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Lalabekyan B, Rennie A, Luoma V. Principles of radiation safety for anaesthetists. BJA Educ 2025; 25:181-190. [PMID: 40256653 PMCID: PMC12009085 DOI: 10.1016/j.bjae.2025.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 01/17/2025] [Accepted: 01/27/2025] [Indexed: 04/22/2025] Open
Affiliation(s)
- B. Lalabekyan
- Princess Royal University Hospital, King's College London Hospital NHS Foundation Trust, Orpington, UK
| | - A. Rennie
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - V. Luoma
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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Vanmaele A, Kanamori LR, Vacirca A, Babocs D, Mesnard T, Maximus S, Huang Y, Feng CMJ, Huynh J, Oderich GS. Direct absorbed and equivalent dose of radiation to the eyes in patients and operators during fenestrated and branched endovascular aortic repair. J Vasc Surg 2025:S0741-5214(25)00993-0. [PMID: 40306594 DOI: 10.1016/j.jvs.2025.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 04/11/2025] [Accepted: 04/19/2025] [Indexed: 05/02/2025]
Abstract
OBJECTIVE Fenestrated and branched endovascular aneurysm repairs (FB-EVAR) stand out as interventions with the highest radiation exposure to patients, operators, and staff, raising concerns for accumulating radiation doses to the eye lens. Therefore, this study aimed to describe the absorbed dose of radiation to the eyes of the patient and primary operator and relate this to indirect metrics of radiation exposure. METHODS All consecutive patients undergoing FB-EVAR between March 2022 and September 2024 as part of a prospective, nonrandomized cohort for investigational devices, were included in this cross-sectional study. To the measure absorbed dose of radiation and translate this into equivalent eye lens dose, we placed three nanoDot dosimeters (Landauer, Inc, Glenwood, IL) on each lateral periorbital skin of the patient and primary operator, and one on each eyelid of the patient. The absorbed dose left and right, and between patient and operator were compared using paired t tests. Additionally, these direct measurements were correlated (Pearson) with the indirect radiation metrics recorded by the imaging unit. RESULTS There were 114 patients who were included (78 male [68%]; mean age, 71.0 ± 9.8 years). Investigational devices were off-the-shelf in 34 patients (30%) and patient-specific in 80 (70%). Among patients, the median (25th-75th percentile) absorbed dose of radiation was 0.25 mGy (0.18, 0.36 mGy) mGy at the left and 0.18 mGy (0.13, 0.26 mGy) at the right periorbital skin (mean fold difference, 1.4; 95% confidence interval, 1.3-1.5; P < .001). In the operator, the median (25th-75th percentile) absorbed dose of radiation to the periorbital skin was 0.12 mGy (0.08, 0.18 mGy) on the left (equivalent lens dose: 0.20 (0.13, 0.30) mSv) and 0.02 mGy (0.01, 0.03 mGy) on the right (equivalent lens dose: 0.03 mGy (0.02, 0.05 mGy) (mean fold difference, 7.0; 95% confidence interval, 5.7-8.6; P < .001). The indirect metrics of the radiation unit correlated weakly with the patient's absorbed dose, with correlation coefficients ranging between 0.19 (P = .048) and 0.21 (P = .025). Similarly, the correlation coefficient between fluoroscopy time and the operator's direct radiation exposure was lower at 0.29 (P = .002), whereas total dose (0.45; P < .001) and dose area product (0.49; P < .001) correlated moderately with the operator's absorbed dose. CONCLUSIONS The study suggests that the left eye lens of high-volume FB-EVAR operators could accumulate doses that exceed the European and Japanese, but not United States', annual occupational limits. Metrics recorded by the radiation unit give only a moderate indication of the absorbed radiation.
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Affiliation(s)
- Alexander Vanmaele
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX; Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, the Netherlands; Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Lucas Ruiter Kanamori
- Advanced Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Andrea Vacirca
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX; Vascular Surgery, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Dora Babocs
- Advanced Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Thomas Mesnard
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX
| | - Steven Maximus
- Advanced Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Ying Huang
- Advanced Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Ching Mei J Feng
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX
| | - Jimmy Huynh
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX
| | - Gustavo S Oderich
- Advanced Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
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Sidik AI, Al-Ariki MK, Shafii AI, Hossain ML, Najneen F, Ak G, Ahlam D, Shakiba A, Ghosh D, Ajgar Bithi MA, Kairatuly MI. Advances in Imaging and Diagnosis of Abdominal Aortic Aneurysm: A Shift in Clinical Practice. Cureus 2025; 17:e81321. [PMID: 40291317 PMCID: PMC12033972 DOI: 10.7759/cureus.81321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2025] [Indexed: 04/30/2025] Open
Abstract
Abdominal aortic aneurysm (AAA) is a potentially life-threatening vascular condition, with rupture carrying a high mortality risk. Advances in imaging technologies have significantly improved the detection, risk stratification, and management of AAA, necessitating periodic updates to international clinical guidelines. This review examines recent advancements in AAA imaging modalities, their role in diagnosis and risk assessment, and evolving screening strategies in response to changing epidemiological trends. A systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identifying key studies on diagnostic imaging techniques such as ultrasonography (US), computed tomography angiography (CTA), magnetic resonance angiography (MRA), intravascular US (IVUS), positron emission tomography-computed tomography (PET-CT), and artificial intelligence (AI)-driven imaging. US remains the preferred screening tool due to its cost-effectiveness, while CTA is the gold standard for preoperative planning. MRA is an alternative for patients with renal impairment, and emerging technologies such as AI-based imaging, IVUS, and PET-CT enhance risk prediction and surgical decision-making. Declining AAA prevalence, attributed to reduced smoking rates and improved cardiovascular risk management, has led to a shift from population-wide screening to targeted screening based on individual risk factors. Additionally, the standardization of imaging protocols and caliper placement techniques is crucial for accurate measurements and consistent clinical decision-making. As imaging technology continues to evolve, integrating AI, genetic markers, and biomarkers into screening and diagnostic protocols may enable more precise and personalized AAA management. Future research should focus on refining imaging-based risk stratification models to optimize screening and treatment strategies.
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Affiliation(s)
- Abubakar I Sidik
- Cardiovascular Surgery, Peoples' Friendship University of Russia, Moscow, RUS
| | - Malik K Al-Ariki
- Cardiothoracic Surgery, Peoples' Friendship University of Russia, Moscow, RUS
| | | | | | - Farjana Najneen
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | - Gulten Ak
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | - Derrar Ahlam
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | - Abdoli Shakiba
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | - Debraj Ghosh
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
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Dey R, Guo Y, Liu Y, Puri A, Savastano L, Zheng Y. An intuitive guidewire control mechanism for robotic intervention. Int J Comput Assist Radiol Surg 2025; 20:333-344. [PMID: 39370493 DOI: 10.1007/s11548-024-03279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 09/24/2024] [Indexed: 10/08/2024]
Abstract
PURPOSE Teleoperated Interventional Robotic systems (TIRs) are developed to reduce radiation exposure and physical stress of the physicians and enhance device manipulation accuracy and stability. Nevertheless, TIRs are not widely adopted, partly due to the lack of intuitive control interfaces. Current TIR interfaces like joysticks, keyboards, and touchscreens differ significantly from traditional manual techniques, resulting in a shallow, longer learning curve. To this end, this research introduces a novel control mechanism for intuitive operation and seamless adoption of TIRs. METHODS An off-the-shelf medical torque device augmented with a micro-electromagnetic tracker was proposed as the control interface to preserve the tactile sensation and muscle memory integral to interventionalists' proficiency. The control inputs to drive the TIR were extracted via real-time motion mapping of the interface. To verify the efficacy of the proposed control mechanism to accurately operate the TIR, evaluation experiments using industrial grade encoders were conducted. RESULTS A mean tracking error of 0.32 ± 0.12 mm in linear and 0.54 ± 0.07° in angular direction were achieved. The time lag in tracking was found to be 125 ms on average using pade approximation. Ergonomically, the developed control interface is 3.5 mm diametrically larger, and 4.5 g. heavier compared to traditional torque devices. CONCLUSION With uncanny resemblance to traditional torque devices while maintaining results comparable to state-of-the-art commercially available TIRs, this research successfully provides an intuitive control interface for potential wider clinical adoption of robot-assisted interventions.
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Affiliation(s)
- Rohit Dey
- Mechanical and Materials Engineering, Worcester Polytechnic Institute, Worcester, MA, USA.
| | - Yichen Guo
- Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Yang Liu
- Global Institute of Future Technology, Shanghai Jiao Tong University, Shanghai, China
| | - Ajit Puri
- Radiology, UMass Chan Medical School, Worcester, MA, USA
| | - Luis Savastano
- Neurological Surgery, University of California School of Medicine, San Francisco, CA, USA
| | - Yihao Zheng
- Mechanical and Materials Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
- Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
- Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
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Kuriyama T, Moritake T, Hitomi G, Nakagami K, Morota K, Matsuzaki S, Sakamoto H, Matsumoto K, Kato M, Kitamura H. Influence of Hospital Bed Count on the Positioning of Cardiovascular Interventional Radiology (IR) Nurses: Online Questionnaire Survey of Japanese IR-Specialized Radiological Technologists. NURSING REPORTS 2025; 15:11. [PMID: 39852633 PMCID: PMC11767440 DOI: 10.3390/nursrep15010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Revised: 12/23/2024] [Accepted: 01/02/2025] [Indexed: 01/26/2025] Open
Abstract
BACKGROUND/OBJECTIVES Interventional radiology (IR) utilizing X-rays can lead to occupational radiation exposure, posing health risks for medical personnel in the field. We previously conducted a survey on the occupational radiation exposure of IR nurses in three designated emergency hospitals in Japan. Our findings indicated that a hospital with 214 beds showed a higher lens-equivalent dose than hospitals with 678 and 1182 beds because the distance between the X-ray irradiation field and the IR nurse's position of the hospital with 214 beds was shorter than those of 678 and 1182 beds. Based on these observations, we hypothesized that the number of hospital beds affects the distance between the X-ray irradiation field and the IR nurse's position. METHODS To verify this hypothesis, we conducted a more extensive online questionnaire survey, focusing exclusively on hospitals that perform cardiovascular IR. RESULTS We analyzed data from 78 facilities. The results of this study confirmed our earlier findings, showing that both the number of physicians performing IR procedures and the distance from the X-ray irradiation field to the IR nurse's position are influenced by the number of hospital beds. Additionally, factors such as the type of hospital, emergency medical system, annual number of IR sessions, location of medical equipment, and the positioning of IR nurses appear to be associated with the number of hospital beds. CONCLUSIONS Understanding these relationships could enable the development of individualized and prioritized radiation exposure reduction measures for IR nurses in high-risk settings, provided that comprehensive occupational radiation risk assessments for cardiovascular IR consider the number of hospital beds and related factors. This study was not registered.
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Affiliation(s)
- Tomoko Kuriyama
- Department of Occupational and Community Health Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan;
| | - Takashi Moritake
- Department of Radiation Regulatory Science Research, Institute for Radiological Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan;
| | - Go Hitomi
- Department of Radiological Technology, Kawasaki Medical School Hospital, Kurashiki 701-0192, Japan;
| | - Koichi Nakagami
- Department of Radiology, Hospital of the University of the Occupational and Environmental Health, Japan, Kitakyushu 807-8556, Japan;
| | - Koichi Morota
- Department of Radiology, Shinkomonji Hospital, Kitakyushu 800-0057, Japan;
| | - Satoru Matsuzaki
- Department of Radiation Regulatory Science Research, Institute for Radiological Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan;
| | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Tokyo 113-8421, Japan;
| | - Kazuma Matsumoto
- Department of Radiological Technology, Hyogo Medical University Hospital, Nishinomiya 663-8501, Japan;
| | - Mamoru Kato
- Department of Radiology and Nuclear Medicine, Akita Cerebrospinal and Cardiovascular Center, Akita 010-0874, Japan;
| | - Hiroko Kitamura
- Occupational Health Training Center, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan;
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6
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Clauss N, Kuntz S, Colvard B, Ohana M, Mertz L, Lejay A, Chakfe N. Intraoperative Staff Radiation Exposure During Aortic Endovascular Procedures. Ann Vasc Surg 2024; 106:16-24. [PMID: 38641000 DOI: 10.1016/j.avsg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The risk of radiation exposure in the surgical operating room (OR) and/or catheterization laboratory is now well established. Complex endovascular procedures often require multiple approaches and different positioning of the staff members around the patient, potentially increasing the levels of radiations exposure. Our goal was to evaluate the levels of radiation exposure of the members of the staff during endovascular aortic procedures in order to propose radioprotection optimization. METHODS We included 41 aortic endovascular procedures out of 114 procedures performed between January 12, 2014, and August 31, 2015, including 24 standard endovascular aortic aneurysm repair (EVAR), 7 EVAR with iliac branch (EVARib), 8 complex fenestrated/branched EVAR (F/B EVAR), and 2 thoracic EVAR (TEVAR). Procedures were performed in an OR equipped with a carbon fiber table and a mobile fluoroscopy C-arm. We collected the usual dosimetry data given by the C-arm as well as the patient's peak skin dose (PSD). In all staff members, radiation exposure was measured with thermoluminescent chip dosimeters placed on both temples, on posterior sides of both hands, and on both lower legs. RESULTS PSD levels were low for EVAR because 24 patients had values below the reading threshold. PSD significantly increased with more complex procedures. Main operator (MO) received the higher level of irradiation on whole body, hands, and ankles. Eye lenses irradiation was higher on both assistant operators (AOs). Other members received low levels of irradiation. We found a high ranges of radiation exposure with a high risk of exposure for the AO, mainly for F/B EVAR and EVARib. CONCLUSIONS Even if all personal protections are used, staff positioning is a major point that must be considered. If MO is supposed to be the most exposed to X-rays, specific conditions of positioning of the AO may be at risk of exposure.
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Affiliation(s)
- Nicolas Clauss
- Unit of Radiophysic and Radioprotection, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- GEPROMED, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Benjamin Colvard
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH
| | - Mickael Ohana
- Department of Radiology, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Luc Mertz
- Unit of Radiophysic and Radioprotection, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Unit of Radiophysic and Radioprotection, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France; GEPROMED, Strasbourg, France; Fédération de Médecine Translationelle (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d'Accueil EA3072 "Mitochondrie, Stress Oxydant et Protection Musculaire", Université de Strasbourg, Strasbourg, France
| | - Nabil Chakfe
- Unit of Radiophysic and Radioprotection, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France; GEPROMED, Strasbourg, France; Fédération de Médecine Translationelle (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d'Accueil EA3072 "Mitochondrie, Stress Oxydant et Protection Musculaire", Université de Strasbourg, Strasbourg, France.
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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Mansour A, Gamal NM, Tohamy A, Abdeltawab A. A multicentre survey of knowledge and implementation of radiation protection techniques in cardiac cath-lab medical personnel. Egypt Heart J 2024; 76:69. [PMID: 38829551 PMCID: PMC11147976 DOI: 10.1186/s43044-024-00492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Awareness of radiation hazards and methods to reduce radiation dose is a sine qua non for all staff working in the cath-lab for their own safety and their patient's safety. RESULTS There were large variations in the implementation of radiation protection techniques with overall inadequate radiation risk knowledge. Some members of the cath-lab team are at higher risk of radiation-induced side effects, including the fellows, nurses, technicians, and anaesthesiologists because they spent longer time in the cath-lab and/or their position in relation to the source of radiation. About 10% of the participants have reported different health problems potentially induced by radiation exposure. CONCLUSIONS There is lack of radiation risks knowledge with inadequate radiation protection practice among cath-lab team. Some members such as fellows, nurse, technicians, and cardiac anaesthesiologist are at higher risks. They represent the forgotten members of the Cath-Lab team.
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Affiliation(s)
- Amr Mansour
- Cardiology Department, Ain Shams University Hospital, 62 Hegaz St, Abbassia, Heliopolis, Cairo, Egypt
| | - Noha M Gamal
- Cardiology Department, Assiut University, Asyut, Egypt
| | - Ali Tohamy
- Cardiology Department, Assiut University, Asyut, Egypt
| | - Adham Abdeltawab
- Cardiology Department, Ain Shams University Hospital, 62 Hegaz St, Abbassia, Heliopolis, Cairo, Egypt.
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Rockley M, Nana P, Rebet A, Fabre D, Haulon S. A procedural step analysis of radiation exposure in fenestrated endovascular aortic repair. J Vasc Surg 2024; 79:1306-1314.e2. [PMID: 38368998 DOI: 10.1016/j.jvs.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Radiation exposure during complex endovascular aortic repair may be associated with tangible adverse effects in patients and operators. This study aimed to identify the steps of highest radiation exposure during fenestrated endovascular aortic repair (FEVAR) and to investigate potential intraoperative factors affecting radiation exposure. METHODS Prospective data of 31 consecutive patients managed exclusively with four-fenestration endografts between March 1, 2020, and July 1, 2022 were retrospectively analyzed. Leveraging the conformity of the applied technique, every FEVAR operation was considered a combination of six overall stages composed of 28 standardized steps. Intraoperative parameters, including air kerma, dose area product, fluoroscopy time, and number of digital subtraction angiographies (DSAs) and average angulations were collected and analyzed for each step. RESULTS The mean procedure duration and fluoroscopy time was 140 minutes (standard deviation [SD], 32 minutes), and 40 minutes (SD, 9.1 minutes), respectively. The mean air kerma was 814 mGy (SD, 498 mGy), and the mean dose area product was 66.8 Gy cm2 (SD, 33 Gy cm2). The percentage of air kerma of the entire procedure was distributed throughout the following procedure stages: preparation (13.9%), main body (9.6%), target vessel cannulation (27.8%), stent deployment (29.1%), distal aortoiliac grafting (14.3%), and completion (5.3%). DSAs represented 23.0% of the total air kerma. Target vessel cannulation and stent deployment presented the highest mean lateral angulation (67 and 63 degrees, respectively). Using linear regression, each minute of continuous fluoroscopy added 18.9 mGy of air kerma (95% confidence interval, 17.6-20.2 mGy), and each DSA series added 21.1 mGy of air kerma (95% confidence interval, 17.9-24.3 mGy). Body mass index and lateral angulation were significantly associated with increased air kerma (P < .001). CONCLUSIONS Cannulation of target vessels and bridging stent deployment are the steps requiring the highest radiation exposure during FEVAR cases. Optimized operator protection during these steps is mandatory.
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Affiliation(s)
- Mark Rockley
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France; Division of Vascular Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Petroula Nana
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France
| | | | - Dominique Fabre
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France
| | - Stéphan Haulon
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France.
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10
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Goyal A, Fatima L, Jain H, Tariq MD, Mushtaq F, Suheb MZK, Lu E, Khan R, Sohail AH. Comparison of Outcomes Between Right and Left Upper Extremity Access in Endovascular Aortic Repair for Patients with Thoracoabdominal and Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis. Cardiol Rev 2024:00045415-990000000-00278. [PMID: 38814082 DOI: 10.1097/crd.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Traditionally, left-sided upper extremity (LUE) access has been preferred in patients undergoing endovascular aortic repair (EVAR) to manage aortic aneurysms and decrease the risk of cerebrovascular adverse events. Recently, right-sided upper extremity access (RUE) has gained popularity owing to its greater maneuverability and ergonomics. However, synthesized data comparing the safety and efficacy of RUE and LUE accesses are limited. A comprehensive literature search was conducted on various databases from inception to September 2023 to retrieve all studies that compared RUE and LUE access in EVAR. Data on stroke, 30-day mortality, technical success, access-site complications, total time required for fluoroscopy, and contrast agent requirement were extracted, pooled, and analyzed. Forest plots were generated using a random-effects model on review manager by pooling the risk ratios (RRs) and standard mean differences (SMDs). Ten observational studies with a total of 3994 patients were included in our analysis with 1186 patients in the RUE and 2808 patients in the LUE access groups. EVAR using RUE access was associated with a significantly lower amount of contrast agent requirement than the LUE access group [SMD, -0.23; 95% confidence interval (CI), -0.45 to -0.02; P = 0.03]. There was no significant difference between the 2 groups in terms of the risk of stroke (RR, 1.62; 95% CI, 0.81-3.22; P = 0.17), 30-day mortality (RR, 1.42; 95% CI, 0.50-4.06; P = 0.51), rate of technical success (RR, 0.98; 95% CI, 0.95-1.01; P = 0.18), risk of access-site complications (RR, 1.00; 95% CI, 0.72-1.39; P = 0.99), and total time required for fluoroscopy (SMD, 0.07; 95% CI, -0.39 to 0.26; P = 0.69). The use of RUE access in EVAR appears to be comparable to LUE access in terms of the risk of stroke, access-related complications, all-cause mortality, technical success rate, and fluoroscopy duration. The RUE group required a lower volume of contrast agent.
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Affiliation(s)
- Aman Goyal
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Muhammad Daoud Tariq
- Department of Internal Medicine, Foundation University Medical College, Islamabad, Pakistan
| | - Fiza Mushtaq
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Eileen Lu
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rozi Khan
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM
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11
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Soenens G, Doyen B, Vlerick P, Hertault A, Maurel B, Kellens PJ, Bacher K, Van Herzeele I. Development, Feasibility, and Knowledge Impact of a Massive Open Online Course on Radiation Safety: A Multicentre Prospective Cohort Study. Eur J Vasc Endovasc Surg 2024; 67:838-846. [PMID: 38042252 DOI: 10.1016/j.ejvs.2023.11.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE This study reports the development of an innovative, interactive Massive Open Online Course (MOOC) teaching radiation safety principles in the vascular workplace, using stepwise e-learning with multiple choice question tests (MCQs), educational videos, and a serious game. The aim was to study the MOOC impact on radiation safety knowledge and assess its feasibility and acceptability. METHODS An international multicentre prospective study included team members active in the hybrid operating room. The MOOC was offered voluntarily via a secure online learning platform. A standardised MCQ test (15 questions) assessed radiation safety knowledge pre- and post-course (range 0 - 100%). Acceptability and feasibility were tested via the previously validated, Evaluating e-learning system success (EESS) model, using five point Likert scales. RESULTS In eight centres across four countries, 150 of 203 invited endovascular team members consented. Over a seven week study period, surgeons (28%, including vascular surgery trainees and consultants), nurses (27%, including scrub, circulating and anaesthetic nurses), anaesthetists (43%, including trainees and consultants), and radiographers (3%) participated. Of those, 67% completed the course. The average radiation knowledge improved by 22.8% (95% CI 19.5 - 26.0%; p < .001) after MOOC completion, from 48% to 71% (standard deviation [SD] 14 and 15% respectively), requiring a mean time investment of 169 minutes (SD 89 minutes). In centres with a radiographer, mean knowledge gain after MOOC completion was significantly smaller (14%, SD 19% vs. 24%, SD 16%, p = .036). The course was deemed feasible and acceptable according to the EESS model with a total mean score of 3.68/5. CONCLUSION This newly developed, multimodal MOOC was deemed feasible and effective across multiple international centres. The MOOC significantly contributes to radiation safety education of the entire endovascular team, improving radiation safety knowledge. The course may optimise workplace radiation safety behaviour and therefore enhance team and patient safety.
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Affiliation(s)
- Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Peter Vlerick
- Department of Work, Organisation and Society, Ghent University, Ghent, Belgium
| | - Adrien Hertault
- Department of Vascular Surgery, Ramsay Santé, Hôpital Privé de Villeneuve d'Ascq, France
| | - Blandine Maurel
- Department of Vascular Surgery, University Hospital Centre of Nantes, Nantes, France
| | - Pieter-Jan Kellens
- Medical Physics, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Klaus Bacher
- Medical Physics, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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12
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Mussmann B, Larsen TR, Godballe M, Abdi AJ, Kantsø A, Jakobsen AR, Nielsen MV, Jensen J. Radiation dose to multidisciplinary staff members during complex interventional procedures. Radiography (Lond) 2024; 30:512-516. [PMID: 38241981 DOI: 10.1016/j.radi.2024.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Complex interventional radiology procedures involve extensive fluoroscopy and image acquisition while staff are in-room. Monitoring occupational radiation dose is crucial in optimization. The purpose was to determine radiation doses received by staff involved in complex interventional procedures performed in a dedicated vascular or neuro intervention room. METHODS Individual real-time radiation dose for all staff involved in vascular and neuro-interventional procedures in adult patients was recorded over a one-year period using wireless electronic dosimeters attached to the apron thyroid shield. A reference dosimeter was attached to the C-arm near the tube housing to measure scattered, unshielded radiation. Radiology staff carried shoulder thermo-luminescent dosimeters with monthly read-out to monitor dose over time. RESULTS Occupational radiation dose was measured in 99 interventional procedures. In many cases prostate artery embolization procedures exposed radiologists to high radiation doses with a median of 15.0 μSv and a very large spread, i.e. 0.2-152.5 μSv. In all procedures except uterine fibroid embolization radiographers were exposed to lower doses than those of radiologists, with endovascular aortic repair being the procedure with highest median exposure to assisting radiographers, i.e. 2.2 μSv ranging from 0.1 to 36.1 μSv. Median radiation dose for the reference dosimeter was 670 μGy while median staff dose for all procedures combined was 3.2 μGy. CONCLUSION Radiation doses for multiple staff were determined and the ratio between staff dose and reference dosimeter indicated proper use of shielding in general. Some high-dose procedures may need further optimization for certain staff members, especially those not primarily employed in radiology. IMPLICATIONS FOR PRACTICE The study provides benchmark doses that may be used widely in audits and in the ongoing effort to optimize radiation protection for staff in interventional radiology.
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Affiliation(s)
- B Mussmann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, 2nd. Floor. 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Pilestedet 48, Oslo, Norway.
| | - T R Larsen
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - M Godballe
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - A J Abdi
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, 2nd. Floor. 5000 Odense C, Denmark; Department of Clinical Engineering, Region of Southern Denmark, Kloevervaenget 18, 5000 Odense C, Denmark
| | - A Kantsø
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - A R Jakobsen
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - M V Nielsen
- Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
| | - J Jensen
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, 2nd. Floor. 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, JB Winslows Vej 4, 5000 Odense C, Denmark
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13
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 116] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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14
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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 350] [Impact Index Per Article: 350.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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15
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Mandigers TJ, Fulgheri I, Pugliese G, Bissacco D, Savarè L, Ieva F, Campoleoni M, van Herwaarden JA, Trimarchi S, Domanin M. Patients' Radiation Exposure During Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2024; 98:115-123. [PMID: 37356660 DOI: 10.1016/j.avsg.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND To investigate associations between patient characteristics, intraprocedural complexity factors, and radiation exposure to patients during endovascular abdominal aortic aneurysm repair (EVAR). METHODS Elective standard EVAR procedures between January 2015 and December 2020 were retrospectively analyzed. Patient characteristics and intraprocedural data (i.e., type of device, endograft configuration, additional procedures, and contralateral gate cannulation time [CGCT]) were collected. Dose area product (DAP) and fluoroscopy time were considered as measurements of radiation exposure. Furthermore, effective dose (ED) and doses to internal organs were calculated using PCXMC 2.0 software. Descriptive statistics, univariable, and multivariable linear regression were applied to investigate predictors of increased radiation exposure. RESULTS The 99 patients were mostly male (90.9%) with a mean age of 74 ± 7 years. EVAR indications were most frequently abdominal aortic aneurysm (93.9%), penetrating aortic ulceration (2.0%), focal dissection (2.0%), or subacute rupture of infrarenal abdominal aortic aneurysm (2.0%). Median fluoroscopy time was 19.6 minutes (interquartile range [IQR], 14.1-29.4) and median DAP was 86,311 mGy cm2 (IQR, 60,160-130,385). Median ED was 23.2 mSv (IQR, 17.0-34.8) for 93 patients (93.9%). DAP and ED were positively correlated with body mass index (BMI) and CGCT. Kidneys, small intestine, active bone marrow, colon, and stomach were the organs that received the highest equivalent doses during EVAR. Higher DAP and ED values were observed using the Excluder endograft, other bi- and tri-modular endografts, and EVAR with ≥2 additional procedures. Multivariable linear regression analysis revealed that BMI, ≥2 additional procedures during EVAR, and CGCT were independent positive predictors of DAP and ED levels after accounting for endograft type. CONCLUSIONS Patient-related and procedure-related factors such as BMI, ≥2 additional procedures during EVAR, and CGCT resulted predictors of radiation exposure for patients undergoing EVAR, as quantified by higher DAP and ED levels. The main intraprocedural factor that increased radiation exposure was CGCT. These data can be of importance for better managing radiation exposure during EVAR.
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Affiliation(s)
- Tim J Mandigers
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Irene Fulgheri
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgia Pugliese
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Daniele Bissacco
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Savarè
- Laboratory for Modelling and Scientific Computing MOX, Department of Mathematics of Politecnico of Milan, Milan, Italy; Health Data Science Center (CHDS), Human Technopole, Milan, Italy
| | - Francesca Ieva
- Laboratory for Modelling and Scientific Computing MOX, Department of Mathematics of Politecnico of Milan, Milan, Italy; Health Data Science Center (CHDS), Human Technopole, Milan, Italy
| | - Mauro Campoleoni
- Medical Physics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Santi Trimarchi
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
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16
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Augustin AM, Detomas M, Hartung V, Thurner A, Tröger V, Deutschbein T, Kickuth R. Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study. ROFO-FORTSCHR RONTG 2023; 195:1009-1017. [PMID: 37224864 DOI: 10.1055/a-2083-9942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To assess radiation exposure and diagnostic performance of bilateral inferior petrosal sinus sampling for the distinction of pituitary and ectopic adrenocorticotropin-dependent Cushing's syndrome. MATERIALS AND METHODS Procedural data of bilateral inferior petrosal sinus procedures were retrospectively evaluated. The analysis included the patients' clinical and demographic data, procedural radiation exposure, and complication rates, sampling results, clinical course of the patients, and calculation of diagnostic performance data. RESULTS The cases of 46 patients diagnosed with adrenocorticotropin-dependent Cushing's syndrome were evaluated. Bilateral inferior petrosal sinus sampling was successfully performed in 97.8 % of the cases. The overall median procedure-related fluoroscopy time was 7.8 min. (range 3.2-36.2 min.), and the median procedural dose area product was 11.9 Gy*cm2 (range 2.1-73.7 Gy*cm2). Radiation doses due to digital subtraction angiography series for visualization of the inferior petrosal sinus were 3.6 Gy*cm2 (range 1.0-18.1 Gy*cm2). Radiation doses due to fluoroscopy had a higher impact on the overall radiation exposure and were significantly influenced by the patients' habitus. The sensitivity, specificity, and positive and negative predictive values were 84 %, 100 %, 100 %, and 72 % before stimulation with corticotropin-releasing hormone, and 97 %, 100 %, 100 %, and 93 % after stimulation. Concordance between magnetic resonance imaging studies and bilateral inferior petrosal sinus sampling results was only found in 35.6 % of the cases. The periprocedural complication rate was 2.2 %, with one patient experiencing vasovagal syncope during catheterization. CONCLUSION Bilateral inferior petrosal sinus sampling is a safe procedure with high technical success rates und excellent diagnostic performance. The procedure-related radiation exposure shows large variations and depends on the complexity of cannulation as well as the patients' habitus. Fluoroscopy accounted for the largest proportion of radiation exposure. Acquisition of digital subtraction angiography series for the verification of correct catheter placement appears justified. KEY POINTS · Bilateral inferior petrosal sinus sampling with CRH stimulation provides high diagnostic performance in the distinction of pituitary and ectopic Cushing's syndrome.. · The associated radiation exposure is not negligible and is significantly influenced by the use of fluoroscopy and the patients' habitus.. · Digital subtraction angiography contributes less to the overall radiation dose and appears justified for the verification of correct catheter placement.. CITATION FORMAT · Augustin A, Detomas M, Hartung V et al. Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study. Fortschr Röntgenstr 2023; 195: 1009 - 1017.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Mario Detomas
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Germany
| | - Viktor Hartung
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Viola Tröger
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Germany
- Medicover Oldenburg MVZ, Medicover Oldenburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
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17
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Kim DK, Woo J, Yi BJ, Song HS, Kim GM, Kwon JH, Han K, Won JY. Robot-Assisted Transarterial Chemoembolization of Hepatocellular Carcinoma Using a Coaxial Microcatheter Driving Controller-Responder Robot System: Clinical Pilot Study. J Vasc Interv Radiol 2023; 34:1565-1574. [PMID: 37302472 DOI: 10.1016/j.jvir.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE To evaluate the feasibility and safety of robot-assisted transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) using a new coaxial microcatheter driving controller-responder robot (CRR) system. MATERIALS AND METHODS A single-center prospective pilot study approved by the institutional review board was conducted using this CRR developed after analyzing 20 cases of conventional TACE procedures from May to October 2021. The study included 10 patients with HCCs: 5 (median age, 72 years; range, 64-73 years) underwent robot-assisted TACE, and 5 (median age, 57 years; range, 44-76 years) underwent conventional TACE for comparison. The feasibility and safety of robot-assisted TACE were evaluated by assessing the technical success, procedure time, adverse event rate, radiation dose, and early tumor response. RESULTS The entire TACE procedure was divided into 30 steps, of which 8 could be robotized. In robot-assisted TACE, technical success was achieved in 4 (80%) of 5 patients. No procedure-related adverse event was observed. The median procedure time was 56 minutes. At the 1-month follow-up, 3 of the 4 patients showed a complete or partial response after robot-assisted TACE. The median radiation doses for the operator and patients were 0.4 and 2,167.5 μSv in robot-assisted TACE and 53.2 and 2,989.7 μSv in conventional TACE, respectively. CONCLUSIONS Robot-assisted TACE using a new CRR system was feasible and safe for the treatment of HCC and could remarkably decrease radiation exposure for the operators.
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Affiliation(s)
- Dong Kyu Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaehong Woo
- Department of Robotics and Convergence, Hanyang University, Ansan, Republic of Korea
| | - Byung-Ju Yi
- Department of Electrical and Electronic Engineering, School of Electrical Engineering, Hanyang University, Ansan, Republic of Korea
| | - Hwa-Seob Song
- Department of Electrical and Electronic Engineering, School of Electrical Engineering, Hanyang University, Ansan, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
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18
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Roguin A, Wu P, Cohoon T, Gul F, Nasr G, Premyodhin N, Kern MJ. Update on Radiation Safety in the Cath Lab - Moving Toward a "Lead-Free" Environment. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101040. [PMID: 39131633 PMCID: PMC11307637 DOI: 10.1016/j.jscai.2023.101040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 08/13/2024]
Abstract
Radiation exposure in the cardiac catheterization laboratory (CCL) is an occupational hazard that predisposes health care workers to the development of adverse health effects such as cataracts, cancer, and orthopedic injury. To mitigate radiation exposure, personal protective shielding as well as permanently installed shields reduces these adverse effects. Yet, heavy protective lead aprons and poor ergonomics required for positioning movable shields remain barriers to a safer environment. Recent innovations to enhance personal protective equipment and revolutionize fixed shielding systems will permit the CCL team to work in a personal "lead-free" environment, markedly reducing occupational hazards. The purpose of this review is to update the status and future of radiation protection in the CCL.
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Affiliation(s)
- Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion - Israel Institute of Technology, Israel
| | - Perry Wu
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Travis Cohoon
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Fahad Gul
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - George Nasr
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Ned Premyodhin
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Morton J. Kern
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
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19
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Jang SY, Kim HS, Jeong SH, Kim YM. [Factors Affecting Radiation Protective Behaviors in Perioperative Nurses Applying the Theory of Planned Behavior: Path Analysis]. J Korean Acad Nurs 2023; 53:222-235. [PMID: 37164349 DOI: 10.4040/jkan.22099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE The aim of this study was to identify the factors explaining protective behaviors against radiation exposure in perioperative nurses based on the theory of planned behavior. METHODS This was a cross-sectional study. A total of 229 perioperative nurses participated between October 3 and October 20, 2021. Data were analyzed using SPSS/WIN 23.0 and AMOS 23.0 software. The three exogenous variables (attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control) and two endogenous variables (radiation protective intention and radiation protective behaviors) were surveyed. RESULTS The hypothetical model fit the data (χ²/df = 1.18, SRMR = .02, TLI = .98, CFI = .99, RMSEA = .03). Radiation protective intention (β = .24, p = .001) and attitude toward radiation protective behaviors (β = .32, p = .002) had direct effects on radiation protective behaviors. Subjective norm (β = .43, p = .002) and perceived behavior control (β = .24, p = .003) had direct effects on radiation protective intention, which explained 38.0% of the variance. Subjective norm (β = .10, p = .001) and perceived behavior control (β = .06, p = .002) had indirect effects via radiation protective intention on radiation protective behaviors. Attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control were the significant factors explaining 49.0% of the variance in radiation protective behaviors. CONCLUSION This study shows that the theory of planned behavior can be used to effectively predict radiation protective behaviors in perioperative nurses. Radiation safety guidelines or education programs to enhance perioperative nurses' protective behaviors should focus on radiation protective intention, attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control.
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Affiliation(s)
- Se Young Jang
- Department of Nursing, Jeonbuk National University Hospital, Jeonju, Korea
| | - Hee Sun Kim
- College of Nursing·Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.
| | - Seok Hee Jeong
- College of Nursing·Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea
| | - Young Man Kim
- College of Nursing·Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea
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20
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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21
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Klaassen J, Vijn LJ, Hazenberg CEVB, van Herwaarden JA. New tools to reduce radiation exposure during aortic endovascular procedures. Expert Rev Cardiovasc Ther 2022; 20:567-580. [PMID: 35726665 DOI: 10.1080/14779072.2022.2092096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The evolution of endovascular surgery over the past 30 years has made it possible to treat increasingly complex vascular pathologies with an endovascular method. Although this generally speeds up the patient's recovery, the risks of health problems caused by long-term exposure to radioactive radiation increase. This warrants the demand for radiation-reducing tools to reduce radiation exposure during these procedures. AREAS COVERED For this systematic review Pubmed, Embase and Cochrane library databases were searched on 28 December 2021 to provide an overview of tools that are currently used or have the potential to contribute to reducing radiation exposure during endovascular aortic procedures. In addition, an overview is presented of radiation characteristics of clinical studies comparing a (potential) radiation-reducing device with conventional fluoroscopy use. EXPERT OPINION Radiation-reducing instruments such as fiber optic shape sensing or electromagnetic tracking devices offer the possibility to further reduce or even eliminate the use of radiation during endovascular procedures. In an era of increasing endovascular interventional complexity and awareness of the health risks of long-term radiation exposure, the use of these technologies could have a major impact on an ongoing challenge to move toward radiation-free endovascular surgery.
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Affiliation(s)
- Jurre Klaassen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linde J Vijn
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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22
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Sierra LAM, Katsnelson JY, Pineda DM. Occupational Radiation Exposure Among General Surgery Residents: Should We Be Concerned? JOURNAL OF SURGICAL EDUCATION 2022; 79:463-468. [PMID: 34922884 DOI: 10.1016/j.jsurg.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Low-dose ionizing radiation exposure is associated with development of solid organ tumors as well as increased risk of cataract formation in a linear-dose response. While occupational radiation exposure has been studied across subspecialties with regular fluoroscopy exposure such as interventional radiology and urology, the contribution of increasing endovascular case volume to occupational radiation exposure among general surgery residents remains largely unreported. In this study, we sought to determine typical occupational radiation exposure among a pool of general surgery residents as part of a formal radiation safety curriculum. METHODS A radiation safety program was introduced to a group of 28 general surgery residents who rotate on a vascular surgery service with a high endovascular volume in a hybrid room setting. All residents received training in proper use of a radiation dosimeter and minimizing exposure during fluoroscopy times in the operating room. Data was collected from radiation film dosimetry badges distributed to general surgery residents on a bimonthly basis throughout the year, and radiation exposure in mRem was compared between residents rotating on vascular and nonvascular surgical services during 4-week rotations. RESULTS A total of 14 months of data were collected. Resident compliance was 84% with regular use and return of dosimeters at the end of each bimonthly cycle. The radiation exposure among residents rotating on vascular surgery was significantly higher compared to those on nonvascular rotations (mean = 71 mRem vs 3.13 mRem, p = 0.02). Exposure among senior residents was not statistically different than that of attending vascular surgeons (mean = 212 mRem vs 164 mRem, p = 0.20). All exposures were significantly lower than institutional ALARA dose limits for radiation exposure (5000 mRem/year). CONCLUSION General surgery residents are routinely exposed to measurable occupational radiation levels, especially while participating in endovascular procedures during their training. However, data from our study suggests that these levels are below ALARA dose limits and senior surgical residents are not at greater risk than vascular surgery attending surgeons while on their vascular rotation. The results of this study will be used to help guide resident education on radiation safety and identify institution-specific practices which can minimize exposure and improve radiation safety adherence.
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Affiliation(s)
- Luis A Mejia Sierra
- Department of Surgery, Abington Memorial Hospital-Jefferson Health, Abington, Pennsylvania
| | - Jacob Y Katsnelson
- Department of Surgery, Abington Memorial Hospital-Jefferson Health, Abington, Pennsylvania
| | - Danielle M Pineda
- Department of Surgery, Abington Memorial Hospital-Jefferson Health, Abington, Pennsylvania.
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23
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Kannaujia A, Haldar R, Shamim R, Mondal H, Mishra P, Agarwal A. A survey on knowledge, attitude, and practices of workplace radiation safety amongst anaesthesiology personnel in northern Indian tertiary care institutes. Indian J Anaesth 2022; 66:S137-S147. [PMID: 35774241 PMCID: PMC9238231 DOI: 10.4103/ija.ija_838_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/10/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Exposure to ionising radiation to Anaesthesiology consultants, residents, technicians and nurses (Anaesthesiology personnel) is steadily increasing as a consequence of growing usage of imaging technology for diagnostic and therapeutic purposes. We conducted a questionnaire-based survey of Anaesthesiology professionals (consultants, residents, technicians and nursing staff) working in three major tertiary care medical institutes in northern India regarding the existing knowledge, attitudes and practices of radiation safety at their workplaces. Methods: A printed and validated 30-point questionnaire was distributed. Questions were graded into the domains of demographics (6 questions), knowledge (9 questions), attitude (4 questions) and practice (11 questions). Data obtained from the responses was collated and analysed statistically Results: Out of the 403 questionnaires distributed, 222 were returned completed (55%). Majority of the respondents were residents (53.60%) and males (57.20%). Many were unaware of the principle of As Low As Reasonably Achievable (ALARA), (70.7%) regarding collimators (65.85%) and their usage (41.9%). Maximum respondents stressed on the necessity of knowing the exposure dosage of radiations (89.2%) and were concerned regarding the same (87.8%). Lead apron was the commonest protection equipment and 97.3% of them were not using dosimeters. Highest levels of knowledge, attitude, and practices were demonstrated by the consultants. In terms of practices, the technicians fared better than the residents. Conclusion: Knowledge, attitude and practices regarding radiation protection issues and doses of radiological procedures is limited. Although all the cadres scored high on their attitude scores, the practice sector requires improvement.
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24
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Choi J, Park S, Kim YH, Moon Y, Choi J. A Vascular Intervention Assist Device Using Bi-Motional Roller Cartridge Structure and Clinical Evaluation. BIOSENSORS-BASEL 2021; 11:bios11090329. [PMID: 34562918 PMCID: PMC8472030 DOI: 10.3390/bios11090329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
Conventional vascular intervention procedures present issues including X-ray exposure during operation, and an experience-dependent success rate and clinical outcome. This paper presents a novel robotic system using modularized bi-motional roller cartridge assemblies for robotic vascular interventions, specifically percutaneous coronary interventions (PCIs). The patient-side robot manipulates instruments such as the guiding catheter, guidewire, balloon/stent catheter, and diagnostic sensor catheter via commands from the user interface device, which is controlled by the physician. The proposed roller cartridge assembly can accommodate instruments of various sizes with an active clamping mechanism, and implements simultaneous translation and rotation motions. It also implements force feedback in the physician-side system, to effectively monitor the patient-side system’s status. The positioning accuracy and precision in using the robotic system showed satisfactory performance in a phantom-based test. It was also confirmed, through animal experiments and a pilot clinical trial, that the system demonstrates feasibility for clinical use.
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Affiliation(s)
- Jueun Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Sangeun Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, Korea;
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Youngjin Moon
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, Korea;
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
- Correspondence: (Y.M.); (J.C.); Tel.: +82-2-3010-6347 (Y.M.); +82-2-3010-2092 (J.C.)
| | - Jaesoon Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, Korea;
- Correspondence: (Y.M.); (J.C.); Tel.: +82-2-3010-6347 (Y.M.); +82-2-3010-2092 (J.C.)
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25
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Efthymiou FO, Metaxas VI, Dimitroukas CP, Kakkos SK, Panayiotakis GS. KERMA-AREA PRODUCT, ENTRANCE SURFACE DOSE AND EFFECTIVE DOSE IN ABDOMINAL ENDOVASCULAR ANEURYSM REPAIR. RADIATION PROTECTION DOSIMETRY 2021; 194:121-134. [PMID: 34227656 DOI: 10.1093/rpd/ncab082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/15/2021] [Accepted: 05/09/2021] [Indexed: 06/13/2023]
Abstract
This study aims to evaluate patient radiation dose during fluoroscopically guided endovascular aneurysm repair (EVAR) procedures. Fluoroscopy time (FT) and kerma-area product (KAP) were recorded from 87 patients that underwent EVAR procedures with a mobile C-arm fluoroscopy system. Effective dose (ED) and organs' doses were calculated utilising appropriate conversion coefficients based on the recorded KAP values. Entrance surface dose (ESD) was calculated based on KAP values and technical parameters. The mean FT was 22.7 min (range 6.4-76.8 min), resulting in a mean KAP of 36.6 Gy cm2 (range 2.0-167.8 Gy cm2), a mean ED of 6.2 mSv (range 0.3-28.5 mSv) and a mean ESD of 458 mGy (range 26-2098 mGy). The corresponding median values were 17.4 min, 25.6 Gy cm2, 4.4 mSv and 320 mGy. The threshold of 2 Gy for skin erythema was exceeded in two procedures for a focus-to-skin distance (FSD) of 40 cm and six procedures when an FSD of 30 cm was considered. The highest doses absorbed by the adrenals, kidneys, spleen and pancreas and ranged between 3.7 and 313.3 mGy (average 66.8 mGy), 3.3 and 285.1 mGy (average 60.8 mGy), 1.3 and 111.1 mGy (average 23.7 mGy), 1.1 and 92.1 mGy (average 19.6 mGy), respectively. A wide range of patient doses was reported in the literature. The radiation dose received by the patients was comparative or lower than most of the previously reported values. However, higher doses can be revealed due to the X-ray system's non-optimum use and extended FTs, mainly affected by complex clinical conditions, patients' body habitus and vascular surgeon experience. The large variation of patient doses highlights the potential to optimise the EVAR procedure by considering the balance between the radiation dose and the required image quality. Additional studies need to be conducted in increasing the vascular surgeons' awareness regarding patient dose and radiation protection issues during EVAR procedures.
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Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Christos P Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Vascular Surgery, University Hospital of Patras, 26504 Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
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Zhang L, Gu S, Guo S, Tamiya T. A Magnetorheological Fluids-Based Robot-Assisted Catheter/Guidewire Surgery System for Endovascular Catheterization. MICROMACHINES 2021; 12:mi12060640. [PMID: 34070909 PMCID: PMC8226888 DOI: 10.3390/mi12060640] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
A teleoperated robotic catheter operating system is a solution to avoid occupational hazards caused by repeated exposure radiation of the surgeon to X-ray during the endovascular procedures. However, inadequate force feedback and collision detection while teleoperating surgical tools elevate the risk of endovascular procedures. Moreover, surgeons cannot control the force of the catheter/guidewire within a proper range, and thus the risk of blood vessel damage will increase. In this paper, a magnetorheological fluid (MR)-based robot-assisted catheter/guidewire surgery system has been developed, which uses the surgeon’s natural manipulation skills acquired through experience and uses haptic cues to generate collision detection to ensure surgical safety. We present tests for the performance evaluation regarding the teleoperation, the force measurement, and the collision detection with haptic cues. Results show that the system can track the desired position of the surgical tool and detect the relevant force event at the catheter. In addition, this method can more readily enable surgeons to distinguish whether the proximal force exceeds or meets the safety threshold of blood vessels.
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Affiliation(s)
- Linshuai Zhang
- School of Control Engineering, Chengdu University of Information Technology, Chengdu 610225, China;
| | - Shuoxin Gu
- School of Control Engineering, Chengdu University of Information Technology, Chengdu 610225, China;
- Correspondence: (S.G.); (S.G.); Tel.: +86-180-8684-8801 (Shuoxin Gu)
| | - Shuxiang Guo
- Faculty of Engineering and Design, Kagawa University, Takamatsu 761-0396, Japan
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, the Ministry of Industry Information Technology, School of Life Science, Beijing Institute of Technology, Beijing 100081, China
- Correspondence: (S.G.); (S.G.); Tel.: +86-180-8684-8801 (Shuoxin Gu)
| | - Takashi Tamiya
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Takamatsu 761-0396, Japan;
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Souza SP, Silva MF, Tavares OJ, Souza LWG, Silva DC, Santos WS, Belinato W, Perini AP, Neves LP. Monte Carlo evaluation of occupational exposure during uterine artery embolization. Phys Med 2021; 85:50-56. [PMID: 33965741 DOI: 10.1016/j.ejmp.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Uterine fibroids affect women mainly of childbearing age, an alternative for the treatment of these fibroids is uterine artery embolization (UAE), a minimally invasive procedure which uses fluoroscopy, providing radiation doses often high, due to the fact that professionals remain in the room throughout the procedure. In this work, equivalent and effective doses were evaluated for the main physician, for the assistant and for the patient during the UAE procedure. METHODS Doses were calculated using computer simulation with the Monte Carlo Method, and virtual anthropomorphic phantoms, in a typical scenario of interventional radiology with field sizes of 20 × 20, 25 × 25 and 32 × 32 cm2, tube voltages of 70, 80, 90 and 100 kV, and projections of LAO45, RAO45 and PA. RESULTS The results showed that the highest doses received by the professionals were for the LAO45 projection with 32 × 32 cm2 field size and 100 kV tube voltage, which is in accordance with the existing literature. The highest equivalent doses, without the protective equipment, were in the eyes, skin, breast and stomach for the main physician, and for the assistant they were in the eyes, breast, thyroid and skin. When she used the protective equipment, the highest equivalent doses for the main physician were on the skin, brain, bone marrow and bone surface, and for the assistant they were on the skin, brain, red bone marrow and bone surface. CONCLUSIONS Effective doses increased up to 3186% for the main physician, and 2462% for the assistant, without protective equipment, thus showing their importance.
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Affiliation(s)
- Samara P Souza
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil
| | - Monique F Silva
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil
| | - Otávio J Tavares
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil
| | - Lucas W G Souza
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil; Instituto Maria Ranulfa Ltda, FATRA - Faculdade do Trabalho, Av. Paes Leme Osvaldo, 38408000 Uberlândia, MG, Brazil
| | - Daniela C Silva
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil
| | - William S Santos
- Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Walmir Belinato
- Instituto Federal da Bahia (IFBA), Vitória da Conquista, BA, Brazil
| | - Ana P Perini
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil; Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Lucio P Neves
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil; Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
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Haga Y, Chida K, Sota M, Kaga Y, Abe M, Inaba Y, Suzuki M, Meguro T, Zuguchi M. Hybrid Operating Room System for the Treatment of Thoracic and Abdominal Aortic Aneurysms: Evaluation of the Radiation Dose Received by Patients. Diagnostics (Basel) 2020; 10:diagnostics10100846. [PMID: 33086733 PMCID: PMC7589961 DOI: 10.3390/diagnostics10100846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022] Open
Abstract
In recent years, endovascular treatment of aortic aneurysms has attracted considerable attention as a promising alternative to traditional surgery. Hybrid operating room systems (HORSs) are increasingly being used to perform endovascular procedures. The clinical benefits of endovascular treatments using HORSs are very clear, and these procedures are increasing in number. In procedures such as thoracic endovascular aortic repair (TEVAR) and endovascular aortic repair (EVAR), wires and catheters are used to deliver and deploy the stent graft in the thoracic/abdominal aorta under fluoroscopic control, including DSA. Thus, the radiation dose to the patient is an important issue. We determined radiation dose indicators (the dose–area product (DAP) and air karma (AK) parameters) associated with endovascular treatments (EVAR and TEVAR) using a HORS. As a result, the mean ± standard deviation (SD) DAPs of TEVAR and EVAR were 323.7 ± 161.0 and 371.3 ± 186.0 Gy × cm2, respectively. The mean ± SD AKs of TEVAR and EVAR were 0.92 ± 0.44 and 1.11 ± 0.54 Gy, respectively. The mean ± SD fluoroscopy times of TEVAR and EVAR were 13.4 ± 7.1 and 23.2 ± 11.7 min, respectively. Patient radiation dose results in this study of endovascular treatments using HORSs showed no deterministic radiation effects, such as skin injuries. However, radiation exposure during TEVAR and EVAR cannot be ignored. The radiation dose should be evaluated in HORSs during endovascular treatments. Reducing/optimizing the radiation dose to the patient in HORSs is important.
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Affiliation(s)
- Yoshihiro Haga
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan; (Y.H.); (M.S.); (Y.I.); (M.S.); (M.Z.)
- Department of Radiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai 980-0873, Japan; (Y.K.); (M.A.)
| | - Koichi Chida
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan; (Y.H.); (M.S.); (Y.I.); (M.S.); (M.Z.)
- Department of Radiation Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aramaki Aza-Aoba, Aoba, Sendai, Miyagi 980-0845, Japan
- Correspondence: ; Tel.: +81-22-717-7943
| | - Masahiro Sota
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan; (Y.H.); (M.S.); (Y.I.); (M.S.); (M.Z.)
- Department of Radiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai 980-0873, Japan; (Y.K.); (M.A.)
| | - Yuji Kaga
- Department of Radiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai 980-0873, Japan; (Y.K.); (M.A.)
| | - Mitsuya Abe
- Department of Radiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai 980-0873, Japan; (Y.K.); (M.A.)
| | - Yohei Inaba
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan; (Y.H.); (M.S.); (Y.I.); (M.S.); (M.Z.)
- Department of Radiation Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aramaki Aza-Aoba, Aoba, Sendai, Miyagi 980-0845, Japan
| | - Masatoshi Suzuki
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan; (Y.H.); (M.S.); (Y.I.); (M.S.); (M.Z.)
- Department of Radiation Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aramaki Aza-Aoba, Aoba, Sendai, Miyagi 980-0845, Japan
| | - Taiichiro Meguro
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, 4-15 Hirose-machi, Aoba, Sendai 980-0873, Japan;
| | - Masayuki Zuguchi
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan; (Y.H.); (M.S.); (Y.I.); (M.S.); (M.Z.)
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Mirza AK, Tenorio ER, Marcondes GB, Lima GBB, Macedo TA, Mendes BC, Oderich GS. Comparison of Cerebral Embolic Events Between Right and Left Upper Extremity Access During Fenestrated/Branched Endovascular Aortic Repair. J Endovasc Ther 2020; 28:70-77. [DOI: 10.1177/1526602820953511] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To evaluate the incidence and outcomes of cerebral embolic events when using right (RUE) vs left upper extremity (LUE) access for fenestrated/branched endovascular aneurysm repair (f/bEVAR). Materials and Methods: A retrospective review was conducted of 290 consecutive patients enrolled in a physician-sponsored Investigational Device Exemption study to evaluate f/bEVAR between 2013 and 2018. Of these, 270 patients (93%) had an upper extremity access with 12-F sheaths, including 205 patients (mean age 75±8 years; 147 men) with LUE and 65 patients (mean age 73±8 years; 42 men) with RUE access. Outcome measures were technical success, procedural metrics, major adverse events (MAEs), any stroke or transient ischemic attack (TIA), and mortality. Results: Technical success was higher (p=0.04) for LUE (99.6%) vs RUE access (98.4%). Patients treated via RUE access more often had extent I-III thoracoabdominal aortic aneurysms (57% vs 39%, p=0.03). Procedural metrics were similar for LUE vs RUE sides, including endovascular time (255±80 vs 246±83 minutes, respectively; p=0.23), fluoroscopy time (84±32 vs 90±35 minutes, respectively; p=0.80), and contrast volume (156±57 vs 153±56 mL, respectively; p=0.82). Total radiation exposure was significantly higher for LUE vs RUE access (2463±1912 vs 1757±1494 mGy, respectively; p=0.02). There were 2 deaths (1%) at 30 days or during hospital admission, both unrelated to access site complications. MAEs occurred in 32% of patients who had LUE and 26% of those who had RUE access (p=0.44). Five patients (2%) had embolic stroke and none had TIA. Embolic strokes were ipsilateral to the access side in 4 patients and affected the posterior circulation in 3. Two patients (1%) had hemorrhagic strokes. The incidence of stroke was 3% for LUE and 2% for RUE access (p>0.99). Conclusion: Fenestrated/branched stent-graft repair was associated with low rates of cerebral embolic events and no significant difference between the right vs left upper extremity approach.
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Affiliation(s)
- Aleem K. Mirza
- Advanced Endovascular Aortic Research Program, Mayo Clinic, Rochester, MN, USA
| | - Emanuel R. Tenorio
- Advanced Aortic Research Program, University of Texas Health Science at Houston, McGovern Medical School, Houston, TX, USA
| | - Giulianna B. Marcondes
- Advanced Aortic Research Program, University of Texas Health Science at Houston, McGovern Medical School, Houston, TX, USA
| | - Guilherme B. B. Lima
- Advanced Aortic Research Program, University of Texas Health Science at Houston, McGovern Medical School, Houston, TX, USA
| | - Thanila A. Macedo
- Advanced Aortic Research Program, University of Texas Health Science at Houston, McGovern Medical School, Houston, TX, USA
| | - Bernardo C. Mendes
- Advanced Endovascular Aortic Research Program, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S. Oderich
- Advanced Aortic Research Program, University of Texas Health Science at Houston, McGovern Medical School, Houston, TX, USA
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Theilig D, Mayerhofer A, Petschelt D, Elkilany A, Hamm B, Gebauer B, Geisel D. Impact of interventionalist's experience and gender on radiation dose and procedural time in CT-guided interventions-a retrospective analysis of 4380 cases over 10 years. Eur Radiol 2020; 31:569-579. [PMID: 32851446 PMCID: PMC8263432 DOI: 10.1007/s00330-020-07185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/30/2020] [Accepted: 08/12/2020] [Indexed: 11/09/2022]
Abstract
Objectives To investigate the impact of the interventionalist’s experience and gender on radiation dose and procedural time in CT-guided interventions. Methods We retrospectively analyzed 4380 CT-guided interventions performed at our institution with the same CT scanner from 2009 until 2018, 1287 (29%) by female and 3093 (71%) by male interventionalists. Radiation dose, number of CT fluoroscopy images taken per intervention, total procedural time, type of intervention, and degree of difficulty were derived from the saved dose reports and images. All 16 interventionalists included in this analysis performed their first CT-guided interventions during the study period, and interventions performed by each interventionalist were counted to assess the level of experience for each intervention in terms of the number of prior interventions performed by her or him. The Mann-Whitney U test (MWU test), multivariate regression, and linear mixed model analysis were performed. Results Assessment of the impact of gender with the MWU test revealed that female interventionalists took a significantly smaller number of images (p < 0.0001) and achieved a lower dose-length product per intervention (p < 0.0001) while taking more time per intervention (p = 0.0001). This finding was confirmed for most types of interventions when additionally accounting for other possible impact factors in multivariate regression analysis. In linear mixed model analysis, we found that radiation dose, number of images taken per intervention, and procedural time decreased statistically significantly with interventionalist’s experience. Conclusions Radiation doses of CT-guided interventions are reduced by interventionalist’s experience and, for most types of interventions, when performed by female interventionalists. Key Points • Radiation doses in CT-guided interventions are lower when performed by female interventionalists. • Procedural times of CT-guided interventions are longer when performed by female interventionalists. • Radiation doses of CT-guided interventions decrease with the interventionalist’s experience. Electronic supplementary material The online version of this article (10.1007/s00330-020-07185-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorothea Theilig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Anna Mayerhofer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - David Petschelt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Aboelyazid Elkilany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd Hamm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
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Zhou J, Mei Z, Miao J, Mao J, Wang L, Wu D, Sun D, Zhao Y. A Remote-Controlled Robotic System with Safety Protection Strategy Based on Force-Sensing and Bending Feedback for Transcatheter Arterial Chemoembolization. MICROMACHINES 2020; 11:mi11090805. [PMID: 32854264 PMCID: PMC7569875 DOI: 10.3390/mi11090805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 01/04/2023]
Abstract
Transcatheter arterial chemoembolization (TACE) is the common choice of non-open surgery for hepatocellular carcinoma (HCC) now. In this study, a simple TACE robotic system of 4-degree-of-freedom is proposed to get higher accuracy and stability of the surgery operation and reduce X-ray exposure time of the surgeons. The master-slave control strategy is adopted in the robotic system and a customized sigmoid function is designed to optimize the joystick control of the master-slave robotic control system. A force-sensing module is developed to sense the resistance of the guide wire in linear delivery motion and an auxiliary bending feedback method based on constraint pipe with a film sensor is proposed. With two force-sensing methods, the safety strategy of robotic motion with 9 different motion constraint coefficients is given and a human-computer interface is developed. The TACE robot would monitor the value of the force sensor and the analog voltage of the film sensor to adopt the corresponding motion constraint coefficient in every 10 ms. Vascular model experiments were performed to validate the robotic system, and the results showed that the safety strategy could improve the reliability of the operation with immediate speed constraint and avoid potential aggressive delivery.
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Affiliation(s)
- Junqiang Zhou
- Department of Mechanical and Electrical Engineering, Xiamen University, Xiamen 361102, China
| | - Ziyang Mei
- Department of Mechanical and Electrical Engineering, Xiamen University, Xiamen 361102, China
| | - Jia Miao
- Department of Mechanical and Electrical Engineering, Xiamen University, Xiamen 361102, China
| | - Jingsong Mao
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen 361102, China
| | - Lingyun Wang
- Department of Mechanical and Electrical Engineering, Xiamen University, Xiamen 361102, China
| | - Dezhi Wu
- Department of Mechanical and Electrical Engineering, Xiamen University, Xiamen 361102, China
| | - Daoheng Sun
- Department of Mechanical and Electrical Engineering, Xiamen University, Xiamen 361102, China
| | - Yang Zhao
- Department of Mechanical and Electrical Engineering, Xiamen University, Xiamen 361102, China
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Editor's Choice - Comprehensive Literature Review of Radiation Levels During Endovascular Aortic Repair in Cathlabs and Operating Theatres. Eur J Vasc Endovasc Surg 2020; 60:374-385. [PMID: 32682690 DOI: 10.1016/j.ejvs.2020.05.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/02/2020] [Accepted: 05/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Occupational exposure is a growing concern among the endovascular specialist community. Several types of imaging equipment are available, such as mobile C arms or hybrid rooms, and some have been shown to deliver higher levels of radiation. A literature review was conducted to identify studies reporting dose data during standard (EVAR) and complex abdominal aortic endovascular repair (fenestrated/branched EVAR [F/BEVAR]). METHODS A search of the MEDLINE and the Cochrane databases was performed by two independent investigators using the medical subject heading terms "aortic aneurysms", "radiation", and "humans" over a search period of 10 years. Studies with full text available in English and reporting radiation data independently from the imaging equipment type were included. Experimental studies were excluded. RESULTS The lowest dose-area product levels during EVAR and F/BEVAR were identified in hybrid rooms, while the highest were with fixed systems. When adherence to the as low as reasonably achievable principles was stipulated by the authors, dose reports tended to be among the lowest. Several studies, especially of F/BEVAR, report concerning levels of radiation for both patients and staff. CONCLUSION Modern imaging equipment type, team involvement with radiation management, and the support of recent imaging technologies such as fusion help to reduce the dose delivered during standard and complex EVAR. Investment in modern imaging technology should be considered in every centre providing endovascular management of aortic aneurysms.
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Klein A, Xi Y, Guild J, Tsai S, Ramanan B, Chamseddin K, Timaran C, Kirkwood M. The Effects of Gender on Radiation Dose during Fenestrated Endovascular Aneurysm Repair. Ann Vasc Surg 2020; 68:305-309. [PMID: 32479875 DOI: 10.1016/j.avsg.2020.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Female gender is considered a risk factor for worse perioperative outcomes after fenestrated endovascular aneurysm repair (FEVAR). We hypothesized that women would have more unfavorable anatomy, increasing case complexity and leading to higher radiation doses. Our aim was to evaluate the effect of gender on radiation dose during FEVARs. METHODS This single-center retrospective study was performed from 1/2015 to 2/2018. For patient data, linear model and stepwise variable selection algorithm were used. All dose measurements were log transformed before analysis. Significance level for parameter estimates and corresponding 95% confidence intervals were all transformed back using an exponential function. P-value of <0.05 was considered statistically significant. All analyses were performed in SAS 9.4 (SAS Institute Inc., Cary, NC). RESULTS A total of 169 FEVARs (45 women) were performed on a Philips Allura Xper FD 20 fluoroscopy system equipped with clarity technology. There was no difference in body mass index (BMI) or operative time between genders, P = 0.9. The median reference air kerma for women was significantly lower than that for men (1,672 mGy vs. 2,496 mGy), P < 0.001. Women had on average a 28% total dose reduction after controlling for BMI, number of vessels fenestrated, operative time, and type of device, P < 0.001. The median fluorography and fluoroscopy doses for women were significantly lower than those for men (973 mGy vs. 1,401 mGy and 659 mGy vs. 1,008 mGy), resulting in a 24% fluorography dose reduction and a 38% fluoroscopy dose reduction for women, P < 0.001. CONCLUSIONS FEVARs can be performed successfully in women with comparatively lower radiation doses.
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Affiliation(s)
| | - Yin Xi
- UT Southwestern Medical Center, Dallas, TX
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Godzik J, Mastorakos GM, Nayar G, Hunter WD, Tumialán LM. Surgeon and staff radiation exposure in minimally invasive spinal surgery: prospective series using a personal dosimeter. J Neurosurg Spine 2020; 32:817-823. [PMID: 32032959 DOI: 10.3171/2019.11.spine19448] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The level of radiation awareness by surgeons and residents in spinal surgery does not match the ubiquity of fluoroscopy in operating rooms in the United States. The present method of monitoring radiation exposure may contribute to the current deficiency in radiation awareness. Current dosimeters involve a considerable lag from the time that the surgical team is exposed to radiation to the time that they are provided with that exposure data. The objective of the current study was to assess the feasibility of monitoring radiation exposure in operating room personnel during lateral transpsoas lumbar interbody fusion (LLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) procedures by using a wearable personal device with real-time feedback. METHODS Operating room staff participating in minimally invasive surgical procedures under a single surgeon during a 6-month period were prospectively enrolled in this study. All radiation dose exposures were recorded for each member of the surgical team (surgeon, assistant surgeon, scrub nurse, and circulating nurse) using a personal dosimeter (DoseAware). Radiation doses were recorded in microsieverts (μSv). Comparisons between groups were made using ANOVA with the Tukey post hoc test and Student t-test. RESULTS Thirty-nine patients underwent interbody fusions: 25 underwent LLIF procedures (14 LLIF alone, 11 LLIF with percutaneous screw placement [PSP]) and 14 underwent MI-TLIF. For each operative scenario per spinal level, the surgeon experienced significantly higher (p < 0.035) average radiation exposure (LLIF: 167.9 μSv, LLIF+PSP: 424.2 μSv, MI-TLIF: 397.9 μSv) than other members of the team, followed by the assistant surgeon (LLIF: 149.7 μSv, LLIF+PSP: 242.3 μSv, MI-TLIF: 274.9 μSv). The scrub nurse (LLIF: 15.4 μSv, LLIF+PSP: 125.7 μSv, MI-TLIF: 183.0 μSv) and circulating nurse (LLIF: 1.2 μSv, LLIF+PSP: 9.2 μSv, MI-TLIF: 102.3 μSv) experienced significantly lower exposures. Radiation exposure was not correlated with the patient's body mass index (p ≥ 0.233); however, it was positively correlated with increasing patient age (p ≤ 0.004). CONCLUSIONS Real-time monitoring of radiation exposure is currently feasible and shortens the time between exposure and the availability of information regarding that exposure. A shortened feedback loop that offers more reliable and immediate data would conceivably raise the level of concern for radiation exposure in spinal surgeries and could alter patterns of behavior, leading to decreased exposures. Further studies are ongoing to determine the effect of real-time dosimetry in spinal surgery.
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Affiliation(s)
- Jakub Godzik
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Gautam Nayar
- 3Duke University School of Medicine, Department of Neurosurgery, Durham, North Carolina
| | - William D Hunter
- 4Department of Neurosurgery, CaroMont Health Regional Medical Center, Gastonia, North Carolina; and
| | - Luis M Tumialán
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- 5Spine Group Arizona, HonorHealth, Greenbaum Surgical Specialty Hospital, Scottsdale, Arizona
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Timaran LI, Timaran CH, Scott CK, Soto-Gonzalez M, Timaran-Montenegro DE, Guild JB, Kirkwood ML. Dual fluoroscopy with live-image digital zooming significantly reduces patient and operating staff radiation during fenestrated-branched endovascular aortic aneurysm repair. J Vasc Surg 2020; 73:601-607. [PMID: 32473339 DOI: 10.1016/j.jvs.2020.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/10/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Fenestrated-branched endovascular aneurysm repair (F/B-EVAR) is a complex procedure that generates high radiation doses. Magnification aids in vessel cannulation but increases radiation. The aim of the study was to compare radiation doses to patients and operating room staff from two fluoroscopy techniques, standard magnification vs dual fluoroscopy with live-image digital zooming during F/B-EVAR. METHODS An observational, prospective, single-center study of F/B-EVAR procedures using Philips Allura XperFD20 equipment (Philips Healthcare, Amsterdam, The Netherlands) was performed during a 42-month period. Intravascular ultrasound, three-dimensional fusion, and extreme collimation were used in all procedures. Intraoperative live-image processing was performed with two imaging systems: standard magnification in 123 patients (81%) and dual fluoroscopy with live-image digital zooming in 28 patients (18%). In the latter, the live "processed" zoomed images are displayed on examination displays and live images are displayed on reference displays. The reference air kerma was collected for each case and represents patient dose. Operating staff personal dosimetry was collected using the DoseAware system (Philips Healthcare). Patient and staff radiation doses were compared using nonparametric tests. RESULTS Mean age was 71.6 ± 11.4 years. The median body mass index was 27 kg/m2 (interquartile range [IQR], 24.4-30.6 kg/m2) and was the same for both groups. Procedures performed with dual fluoroscopy with digital zooming demonstrated significantly lower median patient (1382 mGy [IQR, 999-2045 mGy] vs 2458 mGy [IQR, 1706-3767 mGy]; P < .01) and primary operator radiation doses (101 μSv [IQR, 34-235 μSv] vs 266 μSv [IQR, 104-583 μSv]; P < .01) compared with standard magnification. Similar significantly reduced radiation doses were recorded for first assistant, scrub nurse, and anesthesia staff in procedures performed with dual fluoroscopy. According to device design, procedures performed with four-fenestration/branch devices generated higher operator radiation doses (262 μSv [IQR, 116.5-572 μSv] vs 171 μSv [IQR, 44-325 μSv]; P < .01) compared with procedures with three or fewer fenestration/branches. Among the most complex design (four-vessel), operator radiation dose was significantly lower with digital zooming compared with standard magnification (128.5 μSv [IQR, 70.5-296 μSv] vs 309 μSv [IQR, 150-611 μSv]; P = .01). CONCLUSIONS Current radiation doses to patients and operating personnel are within acceptable limits; however, dual fluoroscopy with live-image digital zooming results in dramatically lower radiation doses compared with the standard image processing with dose-dependent magnification. Operator radiation doses were reduced in half during procedures performed with more complex device designs when digital zooming was used.
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Affiliation(s)
- Laura I Timaran
- Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pa
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Carla K Scott
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Marilisa Soto-Gonzalez
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - David E Timaran-Montenegro
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Jeffrey B Guild
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex
| | - Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex.
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Abstract
The trend towards more minimally invasive procedures in the past few decades has resulted in an exponential growth in fluoroscopy-guided catheter-based cardiology procedures. As these techniques are becoming more commonly used and developed, the adverse effects of radiation exposure to the patient, operator, and ancillary staff have been a subject of concern. Although occupational radiation dose limits are being monitored and seldom reached, exposure to chronic, low dose radiation has been shown to have harmful biological effects that are not readily apparent until years after. Given this, it is imperative that reducing radiation dose exposure in the cardiac catheterization laboratory remains a priority. Staff education and training, radiation dose monitoring, ensuring use of proper personal protective equipment, employment of shields, and various procedural techniques in minimizing radiation must always be diligently employed. Special care and consideration should be extended to pregnant women working in the cardiac catheterization laboratory. This review article presents a practical approach to radiation dose management and discusses best practice recommendations in the cardiac catheterization laboratory.
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Affiliation(s)
- Sylvia Marie R Biso
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mladen I Vidovich
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Serna Santos J, Uusi-Simola J, Kaasalainen T, Aho P, Venermo M. Radiation Doses to Staff in a Hybrid Operating Room: An Anthropomorphic Phantom Study with Active Electronic Dosimeters. Eur J Vasc Endovasc Surg 2020; 59:654-660. [DOI: 10.1016/j.ejvs.2020.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/15/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
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Percutaneous AXillary Artery (PAXA) Access at the First Segment During Fenestrated and Branched Endovascular Aortic Procedures. Eur J Vasc Endovasc Surg 2020; 59:929-938. [PMID: 32089506 DOI: 10.1016/j.ejvs.2020.01.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/01/2020] [Accepted: 01/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility and safety of percutaneous axillary access with vessel closure device closure after puncturing the first segment during endovascular treatment of complex aneurysms with fenestrated and branched endografts (F/BEVAR). METHODS The PAXA (Percutaneous AXillary Access) study is a physician initiated, single centre, ambispective, non-randomised study (clinicaltrials.gov: NCT03223311). The primary endpoint was the closure success rate defined as the absence of any vascular injury to achieve haemostasis at the puncture site, requiring any treatment other than manual compression or adjunctive endovascular ballooning. The secondary endpoints were minor access complications, cerebrovascular complication rate, short term access vessel patency, and study cohort anatomical evaluation of the axillary artery. RESULTS Sixty-four patients required an upper extremity access during F/BEVAR procedure during study period (November 2016 to July 2019) and were screened for the PAXA study: 59 patients (47 males; median age: 75 years, IQR 69-78) met the study inclusion criteria and were enrolled (one patient had bilateral access). Closure success was obtained in 54 cases (90%) with no open conversion required: five patients received a bare or covered stenting to the AXA and in one patient mechanical failure of the delivery system was recorded. No 30 day permanent peripheral nerve injuries and two non-ipsilateral ischaemic strokes (3.4%) were recorded. Seven patients (12%) had access haematomas managed conservatively associated with closure failure (p = .002), oral anticoagulants therapy (p = .005) and procedure length (p = .028). At short term follow up (6 months), no late complications were observed, and all access vessels were patent. CONCLUSION PAXA on the first segment using a large sheath (10-16F) is technically feasible, relatively safe with no need for open conversion but it may require access related secondary endovascular procedures. Further prospective studies are needed to modify the device instruction for use and to put the procedure on label.
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Pedraza de Leistl MC, Silber M, Knez P, Adili F. [Monitoring Radiation Exposure During Surgery with Real Time Measurements: Opportunities and Limitations]. Zentralbl Chir 2020; 145:531-540. [PMID: 31940669 DOI: 10.1055/a-1073-8293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Germany, staff exposed to radiation is monitored with official individual dosimeters. Commercially available real-time dosimeters (RTD) can be used as radiation protection dosimeters. They are worn over the apron and display the radiation dose being measured at the desired location at intervals of one second. These real-time radiation exposure measurements enable the surgical staff to take suitable measures to reduce the radiation during the operation. The objective of our study was to monitor the accuracy of the measurements taken from the real-time dosimeter and to determine the radiation scatter for individual members of the surgical staff. MATERIALS AND METHODS Prospective measurements of the operating team's exposure to radiation were carried out using a real-time dosimeter system in an operating room for vascular surgery equipped with a C-arm. Firstly the calibration of the RTD at the operating table was checked using a water phantom. Subsequently, measurements were taken during vascular interventions and surgery. RESULTS When calibrated, the values of the individual RTD revealed internal significant deviations, thus a corrective factor was calculated for each RTD. In total 55 interventions on 53 patients were studied. The average dose for the RTD of the surgeon during endovascular aortic repair (n = 11) amounted to 9 ± 9 µSv (range 3.6 - 50 µSv) and during thoracic endovascular aortic repair (n = 6) 35 ± 49 µSv (3.8 - 190.3 µSv). In the case of percutaneous transluminal angioplasty of the pelvis and of the lower extremities (n = 20), the average dose for the RTD of the surgeon was 7 ± 7 µSv (1.2 - 35 µSv) and for the angiographies of the lower extremities (n = 12) at 2 ± 3 µSv (0.2 - 15.9 µSv). The real-time dosimetry provided data which contributed to the operating team changing their behaviour in the operating room. DISCUSSION Since the dose values determined by the official dosimetry are generally very low, it is not possible to optimise the behaviour and thus the radiation protection using these dose values. This can be achieved with the radiation protection dosimeter and the dose reference levels can be defined in the new Radiation Protection Ordinance (StrlSchV). Instant feedback of the current dose rate at the place where the RTD is worn can lead to both the individual adjusting his or her personal behaviour and to optimisation of the individual's radiation protection. It is only possible to compare the measured data obtained with the RTD when calibration is carried out in advance.
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Affiliation(s)
| | - Martin Silber
- Institut für Radioonkologie und Strahlentherapie, Bereich Medizinische Physik, Klinikum Darmstadt, Deutschland
| | - Peter Knez
- Gefäßchirurgie, Lahn-Dill-Kliniken GmbH, Wetzlar, Deutschland
| | - Farzin Adili
- Klinik für Gefäßmedizin - Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
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Wong T, Georgiadis PL, Urman RD, Tsai MH. Non-Operating Room Anesthesia: Patient Selection and Special Considerations. Local Reg Anesth 2020; 13:1-9. [PMID: 32021414 PMCID: PMC6956865 DOI: 10.2147/lra.s181458] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022] Open
Abstract
Non-operating room anesthesia (NORA) represents a growing field of medicine with an increasing trend in the number of cases performed over the previous decade. As a result, anesthesia providers will need to enhance their familiarity with the resources, personnel, and environment outside of the operating room. Anesthesia delivery in NORA settings should be held with the same high-quality standards as that within the operating room. This review looks at special considerations in patient selection and the preoperative, intraoperative, and postoperative periods. In addition, there is a discussion on the unique aspects of specific NORA areas and the considerations that come with them.
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Affiliation(s)
- Timothy Wong
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Paige L Georgiadis
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mitchell H Tsai
- Department of Anesthesiology, Department of Orthopaedics and Rehabilitation (by Courtesy), Department of Surgery (by Courtesy), University of Vermont Larner College of Medicine, Burlington, VT, USA
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Advantage of Steerable Catheter and Haptic Feedback for a 5-DOF Vascular Intervention Robot System. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9204305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vascular intervention involves inserting a catheter and guidewire into blood vessels to diagnose and treat a disease in an X-ray environment. In this conventional vascular intervention procedure, the doctor is exposed to considerable radiation. To reduce the exposure, we developed a master–slave robot system. A steerable catheter is employed to shorten the task-time and reduce the contact force applied to the vessel walls during catheter insertion. The steerable catheter helps to select a vascular branch; thus, the radiation exposure time for patients is reduced, and perforation in the patient’s vessel is prevented. Additionally, the robot system employs a haptic function to replicate the physician’s tactile sensing in vascular intervention. In this study, the effectiveness of the steering catheter and haptic function was demonstrated experimentally in comparison with a conventional catheter.
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Wilson-Stewart K, Hartel G, Fontanarosa D. Occupational radiation exposure to the head is higher for scrub nurses than cardiologists during cardiac angiography. J Adv Nurs 2019; 75:2692-2700. [PMID: 31144368 DOI: 10.1111/jan.14085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 10/26/2022]
Abstract
AIMS This study aimed to compare the head dose of a cardiologist to scrub and scout nurses during cardiac angiography. DESIGN A correlational longitudinal quantitative design was used to examine the relationship between the variable of occupational dose to the medical operator when compared with the dose to the scrub and scout nurses. METHODS A quantitative analysis was performed on data collected during coronary angiograms (N = 612) for one cardiologist and 22 nurses performing either the scrub or scout role between May 2015 and February 2017. Analysis was based on log-transformed dose levels and reported as geometric means and associated 95% confidence intervals. RESULTS It was found that scrub nurses received on average 41% more head dose than the cardiologist during diagnostic procedures and 52% higher doses during interventional cases. CONCLUSION Nurses working in fluoroscopic cardiovascular procedures should be provided with appropriate training and protective equipment, notably lead skull caps, to minimize their occupational radiation exposure. IMPACT There is a notable lack of research evaluating the occupational head and eye exposure to nurses involved in fluoroscopic procedures. This study found that during diagnostic coronary angiograms, the scrub nurses received 41% more occupational head dose than the cardiologist and 52% higher head doses during interventional cases. Radial access resulted in higher doses to scrub nurses than femoral artery access. It is advisable that staff wear protective lead glasses and skull caps and use appropriately positioned ceiling mounted lead shields to minimize the risk of adverse effects of occupational exposure to ionizing radiation.
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Affiliation(s)
- Kelly Wilson-Stewart
- Cardiovascular Suites, Greenslopes Private Hospital, Brisbane, Qld, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
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Landry GJ. Invited commentary. J Vasc Surg 2019; 69:1785. [PMID: 31159982 DOI: 10.1016/j.jvs.2018.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022]
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Swerdlow NJ, Jones DW, Pothof AB, O'Donnell TF, Liang P, Li C, Wyers MC, Schermerhorn ML. Three-dimensional image fusion is associated with lower radiation exposure and shorter time to carotid cannulation during carotid artery stenting. J Vasc Surg 2019; 69:1111-1120. [DOI: 10.1016/j.jvs.2018.07.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022]
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Outcomes of upper extremity access during fenestrated-branched endovascular aortic repair. J Vasc Surg 2019; 69:635-643. [DOI: 10.1016/j.jvs.2018.05.214] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/05/2018] [Indexed: 11/22/2022]
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Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, ESVS Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57:8-93. [DOI: 10.1016/j.ejvs.2018.09.020] [Citation(s) in RCA: 1724] [Impact Index Per Article: 287.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Choi BH, Yaya K, Prabhu V, Fefferman N, Mitchell B, Kuenzler KA, Ginsburg HB, Fisher JC, Tomita S. Simple preoperative radiation safety interventions significantly lower radiation doses during central venous line placement in children. J Pediatr Surg 2019; 54:170-173. [PMID: 30415958 DOI: 10.1016/j.jpedsurg.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/01/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of this study was to reduce radiation exposure during pediatric central venous line (CVL) placement by implementing a radiation safety process including a radiation safety briefing and a job-instruction model with a preradiation time-out. METHODS We reviewed records of all patients under 21 who underwent CVL placement in the operating room covering 22 months before the intervention through 10 months after 2013-2016. The intervention consisted of a radiation safety briefing by the surgeon to the intraoperative staff before each case and a radiation safety time-out. We measured and analyzed the dose area product (DAP), total radiation time pre- and postintervention, and the use of postprocedural chest radiograph. RESULTS 100 patients with valid DAP measurements were identified for analysis (59 preintervention, 41 postintervention). Following implementation of the radiation safety process, there was a 79% decrease in median DAP (61.4 vs 13.1 rad*cm2, P < 0.001) and a 73% decrease in the median radiation time (28 vs 7.6 s, P < 0.001). Additionally, there was a significant reduction in use of confirmatory CXR (95% vs 15%, P < 0.01). CONCLUSION A preoperative radiation safety briefing and a radiation safety time-out supported by a job-instruction model were effective in significantly lowering the absorbed doses of radiation in children undergoing CVL insertion. TYPE OF STUDY Case-control study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Beatrix Hyemin Choi
- Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY.
| | - Kamalou Yaya
- Department of Radiology, NYU School of Medicine, NYU Langone Health, New York, NY
| | - Vinay Prabhu
- Department of Radiology, NYU School of Medicine, NYU Langone Health, New York, NY
| | - Nancy Fefferman
- Department of Radiology, NYU School of Medicine, NYU Langone Health, New York, NY
| | - Beverly Mitchell
- Department of Surgery, NYU School of Medicine, NYU Langone Health, New York, NY
| | - Keith A Kuenzler
- Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
| | - Howard B Ginsburg
- Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
| | - Jason C Fisher
- Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
| | - Sandra Tomita
- Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
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Wilson‐Stewart K, Shanahan M, Fontanarosa D, Davidson R. Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature. J Appl Clin Med Phys 2018; 19:282-297. [PMID: 30294978 PMCID: PMC6236819 DOI: 10.1002/acm2.12461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/19/2018] [Accepted: 07/14/2018] [Indexed: 11/16/2022] Open
Abstract
Fluoroscopy is a method used to provide real time x-ray imaging of the body during medical procedures to assist with medical diagnosis and treatment. Recent technological advances have seen an increase in the number of fluoroscopic examinations being performed. Nurses are an integral part of the team conducting fluoroscopic investigations and are often located close to the patient resulting in an occupational exposure to radiation. The purpose of this review was to examine recent literature which investigates occupational exposure received by nursing staff during cardiovascular fluoroscopic procedures. Articles published between 2011 and 2017 have been searched and comprehensively reviewed on the referenced medical search engines. Twenty-four relevant studies were identified among which seventeen investigated nursing dose comparative to operator dose. Seven researched the effectiveness of interventions in reducing occupational exposure to nursing staff. While doctors remain at the highest risk of exposure during procedures, evidence suggests that nursing staff may be at risk of exceeding recommended dose limits in some circumstances. There is also evidence of inconsistent use of personal protection such as lead glasses and skull caps by nursing staff to minimize radiation exposure. Conclusions: The review has highlighted a lack of published literature focussing on dose to nurses. There is a need for future research in this area to inform nursing staff of factors which may contribute to high occupational doses and of methods for minimizing the risk of exposure, particularly regarding the importance of utilizing radiation protective equipment.
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Affiliation(s)
- Kelly Wilson‐Stewart
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQldAustralia
- Cardiovascular SuitesGreenslopes Private HospitalBrisbaneQldAustralia
- Faculty of HealthUniversity of CanberraCanberraACTAustralia
| | | | - Davide Fontanarosa
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQldAustralia
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneQldAustralia
| | - Rob Davidson
- Faculty of HealthUniversity of CanberraCanberraACTAustralia
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de Ruiter QMB, Jansen MM, Moll FL, Hazenberg CEVB, Kahya NN, van Herwaarden JA. Procedure and step-based analysis of the occupational radiation dose during endovascular aneurysm repair in the hybrid operating room. J Vasc Surg 2018; 67:1881-1890. [PMID: 29801556 DOI: 10.1016/j.jvs.2017.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/21/2017] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study measured the cumulative occupational X-ray radiation dose received by support staff during endovascular aortic procedures and during additional intraoperative steps in the hybrid operating room. METHODS Radiation dose measurements were performed during interventions on 65 patients receiving 90 stent grafts during endovascular aneurysm repair (EVAR), bifurcated EVAR, thoracic EVAR, iliac branched device deployment, aortouni-iliac stenting, and fenestrated/branched EVAR (F/BrEVAR). X-ray imaging was acquired using the Philips Allura FD20 Clarity System (Philips Medical Systems, Best, The Netherlands). The occupational radiation dose (also referred to as the estimated effective dose, E, measured in millisieverts) was measured with the DoseAware Xtend system (Philips Medical Systems) personal dosimeters. E was reported per staff member (ESTAFF), where "staff" was a generic term for each staff member included in the study: the first operator (FO), the second operator (ESO), a virtual maximum operator (MO), and all additional supporting staff, including the sterile nurse, nonsterile nurse, anaesthesiologist, and radiation technician. The primary outcome was the median cumulative ESTAFF (or EFO, EMO, and so on), which was presented as the median cumulative dose per intervention and stratified for several within-interventional EVAR and F/BrEVAR steps or stents. The second outcome was the percentage of the absorbed E by a supporting staff member in relation to the E measured by the reference badge attached on the C-arm (ESTAFF% or EFO%, EMO%, and so on). All outcomes are presented as median with interquartile range, unless stated differently. RESULTS The occupational effective dose in millisieverts of the MO (EMO) was 0.055 (0.029-0.082) for aortouni-iliac stenting (n = 6), 0.084 (0.054-0.141) during thoracic EVAR (n = 14), 0.036 (0.026-0.068) during bifurcated EVAR (n = 38), 0.054 (0.035-0.126) during iliac branched device deployment (n = 8), and 0.345 (0.235-0.757) during F/BrEVAR (n = 24). The median EMO in millisieverts was 0.025 (0.012-0.062) per renal target vessel (TV) and 0.146 (0.07-0.315) for a nonrenal visceral TV. During all noncomplex interventions, the EMO% was 4.4% (2.7%-7.3%), with the lowest median rate at 3.5% (2.5%-5%) for EVAR. The highest median rate EMO% was found for F/BrEVAR procedures: 8.2% (5.0%-14.4%). CONCLUSIONS With maximum operator shielding during femoral access, relative occupational radiation risk can be minimized. However, digital subtraction angiography image acquisition, recanalization of TVs, recanalization of superior mesenteric artery or celiac artery, and recanalization of branched TVs are predictors for increased occupational radiation dose risks caused by increased radiation doses to the patient and reduced options for shielding of the operator.
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Affiliation(s)
- Quirina M B de Ruiter
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marloes M Jansen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices. J Vasc Surg 2018; 68:1281-1286. [PMID: 30369410 DOI: 10.1016/j.jvs.2018.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/17/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Fenestrated endovascular aneurysm repair (FEVAR) is the highest radiation dose procedure performed by vascular surgeons. We sought to characterize the radiation dose to patients and staff during FEVAR procedures with different premanufactured devices. METHODS A single-center prospective study of FEVARs was performed over 24 months. Three FEVAR devices were included: off-the-shelf (OTS; t-Branch, p-Branch), Zenith Fenestrated (ZFen), and investigational custom-made devices (CMDs). Radiation doses to the surgeon, trainee, anesthesiologist, and scrub/circulating nurses were measured using a personal dosimetry system (DoseAware, Philips Healthcare, Amsterdam, The Netherlands). Procedure type, patient body mass index (BMI), reference air kerma (RAK), and kerma area product (KAP) were recorded. RAK and KAP were corrected for BMI based on an exponential fit of fluoroscopy dose rate and the dose per radiographic frame. Operator dose was corrected for BMI by the ratio of corrected to actual KAP. A one-sided Wilcox rank-sum test was used to compare personnel radiation doses, RAKs, and KAPs between procedure types. Statistical significance was set at P ≤ .05. RESULTS There were 80 FEVARs performed by a single surgeon on a Philips Allura XperFD20 fluoroscopy system equipped with Clarity technology. Average BMI was 27 kg/m2. Sixty CMDs (36 four-, 21 three-, and 3 two-vessel fenestrations), 11 ZFens (8 three- and 3 two-vessel fenestrations), and 9 OTS devices (4 p-Branch, 5 t-Branch) were included. ZFens had significantly lower patient (1800 mGy vs 2950 mGy; P = .004), operator (120 μSv vs 370 μSv; P = .004), assistant (60 μSv vs 210 μSv; P = .003), circulator (10 μSv vs 30 μSv; P = .049), and scrub nurse dose (10 μSv vs 40 μSv; P = .02) compared with CMDs. OTS devices had significantly lower operator (220 μSv vs 370 μSv; P = .04), assistant (110 μSv vs 210 μSv; P = .02), and circulator doses (4 μSv vs 30 μSv; P = .001) compared with CMDs. Four-vessel fenestrated devices had significantly higher patient dose (3020 mGy) compared with three-vessel FEVARs (2670 mGy; P = .03) and two-vessel FEVARs (1600 mGy; P = .0007), and significantly higher operator dose (440 μSv) compared with three-vessel FEVARs (170 μSv; P = .0005). Patient dose was lowest with ZFens. Operating room personnel dose was lower with ZFens and OTS devices compared with CMDs. Four-vessel fenestrations required significantly more radiation compared with those involving three-vessel fenestrations; however, the dose increase was only 12% and should not preclude operators from extending coverage, if anatomically required. CONCLUSIONS Overall, patient and personnel radiation doses during FEVAR with all devices were within acceptable limits and lower in our series than previously reported.
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