Shields and garb for decreasing radiation exposure in the cath lab

An investigation into the knowledge, attitudes, and practice of radiation protection in interventional radiology and cardiac catheter-laboratories

BACKGROUND

According to current literature, there is a lack of information regarding the radiation protection (RP) practices of interventional radiology (IR) and cardiology catheter laboratory (CCL) staff. This study aims to determine the RP practices of staff within IR and CCLs internationally and to suggest areas for improvement.

METHODS

A cross-sectional study in the form of an online questionnaire was developed. Participation was advertised via online platforms and through email. Participants were included if they were healthcare professionals currently working in IR and CCLs internationally. Questionnaire design included Section 1 demographic data, Section 2 assessed RP training and protocols, Section 3 surveyed the use of different types of RP lead shields, both personal and co-worker use and Section 4 assessed other methods of minimising radiation dose within practice. Questions were a mix of open and closed ended, descriptive statistics were used for closed questions and thematic analysis was employed for open ended responses.

RESULTS

A total of 178 responses to the questionnaire were recorded with 130 (73 %) suitable for analysis. Most respondents were female (n = 94, 72 %) and were radiographers (n = 97, 75 %). Only 68 (53 %) had received training, the majority receiving this in-house (n = 54, 79 %). 118 (98 %) of respondents had departmental protocols in place for RP. Radiology managers (n = 106, 82 %) were most likely to contribute to such protocols. Multiple methods of dose minimisation exist, these include low-dose fluoroscopy, staff rotation, radiation dose audits and minimal time in the controlled areas. Respondents reported that lead apron shields were wore personally by 99 % of respondents and by co-workers in 95 % of cases.

CONCLUSION

The practices of RP by IR and CCL staff in this survey was variable and can be improved. The unavailability of basic radiation protection tools and RP specific training courses/modules were some of the reasons for sub-optimal self-protection against ionising radiation reported by respondents.

Value of interventional radiology and their contributions to modern medical systems

Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.

Measurement of Occupational Eye and Thyroid Radiation Doses in Pediatric Interventional Cardiologists at a Tertiary Hospital

Background Advances in imaging techniques have led to increased utilization of imaging devices in catheterization laboratories. Invasive surgical procedures for cardiac disorders have been largely replaced by fluoroscopic cardiac catheterization. With this increase, concerns and risks associated with exposure to ionizing radiation among interventional cardiologists are growing. This study aims to measure and compare the occupational doses to the eye lens and thyroid of pediatric interventional cardiologists during different procedures in the catheterization laboratory and its significance. Methodology In this study, cardiologists wore bandanas with attached dosimeters to measure the absorbed doses to the eyes and thyroid gland. The dosimeters were collected for reading. The procedure types were also collected. In addition, the total fluoroscopy time and tube voltage of the biplane machine were measured. SPSS version 23 (IBM Corp., Armonk, NY, USA) was used to analyze the data. The characteristics of the study sample were described using simple counts and percentages, whereas means and standard deviations were used for continuous variables. Statistical significance was set at p-values <0.05. Results A total of 93 procedures were evaluated. The mean absorbed doses for all 93 procedures in both eyes and thyroid were 0.09 mGy and 0.08 mGy, respectively. A significant difference was found between the left and right eye measurements (p = 0.034), with higher doses administered to the left eye. However, no significant difference was observed between the right and left thyroid doses (p = 0.281). Significant correlations were found between the eye and thyroid doses and the procedure type (p = 0.02 and p = 0.009, respectively). Conclusions A significant amount of radiation was measured in the measurements of both organs. In addition, radiation dose measurements varied between different types of procedures. Our current results indicate the importance and necessity of applying the radiation protection concept of dose optimization.

Educational Experience of Interventional Cardiology Fellows in the United States and Canada

BACKGROUND

The COVID-19 pandemic and iodinated contrast shortage may have affected interventional cardiology (IC) fellowship training.

OBJECTIVES

The aim of this study was to investigate the educational experience of first-year IC fellows in the United States and Canada.

METHODS

A 59-question online survey was conducted among 2021-2022 first-year IC fellows in the United States and Canada.

RESULTS

Of the 360 IC fellows invited to participate, 111 (31%) responded; 95% were from the United States, and 79% were men. Participants were mostly from university programs (70%), spent 61 to 70 hours/week in the hospital, and had an annual percutaneous coronary intervention case number of <200 (5%), 200 to 249 (8%), 250 to 349 (33%), 350 to 499 (39%), 500 to 699 (12%), or ≥700 (3%). For femoral access, a micropuncture needle was used regularly by 89% and ultrasound-guided puncture by 81%, and 43% used vascular closure devices in most cases (>80%). Intravascular ultrasound was performed and interpreted very comfortably by 62% and optical coherence tomography (OCT) by 32%, and 20% did not have access to OCT. Approximately one-third felt very comfortable performing various atherectomy techniques. Covered stents, fat embolization, and coil embolization were used very comfortably by 14%, 4%, and 3%, respectively. Embolic protection devices were used very comfortably by 11% to 24% of IC fellows. Almost one-quarter of fellows (24%) were warned about their high radiation exposure. Eighty-four percent considered IC fellowship somewhat or very stressful, and 16% reported inadequate psychological support.

CONCLUSIONS

This survey highlights opportunities for improvement with regard to the use of intravascular imaging, atherectomy techniques, complication prevention and management strategies, radiation awareness and mitigation, and psychological support.

CURRENT TRENDS OF RADIATION PROTECTION EQUIPMENT IN INTERVENTIONAL RADIOLOGY

Interventional radiology represents subspecialty of radiology, which does not use imaging modalities only for diagnostics, but mostly for therapeutic purposes. Realisation of interventional procedures is done through X-rays, which replaces direct visual control done by interventional radiologist or cardiologist. For the targeted reduction of the radiation exposure, the interventional radiology staff use personal protective equipment. Usually, aprons with lead-equivalent are used, which provide protection for 75% of the radiosensitive organs. As the eye lens and thyroid gland belong to the radiosensitive organs, lead eyeglasses and thyroid collar are commonly used for their protection. Cap and gloves with lead-equivalent can be utilised as an additional personal protective equipment, that is commercially available. Innovative protection systems, such as mobile radiation protection cabin and suspended radiation protection, have been designed to ensure better radiation protection and safety. These systems provide the comfort for the interventional radiologists at work, while offering better protection against ionising radiation.

Personalized Radiation Attenuating Materials for Gastrointestinal Mucosal Protection

Cancer patients undergoing therapeutic radiation routinely develop injury of the adjacent gastrointestinal (GI) tract mucosa due to treatment. To reduce radiation dose to critical GI structures including the rectum and oral mucosa, 3D-printed GI radioprotective devices composed of high-Z materials are generated from patient CT scans. In a radiation proctitis rat model, a significant reduction in crypt injury is demonstrated with the device compared to without (p < 0.0087). Optimal device placement for radiation attenuation is further confirmed in a swine model. Dosimetric modeling in oral cavity cancer patients demonstrates a 30% radiation dose reduction to the normal buccal mucosa and a 15.2% dose reduction in the rectum for prostate cancer patients with the radioprotectant material in place compared to without. Finally, it is found that the rectal radioprotectant device is more cost-effective compared to a hydrogel rectal spacer. Taken together, these data suggest that personalized radioprotectant devices may be used to reduce GI tissue injury in cancer patients undergoing therapeutic radiation.

Double-layered fiber for lightweight flexible clothing providing shielding from low-dose natural radiation

Natural and medical radiation are the most frequent sources of daily low-dose radiation exposure for the general public, but these radiation levels are generally acceptable. Among various occupations, aviation crew members and medical workers are exposed to high levels of radiation from scattered rays. This study focused on developing clothing for shielding aviation crew members from natural radiation during air travel. Materials were selected considering their radiation-shielding properties. A tungsten double-layered composite yarn and a polyethylene terephthalate (PET) fiber fabric containing BaSO4 were manufactured. The characteristics and shielding performances of the products were analyzed. Prototypes of a protective scarf (for shielding the thyroid gland) and apron (for shielding the torso) for flight attendants were produced. A lightweight fabric was produced that neither restricts the movement of the wearer nor causes them skin discomfort. The shielding performances of the tungsten composite and PET fiber fabrics containing BaSO4 were 0.018 mmPb and 0.03 mmPb, respectively, demonstrating low-dose shielding that may be useful for protecting aviation crew members from scattered rays. The characteristics of the developed fibers are comparable to those of materials used in clothing production; therefore, low-dose radiation-shielding clothing could be manufactured for use in aviation, medical, and other industries.

Current utilization and future directions of robotic-assisted endovascular surgery

INTRODUCTION

Endovascular surgery has become the standard of care to treat most vascular diseases using a minimally invasive approach. The CorPath system further enhances the potential and enables surgeons to perform robotic-assisted endovascular procedures in interventional cardiology, peripheral vascular surgery, and neurovascular surgery. With the introduction of this technique, the operator can perform multiple steps of endovascular interventions outside of the radiation field with high precision movements even from long-geographical distances.

AREAS COVERED

The first and second-generation CorPath systems are currently the only commercially available robotic devices for endovascular surgery. This review article discusses the clinical experiences and outcomes with the robot, the advanced navigational features, and the results with recent hardware and software modifications, which enables the use of the system for neurovascular interventions, and long-distance interventional procedures.

EXPERT OPINION

A high procedural success was achieved with the CorPath robotic systems in coronary and peripheral interventions, and the device seems promising in neurovascular procedures. More experience is needed with robotic neurovascular interventions and with complex peripheral arterial cases. In the future, long-distance endovascular surgery can potentially transform the management and treatment of acute myocardial infarction and stroke, with making endovascular care more accessible for patients in remote areas.