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Ingleby HR, Bonilha HS, Steele CM. A Tutorial on Diagnostic Benefit and Radiation Risk in Videofluoroscopic Swallowing Studies. Dysphagia 2023; 38:517-542. [PMID: 34254167 DOI: 10.1007/s00455-021-10335-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
The videofluoroscopic swallowing study (VFSS) is a key tool in assessing swallowing function. As with any diagnostic procedure, the probable benefits of the study must be weighed against possible risks. The probable benefit of VFSS is an accurate assessment of swallowing function, enabling patient management decisions potentially leading to improved patient health status and quality of life. A possible (though highly unlikely) risk in VFSS is carcinogenesis, arising from the use of ionizing radiation. Clinicians performing videofluoroscopic swallowing studies should be familiar with both sides of the risk benefit equation in order to determine whether the study is medically justified. The intent of this article is to provide the necessary background for conversations about benefit and risk in videofluoroscopic swallowing studies.
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Affiliation(s)
- Harry R Ingleby
- Division of Medical Physics, CancerCare Manitoba; Departments of Radiology and Physics & Astronomy, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada.
| | - Heather S Bonilha
- Departments of Rehabilitation Sciences; Health Science and Research; and Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Catriona M Steele
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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2
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Gutierrez-Barrios A, Cañadas-Pruaño D, Noval-Morillas I, Gheorghe L, Zayas-Rueda R, Calle-Perez G. Radiation protection for the interventional cardiologist: Practical approach and innovations. World J Cardiol 2022; 14:1-12. [PMID: 35126868 PMCID: PMC8788173 DOI: 10.4330/wjc.v14.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/06/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and medical staff. In recent years, radiation dose in cardiac catheterization interventions has become a topic of increasing interest in interventional cardiology and there is a strong interest in reducing radiation exposure during the procedures. This review presents the current status of radiation protection in the cardiac catheterization laboratory and summarizes a practical approach for radiation dose management for minimizing radiation exposure. This review also presents recent innovations that have clinical potential for reducing radiation during cardiac interventions.
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Affiliation(s)
| | | | | | - Livia Gheorghe
- Department of Cardiology, Hospital Puerta del Mar, Cadiz 11009, Spain
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Kaatsch HL, Schneider J, Brockmann C, Brockmann MA, Overhoff D, Becker BV, Waldeck S. Radiation exposure during angiographic interventions in interventional radiology - risk and fate of advanced procedures. Int J Radiat Biol 2022; 98:865-872. [PMID: 34982640 DOI: 10.1080/09553002.2021.2020362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Advanced angiographic procedures in interventional radiology are becoming more important and are more frequently used, especially in the treatment of several acute life-threatening diseases like stroke or aortic injury. In recent years, technical advancement has led to a broader spectrum of interventions and complex procedures with longer fluoroscopy times. This involves the risk of higher dose exposures, which, in rare cases, may cause deterministic radiation effects, e.g. erythema in patients undergoing angiographic procedures. Against this background, these procedures recently also became subject to national and international regulations regarding radiation protection. At the same time, individual risk assessment of possible stochastic radiation effects for each patient must be weighed up against the anticipated benefits of the therapy itself. Harmful effects of the administered dose are not limited to the patient but can also affect the radiologist and the medical staff. In particular, the development of cataracts in interventionalists is a rising matter of concern. Furthermore, long-term effects of repeated and prolonged x-ray exposure have long been neglected by radiologists but have come into focus in the past years. CONCLUSIONS With all this in mind, this review discusses different efforts to reduce radiation exposition levels for patients and medical staff by means of technical, personal as well as organizational measures.
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Affiliation(s)
| | - Julian Schneider
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
| | - Carolin Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Daniel Overhoff
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
| | | | - Stephan Waldeck
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
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Burman S, Das A, Mahajan C, Rath GP. Radiation Concerns for the Neuroanesthesiologists. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2020. [DOI: 10.1055/s-0040-1715354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractWith the advent of minimally invasive neurosurgical techniques and rapid innovations in the field of neurointervention, there has been a sharp rise in diagnostic and therapeutic modalities requiring radiation exposure. Neuroanesthesiologists are currently involved in various procedures inside as well as outside the operating room (OR) like intensive care units, interventional suites, and gamma knife units. The ambit expands from short-lasting diagnostic scans to lengthy therapeutic procedures performed under fluoroscopic guidance. Hence, a modern-day neuroanesthesiologist has to bear the brunt of the radiation exposure in both inside and outside the OR. However, obliviousness and nonadherence to the relevant radiation safety measures are still prevalent. Radiation protection and safety are topics that need to be discussed with new vigor in the light of current practice.
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Affiliation(s)
- Sourav Burman
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abanti Das
- Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Girija P. Rath
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Mohd Ridzwan SF, Bhoo-Pathy N, Isahak M, Wee LH. Perceptions on radioprotective garment usage and underlying reasons for non-adherence among medical radiation workers from public hospitals in a middle-income Asian setting: A qualitative exploration. Heliyon 2019; 5:e02478. [PMID: 31687573 PMCID: PMC6819771 DOI: 10.1016/j.heliyon.2019.e02478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/07/2019] [Accepted: 09/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background Radioprotective garments protect medical radiation workers from exposure to radiation at workplace. However, previous studies have found poor adherence to the use of radioprotective garments. Objectives We explored the perceptions and practices related to the use of radioprotective garments among medical radiation workers in public hospitals, and sought to understand the reasons for non-adherence. Design and setting A qualitative approach was applied by conducting face-to-face in-depth interviews with 18 medical radiation workers from three university hospitals using a semi-structured interview guide. Results Five themes emerged with respect to perceptions on the use of radioprotective garments: (i) the dilemmas in practising radiation protection, (ii) indication of workers' credibility, (iii) physical appearance of radioprotective garments, (iv) practicality of radioprotective garment use, and (v) impact on workflow. Actual lack of radioprotective garment use was attributed to inadequate number of thyroid shield and other garments, radioprotective garments' unsightly appearance including being dirty and defective, impracticality of using radioprotective garments for some nuclear medicine procedures, disruption of workflow because of workers’ limited movements, attitudes of workers, and organisational influences. Conclusion Medical radiation workers demonstrated a definitive practice of using radioprotective aprons, but often neglected to use thyroid shields and other garments. Availability and hygiene are reported as the core issues, while unclear guidelines on practical use of radioprotective garments appear to lead to confusion among medical radiation workers. To the best of our knowledge, this is the first qualitative study of its kind from a middle-income Asian setting.
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Affiliation(s)
- Siti Farizwana Mohd Ridzwan
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Kuala Lumpur, Malaysia.,Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Marzuki Isahak
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Lei Hum Wee
- Health Education Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
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Omi H, Itabashi T, Nagaoki T, Ogawa T, Tomita T, Sato H, Ito J. Protecting Surgeons' Fingers from Radiation Exposure during Lumbosacral Selective Nerve Root Block. Spine Surg Relat Res 2019; 3:178-182. [PMID: 31435572 PMCID: PMC6690092 DOI: 10.22603/ssrr.2018-0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Fluoroscopy-guided selective nerve root block (SNRB) is useful for the diagnosis and treatment of nerve root pain. However, the procedure exposes the surgeon's hands to radiation. Therefore, the purpose of this randomized prospective study was to assess the radiation exposure per unit time of the surgeon's fingers during performance of a lumbosacral SNRB and to calculate the annual exposure time limits for four hand-protection methods. Methods We prospectively recruited patients scheduled for an SNRB and measured the radiation exposure using a ring-type passive radiation dosimetry device attached to the distal phalanx of the index finger of the hand performing the needle placement. Patients were randomly divided into the following four groups: a) the direct exposure group, b) the 0.03-mmPb glove group, c) the 0.25-mmPb glove group, and d) the forceps group (in which the needle was held using forceps such that the fingers did not enter the irradiation field). Results We recruited 40 consecutive patients (16 men and 24 women), with a mean age of 69 years. In all cases, SNRB was successfully performed without complications. The average exposure per hour for each of the four groups was as follows: 0.67 ± 0.56 mSv/s in the direct exposure group, 0.12 ± 0.07 mSv/s in the 0.03-mmPb glove group, 0.019 ± 0.02 mSv/s in the 0.25-mmPb glove group, and 0.001 ± 0.004 mSv/s in the forceps group (p < 0.01). The average annual exposure time limit was 12.4 min in the direct exposure group, 67.9 min in the 0.03-mmPb glove group, 7.5 h in the 0.25-mmPb glove group, and 5.0 days in the forceps group. Conclusions Using a radiation reduction glove or forceps greatly decreased the radiation exposure and increased the annual exposure time limit for SNRB.
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Affiliation(s)
- Hirotsugu Omi
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Taito Itabashi
- Department of Orthopedic Surgery, Towada City Hospital, Aomori, Japan
| | - Toshihide Nagaoki
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Tetsuya Ogawa
- Department of Orthopedic Surgery, Mutsu General Hospital, Aomori, Japan
| | - Takashi Tomita
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Hideki Sato
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Junji Ito
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
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Smith JR, Marsh RM, Silosky MS. Is lead shielding of patients necessary during fluoroscopic procedures? A study based on kyphoplasty. Skeletal Radiol 2018; 47:37-43. [PMID: 28821928 DOI: 10.1007/s00256-017-2756-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the benefits, risks, and limitations associated with wrapping a patient with lead shielding during fluoroscopy-guided kyphoplasty procedures as a way to reduce operator radiation exposure. MATERIALS AND METHODS An anthropomorphic phantom was used to mimic a patient undergoing a kyphoplasty procedure under fluoroscopic guidance. Radiation measurements of the air kerma rate (AKR) were made at several locations and under various experimental conditions. First, AKR was measured at various angles along the horizontal plane of the phantom and at varying distances from the phantom, both with and without a lead apron wrapped around the lower portion of the phantom (referred to here as phantom shielding). Second, the effect of an operator's apron was simulated by suspending a lead apron between the phantom and the measurement device. AKR was measured for the four shielding conditions-phantom shielding only, operator apron only, both phantom shielding and operator apron, and no shielding. Third, AKR measurements were made at various heights and with varying C-arm angle. RESULTS At all locations, the phantom shielding provided no substantial protection beyond that provided by an operator's own lead apron. Phantom shielding did not reduce AKR at a height comparable to that of an operator's head. CONCLUSIONS Previous reports of using patient shielding to reduce operator exposure fail to consider the role of an operator's own lead apron in radiation protection. For an operator wearing appropriate personal lead apparel, patient shielding provides no substantial reduction in operator dose.
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Affiliation(s)
- Joshua R Smith
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA
| | - Rebecca M Marsh
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA.
| | - Michael S Silosky
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA
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Yamagata K, Aldhoon B, Kautzner J. Reduction of Fluoroscopy Time and Radiation Dosage During Catheter Ablation for Atrial Fibrillation. Arrhythm Electrophysiol Rev 2016; 5:144-9. [PMID: 27617094 DOI: 10.15420/aer.2016.16.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Radiofrequency catheter ablation has become the treatment of choice for atrial fibrillation (AF) that does not respond to antiarrhythmic drug therapy. During the procedure, fluoroscopy imaging is still considered essential to visualise catheters in real-time. However, radiation is often ignored by physicians since it is invisible and the long-term risks are underestimated. In this respect, it must be emphasised that radiation exposure has various potentially harmful effects, such as acute skin injury, malignancies and genetic disease, both to patients and physicians. For this reason, every electrophysiologist should be aware of the problem and should learn how to decrease radiation exposure by both changing the setting of the system and using complementary imaging technologies. In this review, we aim to discuss the basics of X-ray exposure and suggest practical instructions for how to reduce radiation dosage during AF ablation procedures.
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Affiliation(s)
- Kenichiro Yamagata
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Bashar Aldhoon
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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