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Almesned A, Bhat YA. The Effectiveness of Leadership Interventions on Cardiologists' Performance Using Benchmarking as a Tool. Cureus 2024; 16:e66744. [PMID: 39268325 PMCID: PMC11391163 DOI: 10.7759/cureus.66744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Aligned with the Health Sector Transformation Strategy of Saudi Vision 2030, the study analyzed the attitudes and behaviors of cardiologists toward change and identified factors that could either facilitate or hinder the success of leadership interventions. At our cardiac center, the cath lab department is at the forefront of operations, accounting for 80% of the procedures. Our team members may not be fully equipped with the necessary attitudes and behaviors to drive successful improvement projects. Therefore, our top priority is ensuring they remain productive and engaged throughout the process. This is especially crucial because 60% of our budget is allocated to the cath lab department. OBJECTIVES The study aimed to assess the effectiveness of a leadership intervention on cardiologists' performance in terms of safety, speed, and cost. The research analyzed the behavior and attitude of cardiologists towards change and encouraged progress and collaborative learning between doctors, using benchmarking as a tool. Besides, the study sought to determine the contribution of the interventions used to overall efficiency in performing interventions. This case study focuses on four main aspects of the program. First, it aims to explore an innovative approach to improving the PSCCQ cath lab for patients. Second, it assesses the collective effort of all participants involved in the program. Third, it analyzes the program results and compares them with those of international experiences. And finally, it examines the program's potential benefits for our patients. METHODS The study's objectives were evaluated through qualitative analysis of in-depth interviews and quantitative data analysis of three variables in the cath lab: radiation dose, time, and inventory. The reason for using mixed methods was to comprehensively understand the same concept from different angles. RESULTS According to the study, participants improved the safety and effectiveness of our cath lab by reducing the radiation dose and its cost. The study revealed a 52% decrease in the radiation dose for diagnostic cases and an 11% decrease for interventional cases. Similarly, the cost of the radiation dose decreased by 28% for diagnostic cases and 11% for interventional cases. During the observation, it was noted that the participants were highly engaged and willing to adapt to the situation. Some even viewed it as an opportunity for personal growth and improvement in the cath lab. However, they stressed the significance of awareness as a crucial element in improving their behavior and reinforcing it as the foundation for maintaining progress. Furthermore, the study revealed that collaborative work among the participants could have been more optimal. CONCLUSION The study concludes that implementing innovative improvements to the cath lab was a necessary yet complex undertaking. Participants were more inclined to embrace the changes when they were easily understandable and motivating. The study recommends the appointment of a change agent, the establishment of benchmarks, and the creation of a collaborative working environment between leaders and staff. Above all, the leader should support and sponsor the change to facilitate the transition at various levels.
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Affiliation(s)
| | - Yasser A Bhat
- Pediatric Cardiology, Prince Sultan Cardiac Center Qassim, Buraidah, SAU
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2
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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Fluoroscopically guided vascular and cardiac transcatheter procedures: a comparison of occupational and patient dose by anatomical region. Phys Eng Sci Med 2023; 46:353-365. [PMID: 36877360 PMCID: PMC10030543 DOI: 10.1007/s13246-023-01226-7] [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: 08/15/2022] [Accepted: 01/27/2023] [Indexed: 03/07/2023]
Abstract
X-ray guided procedures are being performed by an increasing variety of medical specialties. Due to improvements in vascular transcatheter therapies, there is an increasing overlap of imaged anatomy between medical specialties. There is concern that non-radiology fluoroscopic operators may not have sufficient training to be well informed of the potential implications of radiation exposure and mitigation strategies to reduce dose. This was a prospective, observational, single center study to compare occupational and patient dose levels when imaging different anatomical regions during fluoroscopically guided cardiac and endovascular procedures. Occupational radiation dose was measured at the level of the temple of 24 cardiologists and 3 vascular surgeons (n = 1369), 32 scrub nurses (n = 1307) and 35 circulating nurses (n = 885). The patient dose was recorded for procedures (n = 1792) performed in three angiography suites. Abdominal imaging during endovascular aneurysm repair (EVAR) procedures was associated with a comparatively high average patient, operator and scrub nurse dose despite additional table-mounted lead shields. Air kerma was relatively high for procedures performed in the chest, and chest + pelvis. Higher dose area product and staff eye dose were recorded during procedures of the chest + pelvis due to the use of digital subtraction angiography to evaluate access route prior to/during transaortic valve implantation. Scrub nurses were exposed to higher average radiation levels than the operator during some procedures. Staff should be cognizant of the potentially higher radiation burden to patients and exposed personnel during EVAR procedures and cardiac procedures using digital subtraction angiography.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.
- Cardiovascular Suites, Greenslopes Private Hospital, Ramsay Health Care, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, Australia.
- Centre for Biomedical Technologies (CBT), Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
- Centre for Biomedical Technologies (CBT), Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
- Centre for Biomedical Technologies (CBT), Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. A comparison of patient dose and occupational eye dose to the operator and nursing staff during transcatheter cardiac and endovascular procedures. Sci Rep 2023; 13:2391. [PMID: 36765105 PMCID: PMC9918729 DOI: 10.1038/s41598-023-28704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
The number and complexity of transcatheter procedures continue to increase, raising concerns regarding radiation exposure to patients and staff. Procedures such as transaortic valve implantations (TAVI) have led to cardiologists adopting higher dose techniques, such as digital subtraction angiography (DSA). This study compared the estimated patient and occupational eye dose during coronary angiography (CA), percutaneous coronary intervention (PCI), TAVI workups (TWU), TAVI, endovascular aneurysm repairs (EVAR), and other peripheral diagnostic (VD) and interventional (VI) vascular procedures. A quantitative analysis was performed on patient dose during 299 endovascular and 1498 cardiac procedures. Occupational dose was measured for the cardiologists (n = 24), vascular surgeons (n = 3), scrub (n = 32) and circulator nurses (n = 35). TAVI and EVAR were associated with the highest average dose for all staff, and significantly higher patient dose area product, probably attributable to the use of DSA. Scrub nurses were exposed to higher average doses than the operator and scout nurse during CA, VD and VI. Circulating nurses had the highest average levels of exposure during TAVI. This study has demonstrated that EVAR and TAVI have similar levels of occupational and patient dose, with a notable increase in circulator dose during TAVI. The use of DSA during cardiac procedures is associated with an increase in patient and staff dose, and cardiologists should evaluate whether DSA is necessary. Scrub nurses may be exposed to higher levels of occupational dose than the operator.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, 4059, Australia. .,Cardiovascular Suites, Greenslopes Private Hospital, Greenslopes, Brisbane, QLD, 4120, Australia.
| | - Davide Fontanarosa
- Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, 4059, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, QLD, 2006, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, 4059, Australia
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Ishibashi T, Masuda T, Kato M, Yamashita Y, Takei Y, Tsukamoto A, Matsumoto K, Sakamoto H. NATIONWIDE SURVEY OF RADIATION EXPOSURE FOR RADIOFREQUENCY CATHETER ABLATION FOR PULMONARY VEIN ISOLATION AND NONPULMONARY VEIN ISOLATION IN JAPAN. RADIATION PROTECTION DOSIMETRY 2022; 198:16-22. [PMID: 35021232 DOI: 10.1093/rpd/ncab185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
To propose typical values for the arrhythmia region between pulmonary vein isolation (PVI) and nonpulmonary vein isolation (non-PVI) in Japan. A nationwide questionnaire was posted to 343 facilities, to which 125 facilities (36.4%) responded. Results is the median for PVI and non-PVI were in terms of Ka,r (317 and 196 mGy), PKA (40.8 and 26.3 Gy.cm2), FT (43.0 and 27.3 min), and CI (326 and 102 images). When comparing PVI and non-PVI procedures, there were significant differences in Ka, r, PKA, FT, and CI (p < 0.05). In other words, by classifying into two types, PVI and non-PVI, we contributed to the establishment of typical values in Japan's RFCA.
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Affiliation(s)
- Toru Ishibashi
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Takanori Masuda
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Mamoru Kato
- Department of Radiological Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima 730-8655, Japan
| | - Yukari Yamashita
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Yasutaka Takei
- Department of Radiological Technology, Faculty of Health Science and Technology, 288 Matsushima, Kurashiki-City, Okayama 701-0193, Japan
| | - Atsuko Tsukamoto
- Department of Radiology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Kazuma Matsumoto
- Department of Clinical Radiology, Hyogo College of Medicine College Hospital, 1-3-6 Minatojima, Chuo-ku, Kobe City, Hyogo 663-8501, Japan
| | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, 2-1-1 Hongo, bunkyou-ku, Tokyo 113-8421, Japan
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Aupongkaroon P, Makarawate P, Chaosuwannakit N. Comparison of radiation dose and its correlates between coronary computed tomography angiography and invasive coronary angiography in Northeastern Thailand. Egypt Heart J 2022; 74:6. [PMID: 35076784 PMCID: PMC8789964 DOI: 10.1186/s43044-022-00241-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background The number of coronary computed tomography angiography (CCTA) exams is steadily growing. A novel computed tomography (CT) system has been developed to increase image quality while lowering patient radiation. The radiation dose attributed to CCTA has received considerable attention, whereas the dose associated with invasive catheter angiography (ICA) has received less. This study aims to investigate the radiation exposure of CCTA in patients and compare it to ICA. Results The mean effective dose of CCTA was 2.88 ± 0.85 mSv which was significantly lower than the mean effective dose of ICA (5.61 ± 0.55 mSv), p < 0.0001. The effective dose of CCTA correlated with the weight, height, and BMI, while the effective dose of ICA was associated with patient weight and BMI. The radiation exposure from CCTA has been considerably reduced over the last ten years by almost 2.5 folds. The mean radiation dose from the newer generation CT used in 2019 was significantly lower than that of the single-source CT in 2010 (2.88 ± 0.85 mSv vs. 7.15 ± 3.4 mSv, p < 0.001). Conclusions CCTA allows evaluation of CAD with a significantly less effective radiation dose to patients than diagnostic ICA. There was a significant decrease in radiation dose from CCTA over time. Regular measurement of patient doses is an essential step to optimize exposure. It makes operators aware of their performance and allows comparisons with generally accepted practices.
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Affiliation(s)
| | - Pattarapong Makarawate
- Cardiology Unit, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narumol Chaosuwannakit
- Radiology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40000, Thailand.
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6
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First local diagnostic reference levels for fluoroscopically guided cardiac procedures in adult patients in Chile. NUCLEAR TECHNOLOGY AND RADIATION PROTECTION 2022. [DOI: 10.2298/ntrp2201084u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The goal of this study was to generate the first values of local diagnostic
reference levels for a range of fluoroscopically guided cardiac diagnostic
and therapeutic procedures in adult patients in Chile and to compare
radiation dose levels with others presented in the literature. The
dosimetric data collection period was conducted over the whole of 2020. The
local diagnostic reference levels were calculated as the 75th percentile
of patient dose data distributions for kerma area-product values. The sample
of collected clinical procedures (480) was divided into diagnostic and
therapeutic procedures. The kerma area-product differences found between
diagnostic and therapeutic procedures were statistically significant. The
local diagnostic reference levels were 81.6 Gy cm2 and 166.9 Gycm2 for
fluoroscopically guided cardiac diagnostic and therapeutic procedures,
respectively. A comparison of our results with results found in the
literature for the last 10 years, showed that there are no published papers
for hospitals in Latin America and the Caribbean. It becomes urgent to be
able to carry out more research of this type, given that the health
reality between countries on different continents is very different. While
in some the establishment of diagnostic reference levels is a legal obligation, in others it is a matter of good or bad will.
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Sothmann PJ, Groenewald WA, Doubell AF, Pitcher RD. TYPICAL VALUES OF DOSIMETRIC DATA FOR CARDIAC FLUOROSCOPY-GUIDED PROCEDURES IN A SOUTH AFRICAN TEACHING HOSPITAL. RADIATION PROTECTION DOSIMETRY 2021; 196:153-158. [PMID: 34595514 DOI: 10.1093/rpd/ncab143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/18/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Currently there are limited diagnostic reference level (DRL) data for South African (SA) public sector cardiac fluoroscopy-guided procedures (FGPs). A 4-y retrospective study of dosimetric data on 6265 patients determined typical values (50th percentile) of dosimetric data for the seven most frequent cardiac FGPs at a SA teaching hospital. Kerma-area-product (KAP), reference point air Kerma (Ka,r) and fluoroscopy time (FT) were, respectively, calculated for coronary angiography (CA) (n = 1935; 61Gy.cm2, 624 mGy, 5 min); CA with left ventriculography (n = 1687; 85Gy.cm2, 840 mGy, 3.9 min), valve screening (n = 129; 6Gy.cm2, 164 mGy, 2.3 min), percutaneous coronary intervention (n = 1922; 145Gy.cm2, 1569 mGy, 11.9 min), pacemaker implantation (n = 432; 9Gy.cm2, 100 mGy, 6.5 min), pericardial tap (n = 115; 1.9Gy.cm2, 18 mGy, 1.5 min) and transcatheter aortic valve implantation (n = 45; 65Gy.cm2, 658 mGy, 14.1 min). This work presents the largest SA public sector cardiac FGP dosimetric data to date and provides a key resource for future work in this domain.
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Affiliation(s)
- P J Sothmann
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - W A Groenewald
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - A F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - R D Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
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Osman E, Sulieman A, Alzimami K, Tamam N, Jambi LK, Babikir E, Abd-Elghany AA, Abuzaid M, Omer H, Bradley D. Radiation exposure during therapeutic cardiac interventional procedures. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kataria V, Yaduvanshi I, Singal G, Nair M. Establishing a diagnostic reference level of radiation dose in coronary angiography and intervention: A prospective evaluation. Indian Heart J 2021; 73:725-728. [PMID: 34861982 PMCID: PMC8642644 DOI: 10.1016/j.ihj.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Invasive Coronary Angiography (CAG) leads to significant radiation exposure to the patients. Guidelines suggest that a local landmark or Diagnostic Reference Level (DRL) for these procedures should be established for every region and country. This study attempts to create a DRL for a tertiary care hospital, acting as an interim DRL for the country/region. METHODS Radiation exposure data for all coronary procedures done at a tertiary care hospital between October 2016 to September 2018 were collected. Data was segregated into diagnostic Coronary Angiography (CAG) and single-vessel Percutaneous Intervention (PCI). The parameters collected include dose surface product (PKA), skin surface entry dose (KAR), and fluoroscopy time (FT). The 75th percentile of the PKA was used to define the DRL. RESULTS 500 Patients were included in the CAG group, in which the Median KAR was 412.05 mGy, Median PKA was 2635.7 μGysqm, and median FT was 2.25 min. The DRL for coronary angiography was calculated as 3695.1 μGysqm. Two hundred fifty patients were in the PCI group, the Median KAR was 1649 mGy, Median PKA was 8822.1 μGysqm, the median FT being 8.2 min. The DRL for single-vessel coronary intervention was calculated as 11038 μGysqm. CONCLUSION This study establishes a benchmark for radiation dose for diagnostic coronary angiography and single-vessel coronary intervention at a tertiary care hospital in NCR. It establishes an interim DRL that can be used for future studies in other institutions in the region and country and to compare with other countries.
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Affiliation(s)
- Vikas Kataria
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Ishita Yaduvanshi
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Gautam Singal
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Mohan Nair
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India.
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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Radiation dose to nurses, cardiologists, and patients during coronary angiography: a comparison of femoral and radial access. Eur J Cardiovasc Nurs 2021; 21:325-331. [PMID: 34718509 DOI: 10.1093/eurjcn/zvab096] [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: 05/20/2021] [Revised: 08/26/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to radiation during fluoroscopically guided cardiac procedures is a cause for concern for both the patient and staff. AIMS This study sought to compare the occupational and patient radiation dose during femoral and radially accessed invasive coronary angiography (CA). METHODS AND RESULTS Occupational dose (µSv) was measured at the left temple of the cardiologist (n = 17), scrub (n = 27), and circulator nurse (n = 27) during 761 femoral and 671 radially accessed diagnostic coronary angiograms and percutaneous coronary intervention (PCI) procedures. Patient dose parameters of dose area product (DAP) (Gy.cm2) and air kerma (AK) (Gy) were also measured. Coronary angiography performed via the radial artery is associated with greater mean dose to the cardiologist, with the exception of procedures including only PCI. Results demonstrated that scrub nurses are exposed to higher mean doses than the cardiologist when using femoral access and similar doses during radial cases. Both AK and DAP were associated with a higher average dose for femoral PCI than radial, with DAP being significantly higher. CONCLUSIONS Awareness of factors that increase the dose to staff and patients is vital to inform and improve practice. This study has demonstrated that access route during diagnostic CA and PCI influences both patient and staff dose. Radiation dose to in-room staff other than the fluoroscopic operator should be a focus of future research. In addition, all staff present during X-ray guided procedures should be provided with radiation education and adopt dose minimization strategies to reduce occupational exposures.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faulty of Science and Engineering, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,Greenslopes Private Hospital, Ramsay Health Care, Newdegate Street, Greenslopes, Brisbane, QLD 4120 Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,Centre for Biomedical Technologies (CBT), Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,QMIR Berghofer Medical Research Institute, 200 Herston Road, Herston, QLD 4006 Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faulty of Science and Engineering, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia
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Crowhurst J, Savage M, Hay K, Murdoch D, Aroney N, Dautov R, Walters DL, Raffel OC. Impact of Patient BMI on Patient and Operator Radiation Dose During Percutaneous Coronary Intervention. Heart Lung Circ 2021; 31:372-382. [PMID: 34654649 DOI: 10.1016/j.hlc.2021.08.019] [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: 01/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022]
Abstract
AIMS This study sought to investigate patient and operator radiation dose in patients undergoing percutaneous coronary intervention (PCI) and the impact of body mass index (BMI) on patient and operator dose. METHODS In patients undergoing PCI, radiation dose parameters, baseline characteristics and procedural data were collected in a tertiary centre for 3.5 years. Operators wore real time dosimeters. Patients were grouped by BMI. Dose area product (DAP) and operator radiation dose were compared across patient BMI categories. Multivariable analysis was performed to investigate the impact of patient BMI and other procedural variables on patient and operator dose. RESULTS 2,043 patients underwent 2,197 PCI procedures. Each five-unit increase in BMI increased patient dose (expressed as DAP) by an average 31% (95% CI: 29-33%) and operator dose by 27% (95% CI: 20-33%). Patient dose was 2.3 times higher and operator dose was 2.4 times higher in patients with a BMI>40 than for normal BMI patients. Multivariable analysis indicated that there were many procedural factors that were predictors for increasing operator dose and patient dose but that patient BMI was a major contributor for both operator dose and patient dose. CONCLUSION Increasing BMI increases the DAP and operator dose for PCI procedures and BMI is demonstrated to be a major factor that contributes to both patient and operator radiation dose.
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Affiliation(s)
- James Crowhurst
- The Prince Charles Hospital, Brisbane, Qld, Australia; Queensland University of Technology, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia.
| | - Michael Savage
- The Prince Charles Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Karen Hay
- QIMR Berghoffer Medical Research Institute, Brisbane, Qld, Australia
| | - Dale Murdoch
- The Prince Charles Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | | | - Rustem Dautov
- The Prince Charles Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Darren L Walters
- The Prince Charles Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia; St. Vincent's Northside Private Hospital, Brisbane, Qld, Australia
| | - Owen Christopher Raffel
- The Prince Charles Hospital, Brisbane, Qld, Australia; Queensland University of Technology, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
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12
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Fernandez R, Ellwood L, Barrett D, Weaver J. Safety and effectiveness of strategies to reduce radiation exposure to proceduralists performing cardiac catheterization procedures: a systematic review. JBI Evid Synth 2021; 19:4-33. [PMID: 32868713 DOI: 10.11124/jbisrir-d-19-00343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this systematic review was to synthesize the best available evidence on the effect of various radiation protection strategies on radiation dose received by proceduralists performing cardiac catheterization procedures involving fluoroscopy. INTRODUCTION Cardiac catheterization procedures under fluoroscopy are the gold standard diagnostic and treatment method for patients with coronary artery disease. The growing demand of procedures means that proceduralists are being exposed to increasing amounts of radiation, resulting in an increased risk of deterministic and stochastic effects. Standard protective strategies and equipment such as lead garments reduce radiation exposure; however, the evidence surrounding additional equipment is contradictory. INCLUSION CRITERIA Randomized controlled trials that compared the use of an additional radiation protection strategy with conventional radiation protection methods were considered for inclusion. The primary outcome of interest was the radiation dose received by the proceduralist during cardiac catheterization procedures. METHODS A three-step search was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library (CENTRAL). Trials published in the English language with adult participants were included. Trials published from database inception until July 2019 were eligible for inclusion. The methodological quality of the included studies was assessed using the JBI critical appraisal checklist for randomized controlled trials. Quantitative data were extracted from the included papers using the JBI data extraction tool. Results that could not be pooled in meta-analysis were reported in a narrative form. RESULTS Fifteen randomized controlled trials were included in the review. Six radiation protection strategies were assessed: leaded and unleaded pelvic or arm drapes, transradial protection board, remotely controlled mechanical contrast injector, extension tubing for contrast injection, real-time radiation monitor, and a reduction in frame rate to 7.5 frames per second. Pooled data from two trials demonstrated a statistically significant decrease in the mean radiation dose (P < 0.00001) received by proceduralists performing transfemoral cardiac catheterization on patients who received a leaded pelvic drape compared to standard protection. One trial that compared the use of unleaded pelvic drapes placed on patients compared to standard protection reported a statistically significant decrease (P = 0.004) in the mean radiation dose received by proceduralists.Compared to standard protection, two trials that used unleaded arm drapes for patients, one trial that used a remotely controlled mechanical contrast injector, and one trial that used a transradial protection board demonstrated a statistically significant reduction in the radiation dose received by proceduralists.Similarly, using a frame rate of 7.5 versus 15 frames per second and monitoring radiation dose in real-time radiation significantly lowered the radiation dose received by the proceduralist. One trial demonstrated no statistically significant difference in proceduralist radiation dose among those who used the extension tubing compared to standard protection (P = 1). CONCLUSIONS This review provides evidence to support the use of leaded pelvic drapes for patients as an additional radiation protection strategy for proceduralists performing transradial or transfemoral cardiac catheterization. Further studies on the effectiveness of using a lower fluoroscopy frame rate, real-time radiation monitor, and transradial protection board are needed.
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Affiliation(s)
- Ritin Fernandez
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia.,School of Nursing, University of Wollongong, Sydney, NSW, Australia
| | - Laura Ellwood
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia
| | - David Barrett
- Interventional Cardiology, St Andrews Private Hospital, Ipswich, QLD, Australia
| | - James Weaver
- Cardiology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
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How significant is the radiation exposure during electrophysiology study and ablation procedures for supraventricular tachycardia? Indian Heart J 2021; 73:221-222. [PMID: 33865523 PMCID: PMC8065359 DOI: 10.1016/j.ihj.2021.03.003] [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] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Abstract
Radiation exposure during electrophysiology procedures has been a point of discussion. We measured the ionising radiation dosage during ablation procedures for supraventricular tachycardia. This was compared with coronary angiographies performed via the radial route to put it in perspective. We found that the radiation dosage during the ablation procedure was far lower, less than forty percent of that during coronary angiography (Air Kerma 249.1 mGy ± 266.95 mGy v/s 671.9 mGy ± 328.6 mGy; p < 0.001).
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14
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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: 1.8] [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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15
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Järvinen J, Sierpowska J, Siiskonen T, Husso M, Järvinen H, Kiviniemi T, Rissanen TT, Lindholm C, Matikka H, Larjava HRS, Mäkelä TJ, Strengell S, Eskola M, Parviainen T, Hallinen E, Pirinen M, Kivelä A, Teräs M. CONTEMPORARY RADIATION DOSES IN INTERVENTIONAL CARDIOLOGY: A NATIONWIDE STUDY OF PATIENT SKIN DOSES IN FINLAND. RADIATION PROTECTION DOSIMETRY 2020; 188:181-190. [PMID: 31838516 DOI: 10.1093/rpd/ncz273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/13/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
In contemporary interventional cardiology, for typical elderly patients, the most severe radiation-related harm to patients can be considered to come from skin exposures. In this paper, maximum local skin doses in cardiological procedures are explored with Gafchromic film dosimetry. Film and reader calibrations and reading were performed at the Secondary Standards Dosimetry Laboratory of the Radiation and Nuclear Safety Authority (STUK), and data were gathered from seven hospitals in Finland. As alert levels for early transient erythema, 200 Gycm2 kerma area product (KAP) and 2000 mGy air kerma levels for transcatheter aortic valve implantations (TAVI) procedures are proposed. The largest doses were measured in TAVI (4158.8 mGy) and percutaneous coronary interventions (PCI) (941.68 mGy). Accuracies of the GE DoseWatch and Siemens CareMonitor skin dose estimates were reasonable, but more results are needed to reliably assess and validate the tools' capabilities and reliabilities. Uncertainty of the Gafchromic dosimetry was estimated as 9.1% for a calibration with seven data points and 19.3% for a calibration with five data points.
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Affiliation(s)
- Jukka Järvinen
- Department of Cardiology, Turku Heart Centre, Turku University Hospital, Turku, 20521 Finland
- Department of Radiology, Turku University Hospital, Turku, 20521 Finland
- Department of Medical Physics, Turku University Hospital, Turku, 20521 Finland
| | - Joanna Sierpowska
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, 80210 Finland
| | - Teemu Siiskonen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Minna Husso
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, 70210 Finland
| | - Hannu Järvinen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Tuomas Kiviniemi
- Department of Cardiology, Turku Heart Centre, Turku University Hospital, Turku, 20521 Finland
| | - Tuomas T Rissanen
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, 80210 Finland
| | - Carita Lindholm
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Hanna Matikka
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, 70210 Finland
| | - Heli R S Larjava
- Department of Medical Imaging, Central Finland Health Care District, Jyväskylä, 40620 Finland
| | - Timo J Mäkelä
- Division of Cardiology, Department of Internal Medicine, Oulu University Hospital, Oulu, 90220 Finland
| | - Satu Strengell
- Cardiology division, Heart and lung center, Helsinki University Hospital, Helsinki, 00029 Finland
| | - Markku Eskola
- Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere, Finland and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, 33520 Finland
| | - Teuvo Parviainen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Elina Hallinen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Markku Pirinen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Antti Kivelä
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, 70210 Finland
| | - Mika Teräs
- Department of Medical Physics, Turku University Hospital, Turku, 20521 Finland
- Institute of Biomedicine, University of Turku, Turku, 20521 Finland
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16
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Ou-Saada I, Boujemaa S, Campoleoni M, Brambilla R, Bentayeb F. Local Diagnostic Reference Levels in Interventional Radiology. J Med Imaging Radiat Sci 2020; 51:307-311. [PMID: 32278664 DOI: 10.1016/j.jmir.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Interventional cardiology procedures, during which live images are acquired, involve exposure to x-rays. The use of fluoroscopy can cause high radiation doses to patients and operators because of the prolonged duration of x-ray emission. For this reason, special attention and constant vigilance represent challenges for commissions and groups of experts in the field. The purpose of this study is to establish local diagnostic reference levels (DRLs) for these procedures, to improve radiological practice, and to optimize radiation doses. METHODS This work was carried out in two university hospitals and two private medical facilities in Rabat, the capital of Morocco, during the period 2017-2018. The study concerns 657 interventional cardiology procedures (457 coronary angiography [CA] and 200 percutaneous transluminal coronary angioplasty [PTCA]), performed by 11 cardiologists on different installations in 5 catheterization rooms. The data collected for each procedure were patient age, height and weight, dosimeter indicators in terms of dose area product (PKA), total air kerma at the reference point (Kar), fluoroscopy time (FT), and the number of frames, together with the primary beam parameters as kV and total mAs. The proposed DRLs were set from the 75th percentile of the PKA and FT. RESULTS The mean of PKA for CA and PTCA procedures were 29.2 Gy∗cm2 and 70.4 Gy∗cm2, respectively, the mean of fluoroscopy time were 4.0 min and 12.17 min for 334 and 685 frames, respectively. Results for the local DRLs were 37.3 and 87.1 Gy cm2 for PKA and 4.48 and 16.15 min for FT, corresponding to CA and PTCA procedures. CONCLUSION This work focuses on proposing local DRLs in Morocco for CA and PTCA procedures. The results show that the values found conform with those of international studies.
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Affiliation(s)
- Imane Ou-Saada
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco
| | - Soumaya Boujemaa
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco
| | - Mauro Campoleoni
- Unità Operativa di Fisica Medica "Fondazione Ca 'Granda - Ospedale Maggiore Policlinico", Milano, Italy
| | - Roberto Brambilla
- Unità Operativa di Fisica Medica "Fondazione Ca 'Granda - Ospedale Maggiore Policlinico", Milano, Italy
| | - Farida Bentayeb
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco.
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17
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Compagnone G, Padovani R, D'Ercole L, Orlacchio A, Bernardi G, D'Avanzo MA, Grande S, Palma A, Campanella F, Rosi A. Provision of Italian diagnostic reference levels for diagnostic and interventional radiology. Radiol Med 2020; 126:99-105. [PMID: 32239471 DOI: 10.1007/s11547-020-01165-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The diagnostic reference level (DRL) is a useful tool for the optimisation of medical exposures. Thus, a Working Party coordinated by the Italian National Institute of Health and the National Workers Compensation Authority has been formed to provide Italian DRLs, for both diagnostic and interventional procedures, to be used as appropriate for the implementation of the 2013/59 European Directive into the national regulation. MATERIALS AND METHODS The multidisciplinary Working Party was formed by professionals involved in diagnostic and interventional radiology medical exposures and started from a critical revision of both the literature and the results of previous Italian surveys. The procedures were divided into five sections for adult (projection radiography, mammography, diagnostic fluoroscopy, CT and interventional radiology) and two sections for paediatric patients (projection radiography and CT). The provided DRL values have been identified for "normal" adult patients and for age-classes of paediatric patients. RESULTS Some of the DRL values provided by the Working Party are reported in this study as an example, divided by adult/paediatric patients, radiological technique and examination: specifically, DRLs for new radiological practices and new dose quantities as DRLs metric were introduced. The median value (rather than the mean) for each procedure, derived from a sample of patients, has to be compared with the corresponding DRL value, and dosimetric data related to a minimum number of patients should be collected for each examination. CONCLUSIONS The approach to the definition and use of DRLs through guidelines of national Authorities in collaboration with scientific Associations should simplify the periodical updating and could be useful for keeping the optimisation of medical exposures faithful to the development of radiological practice.
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Affiliation(s)
- Gaetano Compagnone
- Department of Medical Physics, S.Orsola-Malpighi University Hospital, Via Massarenti, 9, 40138, Bologna, BO, Italy.
| | - Renato Padovani
- Abdus Salam International Centre for Theoretical Physics, Trieste, Italy
| | - Loredana D'Ercole
- Department of Medical Physics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Orlacchio
- Department of Radiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Maria Antonietta D'Avanzo
- Department of Medicine Epidemiology and Environmental Sanitation, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro (INAIL), Rome, Italy
| | - Sveva Grande
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Alessandra Palma
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Francesco Campanella
- Department of Medicine Epidemiology and Environmental Sanitation, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro (INAIL), Rome, Italy
| | - Antonella Rosi
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
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18
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Järvinen J, Sierpowska J, Siiskonen T, Järvinen H, Kiviniemi T, Rissanen TT, Matikka H, Niskanen E, Hurme S, Larjava HRS, Mäkelä TJ, Strengell S, Eskola M, Parviainen T, Hallinen E, Pirinen M, Kivelä A, Teräs M. CONTEMPORARY RADIATION DOSES IN INTERVENTIONAL CARDIOLOGY: A NATIONWIDE STUDY OF PATIENT DOSES IN FINLAND. RADIATION PROTECTION DOSIMETRY 2019; 185:483-493. [PMID: 30989216 DOI: 10.1093/rpd/ncz041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/01/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
The amount of interventional procedures such as percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI), pacemaker implantation (PI) and ablations has increased within the previous decade. Simultaneously, novel fluoroscopy mainframes enable lower radiation doses for patients and operators. Therefore, there is a need to update the existing diagnostic reference levels (DRLs) and propose new ones for common or recently introduced procedures. We sought to assess patient radiation doses in interventional cardiology in a large sample from seven hospitals across Finland between 2014 and 2016. Data were used to set updated national DRLs for coronary angiographies (kerma-air product (KAP) 30 Gycm2) and PCIs (KAP 75 cm2), and novel levels for PIs (KAP 3.5 Gycm2), atrial fibrillation ablation procedures (KAP 25 Gycm2) and TAVI (KAP 90 Gycm2). Tentative KAP values were set for implantations of cardiac resynchronization therapy devices (CRT, KAP 22 Gycm2), electrophysiological treatment of atrioventricular nodal re-entry tachycardia (6 Gycm2) and atrial flutter procedures (KAP 16 Gycm2). The values for TAVI and CRT device implantation are published for the first time on national level. Dose from image acquisition (cine) constitutes the major part of the total dose in coronary and atrial fibrillation ablation procedures. For TAVI, patient weight is a good predictor of patient dose.
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Affiliation(s)
- Jukka Järvinen
- Department of Cardiology, Turku Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Radiology, The Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Joanna Sierpowska
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, Finland
| | | | - Hannu Järvinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Tuomas Kiviniemi
- Department of Cardiology, Turku Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas T Rissanen
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, Finland
| | - Hanna Matikka
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Eini Niskanen
- Department of Radiology, Vaasa Central Hospital, Vaasa, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku
| | - Heli R S Larjava
- Department of Medical Imaging, Central Finland Health Care District, Jyväskylä, Finland
| | - Timo J Mäkelä
- Department of Internal Medicine, Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Satu Strengell
- Department of Cardiology, Cardiology Division, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Markku Eskola
- Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere, Finland and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | | | - Elina Hallinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Markku Pirinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Antti Kivelä
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Mika Teräs
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Department of Biomedicine, Institute of Biomedicine, University of Turku, Turku, Finland
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19
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Mattar E, Alsafi K, Sulieman A, Suliman II. Occupational exposure of the operator eye lens in digital coronary angiography and interventions. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2019.108400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Crowhurst JA, Scalia GM, Whitby M, Murdoch D, Robinson BJ, Turner A, Johnston L, Margale S, Natani S, Clarke A, Burstow DJ, Raffel OC, Walters DL. Radiation Exposure of Operators Performing Transesophageal Echocardiography During Percutaneous Structural Cardiac Interventions. J Am Coll Cardiol 2019; 71:1246-1254. [PMID: 29544609 DOI: 10.1016/j.jacc.2018.01.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transesophageal echocardiography operators (TEEOP) provide critical imaging support for percutaneous structural cardiac intervention procedures. They stand close to the patient and the associated scattered radiation. OBJECTIVES This study sought to investigate TEEOP radiation dose during percutaneous structural cardiac intervention. METHODS Key personnel (TEEOP, anesthetist, primary operator [OP1], and secondary operator) wore instantly downloadable personal dosimeters during procedures requiring TEE support. TEEOP effective dose (E) and E per unit Kerma area product (E/KAP) were calculated. E/KAP was compared with C-arm projections. Additional shielding for TEEOP was implemented, and doses were measured for a further 50 procedures. Multivariate linear regression was performed to investigate independent predictors of radiation dose reduction. RESULTS In the initial 98 procedures, median TEEOP E was 2.62 μSv (interquartile range [IQR]: 0.95 to 4.76 μSv), similar to OP1 E: 1.91 μSv (IQR: 0.48 to 3.81 μSv) (p = 0.101), but significantly higher than secondary operator E: 0.48 μSv (IQR: 0.00 to 1.91 μSv) (p < 0.001) and anesthetist E: 0.48 μSv (IQR: 0.00 to 1.43 μSv) (p < 0.001). Procedures using predominantly right anterior oblique (RAO) and steep RAO projections were associated with high TEEOP E/KAP (p = 0.041). In a further 50 procedures, with additional TEEOP shielding, TEEOP E was reduced by 82% (2.62 μSv [IQR: 0.95 to 4.76] to 0.48 μSv [IQR: 0.00 to 1.43 μSv] [p < 0.001]). Multivariate regression demonstrated shielding, procedure type, and KAP as independent predictors of TEEOP dose. CONCLUSION TEE operators are exposed to a radiation dose that is at least as high as that of OP1 during percutaneous cardiac intervention. Doses were higher with procedures using predominantly RAO projections. Radiation doses can be significantly reduced with the use of an additional ceiling-suspended lead shield.
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Affiliation(s)
- James A Crowhurst
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia.
| | - Gregory M Scalia
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
| | - Mark Whitby
- Biomedical Technical Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Dale Murdoch
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
| | - Brendan J Robinson
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Arianwen Turner
- Medical Imaging Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Liesie Johnston
- Medical Imaging Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Swaroop Margale
- Department of Anaesthesia, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Sarvesh Natani
- Department of Anaesthesia, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Andrew Clarke
- Department of Cardio-thoracic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Darryl J Burstow
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
| | - Owen C Raffel
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
| | - Darren L Walters
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
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21
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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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22
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Osei B, Xu L, Johnston A, Darko S, Darko J, Osei E. Retrospective study of patients radiation dose during cardiac catheterization procedures. Br J Radiol 2019; 92:20181021. [PMID: 31045448 PMCID: PMC6636266 DOI: 10.1259/bjr.20181021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory. METHODS We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient's clinical radiation dose data [kerma-area-product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital's RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software. RESULTS The overall patient median age was 67.0 (range: 26.0-97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9-61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1-203.2), 80.2 (18.9-208.5), 83.7 (48.0-246.1), 113.8 (60.9-284.5), 91.7 (6.0-426.0) and 51.1 (7.0-175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3-3794.0), 1384.7 (291.7-4021.8), 1607.0 (883.5-4448.3), 2260.2 (867.4-5311.9), 1589.3 (100.2-7237.4) and 463.8 (67.7-1695.9) mGy respectively. CONCLUSION We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories. ADVANCES IN KNOWLEDGE We have investigated local patients' radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.
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Affiliation(s)
| | | | | | - Sara Darko
- Department of Clinical Trials, Grand River Regional Cancer Centre, Kitchener, ON, Canada
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Al-Jabri AJ, Alzimami K, Alsafi K, Alaamer AS, Al-Rajhi MA, Suliman II. RETROSPECTIVE ANALYSIS OF PATIENT RADIATION DOSES IN DIGITAL CORONARY ANGIOGRAPHY AND INTERVENTIONS. RADIATION PROTECTION DOSIMETRY 2019; 183:496-501. [PMID: 30260437 DOI: 10.1093/rpd/ncy168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/19/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
This study sought to assess patient and operator eye lens doses in diagnostic coronary angiography (DCA) and percutaneous coronary interventions (PCI) in a University hospital in Oman. Kerma area product (PkA), cumulative air kerma (CAK) and fluoroscopic time (FT) were retrospectively recorded from the DICOM header for 264 patients. The median (interquartile range) of FT, PKA and CAK were: 5.3 min (2.6-10.5), 60.9 Gy cm2 (41.3-91.4) and 0.86 Gy (0.61-1.29), respectively, for DCA procedures, and they were 20.2 min (13.3-30.1), 174.0 Gy cm2 (113.7-253.3) and 2.6 Gy (1.8-3.9), respectively, for PCI procedures. The results revealed wide variability in patient doses among individual patients. Monitoring and recording patient dose data can be valuable for quality assurance and patient safety purposes. Feedback to the operator may help optimize radiation doses to patients and prompt further action, as needed.
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Affiliation(s)
- Amna J Al-Jabri
- Department of Radiology and Molecular Imaging, Medical Physics Section, College of Medicine & Health Sciences, Sultan Qaboos University, Al-Khod 123, Oman
| | - Khalid Alzimami
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - K Alsafi
- Department of Radiology, Medical Physics Unit, King Abdul Aziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz S Alaamer
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
| | - M A Al-Rajhi
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
| | - I I Suliman
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
- Sudan Atomic Energy Commission, Institute of Nuclear and Radiological Safety, Khartoum, Sudan
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Fernandez R, Ellwood L, Barrett D, Weaver J. Effectiveness of protection strategies for reducing radiation exposure in proceduralists during cardiac catheterization procedures: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:660-666. [PMID: 30889072 DOI: 10.11124/jbisrir-2017-003834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
REVIEW QUESTION What is the effectiveness of radiation protection strategies for reducing the radiation dose received by the proceduralist during cardiac catheterization procedures?
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Affiliation(s)
- Ritin Fernandez
- Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Centre of Excellence, Australia
- Centre for Research in Nursing and Health, St George Hospital, Sydney, Australia
- School of Nursing, University of Wollongong, Sydney, Australia
| | - Laura Ellwood
- Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Centre of Excellence, Australia
- Centre for Research in Nursing and Health, St George Hospital, Sydney, Australia
| | - David Barrett
- Interventional Cardiology, St Andrews Private Hospital, Ipswich, Australia
| | - James Weaver
- Cardiology Department, St George Hospital, Sydney, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
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Crowhurst JA, Whitby M, Savage M, Murdoch D, Robinson B, Shaw E, Gaikwad N, Saireddy R, Hay K, Walters DL. Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography. J Med Radiat Sci 2019; 66:20-29. [PMID: 30488575 PMCID: PMC6399189 DOI: 10.1002/jmrs.315] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/27/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Diagnostic coronary angiography (CA) uses ionising radiation with relatively high doses, which impact on both patients and staff. This study sought to identify which patient and procedural factors impact patient and operator dose the most during CA. METHODS Patient and procedure related variables impacting on Kerma area product (PKA ) and operator dose (OD) were collected for 16 months. Procedures were separated into 10 different procedure categories. PKA was used for patient dose and OD was measured with an instantly downloadable dosimeter (IDD) - downloaded at the end of each procedure. High and low radiation dose was defined by binary variables based on the 75th percentile of the continuous measures. Univariate and multivariate regression were used to identify predictors. RESULTS Of 3860 patients included, the IDD was worn for 2591 (61.7%). Obesity (BMI > 30 compared to BMI < 25) was the strongest predictor for both a PKA (odds ratio (OR) = 19.1 (95% CI 13.5-26.9) P < 0.001) and OD (OR = 3.3 (2.4-4.4) P < 0.001) above the 75th percentile. Male gender, biplane imaging, the X-ray unit used, operator experience and procedure type also predicted a high PKA . Radial access, male gender, biplane imaging and procedure type also predicted a high OD. CONCLUSION Radiation dose during CA is multifactorial and is dependent on patient and procedure related variables. Many factors impact on both PKA and OD but obesity is the strongest predictor for both patients and operators to receive a high radiation dose.
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Affiliation(s)
- James A. Crowhurst
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Mark Whitby
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Bio‐Medical Technical ServicesThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Michael Savage
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Dale Murdoch
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Brendan Robinson
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Elizabeth Shaw
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Niranjan Gaikwad
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Ramkrishna Saireddy
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Cairns Base HospitalCairnsQueenslandAustralia
| | - Karen Hay
- QIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Darren L. Walters
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
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Badawy MK, Scott M, Farouque O, Horrigan M, Clark DJ, Chan RK. Feasibility of using ultra-low pulse rate fluoroscopy during routine diagnostic coronary angiography. J Med Radiat Sci 2018; 65:252-258. [PMID: 30014587 PMCID: PMC6275254 DOI: 10.1002/jmrs.293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Coronary angiogram, while a powerful diagnostic tool in coronary artery disease, is not without an associated risk from ionising radiation. There are a number of factors that influence the amount of radiation the patient receives during the procedure, some of which are under the control of the operator. One of these is an adjustment of the fluoroscopic pulse rate. This study aims to assess the feasibility of using ultra-low pulse rate (3 pulses per second(pps)) fluoroscopy during routine diagnostic coronary angiogram procedures and the effect it has on fluoroscopy time, diagnostic clarity and radiation dose. METHODS A retrospective study of three operators each undertaking 50 coronary angiogram procedures was performed. One of the operators used a pulse rate of 3 pps and 6 pps for fluoroscopic screening while the control groups used the standard 10 pps mode utilised at this centre. RESULTS Results demonstrated no reduction of diagnostic clarity, up to a 58% reduction in Dose Area Product and no increase in fluoroscopy time with the 3 pps setting. CONCLUSIONS Findings from this pilot study suggest that utilisation of ultra-low pulse rate fluoroscopy in routine transfemoral diagnostic coronary angiography in the catheterisation laboratory is feasible.
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Affiliation(s)
- Mohamed Khaldoun Badawy
- Monash ImagingMonash HealthClaytonVictoriaAustralia
- School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Matthew Scott
- Cardiovascular Procedure CentreWarringal Private Hospital, Ramsay HealthcareHeidelbergVictoriaAustralia
| | - Omar Farouque
- Department of CardiologyAustin HealthHeidelbergVictoriaAustralia
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Mark Horrigan
- Department of CardiologyAustin HealthHeidelbergVictoriaAustralia
| | - David J. Clark
- Department of CardiologyAustin HealthHeidelbergVictoriaAustralia
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Robert K. Chan
- Department of CardiologyAustin HealthHeidelbergVictoriaAustralia
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Ngaile JE, Msaki PK, Mvungi R, Schreiner LJ. PRELIMINARY INVESTIGATION OF RADIATION DOSE TO PATIENTS FROM CARDIOVASCULAR INTERVENTIONAL PROCEDURES IN TANZANIA. RADIATION PROTECTION DOSIMETRY 2018; 181:317-332. [PMID: 29474654 DOI: 10.1093/rpd/ncy030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Although contemporary cardiac X-ray exams are typically set so benefits outweighs the risk, the growing use and increasing complexity of the cardiovascular interventional radiological (CVIR) procedures does increase the risk of radiation-related tissue effects and stochastic effects to the individual patients and the population. In view of these radiological concerns there is a need to investigate factors that influence the doses received by the patients and enable optimisation needed. The air kerma area product (KAP), cumulative air kerma (CAK) and fluoroscopy time (FT) to patients from two major CVIR procedures: coronary angiography (CA) and percutaneous coronary interventions (PCI), were obtained from two major hospitals in Tanzania. The CAK and KAP were determined using ionisation chambers equipped in each angiographic unit. The median values of the KAP, CAK and FT for the CA procedures were 37.8 Gy cm2, 425.5 mGy and 7.6 min, respectively, while for the PCI were 86.5 Gy cm2, 1180.3 mGy and 19.0 min, respectively. The overall differences among individual KAP, CAK and FT values across the two hospitals investigated differed by factors of up to 33.5, 58.7 and 26.3 for the CA, while for the PCI procedures differed by factors of up to 10.9, 25.3 and 13.8, respectively. The mean values of KAP and FT for both CA and PCI were mostly higher than those reported values for Ireland, Belgium, Greece, France, China and Australia. The third quartiles of the KAP, CAK and FT for both CA and PCI were relatively above the preliminary diagnostic reference levels proposed by the IAEA, DIMOND III and SENTINEL. The observed substantial variations of mean values of technical parameters and patient doses (KAP, CAK and FT values) observed for the CA and PCI procedures inter and intra-hospitals were mainly explained by the complexity of the CVIR procedures, the nature of pathology, patient-specific characteristics, the variation in levels of skills and experiences among IC personnel, and the different procedural protocols employed among interventional cardiologists and hospitals. The observed great variations of procedural protocols and patient doses within and across the hospitals and relative higher dose than reported values from the literature call for the need to optimise radiation dose to patient from IC procedures.
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Affiliation(s)
- J E Ngaile
- Department of Physics, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - P K Msaki
- Department of Physics, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - R Mvungi
- Jakaya Kikwete Cardiac Institute, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - L J Schreiner
- Departments of Oncology and Physics, Queens University, Kingston, Onatrio, Canada
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Radiation Dose Optimization in Interventional Cardiology: A Teaching Hospital Experience. Cardiol Res Pract 2018; 2018:6912841. [PMID: 29850228 PMCID: PMC5925206 DOI: 10.1155/2018/6912841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/08/2018] [Indexed: 11/27/2022] Open
Abstract
Radiological interventions play an increasingly relevant role in cardiology. Due to the inherent risks of ionizing radiation, proper care must be taken with monitoring and optimizing the dose delivered in angiograms to pose as low risk as possible to staff and patients. Dose optimization is particularly pertinent in teaching hospitals, where longer procedure times are at times necessary to accommodate the teaching needs of junior staff, and thus impart a more significant radiation dose. This study aims to analyze the effects of different protocol settings in routine coronary angiograms, from the perspective of a large tertiary center implementing a rapid dose reduction program. Routine coronary angiograms were chosen to compare baseline levels of radiation, and the dose imparted before and after dose optimization techniques was measured. Such methods included lowering dose per pulse, fluoroscopic pulse rates, and cine acquisition frame rates. The results showed up to 63% reduction in radiation dose without adverse impact on clinical or teaching outcomes. A 10 fps/low and 5 pps/low setting was found to achieve maximum dose optimization, with the caveat that settings require incremental changes to accommodate for patient complexities.
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Balter S, Brinkman M, Kalra S, Nazif T, Parikh M, Kirtane A, Moses J, Leon M, Feri A, Green P, Ali Z, Liao M, Karmpaliotis D. Novel radiation dose reduction fluoroscopic technology facilitates chronic total occlusion percutaneous coronary interventions. EUROINTERVENTION 2017; 13:e1468-e1474. [DOI: 10.4244/eij-d-16-00216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Crowhurst J, Haqqani H, Wright D, Whitby M, Lee A, Betts J, Denman R. Ultra-low radiation dose during electrophysiology procedures using optimized new generation fluoroscopy technology. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:947-954. [PMID: 28618036 DOI: 10.1111/pace.13141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Electrophysiology procedures require fluoroscopic guidance, with the associated potentially adverse effects of ionizing radiation. Newer fluoroscopy systems have more features that enable dose-reduction strategies. This study aimed to investigate any reduction in radiation dose between an older fluoroscopy system (Philips Integris H5000, Philips Healthcare, Einhoven, Netherlands) and one of the latest systems (Siemens Artis Q, Siemens Healthcare, Erlangen, Germany), optimized with dose-reduction strategies. METHODS Radiation dose measures were collected over a 2-year period in a single electrophysiology laboratory. Procedures were separated into seven groups: devices, biventricular devices, electrophysiology studies, standard radiofrequency ablation, complex atrial ablation, ablation for ventricular arrhythmias, and pulmonary vein isolation. In the first year, an older fluoroscopy system was used, and in the second year, a new system, with dose reduction strategies. Comparisons were also made to the literature with regard to radiation dose levels. RESULTS Patient characteristics, fluoroscopy times, number of digital acquisitions, procedural times, and procedural success were largely similar between the old and new system across procedure groups. Overall dose area product (DAP) was reduced by 91% (5.0 [2.0-17.0] to 0.45 [0.16-2.61] Gycm2 [P > 0.001]) with the new system and was lower across all groups. DAP readings with the new system are some of the lowest published in the literature in all groups. CONCLUSION An optimized contemporary digital fluoroscopy system, with low radiation dose configuration and continued good procedural practice, can result in ultra-low radiation levels for all electrophysiology procedures, without compromising procedural time or procedural success.
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Affiliation(s)
- James Crowhurst
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland
| | - Haris Haqqani
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland
| | - Daniel Wright
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Mark Whitby
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston Queensland, Australia
| | - Adam Lee
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - John Betts
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Russell Denman
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
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Assessment of Local Dose Reference Values for Recanalization of Chronic Total Occlusions and Other Occlusions in a High-Volume Catheterization Center. Am J Cardiol 2015; 116:1179-84. [PMID: 26275581 DOI: 10.1016/j.amjcard.2015.07.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/16/2015] [Accepted: 07/16/2015] [Indexed: 11/22/2022]
Abstract
The increasing number and complexity of these procedures have led to a higher number of patients at risk for tissue reactions like skin injuries. Monitoring of their dose indicators is essential in recognizing these patients. The aim of this work was to determine local diagnostic reference levels (DRLs) for recanalization of chronic total occlusion (CTO) and other occlusions procedures. All data from patients who underwent cardiac procedures were reviewed and classified according to their complexity. Dose indicators such as fluoroscopy time (FT), dose area product (DAP), and air kerma at patient entrance reference point (AKr) were recorded. Correlations with patient's body mass index, operators, procedure strategy, and complexity were studied. For CTO, the mean DAP, AKr, and FT were 252 ± 234 Gycm(2), 3,985 ± 3,579 mGy, and 47 ± 36 minutes, respectively. To better reflect the non-Gaussian distribution of data, the median and the 75th percentile values were also reported: median DAP, 172 Gycm(2); 75th percentile DAP, 350 Gycm(2); median AKr, 2,714 mGy; and 75th percentile AKr, 5,921 mGy. A tentative new set of values were suggested to take into account the complexity difference in recanalization of total occlusions according to their antegrade or retrograde approach. These approach-specific DRLs for total occlusions were mean DAP (120 ± 114 Gycm(2)), mean AKr (1,789 ± 1,933 mGy), and mean FT (22 ± 18 minutes) for antegrade approach and mean DAP (459 ± 304 Gycm(2)), mean AKr (6,881 ± 4,243 mGy), and mean FT (82 ± 40 minutes) for retrograde approach. The other significant values were median DAP (84 Gycm(2)), 75th percentile DAP (147 Gycm(2)), median AKr (1,160 mGy), and 75th percentile AKr (2,176 mGy) for antegrade approach and median DAP (422 Gycm(2)), 75th percentile DAP (552 Gycm(2)), median AKr (6,295 mGy), and 75th percentile AKr (8,064 mGy) for retrograde approach. In conclusion, a set of local DRL values from a large center were assessed. DRLs were provided for antegrade and retrograde approaches, reflecting the difference in difficulty from these 2 kinds of CTOs. The wide dose estimator values variations were explained through procedure complexity. The values obtained for the other more classic percutaneous coronary interventions were comparable with those found in the literature.
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