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Kataoka A, Takata T, Yanagawa A, Kito K, Arakawa M, Ishibashi R, Katayama T, Mitsui M, Nagura F, Kawashima H, Hioki H, Watanabe Y, Kozuma K, Kotoku J. Body Surface Radiation Exposure in Interventional Echocardiographers During Structural Heart Disease Procedures. JACC. ASIA 2023; 3:301-309. [PMID: 37181397 PMCID: PMC10167512 DOI: 10.1016/j.jacasi.2022.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 05/16/2023]
Abstract
Background The distribution of radiation exposure on the body surface of interventional echocardiographers during structural heart disease (SHD) procedures is unclear. Objectives This study estimated and visualized radiation exposure on the body surface of interventional echocardiographers performing transesophageal echocardiography by computer simulations and real-life measurements of radiation exposure during SHD procedures. Methods A Monte Carlo simulation was performed to clarify the absorbed dose distribution of radiation on the body surface of interventional echocardiographers. The real-life radiation exposure was measured during 79 consecutive procedures (44 transcatheter edge-to-edge repairs of the mitral valve and 35 transcatheter aortic valve replacements [TAVRs]). Results The simulation demonstrated high-dose exposure areas (>20 μGy/h) in the right half of the body, especially the waist and lower body, in all fluoroscopic directions caused by scattered radiation from the bottom edge of the patient bed. High-dose exposure occurred when obtaining posterior-anterior and cusp-overlap views. The real-life exposure measurements were consistent with the simulation estimates: interventional echocardiographers were more exposed to radiation at their waist in transcatheter edge-to-edge repair than in TAVR procedures (median 0.334 μSv/mGy vs 0.053 μSv/mGy; P < 0.001) and in TAVR with self-expanding valves than in those with balloon-expandable valves (median 0.067 μSv/mGy vs 0.039 μSv/mGy; P < 0.01) when the posterior-anterior or the right anterior oblique angle fluoroscopic directions were used. Conclusions During SHD procedures, the right waist and lower body of interventional echocardiographers were exposed to high radiation doses. Exposure dose varied between different C-arm projections. Interventional echocardiographers, especially young women, should be educated regarding radiation exposure during these procedures. (The development of radiation protection shield for catheter-based treatment of structural heart disease [for echocardiologists and anesthesiologists]; UMIN000046478).
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Affiliation(s)
- Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Takeshi Takata
- Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan
| | - Ayaka Yanagawa
- Department of Anesthesia, Teikyo University, Tokyo, Japan
| | - Kento Kito
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Masataka Arakawa
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
- Department of Cardiovascular Medicine, Asahi General Hospital, Tokyo, Japan
| | - Ruri Ishibashi
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Taiga Katayama
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Miho Mitsui
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Fukuko Nagura
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hideyuki Kawashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Jun’ichi Kotoku
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
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Yanagawa A, Takata T, Onimaru T, Honjo T, Sajima T, Kakinuma A, Kataoka A, Kotoku J. New perforated radiation shield for anesthesiologists: Monte Carlo simulation of effects. JOURNAL OF RADIATION RESEARCH 2023; 64:379-386. [PMID: 36702614 PMCID: PMC10036102 DOI: 10.1093/jrr/rrac106] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/15/2022] [Indexed: 06/18/2023]
Abstract
Catheterization for structural heart disease (SHD) requires fluoroscopic guidance, which exposes health care professionals to radiation exposure risk. Nevertheless, existing freestanding radiation shields for anesthesiologists are typically simple, uncomfortable rectangles. Therefore, we devised a new perforated radiation shield that allows anesthesiologists and echocardiographers to access a patient through its apertures during SHD catheterization. No report of the relevant literature has described the degree to which the anesthesiologist's radiation dose can be reduced by installing radiation shields. For estimating whole-body doses to anesthesiologists and air dose distributions in the operating room, we used a Monte Carlo system for a rapid dose-estimation system used with interventional radiology. The simulations were performed under four conditions: no radiation shield, large apertures, small apertures and without apertures. With small apertures, the doses to the lens, waist and neck surfaces were found to be comparable to those of a protective plate without an aperture, indicating that our new radiation shield copes with radiation protection and work efficiency. To simulate the air-absorbed dose distribution, results indicated that a fan-shaped area of the dose rate decrease was generated in the area behind the shield, as seen from the tube sphere. For the aperture, radiation was found to wrap around the backside of the shield, even at a height that did not match the aperture height. The data presented herein are expected to be of interest to all anesthesiologists who might be involved in SHD catheterization. The data are also expected to enhance their understanding of radiation exposure protection.
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Affiliation(s)
- Ayaka Yanagawa
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Takeshi Takata
- Advanced Comprehensive Research Organization, Teikyo University, Tokyo 173-8605, Japan
| | - Taichi Onimaru
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Takahiro Honjo
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Takeyuki Sajima
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Akihito Kakinuma
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo 173-8605, Japan
| | - Jun’ichi Kotoku
- Corresponding author. Graduate School of Medical Care and Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan. Tel: +81-3-3964-1211; Fax: +81-3-3964-6022;
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Takata T, Nakabayashi S, Kondo H, Yamamoto M, Furui S, Shiraishi K, Kobayashi T, Oba H, Okamoto T, Kotoku J. Mixed Reality Visualization of Radiation Dose for Health Professionals and Patients in Interventional Radiology. J Med Syst 2021; 45:38. [PMID: 33594609 PMCID: PMC7886835 DOI: 10.1007/s10916-020-01700-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
For interventional radiology, dose management has persisted as a crucially important issue to reduce radiation exposure to patients and medical staff. This study designed a real-time dose visualization system for interventional radiology designed with mixed reality technology and Monte Carlo simulation. An earlier report described a Monte-Carlo-based estimation system, which simulates a patient's skin dose and air dose distributions, adopted for our system. We also developed a system of acquiring fluoroscopic conditions to input them into the Monte Carlo system. Then we combined the Monte Carlo system with a wearable device for three-dimensional holographic visualization. The estimated doses were transferred sequentially to the device. The patient's dose distribution was then projected on the patient body. The visualization system also has a mechanism to detect one's position in a room to estimate the user's exposure dose to detect and display the exposure level. Qualitative tests were conducted to evaluate the workload and usability of our mixed reality system. An end-to-end system test was performed using a human phantom. The acquisition system accurately recognized conditions that were necessary for real-time dose estimation. The dose hologram represents the patient dose. The user dose was changed correctly, depending on conditions and positions. The perceived overall workload score (33.50) was lower than the scores reported in the literature for medical tasks (50.60) for computer activities (54.00). Mixed reality dose visualization is expected to improve exposure dose management for patients and health professionals by exhibiting the invisible radiation exposure in real space.
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Affiliation(s)
- Takeshi Takata
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
| | | | - Hiroshi Kondo
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masayoshi Yamamoto
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeru Furui
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenshiro Shiraishi
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takenori Kobayashi
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahide Okamoto
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
- Central Radiology Division, Teikyo University Hospital, Tokyo, Japan
| | - Jun'ichi Kotoku
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan.
- Central Radiology Division, Teikyo University Hospital, Tokyo, Japan.
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