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Galli E, Soliman-Aboumarie H, Gargani L, Szymański P, Gimelli A, Petersen SE, Sade LE, Stankovic I, Donal E, Cosyns B, Agricola E, Dweck MR, Ajmone Marsan N, Delgado V, Muraru D. EACVI survey on radiation exposure in interventional echocardiography. Eur Heart J Cardiovasc Imaging 2024; 25:727-734. [PMID: 38635738 PMCID: PMC11139519 DOI: 10.1093/ehjci/jeae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
AIMS The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey on radiation exposure in interventional echocardiography. The survey aimed to collect data on local practices for radioprotection in interventional echocardiography and to assess the awareness of echocardiography operators about radiation-related risks. METHODS AND RESULTS A total of 258 interventional echocardiographers from 52 different countries (48% European) responded to the survey. One hundred twenty-two (47%) participants were women. Two-thirds (76%) of interventional echocardiographers worked in tertiary care/university hospitals. Interventional echocardiography was the main clinical activity for 34% of the survey participants. The median time spent in the cath-lab for the echocardiographic monitoring of structural heart procedures was 10 (5-20) hours/month. Despite this, only 28% of interventional echocardiographers received periodic training and certification in radioprotection and 72% of them did not know their annual radiation dose. The main adopted personal protection devices were lead aprons and thyroid collars (95% and 92% of use, respectively). Dedicated architectural protective shielding was not available for 33% of interventional echocardiographers. Nearly two-thirds of responders thought that the radiation exposure of interventional echocardiographers was higher than that of interventional cardiologists and 72% claimed for an improvement in the radioprotection measures. CONCLUSION Radioprotection measures for interventional echocardiographers are widely variable across centres. Radioprotection devices are often underused by interventional echocardiographers, portending an increased radiation-related risk. International scientific societies working in the field should collaborate to endorse radioprotection training, promote reliable radiation dose assessment, and support the adoption of radioprotection shielding dedicated to interventional echocardiographers.
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Affiliation(s)
- E Galli
- University of Rennes, CHU Rennes, Inserm, LTSI—UMR 1099, F-35000 Rennes, France
| | - H Soliman-Aboumarie
- Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas NHS Foundation Trust, London, UK
- School of Cardiovascular Sciences and Medicine, King’s College, London, UK
| | - L Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa—Pisa, Italy
| | - P Szymański
- Centre for Postgraduate Medical Education, Warsaw, Poland
- Centre for Clinical Cardiology, National Institute of Medicine MSWiA, Warsaw, Poland
| | - A Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, 56124 Pisa, Italy
| | - S E Petersen
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - L E Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
| | - I Stankovic
- Faculty of Medicine, Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia
| | - E Donal
- University of Rennes, CHU Rennes, Inserm, LTSI—UMR 1099, F-35000 Rennes, France
| | - B Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - E Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh EH16 4SB, UK
| | - N Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - V Delgado
- Department of Cardiovascular Imaging, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - D Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
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2
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Garcia-Sayan E, Jain R, Wessly P, Mackensen GB, Johnson B, Quader N. Radiation Exposure to the Interventional Echocardiographers and Sonographers: A Call to Action. J Am Soc Echocardiogr 2024:S0894-7317(24)00109-3. [PMID: 38490315 DOI: 10.1016/j.echo.2024.03.002] [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: 12/18/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
Interventional echocardiography is a rapidly growing field within the disciplines of cardiology and anesthesiology, with the rise of advanced transcatheter procedures making skilled imagers more important than ever. However, these procedures also involve frequent manipulation of the transesophageal echocardiography probe, which means interventional echocardiographers (IEs) are at risk of long-term occupational radiation exposure. Studies have shown that radiation exposure is linked to various health issues, including cancer, cataracts, hypertension, hyperlipidemia, endothelial dysfunction, vascular aging, and early atherosclerosis. While there is increasing awareness of the occupational radiation dose limits and the need for better shielding methods, the importance of radiation safety for the IE is still not sufficiently prioritized in most cardiac catheterization laboratories/hybrid operating rooms. This is partly due to a paucity of studies looking at long-term radiation exposure to the IE, as this field is newer than that of interventional cardiologists.
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Affiliation(s)
- Enrique Garcia-Sayan
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Renuka Jain
- Aurora Cardiovascular Services, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Priscilla Wessly
- Aurora Cardiovascular Services, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Brianna Johnson
- Aurora Cardiovascular Services, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Nishath Quader
- Division of Cardiology, Washington University School of Medicine-St. Louis, St. Louis, Missouri.
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Olgun Kucuk H, Fetterly KA, Betz JL, Pislaru SV, Rihal CS, Pellikka PA, Wiley BM. Interventional Echocardiographer Radiation Exposure Varies With Procedure Type and Echocardiography Modality. J Am Soc Echocardiogr 2024; 37:110-112. [PMID: 37716461 DOI: 10.1016/j.echo.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Hilal Olgun Kucuk
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Kenneth A Fetterly
- Division of Ischemic Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Betz
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Division of Ischemic Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Brandon M Wiley
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
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Cecconi A, Li CHP, Pombar Camean M, Cruz-Gonzalez I, Martínez Monzonís A. Radiation protection in interventional echocardiography. Recommendations of the SEC-Cardiovascular Imaging Association/SEC-Interventional Cardiology Association. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:956-960. [PMID: 37572774 DOI: 10.1016/j.rec.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Alberto Cecconi
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Chi-Hion Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain.
| | - Miguel Pombar Camean
- Servicio de Radiofísica e Protección Radiológica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Ignacio Cruz-Gonzalez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Amparo Martínez Monzonís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Kataoka A, Takata T, Yanagawa A, Kito K, Arakawa M, Ishibashi R, Katayama T, Mitsui M, Nagura F, Kawashima H, Hioki H, Watanabe Y, Kozuma K, Kotoku J. Body Surface Radiation Exposure in Interventional Echocardiographers During Structural Heart Disease Procedures. JACC. ASIA 2023; 3:301-309. [PMID: 37181397 PMCID: PMC10167512 DOI: 10.1016/j.jacasi.2022.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 05/16/2023]
Abstract
Background The distribution of radiation exposure on the body surface of interventional echocardiographers during structural heart disease (SHD) procedures is unclear. Objectives This study estimated and visualized radiation exposure on the body surface of interventional echocardiographers performing transesophageal echocardiography by computer simulations and real-life measurements of radiation exposure during SHD procedures. Methods A Monte Carlo simulation was performed to clarify the absorbed dose distribution of radiation on the body surface of interventional echocardiographers. The real-life radiation exposure was measured during 79 consecutive procedures (44 transcatheter edge-to-edge repairs of the mitral valve and 35 transcatheter aortic valve replacements [TAVRs]). Results The simulation demonstrated high-dose exposure areas (>20 μGy/h) in the right half of the body, especially the waist and lower body, in all fluoroscopic directions caused by scattered radiation from the bottom edge of the patient bed. High-dose exposure occurred when obtaining posterior-anterior and cusp-overlap views. The real-life exposure measurements were consistent with the simulation estimates: interventional echocardiographers were more exposed to radiation at their waist in transcatheter edge-to-edge repair than in TAVR procedures (median 0.334 μSv/mGy vs 0.053 μSv/mGy; P < 0.001) and in TAVR with self-expanding valves than in those with balloon-expandable valves (median 0.067 μSv/mGy vs 0.039 μSv/mGy; P < 0.01) when the posterior-anterior or the right anterior oblique angle fluoroscopic directions were used. Conclusions During SHD procedures, the right waist and lower body of interventional echocardiographers were exposed to high radiation doses. Exposure dose varied between different C-arm projections. Interventional echocardiographers, especially young women, should be educated regarding radiation exposure during these procedures. (The development of radiation protection shield for catheter-based treatment of structural heart disease [for echocardiologists and anesthesiologists]; UMIN000046478).
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Affiliation(s)
- Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Takeshi Takata
- Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan
| | - Ayaka Yanagawa
- Department of Anesthesia, Teikyo University, Tokyo, Japan
| | - Kento Kito
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Masataka Arakawa
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
- Department of Cardiovascular Medicine, Asahi General Hospital, Tokyo, Japan
| | - Ruri Ishibashi
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Taiga Katayama
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Miho Mitsui
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Fukuko Nagura
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hideyuki Kawashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Jun’ichi Kotoku
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
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6
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Occupational radiation dose and protection to the eye lens for interventional cardiology operators. RADIAT MEAS 2022. [DOI: 10.1016/j.radmeas.2022.106778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hagendorff A, Helfen A, Flachskampf FA, Ewen S, Kruck S, La Rosée K, Knierim J, Voigt JU, Kreidel F, Fehske W, Brandt R, Zahn R, Knebel F. Manual zur Indikation und Durchführung spezieller echokardiographischer Anwendungen. DER KARDIOLOGE 2021. [PMCID: PMC8521495 DOI: 10.1007/s12181-021-00509-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Das zweite Manual zur Indikation und Durchführung der Echokardiographie bezieht sich auf spezifische Anwendungen der Echokardiographie und besondere Fragestellungen bei speziellen Patientengruppen. Dabei stehen v. a. praktische Aspekte im Vordergrund. Methodisch etabliert sind die transösophageale Echokardiographie, die Stressechokardiographie und die Kontrastechokardiographie. Bei nahezu allen echokardiographischen Untersuchungen spielen aktuell 3‑D-Echokardiographie und Deformationsbildgebung eine Rolle. Das gesamte Spektrum der echokardiographischen Möglichkeiten wird derzeit in Notfall- und Intensivmedizin, bei der Überwachung und Führung von Katheterinterventionen, bei strukturellen Herzerkrankungen, bei herzchirurgischen Operationen, bei der Nachsorge von kardialen Unterstützungssystemen, bei kongenitalen Vitien im Erwachsenenalter und bei der Versorgung von hochinfektiösen Patienten in Pandemiezeiten angewandt. Die diagnostischen Fortschritte der konventionellen und modernen echokardiographischen Anwendungen stehen im Fokus dieses Manuals. Die 3‑D-Echokardiographie zur Charakterisierung der kardialen Morphologie und die Deformationsbildgebung zur Objektivierung der kardialen Funktion sind bei vielen Indikationen im klinischen Alltag etabliert. Die Stressechokardiographie zur Ischämie‑, Vitalitäts- und Vitiendiagnostik, die Bestimmung der koronaren Flussreserve und die Kontrastechokardiographie bei der linksventrikulären Wandbewegungsanalyse und kardialen Tumordetektion finden zunehmend klinische Anwendung. Wie für die konventionelle Echokardiographie im ersten Manual der Echokardiographie 2009 beschrieben, erfordert der Einsatz moderner echokardiographischer Verfahren die standardisierte Dokumentation und Akquisition bestimmter Bildsequenzen bei optimierter Geräteeinstellung, da korrekte und reproduzierbare Auswertungen nur bei guter Bildqualität möglich sind.
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Affiliation(s)
- Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Deutschland
| | - Andreas Helfen
- Medizinische Klinik I, Katholisches Klinikum Lünen Werne GmbH St. Marien-Hospital Lünen, Lünen, Deutschland
| | - Frank A. Flachskampf
- Department of Medical Sciences, Universität Uppsala, und Klinisk fysiologi och kardiologi, Uppsala University Hospital, Uppsala, Schweden
| | - Sebastian Ewen
- Klinik für Innere Medizin III – Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Sebastian Kruck
- Cardio Centrum Ludwigsburg Bietigheim, Ludwigsburg, Deutschland
| | - Karl La Rosée
- Gemeinschaftspraxis Dr. La Rosée & Prof. Dr. Müller, Bonn, Deutschland
| | - Jan Knierim
- Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Deutschland
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Gasthuisberg und Department of Cardiovascular Sciences, Cath. University Leuven, Leuven, Belgien
| | - Felix Kreidel
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Wolfgang Fehske
- Klinik III für Innere Medizin, Universitätsklinikum Köln – Herzzentrum, Universität zu Köln, Köln, Deutschland
| | - Roland Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B – Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein, Deutschland
- Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland
| | - Fabian Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland
- Sana Klinikum Lichtenberg, Berlin, Deutschland
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Kubicki R, Hummel J, Höhn R, Müller K, Stiller B, Grohmann J. Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access. Open Heart 2020; 7:openhrt-2020-001267. [PMID: 32595140 PMCID: PMC7322512 DOI: 10.1136/openhrt-2020-001267] [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: 02/14/2020] [Revised: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 01/14/2023] Open
Abstract
Objectives To assess the potential occupational radiation reduction and technical feasibility in patients rotated 180° (upside-down) when requiring neck access for transcervical or trans-subclavian catheterisation. Methods Upside-down positioning is defined as rotating patients in supine position by 180°, so that the feet come to rest where the head would otherwise be. We retrospectively evaluated all these procedures performed between March 2016 and May 2019. Furthermore, two different phantoms (paediatric and adult) were used prospectively to quantify the occupational dose between conventional or upside-down positioning. In this context, ambient dose equivalents were measured using real-time dosimeters. Three different projection angles were applied. Results 44 patients with median age and body weight of 1.0 year (range 0–56) and 9.5 kg (range 1.3–74.3) underwent 63 procedures positioned upside-down. This position proved advantageous for practical reasons, since the length of the examination table could be optimally used. Additionally, it resulted in a significantly lower overall ambient dose equivalent for the primary operator (PO) of 94.8% (mean: 2569±807 vs 135±23 nSv; p<0.01) in the adult, and of 65.5% (mean: 351±104 vs 121±56 nSv; p<0.01) in the paediatric phantom, respectively. Conclusion Upside-down positioning facilitates handling in a straightforward manner when access from the neck is required. Moreover, it significantly reduces local radiation exposure for the PO in the paediatric and, most impressively, in the adult phantom.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Johanna Hummel
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - René Höhn
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Kevin Müller
- Department of Occupational Safety, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
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