Cardiology fellows-in-training are exposed to relatively high levels of radiation in the cath lab compared with staff interventional cardiologists-insights from the RECAP trial

Challenges in coronary angiography through radial artery access due to anatomic variations: A single-center experience

BACKGROUND

Radial artery (RA) access has become common in cardiac catheterization due to fewer vascular complications and MACE compared to transfemoral approach (TFA). However, anatomic variations are more common in the upper-extremity.

METHODS

We performed a single-center retrospective analysis of 926 patients from January 2010 to January 2023 who underwent coronary angiography through transradial approach (TRA) via the right upper-extremity where RA angiogram was performed. Outcomes included anatomic variations, sociodemographic and health characteristics, adverse outcomes, and procedural challenges. Multivariate logistic regression was utilized to estimate the odds ratio of the association between anatomic variations and adverse outcomes and procedural challenges.

RESULTS

Our analysis included 926 patients with a mean age of 59.9 years. Approximately 32.3 % of patients had at least one anatomic variation. Individual variations included 14.4 % radial tortuosity, 12 % high bifurcation, 11.9 % M-sign, and 1 % RA loops. These patients were older (P < 0.001) and more likely to have hyperlipidemia (P = 0.049). They had high odds of high contrast dose (>73.7 mL) (OR = 1.73, P < 0.001), long fluoroscopy time (>10.7 mins) (OR = 2.02, P < 0.001), high radiation exposure (>1120 mGy) (OR = 2.47, P < 0.001), difficulty engaging coronary arteries (OR = 2.70, P < 0.001), and transfer to TFA (OR = 4.89, P < 0.001). Females (OR = 2.89, P < 0.001) and smaller RA size (OR = 2.61, P < 0.001) were associated with spasm. Major complications were not significant.

CONCLUSIONS

We found a high prevalence of anatomic variations in the upper-extremity vasculature. They were associated with high odds of high contrast dose, long fluoroscopy time, high radiation exposure, and procedural challenges during TRA coronary angiography. The rate of major complications was not significant in these patients.

A multicentre survey of knowledge and implementation of radiation protection techniques in cardiac cath-lab medical personnel

BACKGROUND

Awareness of radiation hazards and methods to reduce radiation dose is a sine qua non for all staff working in the cath-lab for their own safety and their patient's safety.

RESULTS

There were large variations in the implementation of radiation protection techniques with overall inadequate radiation risk knowledge. Some members of the cath-lab team are at higher risk of radiation-induced side effects, including the fellows, nurses, technicians, and anaesthesiologists because they spent longer time in the cath-lab and/or their position in relation to the source of radiation. About 10% of the participants have reported different health problems potentially induced by radiation exposure.

CONCLUSIONS

There is lack of radiation risks knowledge with inadequate radiation protection practice among cath-lab team. Some members such as fellows, nurse, technicians, and cardiac anaesthesiologist are at higher risks. They represent the forgotten members of the Cath-Lab team.

Update on Radiation Safety in the Cath Lab - Moving Toward a "Lead-Free" Environment

Radiation exposure in the cardiac catheterization laboratory (CCL) is an occupational hazard that predisposes health care workers to the development of adverse health effects such as cataracts, cancer, and orthopedic injury. To mitigate radiation exposure, personal protective shielding as well as permanently installed shields reduces these adverse effects. Yet, heavy protective lead aprons and poor ergonomics required for positioning movable shields remain barriers to a safer environment. Recent innovations to enhance personal protective equipment and revolutionize fixed shielding systems will permit the CCL team to work in a personal "lead-free" environment, markedly reducing occupational hazards. The purpose of this review is to update the status and future of radiation protection in the CCL.

Fluoroscopy time and scattered radiation during electrophysiology procedures: analysis of one-year data of a laboratory providing electrophysiology training

OBJECTIVES

Patients and medical staff expose to significant radiation during electro-physiological (EP) procedures. There are few data regarding the leading factors of longer fluoroscopy time and higher scattered radiation in a laboratory giving EP training during those interventions.

MATERIAL AND METHODS

The patients' recordings that underwent EP procedure in a single centre arrhythmia unit from February 2019 to January 2020 were examined. Prospectively collected data regarding procedure duration, fluoroscopy time and total air kerma, demographic characteristics of the patients, type of procedure, success of ablation and the use of electro anatomic mapping were retrospectively evaluated. Predictors of total air kerma were analysed with linear regression analysis.

RESULTS

Study population consisted of 437 patients with a median age of 47 (39-56); 184 (42.1%) were male. Median fluoroscopy time was 768 (420-1320) seconds and median cumulative air kerma was 369 (191-750) mGy. Fluoroscopy time and cumulative air kerma were significantly lower in diagnostic EP studies compared to other procedures. There was no difference in terms of total air kerma between the procedures other than the diagnostic EP study. In multivariable linear regression analysis; body surface area, fluoroscopy time, not using the electro-anatomical mapping, unsuccessful ablation and atrial flutter ablation were predictors of total air kerma in EP studies performed by trainees.

CONCLUSION

Scattered radiation during EP procedures performed by in-training operators is related with some factors. Awareness about those may help to effort reducing the harmful effect of ionising radiation.