1
|
Tamirisa KP, Alasnag M, Calvert P, Islam S, Bhardwaj A, Pakanati K, Zieroth S, Razminia M, Dalal AS, Mamas M, Russo AM, Kort S. Radiation Exposure, Training, and Safety in Cardiology. JACC. ADVANCES 2024; 3:100863. [PMID: 38939686 PMCID: PMC11198606 DOI: 10.1016/j.jacadv.2024.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 06/29/2024]
Abstract
Exposure to ionizing radiation is an inherent occupational health hazard in clinical cardiology. Health risks have been reported previously, including predilection to cancer. In addition, orthopedic injury due to prolonged wearing of heavy protective lead aprons, which are mandatory to reduce radiation risk, have been extensively documented. Cardiology as a specialty has grown with rising volumes of increasingly complex procedures. This includes electrophysiological, coronary, and structural intervention, advanced heart failure/transplant management, and diagnostic imaging. Both the operator as well imaging specialists are exposed to radiation, particularly in structural interventions where interventional cardiologists and structural imagers work closely. Increasingly, women interested in cardiology may deselect the field due to radiation concerns. This expert document highlights the risks of radiation exposure in cardiology, including practical tips within various subspecialty fields such as interventional/structural cardiology, electrophysiology, imaging, advanced heart failure, and pediatric cardiology.
Collapse
Affiliation(s)
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Sabrina Islam
- Section of Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Anju Bhardwaj
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas/McGovern Medical School, Texas Medical Center, Houston, Texas, USA
| | - Keerthana Pakanati
- Center for Cardiovascular Health, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Shelley Zieroth
- Department of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | | | - Aarti S. Dalal
- Division of Cardiology, Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
| | - Andrea M. Russo
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
| | - Smadar Kort
- Department of Cardiology, Stony Brook Heart Institute, Stony Brook, New York, USA
| | - ACC Women in Cardiology Advocacy Work Group
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Section of Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas/McGovern Medical School, Texas Medical Center, Houston, Texas, USA
- Center for Cardiovascular Health, Virginia Mason Franciscan Health, Seattle, Washington, USA
- Department of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
- Amita St. Joseph Hospital, Elgin, Illinois, USA
- Division of Cardiology, Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
- Department of Cardiology, Stony Brook Heart Institute, Stony Brook, New York, USA
| |
Collapse
|
2
|
Shekhar S, Ajay A, Agrawal A, Kumar A, Kaur M, Isogai T, Saad A, Abushouk AI, Abdelfattah O, Lak H, Farwati M, Ahuja K, Verma BR, Wunderle K, Ellis S, Khatri J, Ziada K, Krishnaswamy A, Kapadia S. Radiation reduction in a modern catheterization laboratory: A single-center experience. Catheter Cardiovasc Interv 2022; 100:575-584. [PMID: 36073017 DOI: 10.1002/ccd.30396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/31/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Measures were undertaken at the Cleveland Clinic to reduce radiation exposure to patients and personnel working in the catheterization laboratories. We report our experience with these improved systems over a 7-year period in patients undergoing diagnostic catheterization (DC) and percutaneous coronary interventions (PCIs). METHODS Patients were categorized into preinitiative (2009-2012) and postinitiative (2013-2019) groups in the DC and PCI cohorts. Propensity score matching was done between the pre- and postinitiative groups for both cohorts based on age, sex, body surface area, total fluoroscopy time, and total acquisition time. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (Ka,r ), and fluoroscopy- and acquisition-mode air kerma in patients in the two groups. RESULTS In the DC cohort, there was a significant reduction in Ka,r in the postinitiative group in comparison to the preinitiative group (median, 396 vs. 857 mGy; p < 0.001). In the PCI cohort, Ka,r in the postinitiative group was 1265 mGy, which was significantly lower than the corresponding values in the preinitiative group (1994 mGy; p < 0.001). We also observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates, and air kerma area product in the postinitiative group in comparison to the preinitiative group in both matched and unmatched DC and PCI cohorts after the institution of radiation reduction measures. CONCLUSION There was a significant and sustained reduction in radiation exposure to patients in the catheterization laboratory with the implementation of advanced protocols. Similar algorithms can be applied in other laboratories to achieve a similar reduction in radiation exposure.
Collapse
Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhishek Ajay
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anirudh Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Manpreet Kaur
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anas Saad
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Medhat Farwati
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Keerat Ahuja
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni R Verma
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Wunderle
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled Ziada
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|