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Hizukuri K, Fujibuchi T, Han D, Arakawa H, Furuta T. Directional vector-based quick evaluation method for protective plate effects in X-ray fluoroscopy (DQPEX). Radiol Phys Technol 2025; 18:196-208. [PMID: 39733369 DOI: 10.1007/s12194-024-00873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 12/31/2024]
Abstract
One radiation protection measure for medical personnel in X-ray fluoroscopy is using radiation protective plates. A real-time interactive tool visualizing radiation-dose distribution varied with the protective plate position will help greatly to train medical personnel to protect themselves from unnecessary radiation exposure. Monte Carlo simulation can calculate the individual interactions between radiations and objects in the X-ray room, and reproduce the complex dose distribution inside the room. However, Monte Carlo simulation is computationally time-consuming and not suited for real-time feedback. Therefore, we developed a new method to calculate the dose distribution with the presence of protective plates instantly using pre-computed directional vectors, named Directional vector-based Quick evaluation method for Protective plates Effects in X-ray fluoroscopy (DQPEX). DQPEX uses a database of dose distributions and directional vectors precomputed by Monte Carlo code, Particle and Heavy Ion Transport code System (PHITS). Assuming the dose at each position was all contributed from radiations in the direction indicated by the directional vector, the dose reduction by the protective plates at the position was determined whether the backtrace line of the directional vector has a intersect with the protective plate or not. With DQPEX, the whole dose distribution in X-ray room with the presence of a protective plate can be computed about 13 s, which is approximately 1/6000 of the full PHITS simulation. Sufficient accuracy of DQPEX to visualize the effect of a protective plate was confirmed by comparing the obtained dose distribution with those obtained by the full PHITS simulation and measurements.
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Affiliation(s)
- Kyoko Hizukuri
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Toshioh Fujibuchi
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Donghee Han
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Arakawa
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takuya Furuta
- Nucleaer Science and Engineering Center, Japan Atomic Energy Agency, 2-4 Shirakata, Tokai-Mura, Ibaraki, 319-1195, Japan
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Smith L, Caffrey E, Wilson C. A Novel Shielding Device for Cardiac Cath Labs. HEALTH PHYSICS 2025; 128:52-59. [PMID: 39297774 DOI: 10.1097/hp.0000000000001890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
ABSTRACT This research evaluates the effectiveness of a large specialized cardiac catheterization laboratory shielding device (SCCLSD) placed perpendicular to the patient compared to traditional shielding methods in reducing occupational exposure to scattered x rays, contributing to the ongoing enhancement of radiation safety in the cardiac catheterization laboratory (CCL) setting. An experimental setup involving an anthropomorphic phantom on the catheterization table simulated radiation scatter from a patient. Measurements were taken systematically at various grid points and heights in the CCL using a Fluke 451P ion chamber while mimicking a real interventional scenario. In-air peak exposure rates were analyzed at head, chest, and waist heights in the anteroposterior (AP) position. Results demonstrated that the SCCLSD provided a superior radiation shadow and effective whole-body radiation exposure reduction compared to conventional shielding devices. Considering that conventional shielding requires staff to wear lead aprons, an effective dose equivalent correction factor was applied for exposure measurements without the SCCLSD. Even after the correction factor, the SCCLSD continued outperforming lead aprons and offered whole-body protection, including the head and arms, which is typically neglected with conventional shielding. The SCCLSD also reduces exposure to the eyes, aligning with lower occupational exposure recommendations from ICRP and NCRP. However, proper CCL staff positioning is important in maximizing the effectiveness of the SCCLSD. Future research avenues may explore exposure rates at different C-arm angles to more completely assess the SCCLSD's impact on occupational exposure.
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Affiliation(s)
- Lancer Smith
- University of Alabama at Birmingham, 1720 University Blvd., Birmingham, AL 35294
| | - Emily Caffrey
- University of Alabama at Birmingham, 806 Wells Ave SE, Huntsville, AL 35801
| | - Charles Wilson
- University of Alabama at Birmingham School of Health Professions, 447 School of Health Professions Building, Birmingham, Alabama 35124
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Hwang J, Kim B, Jin C, Lee G, Jeong H, Lee H, Noh J, Lim SJ, Kim JY, Choi H. Shortwave Infrared Imaging of a Quantum Dot-Based Magnetic Guidewire Toward Non-Fluoroscopic Peripheral Vascular Interventions. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2025; 21:e2404251. [PMID: 39175372 DOI: 10.1002/smll.202404251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/14/2024] [Indexed: 08/24/2024]
Abstract
Peripheral vascular interventions (PVIs) offer several benefits to patients with lower extremity arterial diseases, including reduced pain, simpler anesthesia, and shorter recovery time, compared to open surgery. However, to monitor the endovascular tools inside the body, PVIs are conducted under X-ray fluoroscopy, which poses serious long-term health risks to physicians and patients. Shortwave infrared (SWIR) imaging of quantum dots (QDs) has shown great potential in bioimaging due to the non-ionizing penetration of SWIR light through tissues. In this paper, a QD-based magnetic guidewire and its system is introduced that allows X-ray-free detection under SWIR imaging and precise steering via magnetic manipulation. The QD magnetic guidewire contains a flexible silicone tube encapsulating a QD polydimethylsiloxane (PDMS) composite, where HgCdSe/HgS/CdS/CdZnS/ZnS/SiO2 core/multi-shell QDs are dispersed in the PDMS matrix for SWIR imaging upon near-infrared excitation, as well as a permanent magnet for magnetic steering. The SWIR penetration of the QD magnetic guidewire is investigated within an artificial tissue model (1% Intralipid) and explore the potential for non-fluoroscopic PVIs within a vascular phantom model. The QD magnetic guidewire is biocompatible in its entirety, with excellent resistance to photobleaching and chemical alteration, which is a promising sign for its future clinical implementation.
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Affiliation(s)
- Junsun Hwang
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, 42988, Republic of Korea
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Robotics and Mechatronics Engineering Research Center, DGIST, Daegu, 42988, Republic of Korea
- Institute of Mechanical Engineering, École polytechnique fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland
| | - Beomjoo Kim
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, 42988, Republic of Korea
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
| | - Chaewon Jin
- Division of Biotechnology, DGIST, Daegu, 42988, Republic of Korea
| | - Gyudong Lee
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Nanotechnology, DGIST, Daegu, 42988, Republic of Korea
| | - Hwajun Jeong
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Nanotechnology, DGIST, Daegu, 42988, Republic of Korea
| | - Hyunki Lee
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Intelligent Robotics, DGIST, Daegu, 42988, Republic of Korea
| | - Jonggu Noh
- Division of Intelligent Robotics, DGIST, Daegu, 42988, Republic of Korea
| | - Sung Jun Lim
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Nanotechnology, DGIST, Daegu, 42988, Republic of Korea
| | - Jin-Young Kim
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Biotechnology, DGIST, Daegu, 42988, Republic of Korea
- Department of Interdisciplinary Engineering, DGIST, Daegu, 42988, Republic of Korea
| | - Hongsoo Choi
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, 42988, Republic of Korea
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Robotics and Mechatronics Engineering Research Center, DGIST, Daegu, 42988, Republic of Korea
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Amin M, Abdrakhmanov A, Kropotkin E, Traykov V, Salló Z, Gellér L, Lorgat F, Sapelnikov O, Toman O, Al-Muti K, Aljaabari M, Bystriansky A, Környei L, Mujović N, Simons S, Szegedi N. Ablation of Supraventricular Arrhythmias With as Low as Reasonably Achievable X-Ray exposure (AALARA): Results of Prospective, Observational, Multicenter, Multinational, Open-Label Registry Study on Real World Data Using Routine Ensite 3D Mapping During SVT Ablation. Pacing Clin Electrophysiol 2024; 47:1441-1448. [PMID: 39331462 DOI: 10.1111/pace.15075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/15/2024] [Accepted: 09/04/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming the standard of care in many parts of the world. While observational studies in the United States and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real-world data for this technique and the generalizability of outcomes in other economic regions. METHOD The AALARA study is a prospective, observational, multicenter, and multinational open-label study. Patients were recruited from 13 countries across Central Eastern Europe, North and South Africa, the Middle East, and the CIS (Commonwealth of Independent States), with different levels of operator expertise using minimal fluoroscopic exposure techniques. Data on radiation exposure, procedural success, complications, recurrence, and quality of life changes were collected and analyzed. RESULT A total of 680 patients were enrolled and followed for 6 months. The majority were ablation naïve with the commonest arrhythmia ablated being typical AVNRT (58%) followed by Atrial Flutter (23%). Zero fluoroscopy exposure was observed in almost 90% of the cases. Fluoroscopy was most commonly used during the ablation phase of the procedure. We observed a high acute success rate (99%), a low complication rate (0.4%), and a 6-month recurrence rate of 3.8%. There was a significant improvement in the patient's symptoms and quality of life as measured by patient global assessment. CONCLUSION The routine use of a 3D mapping system during right-sided ablation was associated with low radiation exposure and associated with high acute success rate, low complications, and recurrence rate along with significant improvement in quality of life. The data confirm the reproducibility of this approach in real-world settings across different healthcare systems, and operator experience supporting this approach to minimize radiation exposure without compromising efficacy and safety. TRIAL REGISTRATION NCT04716270.
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Affiliation(s)
- Mohammad Amin
- Department of Cardiac Electrophysiology, Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | - Ayan Abdrakhmanov
- Department of Cardiology, National Research Cardiac Surgery Center, NPJSC, Nur-Sultan, Kazakhstan
| | - Evgeniy Kropotkin
- Department of Cardiology, Federal Center for Cardiovascular Surgery, Krasnoyarsk Region, Russian Federation
| | - Vasil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Zoltán Salló
- Department of Cardiology, Semmelweis University Heart and Vascular Centre, Budapest, Hungary
| | - László Gellér
- Department of Cardiology, Semmelweis University Heart and Vascular Centre, Budapest, Hungary
| | - Faizel Lorgat
- Department of Cardiology, Christian Barnard Memorial Hospital, Cape Town, South Africa
| | - Oleg Sapelnikov
- Department of Cardiology, Institute of Clinical Cardiology, Moscow, Russian Federation
| | - Ondrej Toman
- Department of Cardiology, University Hospital Brno, Brno-Bohunice, Czech Republic
| | - Khalid Al-Muti
- Department of Cardiology, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Mohamed Aljaabari
- Department of Cardiology, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Adrian Bystriansky
- Department of Cardiology, Central Slovak Institute of Heart and Vascular Diseases, Banská Bystrica, Slovakia
| | - László Környei
- Department of Cardiology, Gottsegen György National Cardiovascular Institute, Budapest, Hungary
| | - Nebojša Mujović
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Nándor Szegedi
- Department of Cardiology, Semmelweis University Heart and Vascular Centre, Budapest, Hungary
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Fardid R, Farah F, Parsaei H, Rezaei H, Jorat MV. Artificial Neural Network-based Model for Predicting Cardiologists' Over-apron Dose in CATHLABs. J Med Phys 2024; 49:623-630. [PMID: 39926153 PMCID: PMC11801080 DOI: 10.4103/jmp.jmp_99_24] [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: 06/12/2024] [Revised: 08/19/2024] [Accepted: 08/21/2024] [Indexed: 02/11/2025] Open
Abstract
Aim The radiation dose that cardiologists receive in the catheterization laboratory is influenced by various factors. Handling high-stress tasks in interventional cardiology departments may cause physicians to overlook the use of dosimeters. Therefore, it is essential to develop a model for predicting cardiologists' radiation exposure. Materials and Methods This study developed an artificial neural network (ANN) model to predict the over-apron radiation dose received by cardiologists during catheterization procedures, using dose area product (DAP) values. Leveraging a validated Monte Carlo simulation program, we generated data from simulations with varying spectra (70, 81, and 90 kVp) and tube orientations, resulting in 125 unique scenarios. We then used these data to train a multilayer perceptron neural network with four input features: DAP, energy spectrum, tube angulation, and the resulting cardiologist's dose. Results The model demonstrated high predictive accuracy with a correlation coefficient (R-value) of 0.95 and a root mean square error (RMSE) of 3.68 µSv, outperforming a traditional linear regression model, which had an R-value of 0.48 and an RMSE of 18.15 µSv. This significant improvement highlights the effectiveness of advanced techniques such as ANNs in accurately predicting occupational radiation doses. Conclusion This study underscores the potential of ANN models for accurate radiation dose prediction, enhancing safety protocols, and providing a reliable tool for real-time exposure assessment in clinical settings. Future research should focus on broader validation and integration into real-time monitoring systems.
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Affiliation(s)
- Reza Fardid
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Ionizing and Nonionizing Radiation Protection Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Farah
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Parsaei
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Rezaei
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Vahid Jorat
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Alvandi M, Javid RN, Shaghaghi Z, Farzipour S, Nosrati S. An In-depth Analysis of the Adverse Effects of Ionizing Radiation Exposure
on Cardiac Catheterization Staffs. Curr Radiopharm 2024; 17:219-228. [DOI: https:/doi.org/10.2174/0118744710283181231229112417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 05/16/2025]
Abstract
Abstract:
Diagnostic and interventional angiograms are instrumental in the multidisciplinary
approach to CAD management, enabling accurate diagnosis and effective targeted treatments
that significantly enhance patient care and cardiovascular outcomes. However, cath lab staff,
including interventional cardiologists, is consistently exposed to ionizing radiation, which poses
inherent health risks. Radiation exposure in the cath lab primarily results from the use of fluoroscopy
and cineangiography during diagnostic and interventional procedures. Understanding
these risks and implementing effective radiation protection measurements are imperative to ensure
the well-being of healthcare professionals while delivering high-quality cardiac care. Prolonged
and repeated exposure can lead to both deterministic and stochastic effects. Deterministic
effects, such as skin erythema and tissue damage, are more likely to occur at high radiation
doses. Interventional cardiologists and staff may experience these effects when safety measures
are not rigorously followed. In fact, while ionizing radiation is essential in the practice of radiation
cardiology ward, cath lab staff faces inherent risks from radiation exposure. Stochastic effects,
on the other hand, are characterized by a probabilistic relationship between radiation exposure
and the likelihood of harm. These effects include the increased risk of cancer, particularly
for those with long-term exposure. Interventional cardiologists, due to their frequent presence
in the cath lab, face a higher lifetime cumulative radiation dose, potentially elevating their cancer
risk. Protective measures, including the use of lead aprons, thyroid shields, and radiation
monitoring devices, play a crucial role in reducing radiation exposure for cath lab personnel.
Adherence to strict dose optimization protocols, such as minimizing fluoroscopy time and maximizing
distance from the radiation source, is also essential in mitigating these risks. Ongoing
research and advancements in radiation safety technology are essential in further for minimizing
the adverse effects of ionizing radiation in the cath lab.
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Affiliation(s)
- Maryam Alvandi
- Cardiovascular Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Zahra Shaghaghi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Soghra Farzipour
- Department of Cardiology, Cardiovascular Diseases Research
Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Sahar Nosrati
- Institute of Nuclear Chemistry and Technology, Dorodna 16 Str, 03-195, Warsaw, Poland
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Hassan WB, Osman H, Alosaimi M, AbuRkbah A, AlQurashi A, Elkhader BA, Alzahrani A, Alshehri M, Faizo NL, Khandaker MU. Ensuring radiation safety: Evaluating dose and compliance among medical staff at King Faisal Medical Complex, Saudi Arabia. Appl Radiat Isot 2024; 211:111386. [PMID: 38870555 DOI: 10.1016/j.apradiso.2024.111386] [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: 02/08/2024] [Revised: 04/30/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Radiation is an integral part of routine medical practice, but it carries a risk to the health of medical staff. Hence, it should be assessed periodically. The study's goal was to quantify the levels of radiation exposure for medical staff at King Faisal Medical Complex (KFMC), Taif City Saudi Arabia, and to assess their radiation protective procedures in practice. METHODS The study looked at the thermoluminescence dosimeters (TLDs) records of 50 medical professionals who were exposed to radiation while working at KFMC from 2019 to 2020 in Taif city, Saudi Arabia. In Riyadh, radiation exposure is read from skin TLDs using Harshaw model 6600 plus detectors. The Excel software was utilized to process the obtained data for calculating effective doses. A questionnaire was also distributed to the medical staff to assess their radiation protection procedures. The Statistical Package for Social Sciences (SPSS) program version 23 was used to analyze the obtained data. RESULTS The mean annual effective doses of the medical staff in 2019 and 2020 were determined to be 1.14 mSv and 1.4645 mSv, respectively, with no significant difference in effective doses between males and females in either year. The socio-demographic features of the medical personnel were examined, and the findings revealed that the majority of participants were male radiological technologists. The rate of adherence to radiation protection techniques was 68%, with a normally distributed dispersal. The amount of adherence varied significantly depending on nationality, occupation, and academic qualification. CONCLUSION According to the research, the mean annual effective dosage for medical professionals at KFMC was significantly below the recommended level, indicating satisfactory compliance with the ALARA radiation safety concept.
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Affiliation(s)
- W B Hassan
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia.
| | - Hamid Osman
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Meshari Alosaimi
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Ahmed AbuRkbah
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Ahmed AlQurashi
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Bahaaedin A Elkhader
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Ahmad Alzahrani
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Mohammed Alshehri
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Nahla L Faizo
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Mayeen Uddin Khandaker
- Applied Physics and Radiation Technologies Group, CCDCU, School of Engineering and Technology, Sunway University, Bandar Sunway, 47500, Selangor, Malaysia; Faculty of Graduate Studies, Daffodil International University, Daffodil Smart City, Birulia, Savar, Dhaka, 1216, Bangladesh
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Hizukuri K, Fujibuchi T, Arakawa H. Directional vector visualization of scattered rays in mobile c-arm fluoroscopy. Radiol Phys Technol 2024; 17:288-296. [PMID: 38316688 DOI: 10.1007/s12194-024-00779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
Previous radiation protection-measure studies for medical staff who perform X-ray fluoroscopy have employed simulations to investigate the use of protective plates and their shielding effectiveness. Incorporating directional information enables users to gain a clearer understanding of how to position protective plates effectively. Therefore, in this study, we propose the visualization of the directional vectors of scattered rays. X-ray fluoroscopy was performed; the particle and heavy-ion transport code system was used in Monte Carlo simulations to reproduce the behavior of scattered rays in an X-ray room by reproducing a C-arm X-ray fluoroscopy system. Using the calculated results of the scattered-ray behavior, the vectors of photons scattered from the phantom were visualized in three dimensions. A model of the physician was placed on the directional vectors and dose distribution maps to confirm the direction of the scattered rays toward the physician when the protective plate was in place. Simulation accuracy was confirmed by measuring the ambient dose equivalent and comparing the measured and calculated values (agreed within 10%). The directional vectors of the scattered rays radiated outward from the phantom, confirming a large amount of backscatter radiation. The use of a protective plate between the patient and the physician's head part increased the shielding effect, thereby enhancing radiation protection for the physicians compared to cases without the protective plate. The use of directional vectors and the surrounding dose-equivalent distribution of this method can elucidate the appropriate use of radiation protection plates.
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Affiliation(s)
- Kyoko Hizukuri
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Toshioh Fujibuchi
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Arakawa
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Ghallab M, Abdelhamid M, Nassar M, Mostafa KS, Salama DH, Elnaggar W, Alramlawy S, Alagha Z, Abdelmoteleb S, Hashad A. Assessing and improving radiation safety in cardiac catheterization: a study from Cairo University Hospital. Egypt Heart J 2024; 76:17. [PMID: 38334916 PMCID: PMC10858008 DOI: 10.1186/s43044-024-00449-7] [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: 07/26/2023] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Catheter laboratories are high-radiation exposure environments, especially during X-ray procedures like percutaneous transluminal coronary angioplasty and electrophysiological studies. Radiation exposure poses risks of stochastic (e.g., cancer) and deterministic (e.g., skin changes) effects. This study assessed radiation safety and health practices in a cardiac catheterization unit to optimize radiation safety. A cross-sectional study in Cairo University Hospital (March-September 2019) evaluated 700 patients and healthcare workers. Real-time radiation measurements, educational lectures, and radiation protection measures were implemented in three phases. Data on radiation exposure, procedures, and compliance were collected and analyzed. RESULTS The total procedure time and fluoroscopy time per cardiologist did not significantly differ between phases, but there was a statistically significant reduction in the mean total cumulative radiation doses between Phase I and Phase III for cardiologists (P = 0.013). Among nurses and technicians, there was no significant difference in radiation doses between the two phases. Significant correlations were found between operators' radiation doses, procedure time, and fluoroscopy time. Patients' radiation doses decreased significantly from Phase I to Phase III, with correlations between dose, procedure time, and gender. Compliance with radiation protection measures was suboptimal. CONCLUSIONS Compliance with radiation safety standards in the cardiac catheterization unit at the Cairo University Hospital needs improvement. The study highlights the importance of adhering to radiation safety principles and optimizing protective measures to reduce radiation exposure for both patients and healthcare personnel. Despite low compliance, significant reductions in radiation doses were achieved with increased awareness and adherence to specific protection measures. Future efforts should focus on enhancing radiation safety protocols and organ-specific radiation impact assessments.
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Affiliation(s)
- Muhammad Ghallab
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt.
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Nassar
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, New York, USA
| | - Karim S Mostafa
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Dina H Salama
- Radiology and Medical Imaging Technology Department, Misr University for Science and Technology, Cairo, Egypt
| | - Wael Elnaggar
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Shaban Alramlawy
- Department of Critical Care Medicine, Cairo University, Cairo, Egypt
| | | | | | - Assem Hashad
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
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10
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Alvandi M, Javid RN, Shaghaghi Z, Farzipour S, Nosrati S. An In-depth Analysis of the Adverse Effects of Ionizing Radiation Exposure on Cardiac Catheterization Staffs. Curr Radiopharm 2024; 17:219-228. [PMID: 38314600 DOI: 10.2174/0118744710283181231229112417] [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: 09/19/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
Diagnostic and interventional angiograms are instrumental in the multidisciplinary approach to CAD management, enabling accurate diagnosis and effective targeted treatments that significantly enhance patient care and cardiovascular outcomes. However, cath lab staff, including interventional cardiologists, is consistently exposed to ionizing radiation, which poses inherent health risks. Radiation exposure in the cath lab primarily results from the use of fluoroscopy and cineangiography during diagnostic and interventional procedures. Understanding these risks and implementing effective radiation protection measurements are imperative to ensure the well-being of healthcare professionals while delivering high-quality cardiac care. Prolonged and repeated exposure can lead to both deterministic and stochastic effects. Deterministic effects, such as skin erythema and tissue damage, are more likely to occur at high radiation doses. Interventional cardiologists and staff may experience these effects when safety measures are not rigorously followed. In fact, while ionizing radiation is essential in the practice of radiation cardiology ward, cath lab staff faces inherent risks from radiation exposure. Stochastic effects, on the other hand, are characterized by a probabilistic relationship between radiation exposure and the likelihood of harm. These effects include the increased risk of cancer, particularly for those with long-term exposure. Interventional cardiologists, due to their frequent presence in the cath lab, face a higher lifetime cumulative radiation dose, potentially elevating their cancer risk. Protective measures, including the use of lead aprons, thyroid shields, and radiation monitoring devices, play a crucial role in reducing radiation exposure for cath lab personnel. Adherence to strict dose optimization protocols, such as minimizing fluoroscopy time and maximizing distance from the radiation source, is also essential in mitigating these risks. Ongoing research and advancements in radiation safety technology are essential in further for minimizing the adverse effects of ionizing radiation in the cath lab.
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Affiliation(s)
- Maryam Alvandi
- Cardiovascular Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Zahra Shaghaghi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Soghra Farzipour
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Sahar Nosrati
- Institute of Nuclear Chemistry and Technology, Dorodna 16 Str, 03-195, Warsaw, Poland
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Szegedi N, Kroptkin E, Traykoc V, Abdrakhmanov A, Lorgat F, Sapelnikov O, Simons S, Amin M. Routine use of a 3D mapping system in the ablation of supraventricular arrhythmias with as low as reasonably achievable X-ray exposure (AALARA): protocol for a prospective, observational, multicentre, multinational, open-label registry study. BMJ Open 2023; 13:e072181. [PMID: 37541748 PMCID: PMC10407390 DOI: 10.1136/bmjopen-2023-072181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming standard of care in many parts of the world. While observational studies in the USA and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real-world data for this technique and generalisability of outcome in other economic regions. METHODS AND ANALYSIS The arrhythmias with as low as reasonably achievable X-ray exposure study is a prospective, observational, multicentre and multinational open-label registry study. Up to 700 patients undergoing catheter ablation for right-sided supraventricular arrhythmias (according to national guidelines) will be enrolled for the routine use of the EnSite Precision 3D mapping system. Participating sites are distributed in 13 countries from Central Eastern Europe, North and South Africa, the Middle East and the CIS (Commonwealth of Independent States), with different levels of expertise using minimal fluoroscopic exposure techniques. After electrophysiological procedure, patients will be followed up for 6 months either in-clinic or via telephone interview. Patients will be asked to complete a study questionnaire at enrolment and 6 months after the invasive procedure to assess quality of life changes secondary to the procedure. The study's primary objective is to describe ionising radiation exposure during catheter ablation when the EnSite Precision 3D mapping system is used in supraventricular tachycardia ablation. The study's secondary objective is to assess the safety and efficacy of this method. Furthermore, fluoroscopy timing, total procedure time, success rate and complications will be reported. ETHICS AND DISSEMINATION The study was approved by the ethics committee at Mohammed Bin Khalifa Specialist Cardiac Centre (BDF/R&REC/2020-504) and the medical ethics committees of all participating sites. Participants will be required to provide informed consent before enrolment in the study. The study results will be published and presented at conferences. TRIAL REGISTRATION NUMBER NCT04716270.
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Affiliation(s)
- Nandor Szegedi
- Semmelweis University Heart and Vascular Centre, Budapest, Hungary
| | - Evgeniy Kroptkin
- Federal Center for Cardiovascular Surgery, Krasnoyarsk region, Russian Federation
| | - Vassil Traykoc
- Federal Center for Cardiovascular Surgery, Krasnoyarsk region, Russian Federation
| | | | - Faizel Lorgat
- Christian Barnard Memorial Hospital, Cape Town, South Africa
| | - Oleg Sapelnikov
- Institute of Clinical Cardiology, Moscow, Russian Federation
| | | | - Mohammad Amin
- Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
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12
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Weyland CS, Jesser J, Bourgart I, Hilgenfeld T, Breckwoldt MO, Vollherbst D, Schmitt N, Seker F, Bendszus M, Möhlenbruch MA. Occupational radiation exposure of neurointerventionalists during endovascular stroke treatment. Eur J Radiol 2023; 164:110882. [PMID: 37201247 DOI: 10.1016/j.ejrad.2023.110882] [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: 02/13/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Radiological neuro-interventions, especially endovascular stroke treatment (EST), are increasing in case numbers worldwide with increasing occupational radiation exposure. Aim of this study was to define the radiation exposure of neurointerventionalists (NI) during EST and to compare the accumulated dose reaching the left arm with the left temple. METHODS This is a prospective observational study in a tertiary stroke center conducted between 11/2021 and 07/2022. Radiation exposure was measured using real time dosimetry with dosimeters being carried by the NI during EST simultaneously at the left temple and left arm. The effective dose [µSV] per dose area product (DAP) and potential influencing factors were compared in univariate analysis between the two dosimeter positions. RESULTS In total, 82 ESTs were analyzed with a median DAP of 6179 µGy*m2 (IQR 3271 µGy*m2-11720 µGy*m2). The accumulated dose at the left arm and left temple correlated with the DAP and fluoroscopy time of the EST (DAP and arm: p = 0.01, DAP and temple: p = 0.006). The radiation exposure (RE) showed a wide range and did not differ between the two dosimeter positions (median, IQR arm 7 µSV, IQR 3.1-16.9 µSV, min. 0.3 µSV max. 64.5 µSV) vs. head 7 µSv, IQR 3.2-17.4 µSV, min. 0.38 µSV, max. 48.6 µSV, p = 0.94). Occupational RE depends on the number of thrombectomy attempts, but not the target vessel occlusion location or the NI's body height. CONCLUSION Neurointerventionalists experience a generally low but very variable radiation exposure during EST, which depends on the intervention's fluoroscopy time and dose area product as well as thrombectomy attempts but does not differ between left temple and left arm.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Neuroradiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52076 Aachen, Germany.
| | - Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Isabella Bourgart
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Michael O Breckwoldt
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Dominik Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Niclas Schmitt
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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Lee S, Kim N, Kwon J, Jang G. Identification of the Position of a Tethered Delivery Catheter to Retrieve an Untethered Magnetic Robot in a Vascular Environment. MICROMACHINES 2023; 14:724. [PMID: 37420957 DOI: 10.3390/mi14040724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 07/09/2023]
Abstract
In this paper, we propose a method of identifying the position of a tethered delivery catheter in a vascular environment, recombining an untethered magnetic robot (UMR) to the tethered delivery catheter, and safely retrieving them from the vascular environment in an endovascular intervention by utilizing a separable and recombinable magnetic robot (SRMR) and a magnetic navigation system (MNS). From images of a blood vessel and a tethered delivery catheter taken from two different angles, we developed a method of extracting the position of the delivery catheter in the blood vessel by introducing dimensionless cross-sectional coordinates. Then, we propose a retrieval method for the UMR by using the magnetic force considering the delivery catheter's position, suction force, and rotating magnetic field. We used thane MNS and feeding robot to simultaneously apply magnetic force and suction force to the UMR. In this process, we determined a current solution for generating magnetic force by using a linear optimization method. Finally, we conducted in vitro and in vivo experiments to verify the proposed method. In the in vitro experiment, which was in a glass tube environment, by using an RGB camera, we confirmed that the location of the delivery catheter in the glass tube could be recognized within an average error of 0.05 mm in each of the X- and Z-coordinates and that the retrieval success rate was greatly improved in comparison with that in the case without the use of magnetic force. In an in vivo experiment, we successfully retrieved the UMR in the femoral arteries of pigs.
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Affiliation(s)
- Serim Lee
- Department of Mechanical Convergence Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Nahyun Kim
- Department of Mechanical Convergence Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Junhyoung Kwon
- Department of Mechanical Convergence Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Gunhee Jang
- Department of Mechanical Convergence Engineering, Hanyang University, Seoul 04763, Republic of Korea
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14
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Saada M, Sanchez-Jimenez E, Roguin A. Risk of ionizing radiation in pregnancy: just a myth or a real concern? Europace 2023; 25:270-276. [PMID: 36125209 PMCID: PMC10103573 DOI: 10.1093/europace/euac158] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
There are natural concerns regarding the risks posed to the foetus by ionizing radiation exposure during pregnancy. Therefore, many female physicians select to avoid working in an environment associated with ionizing radiation exposure like the catheterization laboratory and even exclude training as electrophysiology, interventional cardiologists, or radiologists. For those already working in this field, pregnancy involves usually a 1-year interruption (pregnancy and maternity leave) to their careers, leading at times to delays in the decision to become pregnant. This review describes the low added risk of malformation/cancer in the offspring, highlight gaps in our understanding, discuss several common wrong beliefs, and recommend how to further decrease radiation dose, especially during pregnancy.
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Affiliation(s)
- Majdi Saada
- Cardiology Department, Hillel Yaffe Medical Center, Technion – Israel Institue of Technology, Ha-Shalom St, Hadera 3810101, Israel
| | - Erick Sanchez-Jimenez
- Cardiology Department, Hillel Yaffe Medical Center, Technion – Israel Institue of Technology, Ha-Shalom St, Hadera 3810101, Israel
| | - Ariel Roguin
- Cardiology Department, Hillel Yaffe Medical Center, Technion – Israel Institue of Technology, Ha-Shalom St, Hadera 3810101, Israel
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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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Tian Y, Zhao X, Yang Y, Cai X, Jian L, Guo S, Xia D, Chen X, Li C, Guo Q, Chen B, Lu C. Enhanced stent visualization system for percutaneous coronary intervention in patients with chronic kidney disease: effects on contrast media volume and radiation exposure. BMC Cardiovasc Disord 2022; 22:487. [DOI: 10.1186/s12872-022-02930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Objective
We aimed to assess the impact of using enhanced stent visualization (ESV) systems on contrast media volume and radiation dose in percutaneous coronary intervention (PCI), especially for patients with chronic kidney disease (CKD).
Background
Coronary heart disease (CHD) is associated with chronic kidney disease (CKD), as they share a similar pathological pathway. In addition, the iodinated contrast media used for angiography is a risk factor for contrast-associated acute kidney injury (CA-AKI), which could aggravate the progression of CKD. We hypothesized that ESV systems have the potential to reduce the use of contrast media as well as the radiation dose; however, few studies have reported the impact on contrast media with the use of ESV systems.
Methods
We retrospectively collected 124 patients with acute coronary syndrome who underwent PCI from May 2020 to July 2021. The patients were divided into the ESV-guided group (n = 64) and angiography-guided group (n = 60). Procedural parameters, including contrast media volume, radiation exposure (in Air Kerma-AK and Dose Area Product-DAP), number of cines, cine frames, fluoroscopy and procedure time, were recorded and analysed.
Results
The groups were comparable regarding the patient characteristics. There was a significant reduction in contrast media volume (174.7 ± 29.6 ml vs.132.6 ± 22.3 ml, p = 0.0001), radiation exposure (776 (499 - 1200) mGy vs. 1065 (791 - 1603) mGy, p = 0.002 in AK; 43 (37 - 73) Gycm2 vs. 80 (64 - 133) Gycm2, p = 0.030 in DAP) and procedure time (53.06 ± 21.20 min vs. 72.00 ± 30.55 min, p = 0.01) with the use of ESV systems. Similar results were observed in the subgroup analysis for the patients with CKD.
Conclusion
This study suggested that the use of ESV is associated with reduced contrast media usage, radiation dose and procedure time during PCI. The same results were observed in a subgroup analysis in patients with CKD, and this shows that ESV-guided PCI has the potential to reduce renal impairment and mitigate the progression of CKD for those CHD patients with CKD.
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Loyaga-Rendon RY, Lee S, Dickinson MG, Grayburn R, Gonzalez M, Jani M, Fermin D, Vanoosterhout S, Parker JL, McNamara DA, Madder RD. Physician Radiation Exposure During Endomyocardial Biopsy and Right Heart Catheterization. J Card Fail 2022; 29:473-478. [PMID: 36195201 DOI: 10.1016/j.cardfail.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiologists performing coronary angiography (CA) and percutaneous coronary intervention (PCI) are at risk of health problems related to chronic occupational radiation exposure. Unlike during CA and PCI, physician radiation exposure during right heart catheterization (RHC) and endomyocardial biopsy (EMB) has not been adequately studied. The objective of this study was to assess physicians' radiation doses during RHC with and without EMB and compare them to those of CA and PCI. METHODS Procedural head-level physician radiation doses were collected by real-time dosimeters. Radiation-dose metrics (fluoroscopy time, air kerma [AK] and dose area product [DAP]), and physician-level radiation doses were compared among RHC, RHC with EMB, CA, and PCI. RESULTS Included in the study were 351 cardiac catheterization procedures. Of these, 36 (10.3%) were RHC, 42 (12%) RHC with EMB, 156 (44.4%) CA, and 117 (33.3%) PCI. RHC with EMB and CA had similar fluoroscopy time. AK and DAP were progressively higher for RHC, RHC with EMB, CA, and PCI. Head-level physician radiation doses were similar for RHC with EMB vs CA (P = 0.07). When physicians' radiation doses were normalized to DAP, RHC and RHC with EMB had the highest doses. CONCLUSION Physicians' head-level radiation doses during RHC with EMB were similar to those of CA. After normalizing to DAP, RHC and RHC with EMB were associated with significantly higher physician radiation doses than CA or PCI. These observations suggest that additional protective measures should be undertaken to decrease physicians' radiation exposure during RHC and, in particular, RHC with EMB.
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Affiliation(s)
- Renzo Y Loyaga-Rendon
- Advanced Heart Failure Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health.
| | - Sangjin Lee
- Advanced Heart Failure Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health
| | - Michael G Dickinson
- Advanced Heart Failure Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health
| | - Ryan Grayburn
- Advanced Heart Failure Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health
| | - Matthew Gonzalez
- Advanced Heart Failure Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health
| | - Milena Jani
- Advanced Heart Failure Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health
| | - David Fermin
- Advanced Heart Failure Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health
| | | | | | - David A McNamara
- Advanced Cardiac Imaging Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health
| | - Ryan D Madder
- Interventional Cardiology Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan
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18
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Rose A, Rae WI, Sweetlove MA, Ngetu L, Benadjaoud MA, Marais W. Radiation induced cataracts in interventionalists occupationally exposed to ionising radiation. SA J Radiol 2022; 26:2495. [PMID: 36262829 PMCID: PMC9575381 DOI: 10.4102/sajr.v26i1.2495] [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: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Occupational exposure to ionising radiation may have detrimental health effects. Longer and more complex fluoroscopic procedures have placed interventionalists at increased occupational health risks especially for developing cataracts in the radiosensitive lenses of the eyes. OBJECTIVES This study aimed to determine the prevalence of occupational related cataracts and describe the risk factors for cataracts in occupationally exposed interventionalists compared with unexposed doctors. METHOD A cross-sectional study using multiple methods. A survey was conducted. The radiation workload was determined based on a self-administered questionnaire and dose area product values determined in previous studies. Both groups had slit lamp examinations. The data were analysed analytically using R software version 9.3. RESULTS The study included 98 interventionalists. The combined prevalence of posterior sub-capsular (PSC) and cortical cataracts was 18.8% in the exposed and 13.9% in the unexposed group. The prevalence of PSC cataracts in the exposed group was 5.9% and 2.8% in the unexposed group, with an odds ratio (OR) of 2.2 (95% confidence interval [CI]: 0.58; 8.61). Posterior sub-capsular cataracts were more common in the left eye. The increase in cataracts was not statistically significant in the exposed group but is of clinical significance. CONCLUSION The findings are important as they highlight the need for greater vigilance for protecting the radiation healthcare workforce in a developing country setting. CONTRIBUTION The research is the first of its kind in South Africa and Africa and contributes to determining the prevalence in this highly skilled and occupationally vulnerable group.
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Affiliation(s)
- André Rose
- Center for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - William I.D. Rae
- Prince of Wales Hospital, Faculty of Medical Imaging, University of Sydney, Sydney, Australia
| | - Margaret A. Sweetlove
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Lumko Ngetu
- Department of Ophthalmology, Faculty of Health, University of the Free State, Bloemfontein, South Africa
| | - Mohamed A. Benadjaoud
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France,Department of Radiobiology and Regenerative Medicine (SERAMED), Fontenay-aux-Roses, France
| | - Wayne Marais
- Department of Ophthalmology, Faculty of Health, University of the Free State, Bloemfontein, South Africa
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Kupczyk PA, Attenberger UI, Meyer C, Luetkens JA, Kuetting D. Pilot Animal Study on Robotic-Assisted Endovascular Visceral Interventions. Cardiovasc Intervent Radiol 2022; 45:1207-1213. [PMID: 35764819 PMCID: PMC9307548 DOI: 10.1007/s00270-022-03204-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
Purpose To evaluate technical feasibility and safety of common endovascular visceral interventions using a vascular robotic platform through preclinical study. Material and Methods The CorPath GRX Robotic System (Corindus Inc, Waltham, Massachusetts) was tested in an anesthetized pig for its ability to navigate various commercially available devices in the abdominal vasculature and to perform routine endovascular visceral procedures. After manually placing a guiding catheter in the celiac trunk, several visceral branches were probed with microcatheters and -wires under robotic assistance, and embolization with liquids (lipiodol), detachable coils and plugs were performed. Furthermore, the origin of the celiac trunk was stented before accessing the left hypogastric artery for pelvic embolization. Results All procedures were performed with technical success and without any complications. Navigating the catheters and wires via the steering console proved intuitive. Coil, plug and stent deployment were exclusively controlled by remote with remarkable precision and stability. Conclusion Robotic-assisted visceral embolization and stenting as well as pelvic embolization using the CorPath GRX System is feasible and safe. Application of the platform in the abdominal vasculature is demonstrated for the first time. Considering the precision and the potential for reducing the operator’s radiation exposure, further research in this area is highly encouraged to enable translation into clinical practice.
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Affiliation(s)
- Patrick A Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carsten Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Morcillo AB, Huerga C, Bayón J, López A, Corredoira E, Hernández T, Novo JR, Ponce MD, Fernández L, Rodríguez R, Garzón G, Vañó E, Guibelalde E, Alejo L. ASSESSMENT OF OCCUPATIONAL EXPOSURE IN THE MAIN PAEDIATRIC INTERVENTIONAL RADIOLOGY PROCEDURES. RADIATION PROTECTION DOSIMETRY 2022; 198:386-392. [PMID: 35512690 DOI: 10.1093/rpd/ncac064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/07/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
The aim of this study is to evaluate the personal dose equivalent Hp(10) in the most frequent (non-cardiac) paediatric interventional radiology (PIR) procedures: central venous catheters (CVC), hepatic/biliary and sclerotherapy interventions. i2 active solid-state dosemeters placed over the lead apron were used to monitor the exposure of three interventional radiologists over 18 months. A database was created to register all procedures performed by each radiologist (including the type of procedure and the kerma-area product, PKA). The mean Hp(10) per procedure for CVC, sclerotherapy and hepatic/biliary interventions was respectively 0.01 ± 0.01 mSv, 0.18 ± 0.13 mSv and 0.12 ± 0.06 mSv (k = 2). A similar value of Hp(10)/PKA was found despite the type of procedure or the patient weight (~10 μSv/Gy·cm2). There was high variability among individual interventions, probably due to the variable level of complexity, which led to uncertainties in the measurements' mean higher than those associated with the dosemeter's angular and energy dependence. i2 therefore proved suitable for monitoring Hp(10) in PIR procedures.
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Affiliation(s)
- Ana B Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Antonio López
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Joan R Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María D Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucía Fernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ricardo Rodríguez
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
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21
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Beaman C, Saber H, Tateshima S. A technical guide to robotic catheter angiography with the Corindus CorPath GRX system. J Neurointerv Surg 2022; 14:1284. [PMID: 35169034 DOI: 10.1136/neurintsurg-2021-018347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/31/2022] [Indexed: 11/03/2022]
Abstract
Robotic catheter angiography is an emerging technology with the opportunity to increase procedural precision and decrease occupational hazards.1-5 In this video, we present our initial experiences with the CorPath GRX Robotic System (Corindus, a Seimens Healthineers Company, Waltham, Massachusetts, USA), including various technical considerations such as set-up, operation, and recommended tools (video 1). We demonstrate that the robotic system can be used to reformat catheters and select cervical arteries without the need for manual conversion. Lastly, we discuss the commonly encountered robot-specific operational challenges, along with strategies to overcome them.neurintsurg;neurintsurg-2021-018347v1/V1F1V1Video 1.
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Affiliation(s)
- Charles Beaman
- Department of Neurology, Ronald Reagan UCLA Medical Center & David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hamidreza Saber
- Division of Interventional Neuroradiology, Department of Radiological Sciences, Ronald Reagan UCLA Medical Center & David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiological Sciences, Ronald Reagan UCLA Medical Center & David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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22
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Alnaaimi M, Alduaij M, Shenawy F, Algaily M, Mohammedzein T, Shaaban M, Rehani MM. Assessment of eye doses to staff involved in interventional cardiology procedures in Kuwait. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:639-645. [PMID: 34351496 PMCID: PMC8339394 DOI: 10.1007/s00411-021-00929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
In this study, which is the first of its kind in the gulf region, eye doses of interventional cardiologists and nurses were measured using active dosimeters for left and right eyes, in 60 percutaneous coronary interventions in three main hospitals in Kuwait. The dose given in terms of Hp(0.07) per procedure when ceiling suspended screens were used by main operators ranged from 18.5 to 30.3 µSv for the left eye and from 12.6 to 23.6 µSv for the right eye. Taking into account typical staff workload, the results show that the dose limit of 20 mSv/year to the eyes can be exceeded for interventional cardiologists in some situations, which demonstrates the need of using additional effective radiation protection tools, e.g. protective eye spectacles, in addition to the regular and proper use of ceiling suspended screens. With indications of increase in workload, the need for availability of a dedicated active dosimeter for the regular monitoring of eye doses is emphasized.
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Affiliation(s)
- Meshari Alnaaimi
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait.
| | - Mousa Alduaij
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Faisal Shenawy
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Musab Algaily
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Talal Mohammedzein
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Mohamed Shaaban
- Radiation Protection Department, Shuwaikh, Kuwait City, Kuwait
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23
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Nayak S, Nambi A, Kumar S, Hariprakash P, Yuvaraj P, Poojar B. A systematic review on the effect of low-dose radiation on hearing. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:551-558. [PMID: 34302524 PMCID: PMC8551139 DOI: 10.1007/s00411-021-00926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Numerous studies have documented the adverse effects of high-dose radiation on hearing in patients. On the other hand, radiographers are exposed to a low dose of ionizing radiation, and the effect of a low dose of radiation on hearing is quite abstruse. Therefore, the present systematic review aimed to elucidate the effect of low-dose ionizing radiation on hearing. Two authors independently carried out a comprehensive data search in three electronic databases, including PUBMED/MEDLINE, CINAHL, and SCOPUS. Eligible articles were independently assessed for quality by two authors. Cochrane Risk of Bias tool was used assess quality of the included studies. Two articles met the low-dose radiation exposure criteria given by Atomic Energy Regulatory Board (AERB) and National Council on Radiation Protection (NCRP) guidelines. Both studies observed the behavioral symptoms, pure-tone hearing sensitivity at the standard, extended high frequencies, and the middle ear functioning in low-dose radiation-exposed individuals and compared with age and gender-matched controls. One study assessed the cochlear function using transient-evoked otoacoustic emissions (TEOAE). Both studies reported that behavioral symptoms of auditory dysfunction and hearing thresholds at extended high frequencies were higher in radiation-exposed individuals than in the controls. The current systematic review concludes that the low-dose ionizing radiation may affect the hearing adversely. Nevertheless, further studies with robust research design are required to explicate the cause and effect relationship between the occupational low-dose ionizing radiation exposure and hearing.
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Affiliation(s)
- Srikanth Nayak
- Department of Audiology and Speech—Language Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, 575001 India
- Department of Audiology and Speech-Language Pathology, Yenepoya University (Deemed to be University), Mangalore, Karnataka 575018 India
| | - Arivudai Nambi
- Department of Audiology and Speech—Language Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, 575001 India
| | - Sathish Kumar
- Department of Audiology and Speech—Language Pathology, Madras ENT Research Foundation, Chennai, 600028 India
| | - P Hariprakash
- Department of Speech and Hearing, Manipal College of Health Professionals, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Pradeep Yuvaraj
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029 India
| | - Basavaraj Poojar
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, 575001 India
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24
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Abstract
Data suggest that radiation-induced cataracts may form without a threshold and at low-radiation doses. Staff involved in interventional radiology and cardiology fluoroscopy-guided procedures have the potential to be exposed to radiation levels that may lead to eye lens injury and the occurrence of opacifications have been reported. Estimates of lens dose for various fluoroscopy procedures and predicted annual dosages have been provided in numerous publications. Available tools for eye lens radiation protection include accessory shields, drapes and glasses. While some tools are valuable, others provide limited protection to the eye. Reducing patient radiation dose will also reduce occupational exposure. Significant variability in reported dose measurements indicate dose levels are highly dependent on individual actions and exposure reduction is possible. Further follow-up studies of staff lens opacification are recommended along with eye lens dose measurements under current clinical practice conditions.
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Affiliation(s)
| | - Kenneth A Fetterly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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25
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Mourtada F, Clement CH, Dauer LT, Baureus Koch C, Cosset JM, Doruff M, Damato A, Guedea F, Scalliet P, Thomadsen B, Pinillos-Ashton L, Small W. Occupational Radiological Protection in Brachytherapy. Ann ICRP 2021; 50:5-75. [PMID: 34503342 DOI: 10.1177/01466453211013514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Firas Mourtada
- Chief of Clinical Physics, ChristianaCare, Newark, Delaware.,President, American Brachytherapy Society
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26
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Roh Y, Kim J, Park H, Kim J, Ryu D, Chun K, Seo J, Lee B, Cho B, Yoon Y. Effect of Exposure Angulation on the Occupational Radiation Exposure during Cardiac Angiography: Simulation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8097. [PMID: 34360390 PMCID: PMC8345727 DOI: 10.3390/ijerph18158097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
Cardiac angiography to visualize the cardiac coronary artery for lesions causes a lot of radiation exposure dose to the interventional cardiologist. We evaluated the occupational radiation exposure to the interventional cardiologist based on changes to the angle of the X-ray tube used in cardiac angiography and calculated the conversion factor for effective dose in this study. To evaluate the occupational radiation exposure resulting from scattered radiation to interventional cardiologists, organ doses for eyeball, thyroid, and heart were calculated using Monte Carlo simulation with korean typical man(KTMAN) phantom at the left anterior oblique (LAO)30/cranial (CRAN)30, CRAN40, right anterior oblique (RAO)30/CRAN30, RAO30/caudal(CAUD)20, CAUD39, LAO40/CAUD35, and LAO40 positions in the femoral and the radial artery puncture. In this study, analysis of the different angles showed the highest radiation exposure on LAO30/CRAN30 and CRAN40 position, which were 150.65% and 135.3%, respectively, compared to AP angles. Therefore, to reduce occupational dose for interventional cardiologists, it is recommended that radiation protection, such as using radiation shield and personal protective equipment (PPE), be used at LAO30/CRAN30 and CRAN40 angulation, and the conversion factor for calculating the organ dose received by the interventional cardiologists based on patient dose can be applied for improved occupational dose management.
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Affiliation(s)
- Younghoon Roh
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Jungsu Kim
- Department of Radiologic-Technology, Daegu Health College, 15, Yeongsong-ro, Buk-gu, Daegu 41453, Korea;
| | - Hyemin Park
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Jungmin Kim
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Dongryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Kwangjin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Jeonghun Seo
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Bongki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Byungryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Yongsu Yoon
- Department of Radiological Science, Dongseo University, 47 Jurye-ro, Sasang-gu, Busan 47011, Korea
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27
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Chiang LLW, Li C, Hong KL, Hui WS, Beh SY, Gong M, Liu T, Li G, Xia Y, Ho J, Roever L, Duong S, Huang G, Tse G, Baranchuk A, Glover BM, International Health Informatics Study (IHIS) Network. The use of minimal fluoroscopy for cardiac electrophysiology procedures: A meta-analysis and review of the literature. Clin Cardiol 2021; 44:814-823. [PMID: 33998690 PMCID: PMC8207968 DOI: 10.1002/clc.23609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/13/2021] [Accepted: 03/31/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Conventional catheter ablation involves prolonged exposure to ionizing radiation, potentially leading to detrimental health effects. Minimal fluoroscopy (MF) represents a safer alternative, which should be explored. Data on the safety and efficacy of this technique are limited. HYPOTHESIS Our hypothesis is that MF is of equal efficacy and safety to conventional catheter ablation with the use of fluoroscopy by performing a meta-analysis of both randomized controlled trials (RCTs) and real-world registry studies. METHODS Pubmed and Embase were searched from their inception to July 2020 for RCTs, cohort and observational studies that assessed the outcomes of catheter ablation using a MF technique versus the conventional approach. RESULTS Fifteen studies involving 3795 patients were included in this meta-analysis. There was a significant reduction in fluoroscopy and procedural time with no difference in acute success (odds ratio [OR]:0.74, 95% CI: 0.50-1.10, p = .14), long-term success (OR:0.92, 95% CI: 0.65-1.31, p = .38), arrhythmia recurrence (OR:1.24, 95% CI: 0.75-2.06, p = .97) or rate of complications. (OR:0.83, 95% CI: 0.46-1.48, p = .65). Additionally sub-group analysis for those undergoing catheter ablation for atrial fibrillation (AF) did not demonstrate a difference in success or complication rates (OR:0.86, 95% CI: 0.30-2.42, p = .77). Multivariate meta-regression did not identify the presence of moderator variables. CONCLUSION This updated meta-analysis demonstrated an overall reduction in procedural and fluoroscopy time for those undergoing a minimal fluoroscopic approach. There was no significant difference in either acute or chronic success rates or complications between a MF approach and conventional approach for the management of all arrhythmias including those undergoing catheter ablation for AF.
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Affiliation(s)
| | - Christien Li
- Department of Medicine and Therapeutics, Faculty of MedicineChinese University of Hong KongHong KongChina
- Li Ka Shing Institute of Health Sciences, Faculty of MedicineChinese University of Hong KongHong KongChina
- Faculty of MedicineNewcastle UniversityNewcastleUK
| | - Kathryn L Hong
- Division of CardiologyUniversity of TorontoTorontoOntarioCanada
| | | | - Sze Yi Beh
- Faculty of MedicineNewcastle UniversityNewcastleUK
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Guangping Li
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Yunlong Xia
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Jeffery Ho
- Department of Anaesthesia and Intensive care, Faculty of MedicineChinese University of Hong KongHong KongChina
| | - Leonardo Roever
- Federal University of UberlândiaDepartment of Clinical ResearchUberlândiaMinas GeraisBrazil
| | - Sophia Duong
- Division of CardiologyUniversity of TorontoTorontoOntarioCanada
| | - Grace Huang
- Division of CardiologyUniversity of TorontoTorontoOntarioCanada
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of MedicineChinese University of Hong KongHong KongChina
- Li Ka Shing Institute of Health Sciences, Faculty of MedicineChinese University of Hong KongHong KongChina
| | - Adrian Baranchuk
- Division of CardiologyKingston General Hospital, Queen's UniversityKingstonOntarioCanada
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28
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García Balcaza V, Camp A, Badal A, Andersson M, Almen A, Ginjaume M, Duch MA. Fast Monte Carlo codes for occupational dosimetry in interventional radiology. Phys Med 2021; 85:166-174. [PMID: 34015619 DOI: 10.1016/j.ejmp.2021.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/21/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Interventional radiology techniques cause radiation exposure both to patient and personnel. The radiation dose to the operator is usually measured with dosimeters located at specific points above or below the lead aprons. The aim of this study is to develop and validate two fast Monte Carlo (MC) codes for radiation transport in order to improve the assessment of individual doses in interventional radiology. The proposed methodology reduces the number of required dosemeters and provides immediate dose results. METHODS Two fast MC simulation codes, PENELOPE/penEasyIR and MCGPU-IR, have been developed. Both codes have been validated by comparing fast MC calculations with the multipurpose PENELOPE MC code and with measurements during a realistic interventional procedure. RESULTS The new codes were tested with a computation time of about 120 s to estimate operator doses while a standard simulation needs several days to obtain similar uncertainties. When compared with the standard calculation in simple set-ups, MCGPU-IR tends to underestimate doses (up to 5%), while PENELOPE/penEasyIR overestimates them (up to 18%). When comparing both fast MC codes with experimental values in realistic set-ups, differences are within 25%. These differences are within accepted uncertainties in individual monitoring. CONCLUSION The study highlights the fact that computational dosimetry based on the use of fast MC codes can provide good estimates of the personal dose equivalent and overcome some of the limitations of occupational monitoring in interventional radiology. Notably, MCGPU-IR calculates both organ doses and effective dose, providing a better estimate of radiation risk.
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Affiliation(s)
- V García Balcaza
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona 08028, Spain.
| | - A Camp
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona 08028, Spain
| | - A Badal
- Division of Imaging, Diagnostics, and Software Reliability, OSEL, CDRH, U.S. Food and Drug Administration Silver Spring, Maryland, United States
| | - M Andersson
- Medical Radiation Physics, Department of Translational Medicine (ITM), Lund University, SE-205 02, Malmö, Sweden
| | - A Almen
- Medical Radiation Physics, Department of Translational Medicine (ITM), Lund University, SE-205 02, Malmö, Sweden
| | - M Ginjaume
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona 08028, Spain
| | - M A Duch
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona 08028, Spain
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29
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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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Beaman CB, Kaneko N, Meyers PM, Tateshima S. A Review of Robotic Interventional Neuroradiology. AJNR Am J Neuroradiol 2021; 42:808-814. [PMID: 33541906 PMCID: PMC8115357 DOI: 10.3174/ajnr.a6976] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022]
Abstract
Robotic interventional neuroradiology is an emerging field with the potential to enhance patient safety, reduce occupational hazards, and expand systems of care. Endovascular robots allow the operator to precisely control guidewires and catheters from a lead-shielded cockpit located several feet (or potentially hundreds of miles) from the patient. This has opened up the possibility of expanding telestroke networks to patients without access to life-saving procedures such as stroke thrombectomy and cerebral aneurysm occlusion by highly-experienced physicians. The prototype machines, first developed in the early 2000s, have evolved into machines capable of a broad range of techniques, while incorporating newly automated maneuvers and safety algorithms. In recent years, preliminary clinical research has been published demonstrating the safety and feasibility of the technology in cerebral angiography and intracranial intervention. The next step is to conduct larger, multisite, prospective studies to assess generalizability and, ultimately, improve patient outcomes in neurovascular disease.
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Affiliation(s)
- C B Beaman
- Department of Neurology (C.B.B.), Columbia University Irving Medical Center, New York, New York
| | - N Kaneko
- Department of Radiological Sciences (N.K., S.T.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - P M Meyers
- Department of Radiology and Neurological Surgery (P.M.M.), Columbia University Irving Medical Center, New York, New York
| | - S Tateshima
- Department of Radiological Sciences (N.K., S.T.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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31
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Use of Biological Dosimetry for Monitoring Medical Workers Occupationally Exposed to Ionizing Radiation. RADIATION 2021. [DOI: 10.3390/radiation1020009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Medical workers are the largest group exposed to man-made sources of ionizing radiation. The annual doses received by medical workers have decreased over the last several decades, however for some applications, like fluoroscopically guided procedures, the occupational doses still remain relatively high. Studies show that for some procedures the operator and staff still use insufficient protective and dosimetric equipment, which might cause an underestimation of medical exposures. Physical dosimetry methods are a staple for estimating occupational exposures, although due to the inconsistent use of protection measures, an alternative method such as biological dosimetry might complement the physical methods to achieve a more complete picture. Such methods were used to detect exposures to doses as low as 0.1 mSv/year, and could be useful for a more accurate assessment of genotoxic effects of ionizing radiation in medical workers. Biological dosimetry is usually based on the measurement of the effects present in peripheral blood lymphocytes. Although some methods, such as chromosome aberration scoring or micronucleus assay, show promising results, currently there is no one method recognized as most suitable for dosimetric application in the case of chronic, low-dose exposures. In this review we decided to evaluate different methods used for biological dosimetry in assessment of occupational exposures of medical workers.
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32
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Animal Experiment of a Novel Neurointerventional Surgical Robotic System with Master-Slave Mode. Appl Bionics Biomech 2021; 2021:8836268. [PMID: 33574888 PMCID: PMC7864736 DOI: 10.1155/2021/8836268] [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: 09/14/2020] [Revised: 11/29/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
In order to inspect and improve the system performance of the neuro-interventional surgical robot and its effectiveness and safety in clinical applications, we conducted ten animal experiments using this robotic system. Cerebral angiography was performed on ten experimental animals, and various mechanical performance indicators, operating time, X-ray radiation dosage to the experimental animals and the experimenter, and arterial damage in the experimental animals were recorded when the robotic system completed cerebral angiography. The results show that the robotic system can successfully complete the cerebral angiography surgery, and the mechanical performance is up to standard. The operating time is almost the same as the physician's operating time. And the mean X-ray radiation dosage received by the experimental animals and experimenter was 0.893 Gy and 0.0859 mSv, respectively. There were no complications associated with damage to the vascular endothelium. The robotic system can basically complete the relevant assessment indicators, and its system performance, effectiveness, and safety in clinical applications meet the standards, basically meeting the requirements of clinical applications of neurointerventional surgery.
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Mitsuyoshi Y, Tomoya F, Hisaya S, Kyoichi K. MINIMIZING THE EXPOSURE TO THE EYE LENS OF RADIOLOGIC TECHNOLOGISTS ASSISTING PATIENTS DURING CHEST X RAYS: A PHANTOM STUDY. RADIATION PROTECTION DOSIMETRY 2021; 193:43-54. [PMID: 33765126 DOI: 10.1093/rpd/ncab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/08/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
As chest x rays involve risks of patients falling, radiologic technologists (technologists) commonly assist patients, and as the assistance takes place near the patients, the eye lenses of the technologists are exposed to radiation. The recommendations of the International Commission on Radiological Protection suggest that the risk of developing cataracts due to lens exposure is high, and this makes it necessary to reduce and minimize the exposure. The present study investigated the positions of technologists assisting patients that will minimize exposure of the eye lens to radiation. The results showed that it is possible to reduce the exposure by assisting from the following positions: 50% at the sides rather than diagonally behind, 10% at the right side of the patient rather than the left and 40% at 250 mm away from the patient. The maximum reduction with radiation protection glasses was 54% with 0.07 mmPb and 72% with 0.88 mmPb.
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Affiliation(s)
- Yasuda Mitsuyoshi
- Graduate School of Health Sciences, Showa University, 1-5-8 Hatanodai Shinagawa Tokyo 142-8555, Japan
| | - Funada Tomoya
- Department of Radiological Technology, Showa University Hospital, 1-5-8 Hatanodai Shinagawa Tokyo 142-8555, Japan
| | - Sato Hisaya
- Graduate School of Health Sciences, Showa University, 1-5-8 Hatanodai Shinagawa Tokyo 142-8555, Japan
| | - Kato Kyoichi
- Graduate School of Health Sciences, Showa University, 1-5-8 Hatanodai Shinagawa Tokyo 142-8555, Japan
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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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Roh Y, Nam S, Lee BK, Ryu DR, Chun K, Lee KS, Cho N, Yoon Y, Park H, Cho BR, Kim JS. Radiation exposure of interventional cardiologists during coronary angiography: evaluation by phantom measurement and computer simulation. Phys Eng Sci Med 2020; 43:1279-1287. [DOI: 10.1007/s13246-020-00931-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
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Boice J, Dauer LT, Kase KR, Mettler FA, Vetter RJ. Evolution of radiation protection for medical workers. Br J Radiol 2020; 93:20200282. [PMID: 32496817 PMCID: PMC7446021 DOI: 10.1259/bjr.20200282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/05/2022] Open
Abstract
Within a few months of discovery, X-rays were being used worldwide for diagnosis and within a year or two for therapy. It became clear very quickly that while there were immense benefits, there were significant associated hazards, not only for the patients, but also for the operators of the equipment. Simple radiation protection measures were implemented within a decade or two and radiation protection for physicians and other operators has continued to evolve over the last century driven by cycles of widening uses, new technologies, realization of previously unidentified effects, development of recommendations and regulations, along with the rise of related societies and professional organizations. Today, the continue acceleration of medical radiation uses in diagnostic imaging and in therapeutic modalities not imagined at the turn of this century, such as positron emission tomography, calls for constant vigilance and flexibility to provide adequate protection for the growing numbers of medical radiation workers.
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Affiliation(s)
- John Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
| | - Lawrence T Dauer
- Departments of Medical Physics and Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Fred A Mettler
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque,, NM, USA
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Elshami W, Abuzaid M, Pekkarinen A, Kortesniemi M. ESTIMATION OF OCCUPATIONAL RADIATION EXPOSURE FOR MEDICAL WORKERS IN RADIOLOGY AND CARDIOLOGY IN THE UNITED ARAB EMIRATES: NINE HOSPITALS EXPERIENCE. RADIATION PROTECTION DOSIMETRY 2020; 189:466-474. [PMID: 32424394 DOI: 10.1093/rpd/ncaa060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/17/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Occupational radiation exposure for medical workers in radiology and cardiology was analyzed in nine hospitals in the UAE between 2002 and 2016. The purpose of the study was to determine the time trend and the differences in occupational radiation exposure among worker groups and hospitals in the country. METHODS Readings of 5700 thermoluminescence dosimeters (TLDs) were obtained from 1011 medical workers and grouped into 5 worker groups (radiographers, diagnostic radiologists, nurses, cardiologists and physicians). RESULTS The mean annual effective dose was from 0.38 to 0.62 mSv per worker. Even though an increase in the collective effective dose has been noticed during the study period, no significant time trend was observed in the mean effective dose. Furthermore, cardiologists received higher mean and maximum effective doses than the other worker groups. CONCLUSION The annual effective doses were below the limits set by national legislation and international standards, and for the average worker, the likelihood of high exposure is small. However, improvements in radiation protection practices could be implemented to reduce occupational radiation dose to cardiologists, who were the most exposed worker group in this study.
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Affiliation(s)
- Wiam Elshami
- Medical Diagnostic Imaging Department, College of Health Science, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed Abuzaid
- Medical Diagnostic Imaging Department, College of Health Science, University of Sharjah, Sharjah, United Arab Emirates
| | - Antti Pekkarinen
- Kymsote Radiotherapy and Oncology, Kymenlaakso Central Hospital, Kotka, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
- HUS Medical Imaging Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Mika Kortesniemi
- HUS Medical Imaging Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Bohari A, Hashim S, Mohd Mustafa SN. SCATTER RADIATION IN THE FLUOROSCOPY-GUIDED INTERVENTIONAL ROOM. RADIATION PROTECTION DOSIMETRY 2020; 188:397-402. [PMID: 31950168 DOI: 10.1093/rpd/ncz299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/22/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
Radiation scattered throughout the room during fluoroscopy-guided interventional (FGI) procedures was quantified at different locations using nanoDot optically stimulated luminescence dosemeters. All the tube angulation imaging shows that the radiation spectrum resembled a single peak distribution. The left anterior oblique 90° shows the highest single peak distribution (28.65 mSv/h). The single peak distribution for standard anteroposterior, left anterior oblique 45° and right anterior oblique 45° imaging was 13.32, 22.99 and 17.40 mSv/h, respectively. All tube angulation shows that the position of the interventional radiologist experienced a higher radiation level compared to other staffs. The doses of radiation varied widely around the perimeter of the patient's table and changed in accordance to imaging angles during procedures. Knowledge pertaining to radiation exposure levels is integral in order to avoid adverse risks, particularly among staff.
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Affiliation(s)
- Asmah Bohari
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia
| | - Suhairul Hashim
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia
- Centre for Sustainable Nanomaterials (CSNano), Ibnu Sina Institute for Scientific and Industrial Research (ISI-SIR), Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia
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Crowhurst JA, Whitby M, Aroney N, Dautov R, Walters D, Raffel O. Primary operator radiation dose in the cardiac catheter laboratory. Br J Radiol 2020; 93:20200018. [PMID: 32543896 DOI: 10.1259/bjr.20200018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Radiation from cardiac angiography procedures is harmful to patients and the staff performing them. This study sought to investigate operator radiation dose for a range of procedures and different operators in order to investigate trends and optimise dose. METHODS Real-time dosemeters (RTDs) were worn by operators for angiography procedures for 3 years. Dose-area product (DAP) and RTD were collected. RTD was normalised to DAP (RTD/DAP) to compare radiation dose and radiation protection measures. Comparisons were made across procedure categories and individual operators. RESULTS In 7626 procedures, median and 75th percentile levels were established for operator dose for 8 procedure categories. There was a significant difference in all operator dose measures and DAP across procedure categories (p<0.001). DAP, RTD, and RTD/DAP were significantly different across 22 individual operators (p<0.001). CONCLUSION DAP was significantly different across procedure categories and a higher RTD was seen with higher DAP. RTD/DAP can demonstrate radiation protection effectiveness and identified differences between procedures and individual operators with this measure. Procedures and individuals were identified where further optimisation of radiation protection measures may be beneficial. A reference level for operator dose can be created and audited against on a regular basis. ADVANCES IN KNOWLEDGE This study demonstrates that operator dose can be easily and routinely measured on a case by case basis to investigate dose trends for different procedures. Normalising the operator dose to DAP demonstrates radiation protection effectiveness for the individual operator which can then be optimised as part of an ongoing audit program.
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Affiliation(s)
- James A Crowhurst
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Whitby
- University of Queensland, St Lucia, Brisbane, Australia.,I-MED Radiology, Newstead, Queensland, Australia
| | - Nicholas Aroney
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
| | - Rustem Dautov
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
| | - Darren Walters
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia.,St Vincents Northside Private Hospital, Chermside, Queensland, Australia
| | - Owen Raffel
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
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Cardiac catheterization real-time dynamic radiation dose measurement to estimate lifetime attributable risk of cancer. PLoS One 2020; 15:e0234461. [PMID: 32544209 PMCID: PMC7297332 DOI: 10.1371/journal.pone.0234461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/27/2020] [Indexed: 11/24/2022] Open
Abstract
Cardiac catheterization procedure is the gold standard to diagnose and treat cardiovascular disease. However, radiation safety and cancer risk remain major concerns. This study aimed to real-time dynamic radiation dose measurement to estimate lifetime attributable risk (LAR) of cancer incidence and mortality in operators. Coronary angiography (CA) with percutaneous coronary intervention (PCI), CA, and others (radiofrequency ablation, pacemaker and defibrillator implantation) procedures with different beam directions, were undertaken on x-ray angiography system. A real-time electronic personal dosimeter (EPD) system was used to measure the radiation dose of staff during all procedures. We followed the Biological Effects of Ionizing Radiation (BEIR) VII report to estimate the LAR of all cancer incidence and mortality. Primary operators received radiation dose in CA with PCI, CA, and others procedures were 59.33 ± 95.03 μSv, 39.81 ± 103.85 μSv, and 21.92 ± 37.04 μSv, respectively. As to the assistant operators were 30.03 ± 55.67 μSv, 14.67 ± 14.88 μSv, and 4 μSv, respectively. LAR of all cancer incidences for staffs aged from 18 to 65 are varied from 0.40% for males to 1.50% for females. LAR of all cancer mortality for staffs aged from 18 to 65 are varied from 0.22% for males to 0.83% for females. Our study provided an easy, real-time and dynamic radiation dose measurement to estimate LAR of cancer for staff during the cardiac catheterization procedures. The LAR for all cancer incidence is about twice that for cancer mortality. Although the radiation doses of staff are lower during each procedure, the increased years of service leads to greater radiation risk to the staff.
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Jaramillo-Garzón W, Morales-Aramburo J, Puerta-Ortiz A, Castrillón-Giraldo W. Dosimetría personal y exposición ocupacional en Cardiología intervencionista. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Durán A, Mila R. Prólogo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hernández C, Gómez FE, Cortés MC, Cabrera M, Carvajal CR, Rosenstiehl SM, Ríos HA. Lens changes in cardiovascular catheterization laboratories staff. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tao AT, Miller D, Hindal M, Fetterly KA. Technical Note: Assessment of scatter originating from the x‐ray tube collimator assembly of modern angiography systems. Med Phys 2019; 46:4371-4380. [DOI: 10.1002/mp.13720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ashley T. Tao
- Department of Radiology Mayo Clinic Rochester MN USA
| | - Daniel Miller
- Department of Radiology Mayo Clinic Rochester MN USA
| | - Mark Hindal
- Department of Radiology Mayo Clinic Rochester MN USA
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Brindhaban A. RADIATION DOSE TO PATIENTS IN CORONARY INTERVENTIONAL PROCEDURES: A SURVEY. RADIATION PROTECTION DOSIMETRY 2019; 184:1-4. [PMID: 30289509 DOI: 10.1093/rpd/ncy179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
The objective of this study was to evaluate dose-area product (DAP) and peak skin dose (PSD) for coronary angiography (CA) and percutaneous coronary intervention (PCI). The DAP and PSD of 300 randomly selected patients who were referred to CA and/or PCI, over a period of 3 months were recorded and analyzed. The mean DAP of 32 Gy cm2 and mean PSD of 412 mGy for CA were lower than 118 Gy cm2 and 857 mGy, respectively, for PCI. The DAP range of 2-84 Gy cm2 for CA and 12-378 mGy for PCI were also established. The maximum value of PSD for PCI procedures reached above the 2 Gy threshold for erythema. However, these values are similar to those available in literature. Periodic surveys may be required to monitor and/or reduce radiation doses in coronary interventional procedures.
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Affiliation(s)
- A Brindhaban
- Department of Radiologic Sciences, Kuwait University, Sulaibikhat, Kuwait
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Ahmed IES, Zamzam AM, Yassin HM. Statistical analysis of the occupational radiation doses in three different positron emission tomography-computed tomography centers in Egypt. World J Nucl Med 2019; 18:287-292. [PMID: 31516373 PMCID: PMC6714156 DOI: 10.4103/wjnm.wjnm_42_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/12/2018] [Indexed: 01/04/2023] Open
Abstract
In the present study, we investigated the radiation doses received by the positron emission tomography (PET)/computed tomography (CT) staff in three different diagnostic centers in Egypt. The whole-body effective dose measured by thermoluminescent dosimeters (TLDs) for staff working in PET and the effective dose per study received by physicist, technician, and nurse were measured by an electronic pocket dosimeter (EPD) during a period of 6 months. Statistical analysis was held between the measurements of the TLDs as well as for the EPD for the three studied PET-CT centers. After combining TLD and EPD prospective annual scores for the three studied categories in the three centers, the one-way ANOVA test results have shown that there were statistically significant differences between group means with respect to their TLD mean score (P = 0.041). The mean nurse group TLD score, across the three centers, appeared to be the lowest scoring 3.83 (standard deviation [SD] 0.012) compared to the physicist and technician who measured 4.62 (SD 0.231) and 6.92 (SD 0.018), respectively. Scheffe's test for complex comparisons revealed a significant difference between nurse group and technologist group (P = 0.001). Regarding the annual combined EPD scores, the post hoc test, namely Scheffe's test for complex comparisons, revealed a significant difference between nurse group and technologist group (P = 0.001). This was measured after the one-way ANOVA test results have shown that there were statistically significant differences between annual group EPD means (P = 0.032). Finally, there was no recorded significance for the studied categories across the three centers between their annual TLD and EPD dose scores (P = 0.072). Technicians group received the highest mean effective whole-body doses when compared with the International Commission on Radiological Protection dose limit, each individual worker can work with many more 18F-fluorodeoxyglucose (FDG) PET/CT studies for a (period time) without exceeding the occupational dose limits if the average received effective dose continues with the same rate. The study also confirmed that low levels of radiation dose are received by medical personnel involved in 18F-FDG PET/CT procedures in those centers due to implementing radiation protection measures and procedures.
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Affiliation(s)
- Ibrahim Elsayed Saad Ahmed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
- Department of Nuclear Medicine Technology, Inaya Medical Colleges, Riyadh, Saudi Arabia
| | | | - Hossam Mahmoud Yassin
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Larson AN, Schueler BA, Dubousset J. Radiation in Spine Deformity: State-of-the-Art Reviews. Spine Deform 2019; 7:386-394. [PMID: 31053308 DOI: 10.1016/j.jspd.2019.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/05/2019] [Accepted: 01/06/2019] [Indexed: 01/10/2023]
Abstract
STUDY DESIGN/METHODS Review article. OBJECTIVES This article will provide an overview regarding measurement of radiation exposure and effects on patients with spinal deformity. SUMMARY OF BACKGROUND DATA/RESULTS Pediatric and adult spinal deformity patients are frequently exposed to diagnostic studies exposing them to ionizing radiation. There is a concern that medical radiation can result in increased cancer risk, particularly in children who will live for a long period of time in which cancer may develop and who have rapidly dividing cells that may be more susceptible to DNA damage. CT imaging imparts 10-100 times higher radiation dosing than standard radiographs. Usage of CT imaging studies is growing in the United States and represents 50% of medical imaging exposure. In addition to the 3 millisieverts (mSv) mean natural background exposure, in the United States, the average American experiences an additional 3 mSv of exposure primarily due to medical diagnostic imaging. Early-onset scoliosis patients are at risk of high cumulative radiation exposure given the young age at diagnosis and frequency of multiorgan system involvement in the case of neuromuscular, congenital, and syndromic patients. Biplanar slot scanning reduces patient radiation exposure, and overall levels of exposure from radiographic imaging is quite low compared with CT imaging or historic radiographs. Specialized pediatric CT dosing protocols result in lower patient absorbed dose. Surgeon and team intraoperative exposure to radiation should always be a concern. Appropriate shielding with a lead apron and minimizing radiation exposure are appropriate strategies. CONCLUSIONS This article will help guide surgeons to make appropriate decisions regarding the need for imaging studies and advocate for low-dose imaging protocols within their facilities. LEVEL OF EVIDENCE V.
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Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Beth A Schueler
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jean Dubousset
- Académie National de Médicine, 16 Rue Bonaparte, Paris 75006, France
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Hussey P, Wu I, Johnston T. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness-A Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2019; 33:2902-2908. [PMID: 30979644 DOI: 10.1053/j.jvca.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Indexed: 11/11/2022]
Abstract
The American College of Cardiology, in collaboration with the American Society of Nuclear Cardiology, Heart Rhythm Society, Mended Hearts, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Computed Tomography, and Society of Nuclear Medicine and Molecular Imaging, recently published a consensus document recommending best practices for the use of ionizing radiation in cardiovascular medicine. With the increase in number and complexity of catheter-based cardiovascular interventions, cardiothoracic anesthesiologists are being requested to consult and provide care for these patients. This review summarizes the salient portions of the consensus document as it pertains to the anesthesiologist. Radiation exposure for both patients and providers should be minimized to be as low as reasonably achievable. For the anesthesiologist involved in the procedure, the authors recommend wearing protective garments including apron, vest, neck collar, and glasses of at least 0.25-mm lead or lead equivalent. The addition of a portable shield also is strongly recommended. The anesthesiologist should maintain the maximum distance allowable from the x-ray source, remembering that radiation intensity is inversely proportional to the square of the distance from the x-ray source. Monitoring radiation exposure is done best by both collar and under-apron film badge. A 0.5-mm lead-equivalent apron is expected to shield approximately 95% of the radiation. By using these recommendations, the anesthesiologist should be able to keep radiation exposure under 20 mSv per year as recommended by the International Commission on Radiation Protection.
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Affiliation(s)
- Patrick Hussey
- Department of Anesthesiology, Columbia University Medical Center, New York, NY.
| | - Isaac Wu
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Taylor Johnston
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Columbia University Medical Center, New York, NY
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Suryadevara R, Brown ED, Green SM, Scott TD, Nordberg CM, Blankenship JC. A randomized controlled trial to assess operator radiation exposure from cardiac catheterization procedures using RAD BOARD® with standard pelvic shielding versus standard pelvic shielding alone. Catheter Cardiovasc Interv 2019; 95:83-88. [PMID: 30866175 DOI: 10.1002/ccd.28190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 10/22/2018] [Accepted: 02/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To study radiation exposure to the primary operator during diagnostic cardiac catheterizations using a radio-dense RAD BOARD® radial access arm board. BACKGROUND The use of radial access for catheterization in the United States has increased from 1% in 2007 to 41% in 2018. Compared to femoral access, operator radiation exposure from radial access is similar or higher. The RAD BOARD radio-dense radial access arm board has been marketed as reducing radiation to operators by 44%. MATERIALS AND METHODS We randomized 265 patients undergoing catheterization via right radial access to standard pelvic lead drape shielding (nonboard group) versus RAD BOARD in addition to pelvic drape (board group). Operator radiation exposure was measured using Landauer Microstar nanoDot™ badges worn by the operator. RESULTS Board and nonboard groups were similar with respect to demographic and procedural variables. Mean operator dose per case was higher in the board group (.65mSieverts) than in the nonboard group (.56mSieverts, P < 0.0001). In sub-group analyses, radiation doses were higher in the board group compared to the nonboard group in patients across all body mass index groups (P < 0.03). In multivariate analysis, operator dose correlated with use of the RAD BOARD more closely than any other variable (P < 0.001). Post hoc analysis of the table setup with RAD BOARD revealed that use of RAD BOARD prevented placement of a shield normally inserted into the top of the standard below-table shield. CONCLUSION RAD BOARD with the pelvic shield was associated with higher radiation exposure to the operator compared with pelvic shield alone, likely due to inability to use standard radiation shielding along with the RAD BOARD.
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Affiliation(s)
- Ramya Suryadevara
- Department of Cardiology, Harton Regional Medical Center, Tullahoma, Tennessee
| | - Eddie D Brown
- Department of Cardiology, University of New Mexico, Albuquerque, New Mexico
| | - Sandy M Green
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania
| | - Thomas D Scott
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania
| | - Cara M Nordberg
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania
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