Assessing and improving radiation safety in cardiac catheterization: a study from Cairo University Hospital

BACKGROUND

Catheter laboratories are high-radiation exposure environments, especially during X-ray procedures like percutaneous transluminal coronary angioplasty and electrophysiological studies. Radiation exposure poses risks of stochastic (e.g., cancer) and deterministic (e.g., skin changes) effects. This study assessed radiation safety and health practices in a cardiac catheterization unit to optimize radiation safety. A cross-sectional study in Cairo University Hospital (March-September 2019) evaluated 700 patients and healthcare workers. Real-time radiation measurements, educational lectures, and radiation protection measures were implemented in three phases. Data on radiation exposure, procedures, and compliance were collected and analyzed.

RESULTS

The total procedure time and fluoroscopy time per cardiologist did not significantly differ between phases, but there was a statistically significant reduction in the mean total cumulative radiation doses between Phase I and Phase III for cardiologists (P = 0.013). Among nurses and technicians, there was no significant difference in radiation doses between the two phases. Significant correlations were found between operators' radiation doses, procedure time, and fluoroscopy time. Patients' radiation doses decreased significantly from Phase I to Phase III, with correlations between dose, procedure time, and gender. Compliance with radiation protection measures was suboptimal.

CONCLUSIONS

Compliance with radiation safety standards in the cardiac catheterization unit at the Cairo University Hospital needs improvement. The study highlights the importance of adhering to radiation safety principles and optimizing protective measures to reduce radiation exposure for both patients and healthcare personnel. Despite low compliance, significant reductions in radiation doses were achieved with increased awareness and adherence to specific protection measures. Future efforts should focus on enhancing radiation safety protocols and organ-specific radiation impact assessments.

A paradigm shift in point-of-care imaging in low-income and middle-income countries

The concept of primary healthcare is now regarded as crucial for enhancing access to healthcare services in low-income and middle-income countries (LMICs). Technological advancements that have made many medical imaging devices smaller, lighter, portable and more affordable, and infrastructure advancements in power supply, Internet connectivity, and artificial intelligence, are all increasing the feasibility of POCI (point-of care imaging) in LMICs. Although providing imaging services at the same time as the clinic visit represents a paradigm shift in the way imaging care is typically provided in high-income countries where patients are typically directed to dedicated imaging centres, a POCI model is often the only way to provide timely access to imaging care for many patients in LIMCs. To address the growing burden of non-communicable diseases such as cancer and heart disease, bringing advanced imaging tools to the POCI will be necessary. Strategies tailored to the countries' specific needs, including training, safety and quality, will be of the utmost importance.

2021 NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR PAEDIATRIC COMPUTED TOMOGRAPHY IN EGYPT

OBJECTIVE

To establish national diagnostic reference levels (NDRLs) for most common paediatric computed tomography (CT) examinations in Egypt.

METHODS

This was a prospective study that included all dedicated paediatric imaging centers in Egypt. Data from 1680 individual paediatric patients undergoing CT scanning of the head, chest and abdomen-pelvis were collected. Computed tomography dose indices were recorded, data were analysed and compared with the internationally published paediatric DRLs in14 countries.

RESULTS

The Egyptian NDRLs of the CTDIvol (mGy) for head, chest and abdomen-pelvis scans among four paediatric age groups were found to be (23, 27, 28, 32, 4, 5, 6, 8, 5, 6, 7, 9) mGy, respectively; and the corresponding NDRLs of the DLP (mGycm) for head, chest and abdomen-pelvis scans were found to be (345, 428, 499, 637, 67, 85, 145, 215, 97, 135, 240, 320) mGycm, respectively. There were variations in the radiation doses between CT centers and identical scanners indicating the need for dose optimization. The NDRLs of the CTDIvol (mGy) and the DLP (mGycm) values were similar to or lower than international DRLs.

CONCLUSION

This study summarizes the results of the first Egyptian Computed Tomography survey that provides national diagnostic reference levels for paediatric patients in Egypt. Despite the reasonable NDRLs values, the study depicted certain pros and cons concerning CT practice, and identified some problems that hinder the process of optimization as well as justification in children.

Abstract 236: Evaluation Of The Radiation Safety And Protection Practices At The Cardiac Catheterization Unit Of The Cairo University Hospital

Introduction: Cardiac Catheterization laboratories are one of the most hazardous places to work in. The aim of this study is to evaluate the radiation safety in the cardiac catheterization unit at the Cairo University Hospital in Egypt.

Hypothesis: We hypothesize that the employees of the Cath labs are overexposed to radiation.

Methods: We conducted a cross-sectional observational descriptive study at two Cath labs at the Cairo University Hospital in 2019. The participants were nine cardiologists, six nurses, three technicians, and seven hundred patients. The study was conducted over seven months in three phases. Phase I (Thre months), we measured the real-life radiation exposure for the participants in the Cath lab of our department. Phase II (Four weeks), educational lectures about radioprotection and the hazards of radiation exposure were given. Phase III (Three months) The operators were motivated to use maximally the radiation protection shields that are fixed to the table and the ceiling, and radiation doses were re-meausred.

Results: The total cumulative radiation doses in Phase I ranged from 2.7mSv to 6.5mSv (mean=4.29±1.26), 0.5mSv to 5.5mSv (mean=2.7±1.7), and 0.7 mSv to 4 mSv (mean=2.9±1.9), while in Phase III ranged from 2.1mSv to 5.5 mSv (mean=3.48±1.26), 0.6 mSv to 4.8 mSv (mean=2.4±1.5), and 0.8 mSv to 5.8 mSv (mean=4±2.8); for the cardiologists, the nurses and the technicians respectively. There was a statistically significant difference between the two phases in the mean total cumulative radiation doses received by the cardiologists (P value=0.013), and the mean total dose area product for the patients (P value= <0.001).

Conclusion: The staff compliance with radiation protection standards during cardiac catheterization was insufficient. However, the exposure to radiation to the operators and the patients was significantly lowered after we educated the staff and applied out the methods of radiation protection. To the best of our knowledge, it is the first study to clarify the role of radiation protection on reducing the received radiation doses by the working personnel and patients in the region of Africa. The challenges we faced were huge to introduce then implement the basics of radiation safety and protection practices in our hospital.

An Africa point of view on quality and safety in imaging

Africa has seen an upsurge in diagnostic imaging utilization, with benefits of efficient and accurate diagnosis, but these could easily be offset by undesirable effects attributed to unjustified, unoptimized imaging and poor quality examinations. This paper aims to present Africa’s position regarding quality and safety in imaging, give reasons for the rising interest in quality and safety, define quality and safety from an African context, list drivers for quality and safety in Africa, discuss the impact of COVID-19 on quality and safety, and review Africa’s progress using the Bonn Call for Action framework while proposing a way forward for imaging quality and safety in Africa. In spite of a healthcare setting characterized by meagre financial, human and technology resources, a rapidly widening disease-burden spectrum, growing proportion of non-communicable diseases and resurgence of tropical and global infections, Africa has over the last ten years made significant strides in quality and safety for imaging. These include raising radiation-safety awareness, interest and application of evidence-based radiation safety recommendations and guidance tools, establishing facility and national diagnostic reference levels (DRLs) and strengthening end-user education and training. Major challenges are: limited human resource, low prioritization of imaging in relation to other health services, low level of integration of imaging into the entire health service delivery, insufficient awareness for radiation safety awareness, a radiation safety culture which is emerging, insufficient facilities and opportunities for education and training. Solutions to these challenges should target the entire hierarchy of health service delivery from prioritization, policy, planning, processes to procedures.

Computed tomography radiation doses for common computed tomography examinations: a nationwide dose survey in United Arab Emirates

OBJECTIVES

Computed tomography (CT) scanning is an essential part of diagnostic and treatment plans, providing swift and accurate diagnostic images. The aim of this study is to develop diagnostic reference levels (DRLs) for the adult common CT examination in the United Arab Emirates (UAE).

METHODS

This study presents results of the survey of CT dose indices. The data were collected from 91% of the scanners registered at the Ministry of Health and Prevention (MOHAP) for five common examinations: head, chest, and abdomen-pelvis with and without CM.

RESULTS

CT dose index, dose-length product, and patient weight were analyzed; the reference dose was calculated on the 75th percentile, and an achievable dose was proposed from the median value. The results were compared with the UAE initial National Dose Report as well as the international reports. The proposed dose for CTDI_vol (mGy) and DLP (mGy cm) is as follows: head without CM 40 and 695, head with CM 48 and 820, chest 10 and 275, abdomen-pelvis without CM 14 and 810, and abdomen-pelvis with CM 20 and 1025.

CONCLUSIONS

The results show low dose variations between the MOHAP scanners. The data also revealed CTDI_vol and DLP values comparable to those in the initial NDRL report and international standards. The establishment of diagnostic reference levels will require a continuous dose monitoring system.

Improvement of early detection of breast cancer through collaborative multi-country efforts: Observational clinical study

AIM

The aim of this paper is to present baseline imaging data and the improvement that was achieved by the participating centers after applying practice-specific interventions that were identified during the course of a multicentric multinational research coordinated project.

INTRODUCTION

The incidence and mortality rates from breast cancer are rising worldwide and particularly rapidly across the countries with limited resources. Due to lack of awareness and screening options it is usually detected at a later stage. Breast cancer screening programs and even clinical services on breast cancer have been neglected in such countries particularly due to lack of available equipment, funds, organizational structure and quality criteria.

MATERIALS AND METHODS

A harmonized form was designed in order to facilitate uniformity of data collection. Baseline data such as type of equipment, number of exams, type and number of biopsy procedures, stage of cancer at detection were collected from 10 centers (9 countries: Bosnia-Herzegovina, Costa Rica, Egypt, India, North Macedonia, Pakistan, Slovenia, Turkey, Uganda) were collected. Local practices were evaluated for good practice and specific interventions such as training of professionals and quality assurance programs were identified. The centers were asked to recapture the data after a 2-year period to identify the impact of the interventions.

RESULTS

The data showed increase in the number of training of relevant professionals, positive changes in the mammography practice and image guided interventions. All the centers achieved higher levels of success in the implementation of the quality assurance procedures.

CONCLUSION

The study has encountered different levels of breast imaging practice in terms of expertise, financial and human resources, infrastructure and awareness. The most common challenges were the lack of appropriate quality assurance programs and lack of trained skilled personnel and lack of high-quality equipment. The project was able to create higher levels of breast cancer awareness, collaboration amongst participating centers and professionals. It also improved quality, capability and expertise in breast imaging particularly in centers involved diagnostic imaging.

Cerebral blood flow and serum neuron-specific enolase in early-onset neonatal sepsis

BACKGROUND AND OBJECTIVES

Sepsis leads to systemic inflammatory response with cerebral blood flow (CBF) alteration and blood-brain barrier disruption that contribute to sepsis-associated encephalopathy (SAE). We aimed to evaluate cord blood neuron-specific enolase (cNSE) and CBF in early-onset neonatal sepsis (EONS) as predictors of SAE and to define short-term neurodevelopmental outcomes among survivors.

METHODS

cNSE was measured in 200 neonates with antenatal risk factors for EONS, stratified into two groups: sepsis (n = 96) and no-sepsis (n = 104). Trans-cranial Doppler of peak systolic velocities (PSV), end diastolic velocities (EDV) and resistive indices (RI) of anterior (ACA) and middle (MCA) cerebral arteries recorded on day 1 postnatal. Griffiths mental developmental scale (GMDS) was assessed at 6 months.

RESULTS

Increased cNSE, PSV, EDV, and decreased RI of both ACA and MCA were found in sepsis group compared to no-sepsis group (p < 0.001 for all). Patients with SAE (n = 34) had higher NSE, PSV, and EDV as well as lower RI of ACA and MCA compared to those without (p < 0.01 for all). SAE neonates had lower GMDS than those without. ACA RI of ≤0.61 was the best predictor of SAE.

CONCLUSION

High CBF and cNSE could be useful markers for prediction of SAE. SAE impairs neurodevelopmental scales at 6 months.

Radioiodination and bioevaluation of rolipram as a tracer for brain imaging: In silico study, molecular modeling and gamma scintigraphy

Brain imaging is considered one of the most fruitful applications of radioisotope scanning. Rolipram, a selective phospodiesterase-4 inhibitor, has been labeled using [¹²⁵ I] with chloramine-T (Ch-T) as an oxidizing agent. Factors, such as the amount of substrate, pH, the amount of oxidizing agent, temperature, and the reaction time, have been systematically studied to optimize the iodination process. In addition, bio-distribution studies have indicated that the brain uptake of [¹²⁵ I]iodorolipram is 7.6 ± 0.33 injected dose/g organ at 10 minutes post-injection, which cleared from the brain with time until it reaches 1.30 ± 0.17% at 1 hour post-injection. Therefore, iodorolipram could be considered as a potential, new selective radiotracer for brain imaging.

Radioiodinated famotidine as a new highly selective radiotracer for peptic ulcer disorder detection, diagnostic nuclear imaging and biodistribution

Famotidine was labeled with iodine-125 to obtain 125I-famotidine (125I-fam) as an agent for ulcer imaging. The radiochemical yield of 125I-famotidine reached approximately 98.5 ± 0.23% at optimum conditions of pH, oxidizing agent, reaction time and the amount of substrate. 125I-fam was stable for 48 h. Different chromatographic techniques were used to determine the radiochemical yield and purity. Intravenous biodistribution studies of 125I-fam revealed high concentration in the stomach ulcer, reaching about 65.9 ± 0.28% of the total injected dose at 30 min post injection. This concentration of 125I-fam in stomach ulcer makes this agent promising for stomach ulcer imaging.