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Khambhati J, Leopold JA. Shielding for Radiation Safety in the Cardiac Catheterization Laboratory. Circ Cardiovasc Interv 2023; 16:e013647. [PMID: 37955162 DOI: 10.1161/circinterventions.123.013647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Jay Khambhati
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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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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Beyar R, Davies J, Cook C, Dudek D, Cummins P, Bruining N. Robotics, imaging, and artificial intelligence in the catheterisation laboratory. EUROINTERVENTION 2021; 17:537-549. [PMID: 34554096 PMCID: PMC9724959 DOI: 10.4244/eij-d-21-00145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The catheterisation laboratory today combines diagnosis and therapeutics, through various imaging modalities and a prolific list of interventional tools, led by balloons and stents. In this review, we focus primarily on advances in image-based coronary interventions. The X-ray images that are the primary modality for diagnosis and interventions are combined with novel tools for visualisation and display, including multi-imaging co-registration modalities with three- and four-dimensional presentations. Interpretation of the physiologic significance of coronary stenosis based on prior angiographic images is being explored and implemented. Major efforts to reduce X-ray exposure to the staff and the patients, using computer-based algorithms for image processing, and novel methods to limit the radiation spread are being explored. The use of artificial intelligence (AI) and machine learning for better patient care requires attention to universal methods for sharing and combining large data sets and for allowing interpretation and analysis of large cohorts of patients. Barriers to data sharing using integrated and universal protocols should be overcome to allow these methods to become widely applicable. Robotic catheterisation takes the physician away from the ionising radiation spot, enables coronary angioplasty and stenting without compromising safety, and may allow increased precision. Remote coronary procedures over the internet, that have been explored in virtual and animal studies and already applied to patients in a small pilot study, open possibilities for sharing experience across the world without travelling. Application of those technologies to neurovascular, and particularly stroke interventions, may be very timely in view of the need for expert neuro-interventionalists located mostly in central areas.
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Affiliation(s)
- Rafael Beyar
- Technion–Israel Institute of Technology, The Ruth & Bruce Rappaport Faculty of Medicine, B 9602, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Justin Davies
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Paul Cummins
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Nico Bruining
- Clinical Epidemiology and Innovation, Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
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Gutierrez-Barrios A, Angulo-Pain E, Noval-Morillas I, Cañadas-Pruaño D, de la Lastra IA, Gheorghe L, Zayas-Rueda R, Calle-Perez G, Vázquez-García R. The radioprotective effect of the Cathpax® AIR cabin during interventional cardiology procedures. Catheter Cardiovasc Interv 2021; 98:E523-E530. [PMID: 33979479 DOI: 10.1002/ccd.29773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/02/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The use of ionizing radiation during cardiac catheterization interventions adversely impacts the medical staff. Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has proven to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real-world procedures. METHODS AND RESULTS In this nonrandomized all-comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n = 59) and the non-RPC group (n = 60). No significant changes in the characteristics of patients and procedures, average contrast volume, air kerma (AK), dose area-product (DAP) and fluoroscopy time between both groups were apparent. In the RPC group, the first-operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures. CONCLUSIONS Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real-world setting.
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Affiliation(s)
| | - Esther Angulo-Pain
- Radiophysics and Radioprotection Department, Hospital Puerta del Mar (Cádiz), Spain
| | | | | | | | - Livia Gheorghe
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain
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Vemmou E, Alaswad K, Khatri JJ, Nikolakopoulos I, Karacsonyi J, Xenogiannis I, Karmpaliotis D, Garcia S, Burke MN, Brilakis ES. Patient Radiation Dose During Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2020; 13:e009412. [DOI: 10.1161/circinterventions.120.009412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Evangelia Vemmou
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
| | | | | | - Ilias Nikolakopoulos
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
| | - Judit Karacsonyi
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
| | - Iosif Xenogiannis
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
| | - Dimitri Karmpaliotis
- Center for Interventional Vascular Therapy, Columbia University, Medical Center, New York Presbyterian Hospital, New York City (D.K.)
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (S.G., M.N.B., E.S.B.)
| | - M. Nicholas Burke
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (S.G., M.N.B., E.S.B.)
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute Foundation, MN (E.V., I.N., J.K., I.X., S.G, M.N.B., E.S.B.)
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (S.G., M.N.B., E.S.B.)
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Temporal Trends in X-Ray Exposure during Coronary Angiography and Percutaneous Coronary Intervention. J Interv Cardiol 2020; 2020:9602942. [PMID: 32934609 PMCID: PMC7481933 DOI: 10.1155/2020/9602942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/19/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background Percutaneous coronary intervention exposes patient and staff to ionizing radiation. Although staff only receive a small fraction of patient dose through scatter radiation, there are concerns about the potential health effects of repeated exposure. Minimizing both patient and occupational exposure is needed. Objective This article investigates patient and operator X-ray exposure over time in coronary intervention in relation to upgraded X-ray equipment, improved shielding, and enhanced operator awareness. Materials and Methods Data regarding irradiation time, patient dose, and patient characteristics were extracted from the Norwegian Registry for Invasive Cardiology (NORIC) for procedures performed from 2013 to mid-2019. Personal operator dosimetry records were provided by the Norwegian Radiation and Nuclear Safety Authority. Improved operator shielding and awareness measures were introduced in 2018. Results In the period 2013 through June 2019, 21499 procedures were recorded in our institution. Mean dose area product (DAP) for coronary angiography decreased 37% from 2981 μGy·m2 in 2013 to 1891 μGy·m2 in 2019 (p < 0.001). For coronary intervention, DAP decreased 39% from 8358 μGy·m2 to 5055 μGy·m2. Personal dosimetry data indicate a 70% reduction in operator dose per procedure in 2019 compared to 2013. The most pronounced reduction occurred after improved radiation protection measures were implemented in 2018 (−48%). Conclusions This study shows a temporal trend towards considerable reduction in X-ray doses received by the patient and operator during cardiac catheterization. Upgraded X-ray equipment, improved shielding, and enhanced operator awareness are likely contributors to this development.
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Buda KG, Megaly MS, Omer M, Xenogiannis I, Brilakis ES. Use of Radiation Protection Measures in Live Percutaneous Coronary Interventions Cases at Interventional Scientific Meetings. JACC Cardiovasc Interv 2020; 13:905-906. [PMID: 32273104 DOI: 10.1016/j.jcin.2019.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/26/2019] [Indexed: 10/24/2022]
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Nikolakopoulos I, Brilakis ES. Reducing radiation dose: Yes I can! Catheter Cardiovasc Interv 2019; 94:392-394. [DOI: 10.1002/ccd.28472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/17/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Ilias Nikolakopoulos
- Minneapolis Heart Institute, Minneapolis Heart Institute FoundationAbbott Northwestern Hospital Minneapolis Minnesota
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute, Minneapolis Heart Institute FoundationAbbott Northwestern Hospital Minneapolis Minnesota
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Karatasakis A, Brilakis ES. Shields and garb for decreasing radiation exposure in the cath lab. Expert Rev Med Devices 2018; 15:683-688. [PMID: 30092660 DOI: 10.1080/17434440.2018.1510771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Decreasing radiation exposure of the cardiac catheterization laboratory staff is critical for minimizing radiation-related adverse outcomes and can be accomplished by decreasing patient dose and by shielding. Areas covered: protection from ionizing radiation can be achieved with architectural, equipment-mounted, and disposable shields, as well as with personal protective equipment. Expert commentary: Radiation protective aprons are the most commonly used personal protective equipment and provide robust radiation protection but can cause musculoskeletal strain. Use of a thyroid collar is recommended, as is use of 'shin guards', lead glasses and radioprotective caps, although the efficacy of the latter is being debated. Alternatives to lead aprons include shielding suspended from the ceiling and robotic percutaneous coronary intervention. Radiation protective gloves and cream can be used to protect the hands, but the best protection is to not directly expose them to the radiation beam. Devices that provide real time operator radiation dose monitoring can enable real time adjustments in positioning and shield placement, reducing radiation dose. Shielding can be achieved with architectural, equipment-mounted, and disposable shields. Equipment-mounted shielding includes ceiling-suspended shields, table-suspended drapes, and radioabsorbent drapes. Personal protective equipment and shielding should be consistently and judiciously utilized by all catheterization laboratory personnel.
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Affiliation(s)
- Aris Karatasakis
- a Department of Medicine , Rutgers New Jersey Medical School , Newark , NJ , USA
| | - Emmanouil S Brilakis
- b Minneapolis Heart Institute , Minneapolis , MN , USA.,c Department of Cardiovascular Diseases , UT Southwestern Medical Center and VA North Texas Health Care System , Dallas , TX , USA
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