subject on the basis of the length of employment, individual caseload, and proximity to the radiation source. A complete lifetime effective dose (mSv) was recorded for 57 workers. RESULTS Left, right, and averaged CIMTs were significantly increased in high-exposure workers compared with both control subjects and low-exposure workers (all p values<0.04). On the left side, but not on the right, there was a significant correlation between CIMT and ORRS (p=0.001) as well as lifetime dose (p=0.006). LTL was significantly reduced in exposed workers compared with control subjects (p=0.008). There was a significant correlation between LTL and both ORRS (p=0.002) and lifetime dose (p=0.03). The XRCC3 Met241 allele presented a significant interaction with high exposure for right side (pinteraction=0.002), left side (pinteraction<0.0001), and averaged (pinteraction<0.0001) CIMTs. CONCLUSIONS Long-term radiation exposure in a cath lab may be associated with increased subclinical CIMT and telomere length shortening, suggesting evidence of accelerated vascular aging and early atherosclerosis.
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Affiliation(s)
| | | | - Luna Gargani
- CNR Institute of Clinical Physiology, Pisa, Italy
| | | | | | | | | | - Renato Padovani
- International Centre for Theoretical Physics, Trieste, Italy
| | - Giulio Guagliumi
- Ospedale Papa Giovanni XXIII, Cardiovascular Department, Bergamo, Italy; on behalf of the Healthy Cath Lab (HCL) Study Group of the Italian Society of Invasive Cardiology (GISE)
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McCormick ZL, Cushman D, Lee DT, Scholten P, Chu SK, Babu AN, Caldwell M, Ziegler C, Ashraf H, Sundar B, Clark R, Gross C, Cara J, McCormick K, Ross B, Smith CC, Press J, Smuck M, Walega DR. Is There a Relationship Between Body Mass Index and Fluoroscopy Time During Sacroiliac Joint Injection? A Multicenter Cohort Study. PAIN MEDICINE 2015; 17:1241-8. [DOI: 10.1093/pm/pnv051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/11/2015] [Indexed: 12/17/2022]
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Neuropsychological Testing in Interventional Cardiology Staff after Long-Term Exposure to Ionizing Radiation. J Int Neuropsychol Soc 2015; 21:670-6. [PMID: 26400563 DOI: 10.1017/s135561771500082x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study aimed at comparing neuropsychological test scores in 83 cardiologists and nurses (exposed group, EG) working in the cardiac catheterization laboratory, and 83 control participants (non exposed group, nEG), to explore possible cognitive impairments. The neuropsychological assessment was carried out by means of a battery called "Esame Neuropsicologico Breve." EG participants showed significantly lower scores on the delayed recall, visual short-term memory, and semantic lexical access ability than the nEG ones. No dose response could be detected. EG participants showed lower memory and verbal fluency performances, as compared with nEG. These reduced skills suggest alterations of some left hemisphere structures that are more exposed to IR in interventional cardiology staff. On the basis of these findings, therefore, head protection would be a mandatory good practice to reduce effects of head exposure to ionizing radiation among invasive cardiology personnel (and among other exposed professionals).
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Kohlbrenner R, Kolli KP, Taylor AG, Kohi MP, Fidelman N, LaBerge JM, Kerlan RK, Agarwal VK, Lehrman ED, Nanavati S, Avrin DE, Gould R. Patient Radiation Dose Reduction during Transarterial Chemoembolization Using a Novel X-Ray Imaging Platform. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2015.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Loomba RS, Rios R, Buelow M, Eagam M, Aggarwal S, Arora RR. Comparison of Contrast Volume, Radiation Dose, Fluoroscopy Time, and Procedure Time in Previously Published Studies of Rotational Versus Conventional Coronary Angiography. Am J Cardiol 2015; 116:43-9. [PMID: 25983128 DOI: 10.1016/j.amjcard.2015.03.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
Conventional coronary angiography (CA) with static imaging is limited by the ability to properly select the optimal acquisition angle, vessel foreshortening, and significant radiation exposure. Rotational coronary angiography (RA) acquires coronary images in a multitude of viewing angles during a single injection by means of a moving gantry that rapidly completes a predefined arc. This study compares procedural characteristics of CA and RA. Electronic search of databases such as OVID, Medline, and PubMed was conducted to identify studies comparing procedural characteristics of CA and RA. End points for analysis included contrast volume, radiation dose by dose area product, radiation dose by air kerma, fluoroscopy time, and procedure time. Studies were assessed for quality and bias and were included if they compared coronary imaging of both the right and left coronary systems with CA and RA, included one of the end points of interest, and were in English. A total of 11 studies consisting of 940 patients who underwent RA and 976 who underwent CA were included in the final analysis. Contrast volume, radiation dose by dose area product, and radiation dose by air kerma were all found to be significantly lower with RA compared with CA. There was a statistically significant increase in fluoroscopy time, although this was not clinically significant, and there was no difference in procedure time. RA angiography is a feasible alternative to CA and offers reductions in contrast used and radiation exposure.
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Bosanquet DC, Twine CP, Tang TY, Boyle JR, Bell RE, Bicknell CD, Jenkins MP, Loftus IM, Modarai B, Vallabhaneni SR. Pragmatic Minimum Reporting Standards for Thoracic Endovascular Aortic Repair. J Endovasc Ther 2015; 22:356-67. [DOI: 10.1177/1526602815584925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David C. Bosanquet
- South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, Wales, UK
| | - Christopher P. Twine
- South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, Wales, UK
| | - Tjun Y. Tang
- Department of General Surgery, Changi General Hospital, Singapore
| | - Jonathan R. Boyle
- Regional Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Radiation Practice Patterns and Exposure in the High-volume Endourologist. Urology 2015; 85:1019-1024. [DOI: 10.1016/j.urology.2014.11.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/08/2014] [Accepted: 11/22/2014] [Indexed: 11/23/2022]
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Orme NM, Rihal CS, Gulati R, Holmes DR, Lennon RJ, Lewis BR, McPhail IR, Thielen KR, Pislaru SV, Sandhu GS, Singh M. Occupational health hazards of working in the interventional laboratory: a multisite case control study of physicians and allied staff. J Am Coll Cardiol 2015; 65:820-826. [PMID: 25720626 DOI: 10.1016/j.jacc.2014.11.056] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The occupational hazards of working in the interventional laboratory have been inadequately studied for physicians and remain unaddressed for nonphysician personnel. OBJECTIVES This study sought to determine whether the prevalence of work-related musculoskeletal pain, cancer, and other medical conditions is higher among physicians and allied staff who work in interventional laboratories compared with employees who do not. METHODS Mayo Clinic employees who work in affiliated hospitals with interventional cardiology or interventional radiology laboratories took an electronic survey. Results were stratified on the basis of self-reported occupational exposure to procedures that involve radiation. RESULTS There were 1,543 employees (mean age 43 ± 11.3 years, 33% male) who responded to the survey (response rate of 57%), and 1,042 (67.5%) reported being involved with procedures utilizing radiation. These employees reported experiencing work-related pain more often than the control group before (54.7% vs. 44.7%; p < 0.001) and after adjustment for age, sex, body mass index, pre-existing musculoskeletal conditions, years in profession, and job description (odds ratio: 1.67; 95% confidence interval: 1.32 to 2.11; p < 0.001). Musculoskeletal pain varied significantly by job description, with the highest incidence reported by technicians (62%) and nurses (60%) followed by attending physicians (44%) and trainees (19%; p < 0.001). There was no difference in cancer prevalence between groups (9% vs. 9%; p = 0.96). CONCLUSIONS Musculoskeletal pain is more common among healthcare workers who participate in interventional procedures and is highest in nonphysician employees. The diagnosis of cancer in employees who participate in procedures that utilize radiation was not elevated when compared to controls within the same departments, although any conclusion regarding causality is limited by the cross-sectional nature of the study, as well as the low overall prevalence of malignancy in our study group.
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Affiliation(s)
- Nicholas M Orme
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Gulati
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - David R Holmes
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Ryan J Lennon
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Bradley R Lewis
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Ian R McPhail
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kent R Thielen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Mandeep Singh
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
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Borghini A, Mercuri A, Turchi S, Chiesa MR, Piccaluga E, Andreassi MG. Increased circulating cell-free DNA levels and mtDNA fragments in interventional cardiologists occupationally exposed to low levels of ionizing radiation. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2015; 56:293-300. [PMID: 25327629 DOI: 10.1002/em.21917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/30/2014] [Indexed: 06/04/2023]
Abstract
Circulating cell-free DNA (ccf-DNA) and mtDNA (ccf-mtDNA) have often been used as indicators of cell death and tissue damage in acute and chronic disorders, but little is known about changes in ccf-DNA and ccf-mtDNA concentrations following radiation exposure. The aim of the study was to investigate the impact of chronic low-dose radiation exposure on serum ccf-DNA levels and ccf-mtDNA fragments (mtDNA-79 and mtDNA-230) of interventional cardiologists working in high-volume cardiac catheterization laboratory to assess their possible role as useful radiation biomarkers. We enrolled 50 interventional cardiologists (26 males; age = 48.4 ± 10 years) and 50 age- and gender-matched unexposed controls (27 males; age = 47.6 ± 8.3 years). Quant-iT™ dsDNA High-Sensitivity assay was used to measure circulating ccf-DNA isolated from serum samples. Quantitative analysis of mtDNA fragments was performed by real-time PCR. No significant relationships were found between ccf-DNA and ccf-mtDNA, and age, gender, smoking, or other clinical parameters. Ccf-DNA levels (44.2 ± 31.1 vs. 30.6 ± 19.2 ng/ml, P = 0.013), ccf-mtDNA-79 (2.6 ± 2.1 vs. 1.1 ± 0.8, P < 0.01), and ccf-mtDNA-230 copies (2.0 ± 1.8 vs. 1.04 ± 0.9, P = 0.02) were significantly higher in interventional cardiologists compared with the non-exposed group. In a subset (n = 15) of interventional cardiologists with a reliable reconstruction of cumulative professional exposure (59.7 ± 48.4 mSv; range: 1.4-182 mS), ccf-DNA (53.2 ± 41.3 vs. 36.4 ± 22.9 and 32.2 ± 20.5, P = 0.08), mtDNA-79 (2.4 ± 2.1 vs. 2.03 ± 1.7 and 1.09 ± 0.82, P = 0.05), and mtDNA-230 (2.0 ± 2.2 vs. 1.5 ± 1.4 and 1.04 ± 0.9, P = 0.09) tended to be significantly increased in high-exposure subjects compared with both low-exposure interventional cardiologists and controls. Our results provide evidence for a possible role of circulating DNA as a relevant biomarker of cellular damage induced by exposure to chronic low-dose radiation.
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Affiliation(s)
- Andrea Borghini
- Genetics Research Unit, CNR Institute of Clinical Physiology, Pisa, Italy
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Occupational Radiation Protection of Pregnant or Potentially Pregnant Workers in IR: A Joint Guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2015; 26:171-81. [DOI: 10.1016/j.jvir.2014.11.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/20/2014] [Indexed: 12/17/2022] Open
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Robotic catheterization: the importance of evaluation by interventional radiologists. J Vasc Interv Radiol 2014; 25:1848-9. [PMID: 25457138 DOI: 10.1016/j.jvir.2014.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 11/20/2022] Open
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Cervelli T, Panetta D, Navarra T, Andreassi MG, Basta G, Galli A, Salvadori PA, Picano E, Del Turco S. Effects of single and fractionated low-dose irradiation on vascular endothelial cells. Atherosclerosis 2014; 235:510-8. [PMID: 24953491 DOI: 10.1016/j.atherosclerosis.2014.05.932] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE An increasing number of epidemiological studies suggest that chronic low-dose irradiation increases the risk of atherosclerosis. We evaluated and compared the in vitro biological effects of both single and fractionated low-doses of X-ray irradiation on endothelial cells. METHODS Human umbilical vein endothelial cells (HUVECs) were irradiated with X-rays, with single doses of 0.125, 0.25 and 0.5 Gy or fractionated doses of 2 × 0.125 Gy and 2 × 0.25 Gy, with 24 h interfraction interval. Survival, apoptosis, reactive oxygen species (ROS) production, nuclear factor-κB (NF-κB) activation, intercellular adhesion molecule-1 (ICAM-1) expression, HUVEC adhesiveness and DNA damage were investigated. RESULTS We did not observe any effect on viability and apoptosis. Both single and fractionated doses induced ROS generation, NF-κB activation, ICAM-1 protein expression and HUVEC adhesiveness, but only fractionated doses increase significantly ICAM-1 mRNA. The effects measured after fractionated dose result always higher than those induced by the single dose. Moreover, we observed that DNA double strand break (DSB), visualized with γ-H2AX foci, is dose-dependent and that the kinetics of γ-H2AX foci is not affected by fractionated doses. CONCLUSIONS We showed that single and fractionated low-dose irradiations with low energy X-rays do not affect cell viability and DNA repair. Interestingly, the greater increase of ICAM-1 surface exposure and endothelial adhesiveness observed after fractionated irradiation, suggests that fractionated low-doses may accelerate chronic vascular inflammation, from which the atherosclerotic process can arise.
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Affiliation(s)
- Tiziana Cervelli
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy.
| | - Daniele Panetta
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Teresa Navarra
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Maria Grazia Andreassi
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Giuseppina Basta
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Alvaro Galli
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Piero A Salvadori
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Eugenio Picano
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Serena Del Turco
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
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Gonzales JP, Moran C, Silberzweig JE. Reduction of Operator Radiation Dose by an Extended Lower Body Shield. J Vasc Interv Radiol 2014; 25:462-8, 468.e1. [DOI: 10.1016/j.jvir.2013.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 01/26/2023] Open
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Uthoff H, Benenati MJ, Katzen BT, Peña C, Gandhi R, Staub D, Schernthaner M. Lightweight Bilayer Barium Sulfate–Bismuth Oxide Composite Thyroid Collars for Superior Radiation Protection in Fluoroscopy-guided Interventions: A Prospective Randomized Controlled Trial. Radiology 2014; 270:601-6. [DOI: 10.1148/radiol.13122834] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kirkwood ML, Arbique GM, Guild JB, Timaran C, Chung J, Anderson JA, Valentine RJ. Surgeon education decreases radiation dose in complex endovascular procedures and improves patient safety. J Vasc Surg 2013; 58:715-21. [PMID: 23688628 DOI: 10.1016/j.jvs.2013.04.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/28/2013] [Accepted: 04/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Complex endovascular procedures such as fenestrated endovascular aneurysm repair (FEVAR) are associated with higher radiation doses compared with other fluoroscopically guided interventions (FGIs). The purpose of this study was to determine whether surgeon education on radiation dose control can lead to lower reference air kerma (RAK) and peak skin dose (PSD) levels in high-dose procedures. METHODS Radiation dose and operating factors were recorded for FGI performed in a hybrid room over a 16-month period. Cases exceeding 6 Gy RAK were investigated according to institutional policy. Information obtained from these investigations led to surgeon education focused on reducing patient dose. Points addressed included increasing table height, utilizing collimation and angulation, decreasing magnification modes, and maintaining minimal patient-to-detector distance. Procedural RAK doses and operating factors were compared 8 months pre- (group A) and 8 months post- (group B) educational intervention using analysis of variance with Tukey pairwise comparisons and t-tests. PSD distributions were calculated using custom software employing input data from fluoroscopic machine logs. RESULTS Of 447 procedures performed, 300 FGIs had sufficient data to be included in the analysis (54% lower extremity, 11% thoracic endovascular aneurysm repair, 10% cerebral, 8% FEVAR, 7% endovascular aneurysm repair, 5% visceral, and 5% embolization). Twenty-one cases were investigated for exceeding 6 Gy RAK. FEVAR comprised 70% of the investigated cases and had a significantly higher median RAK dose compared with all other FGIs (P < .0001). There was no difference in body mass index between groups A and B; however, increasing body mass index was an indicator for increased RAK. PSD calculations were performed for the 122 procedures that focused on the thorax and abdomen (group A, 80 patients; group B, 42 patients). Surgeon education most strongly affected table height, with an average table height elevation of 10 cm per case after education (P < .0001). The dose index (PSD/RAK ratio) was used to track changes in operating practices, and it decreased from 1.14 to 0.79 after education (P < .0001). These changes resulted in an estimated 16% reduction in PSD. There was a trend toward a decrease in patient to detector distance, and the use of collimation increased from 25% to 40% (P < .001) for all cases; however, these did not result in a decrease in PSD. The number of cases that exceeded 6 Gy RAK did not change after education; however, the proportion of non-FEVAR cases that exceeded 6 Gy decreased from 40% to 20%. CONCLUSIONS Surgeon education on the appropriate use of technical factors during FGIs improved operating practice, reduced patient radiation dose, and decreased the number of non-FEVAR cases that exceeded 6 Gy. It is essential that vascular surgeons be educated in best operating practices to lower PSD; nonetheless, FEVAR remains a high-dose procedure.
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Affiliation(s)
- Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA.
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Haqqani OP, Agarwal PK, Halin NM, Iafrati MD. Defining the radiation "scatter cloud" in the interventional suite. J Vasc Surg 2013; 58:1339-45. [PMID: 23663872 DOI: 10.1016/j.jvs.2013.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 01/16/2013] [Accepted: 01/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We hypothesized that fluoroscopic imaging creates radiation fields that are unevenly scattered throughout the endovascular suite. We sought to quantify the radiation dose spectrum at various locations during imaging procedures and to represent this in a clinically useful manner. METHODS Digital subtraction imaging (Innova 4100; GE Healthcare, Waukesha, Wisc) of the abdomen and pelvis was performed on a cadaver in anteroposterior, left lateral, and right anterior oblique 45° projections. Radiation exposure was monitored in real time with DoseAware dosimeters (Phillips, Houston, Tex) in eight radial projections at distances of 2, 4, and 6 ft from the center of the imaged field, each at 5-ft heights from the floor. Three to five consecutive data points were collected for each location. RESULTS At most positions around the angiographic table, radiation exposure decreased as the distance from the source emitter increased; however, the intensity of the exposure varied dramatically around the axis of imaging. With anteroposterior imaging, the radiation fields have symmetric dumbbell shapes, with maximal exposure perpendicular to the table at the level of the gantry. Peak levels at 4 and 6 ft from the source emitter were 2.4 times and 3.4 times higher, respectively, than predicted based on the inverse square law. Maximal radiation exposure was measured in the typical operator position 2 ft away and perpendicular to the table (4.99 mSv/h). When the gantry was rotated 45° and 90°, the radiation fields shifted, becoming more asymmetric, with increasing radiation doses to 10.9 and 69 mSv/h, respectively, on the side of the emitter. Minimal exposure is experienced along the axis of the table, decreasing with distance from the source (<0.77 mSv/h). CONCLUSIONS Quantifiable and reproducible radiation scatter is created during interventional procedures. Radiation doses vary widely around the perimeter of the angiography table and change according to imaging angles. These data are easily visualized using contour plots and scatter three-dimensional mesh plots. Rather than the concentric circles predicted by the inverse square law, these data more closely resemble a "scatter cloud." Knowledge of the actual exposure levels within the endovascular environment may help in mitigating these risks to health care providers.
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Affiliation(s)
- Omar P Haqqani
- Department of Vascular Surgery, The Cardiovascular Center, Tufts Medical Center, Boston, Mass.
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Kesavachandran CN, Haamann F, Nienhaus A. Radiation exposure and adverse health effects of interventional cardiology staff. REVIEWS OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2013; 222:73-91. [PMID: 22990945 DOI: 10.1007/978-1-4614-4717-7_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To the best of our knowledge, this chapter constitutes the first systematic review of radiation exposure to eyes, thyroid, and hands for Interventional Cardiology (IC) staff. We have concluded from our review that these anatomical locations are likely to be exposed to radiation as a result of the limited use of personal protective equipment (PPE) among IC staff as shown in Fig. 8. Our review also reveals that, with the exception of three eye exposure cases, the annual radiation dose to eyes, thyroid, and hands among IC staff was within recommended levels and limits. The As Low As Reasonably Achievable (ALARA) limit was not achieved in three cases for fingers/hands and four cases for eyes. However, an increased incidence of cataracts were reported for IC staff, and this gives rise to the concern that low-dose or unnoticed exposures may increase the risk of developing cataracts among cardiology staff. Clearly, the formation of cataracts among IC staff may be an issue and should be studied in more depth. Our review also disclosed that the two groups who receive excessive radiation doses (i.e., exceed the recommended limit) are physicians-in-training and junior staff physicians who work in cardiac catheterization laboratories. In particular, more attention should be given to assessing the effects of radiation exposure among IC staff who work in the Asia Pacific countries, because our review indicates that the number of IC procedures performed by IC staff in these countries is higher than for other continents. There is a huge demand for procedures conducted by IC staff in the Asia-Pacific area, for both treating patients and consulting with specialists. Our review also disclosed that recommended limits for per-procedure radiation doses are needed for IC staff. We recommend that such limits be established by the appropriate national and international agencies that are responsible for occupational radiation exposure. Although our review indicates that the current precautions against LDR exposure for IC staff are adequate in most cases, we are concerned about the relatively high incidence of cataracts reported to exist among IC staff. Therefore, we believe that there is a need for a strict implementation of radiation safety practices in cardiology laboratories and associated workplaces that utilize radiation. The action that is most important for protecting staff in the workplace against radiation exposure is the regular use of personal protective equipment or shielding. Working at a safe distance from instruments and assuring that such instruments are in the proper position are other techniques that can reduce the radiation dose received by IC staff.
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Affiliation(s)
- Chandrasekharan Nair Kesavachandran
- Centre for Epidemiology and Health Services Research in the Nursing Profession (CV care), University Medical Centre Hamburg-Eppendorf, Germany.
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Picano E, Vano E, Domenici L, Bottai M, Thierry-Chef I. Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer 2012; 12:157. [PMID: 22540409 PMCID: PMC3495891 DOI: 10.1186/1471-2407-12-157] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 04/27/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND According to a fundamental law of radiobiology ("Law of Bergonié and Tribondeau", 1906), the brain is a paradigm of a highly differentiated organ with low mitotic activity, and is thus radio-resistant. This assumption has been challenged by recent evidence discussed in the present review. RESULTS Ionizing radiation is an established environmental cause of brain cancer. Although direct evidence is lacking in contemporary fluoroscopy due to obvious sample size limitation, limited follow-up time and lack of focused research, anecdotal reports of clusters have appeared in the literature, raising the suspicion that brain cancer may be a professional disease of interventional cardiologists. In addition, although terminally differentiated neurons have reduced or mild proliferative capacity, and are therefore not regarded as critical radiation targets, adult neurogenesis occurs in the dentate gyrus of the hippocampus and the olfactory bulb, and is important for mood, learning/memory and normal olfactory function, whose impairment is a recognized early biomarker of neurodegenerative diseases. The head doses involved in radiotherapy are high, usually above 2 Sv, whereas the low-dose range of professional exposure typically involves lifetime cumulative whole-body exposure in the low-dose range of < 200 mSv, but with head exposure which may (in absence of protection) arrive at a head equivalent dose of 1 to 3 Sv after a professional lifetime (corresponding to a brain equivalent dose around 500 mSv). CONCLUSIONS At this point, a systematic assessment of brain (cancer and non-cancer) effects of chronic low-dose radiation exposure in interventional cardiologists and staff is needed.
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Affiliation(s)
- Eugenio Picano
- Institute Clinical Physiology of the National Research Council CNR, 56124, Pisa, Italy
| | - Eliseo Vano
- San Carlos University Hospital, Complutense University, Medical Physics Service, Madrid, Spain
| | - Luciano Domenici
- Neuroscience Institute of the National Research Council, CNR, Pisa, and Scienze e Tecnologie Biomediche Department, L'Aquila University, Pisa, Italy
| | - Matteo Bottai
- Institute of Environmental Medicine, Karolinska Institutet, Karolinska, Sweden
| | - Isabelle Thierry-Chef
- Environment and Radiation, International Agency for Research on Cancer, Lyon, France
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Larsen ASF, Østerås BH. Step back from the patient: reduction of radiation dose to the operator by the systematic use of an automatic power injector for contrast media in an interventional angiography suite. Acta Radiol 2012; 53:330-4. [PMID: 22334873 DOI: 10.1258/ar.2011.110560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND During arterial interventional procedures, power injectors allow the operator to step back from the patient or exit the angiography suite during digital subtraction angiography (DSA) acquisitions. Increasing the distance to the radiation source reduces exposure to the operator and staff. PURPOSE To systematically investigate the effect of increasing the distance between the radiation source and the operator during DSA acquisitions in a daily clinical setting, regarding radiation exposure to the operator and patient, as well as the duration of the procedure using a power injector to deliver contrast media. MATERIAL AND METHODS Patients scheduled for arterial interventional procedures in the pelvis or lower extremities were consecutively included. In phase one (duration 6 weeks, 44 patients) contrast media were injected manually. In phase two (duration until the total dose area product [DAP] was equal to phase 1, 41 patients) the operator used a power injector and exited the suite whenever possible. Patient, procedure, and examination data were recorded. Collective dose to the operator's collar, lead apron, and hands was recorded using thermo luminescent dosimetry (TLD). RESULTS Our results showed a dose reduction of 50% to the operator's hands, lead apron, and thyroid collar when using a power injector during DSA, with no significant increase in DAP or procedure time when performing pelvic procedures. For lower extremity procedures there was a small but significant increase in procedure time and DAP. Pelvic procedures yielded substantially higher DAP than lower extremity procedures during both phases. CONCLUSION Utilization of a power injector, thus allowing the operator to step back from the patient, facilitates a radiation dose reduction to the operator of approximately 50% with no significant increase in patient dose or procedure time during pelvic procedures.
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Affiliation(s)
| | - Bjørn Helge Østerås
- The Intervention Centre, Oslo University Hospital, Oslo
- Faculty Division of Clinical Medicine, University of Oslo, Oslo, Norway
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Haqqani OP, Agarwal PK, Halin NM, Iafrati MD. Minimizing radiation exposure to the vascular surgeon. J Vasc Surg 2012; 55:799-805. [DOI: 10.1016/j.jvs.2011.08.055] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 02/03/2023]
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Picano E, Vano E. The radiation issue in cardiology: the time for action is now. Cardiovasc Ultrasound 2011; 9:35. [PMID: 22104562 PMCID: PMC3256101 DOI: 10.1186/1476-7120-9-35] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/21/2011] [Indexed: 02/07/2023] Open
Abstract
The "radiation issue" is the need to consider possible deterministic effects (e.g., skin injuries) and long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing. Although there are currently no data showing that high-dose medical studies have actually increased the incidence of cancer, the "linear-no threshold" model in radioprotection assumes that no safe dose exists; all doses add up in determining cancer risks; and the risk increases linearly with increasing radiation dose. The possibility of deterministic effects should also be considered when skin or lens doses may be over the threshold. Cardiologists have a special mission to avoid unjustified or non-optimized use of radiation, since they are responsible for 45% of the entire cumulative effective dose of 3.0 mSv (similar to the radiological risk of 150 chest x-rays) per head per year to the US population from all medical sources except radiotherapy. In addition, interventional cardiologists have an exposure per head per year two to three times higher than that of radiologists. The most active and experienced interventional cardiologists in high volume cath labs have an annual exposure equivalent to around 5 mSv per head and a professional lifetime attributable to excess cancer risk on the order of magnitude of 1 in 100. Cardiologists are the contemporary radiologists but sometimes imperfectly aware of the radiological dose of the examination they prescribe or practice, which can range from the equivalent of 1-60 mSv around a reference dose average of 10-15 mSv for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multi-detector coronary angiography, or a myocardial perfusion imaging scintigraphy. A good cardiologist cannot be afraid of life-saving radiation, but must be afraid of radiation unawareness and negligence.
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Affiliation(s)
| | - Eliseo Vano
- Institute of Clinical Physiology, CNR, Pisa, Italy
- San Carlos University Hospital, Complutense University of Madrid, Madrid, Spain
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Evaluation of radiation during EVAR performed on a mobile C-arm. Eur J Vasc Endovasc Surg 2011; 43:16-21. [PMID: 22047911 DOI: 10.1016/j.ejvs.2011.09.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 09/14/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate radiation exposure during aortic endovascular aneurysm repair (EVAR) on a mobile C-arm using a low dose and pulse mode. METHODS We performed a retrospective analysis of a prospectively maintained database on patients undergoing EVAR. Indirect dose measurements of dose area product (DAP, mGy m²) calculated by the C-arm (OEC 9900MD), fluoroscopic time (FT), type of procedure, contrast media volume and body mass index were analysed. To confirm the correlation between direct and indirect DAP measurements, direct dose was measured with radiochromic films on a sample of 15 patients. Film grey level response was calibrated according to a reference dose measurement performed with a calibrated dosimeter. DAP and peak skin dose (PSD, Gy) were measured on each film. Correlation between DAP from direct and indirect measures, and between DAP and PSD, were analysed. RESULTS From January 2009 to April 2011, 335 patients underwent EVAR. Complete data were available on 301 procedures including 188 bifurcated, 54 fenestrated, 28 thoracic, 20 branched and 11 aorto-uni-iliac endografts implantation. The respective median FT and DAP was 9.36 min (1.8-67) and 3 mGy m(2) (0.4-28); 27.2 min (2-69) and 7.3 mGy m(2) (1.2-29); 7.75 min (1.2-19.1) and 2 mGy m(2) (0.3-11); 42.98 min (2.4-95.4) and 15.95 mGy m(2) (2.98-77.7); 6.2 min (0.5-36.3) and 2 mGy m(2) (0.3-11). Direct DAP measurement on radiochromic films was strongly correlated with DAP values provided by the C-arm (r = 0.98). PSD correlated weakly with DAP. DAP was significantly increased (p < 0.001) in patients with a body mass index >30. Contrast media volume was significantly increased in the branched endograft group. CONCLUSION Indirect DAP values measured by the C-arm are accurate to evaluate radiation exposure. Compared to the literature, our values for standard procedures are significantly decreased by the usage of low dose and pulse mode. DAP for fenestrated and branched procedures was comparable to published DAP values with standard procedures using a regular fluoroscopic mode.
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Russo GL, Tedesco I, Russo M, Cioppa A, Andreassi MG, Picano E. Cellular adaptive response to chronic radiation exposure in interventional cardiologists. Eur Heart J 2011; 33:408-14. [DOI: 10.1093/eurheartj/ehr263] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Comparison of indirect radiation dose estimates with directly measured radiation dose for patients and operators during complex endovascular procedures. J Vasc Surg 2011; 53:885-894.e1; discussion 894. [DOI: 10.1016/j.jvs.2010.10.106] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 10/18/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022]
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Birnie D, Healey JS, Krahn AD, Ahmad K, Crystal E, Khaykin Y, Chauhan V, Philippon F, Exner D, Thibault B, Hruczkowski T, Nery P, Keren A, Redfearn D. Prevalence and risk factors for cervical and lumbar spondylosis in interventional electrophysiologists. J Cardiovasc Electrophysiol 2011; 22:957-60. [PMID: 21385267 DOI: 10.1111/j.1540-8167.2011.02041.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED INTRODUCTION The volume and complexity of interventional electrophysiology procedures have increased greatly over the last 20 years. Anecdotal reports from Canada and elsewhere have suggested an important prevalence of neck and back problems in interventional electrophysiologists. METHODS AND RESULTS To quantify the scope of neck and back problems, we surveyed 70 interventional electrophysiologists in Canada using an electronic survey with in person and email reminders. We also surveyed an age- and gender-matched group of noninterventional cardiologists. We received responses from a total of 58 of 70 interventional electrophysiologists (response rate 82.8%). There was a significantly higher prevalence of cervical spondylosis among electrophysiologists compared to matched noninterventional cardiologists (20.7% compared to 5.5%, P = 0.033). There was a trend for increased prevalence of lumbar spondylosis (25.9% compared to 16.7%, P = 0.298). Among electrophysiologists, those with cervical spondylosis were older (49.83 ± 10.48 years compared to 44.57 ± 9.20, P = 0.092) and had worked in the specialty for longer in comparison to unaffected physicians (19.67 ± 10.06 years compared to 13.37 ± 8.97 years, P = 0.039). All other variables including gender, height, weight, BMI, type of lead, weekly average lead time, and % of time standing in electrophysiology laboratory were not different. On multivariable analysis there were no independent predictors of disease. CONCLUSIONS There is a significant increased prevalence of cervical spondylosis among interventional electrophysiologists. Programs to improve ergonomics and minimize time spent wearing lead are needed. The same vigilance that is used to ensure radiation safety in the laboratory should be applied to create ergonomic safety.
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Affiliation(s)
- David Birnie
- University of Ottawa Heart Institute, Canada Population Health Research Institute-McMaster University, Canada.
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