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Serna Santos J, Uusi-Simola J, Kaasalainen T, Aho P, Venermo M. Radiation Doses to Staff in a Hybrid Operating Room: An Anthropomorphic Phantom Study with Active Electronic Dosimeters. Eur J Vasc Endovasc Surg 2020; 59:654-660. [DOI: 10.1016/j.ejvs.2020.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/15/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
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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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Maghbool M, Hosseini MA. AN ASSESSMENT OF RADIATION EXPOSURE DOSES IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION BASED ON ANGIOGRAPHIC RECORDS. RADIATION PROTECTION DOSIMETRY 2019; 183:474-481. [PMID: 30289545 DOI: 10.1093/rpd/ncy180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
The stochastic and non-stochastic (deterministic) effects of radiation dose in patients undergoing primary percutaneous coronary intervention (PPCI) have been investigated using data recorded by an angiographic monitoring system. A total of 132 patients with acute myocardial infarction referred to the angiography department of Vali-Asr hospital, Fasa, Iran, during the second half of 2016 were recruited. Quantities like dose-area product (DAP), total air kerma (Ka,r) and fluoroscopy time (FT) were calculated and converted into effective dose (ED) and peak skin dose (PSD). The values for Ka,r, DAP and FT equaled 80 399.20 ± 63 312 mGy cm2, 1392.80 ± 1155.373 mGy and 524.11 ± 423.057 s, respectively, which were within the ranges reported in previous studies. After considering standard dose thresholds for Ka,r and PSD, it was revealed that only a small portion of patients had reached these thresholds and exceeded them (<3%). Moreover, ED < 20 mSv for the majority of patients was fairly consistent with results from a recent research in eight Belgian hospitals. It was shown that angiographic records are reliable for assessing radiation dose in patients.
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Affiliation(s)
- M Maghbool
- Nuclear Engineering Department, Islamic Azad University, Arsanjan Branch, Arsanjan, Iran
| | - M A Hosseini
- Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran
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Occupational doses of medical staff and their relation to patient exposure incurred in coronary angiography and intervention. RADIAT MEAS 2016. [DOI: 10.1016/j.radmeas.2015.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cervelli T, Panetta D, Navarra T, Andreassi MG, Basta G, Galli A, Salvadori PA, Picano E, Del Turco S. Effects of single and fractionated low-dose irradiation on vascular endothelial cells. Atherosclerosis 2014; 235:510-8. [PMID: 24953491 DOI: 10.1016/j.atherosclerosis.2014.05.932] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE An increasing number of epidemiological studies suggest that chronic low-dose irradiation increases the risk of atherosclerosis. We evaluated and compared the in vitro biological effects of both single and fractionated low-doses of X-ray irradiation on endothelial cells. METHODS Human umbilical vein endothelial cells (HUVECs) were irradiated with X-rays, with single doses of 0.125, 0.25 and 0.5 Gy or fractionated doses of 2 × 0.125 Gy and 2 × 0.25 Gy, with 24 h interfraction interval. Survival, apoptosis, reactive oxygen species (ROS) production, nuclear factor-κB (NF-κB) activation, intercellular adhesion molecule-1 (ICAM-1) expression, HUVEC adhesiveness and DNA damage were investigated. RESULTS We did not observe any effect on viability and apoptosis. Both single and fractionated doses induced ROS generation, NF-κB activation, ICAM-1 protein expression and HUVEC adhesiveness, but only fractionated doses increase significantly ICAM-1 mRNA. The effects measured after fractionated dose result always higher than those induced by the single dose. Moreover, we observed that DNA double strand break (DSB), visualized with γ-H2AX foci, is dose-dependent and that the kinetics of γ-H2AX foci is not affected by fractionated doses. CONCLUSIONS We showed that single and fractionated low-dose irradiations with low energy X-rays do not affect cell viability and DNA repair. Interestingly, the greater increase of ICAM-1 surface exposure and endothelial adhesiveness observed after fractionated irradiation, suggests that fractionated low-doses may accelerate chronic vascular inflammation, from which the atherosclerotic process can arise.
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Affiliation(s)
- Tiziana Cervelli
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy.
| | - Daniele Panetta
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Teresa Navarra
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Maria Grazia Andreassi
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Giuseppina Basta
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Alvaro Galli
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Piero A Salvadori
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Eugenio Picano
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Serena Del Turco
- CNR, Institute of Clinical Physiology, San Cataldo Research Area, Via Moruzzi, 1, 56124 Pisa, Italy
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Wang W, Zhang M, Zhang Y. Overall measurements of dose to patients in common interventional cardiology procedures. RADIATION PROTECTION DOSIMETRY 2013; 157:348-354. [PMID: 23770572 DOI: 10.1093/rpd/nct147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study was designed to measure peak skin dose (PSD), dose-area product (DAP), cumulative dose (CD) and fluoroscopy time (FT) for interventional cardiology procedures and to evaluate whether patient doses were higher than that in other published data. Three cardiac procedure types, including coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA) and radio frequency (RF) ablation, were entered into the study. Data of four special metrics (PSD, DAP, CD and FT) for these procedures were collected and measured. A total of 238 patients who underwent interventional radiology procedures participated in this study. For every procedure, data about PSD were resulted from six TLD arrays and DAP, CD and FT were collected from the displayed monitor. The mean, standard deviation (SD), range and third quartile of the distribution of PSD, DAP, CD and FT recorded and measured on spot were calculated for all procedures. High-dose cases were specifically recorded. There was wide variation in the doses observed for different instances of the same procedure. PSD for PTCA and RF ablation ranged from 0.1 Gy to more than 3 Gy. Of 238 instances, there were 22 (9.2 %) with PSDs greater than 2 Gy and 4 (1.7 %) than 3 Gy. The third quartile of the distribution for PTCA had exceeded the DIMOND preliminary reference levels by 41.1 % in DAP and 25.0 % in FT. Mean DAP was in the range of reported values for CAG procedure, but higher than all data obtained in literatures for PTCA. Data from this study are in the range of most reported values for CAG and RF ablation procedure, while higher than that obtained in some literatures for PTCA. In case of a constant delivering of high doses to patient and physician himself, thorough training of interventionalists and staff is necessary, and the legislation has to be revised and set dose constrains especially for the interventional high-dose procedures.
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Affiliation(s)
- Weipeng Wang
- Shandong Medical Imaging Research Institute, Jingwu road No.324, Jinan 250021, P. R. China
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Radiation-induced noncancer risks in interventional cardiology: optimisation of procedures and staff and patient dose reduction. BIOMED RESEARCH INTERNATIONAL 2013; 2013:976962. [PMID: 24027768 PMCID: PMC3762166 DOI: 10.1155/2013/976962] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/28/2013] [Accepted: 07/18/2013] [Indexed: 12/18/2022]
Abstract
Concerns about ionizing radiation during interventional cardiology have been increased in recent years as a result of rapid growth in interventional procedure volumes and the high radiation doses associated with some procedures. Noncancer radiation risks to cardiologists and medical staff in terms of radiation-induced cataracts and skin injuries for patients appear clear potential consequences of interventional cardiology procedures, while radiation-induced potential risk of developing cardiovascular effects remains less clear. This paper provides an overview of the evidence-based reviews of concerns about noncancer risks of radiation exposure in interventional cardiology. Strategies commonly undertaken to reduce radiation doses to both medical staff and patients during interventional cardiology procedures are discussed; optimisation of interventional cardiology procedures is highlighted.
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Navarro VCC, Navarro MVT, Maia AF. Assessments of medical exposures during interventional radiology procedures. RADIATION PROTECTION DOSIMETRY 2013; 154:229-236. [PMID: 22908350 DOI: 10.1093/rpd/ncs172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study aims to contribute to the construction of a scenario regarding patient radiation exposure in Brazilian interventional radiology, aiming to provide data for the future drafting of specific legislation on interventional radiology because there is currently a lack of safety regulations for haemodynamics services in this country. Fourteen haemodynamics services in the states of Santa Catarina and Bahia were evaluated. The radiological devices were characterised through measurements of air kerma-area product, entrance surface air kerma (Ke), exposure time, spatial resolution (SR), low-contrast resolution and half-value layer. During the evaluation of instrument parameters, several non-conformities were found according to current Brazilian regulations, with SR presenting the most critical situation. The results of the present study indicate the need for the optimisation of clinical practices in complex radiological procedures, although the overall results for the dose scenario in the present study revealed values similar to those reported in international publications.
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Affiliation(s)
- Valéria Coêlho Costa Navarro
- Department of Basic Sciences, Federal Institute for Education, Science and Technology of Bahia, Street Emídio dos Santos S/N, CEP: 40302-015, Salvador, Bahia, Brazil.
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Miller DL, Hilohi CM, Spelic DC. Patient radiation doses in interventional cardiology in the U.S.: advisory data sets and possible initial values for U.S. reference levels. Med Phys 2012; 39:6276-86. [PMID: 23039663 DOI: 10.1118/1.4754300] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To determine patient radiation doses from interventional cardiology procedures in the U.S and to suggest possible initial values for U.S. benchmarks for patient radiation dose from selected interventional cardiology procedures [fluoroscopically guided diagnostic cardiac catheterization and percutaneous coronary intervention (PCI)]. METHODS Patient radiation dose metrics were derived from analysis of data from the 2008 to 2009 Nationwide Evaluation of X-ray Trends (NEXT) survey of cardiac catheterization. This analysis used identified data and did not require review by an IRB. Data from 171 facilities in 30 states were analyzed. The distributions (percentiles) of radiation dose metrics were determined for diagnostic cardiac catheterizations, PCI, and combined diagnostic and PCI procedures. Confidence intervals for these dose distributions were determined using bootstrap resampling. RESULTS Percentile distributions (advisory data sets) and possible preliminary U.S. reference levels (based on the 75th percentile of the dose distributions) are provided for cumulative air kerma at the reference point (K(a,r)), cumulative air kerma-area product (P(KA)), fluoroscopy time, and number of cine runs. Dose distributions are sufficiently detailed to permit dose audits as described in National Council on Radiation Protection and Measurements Report No. 168. Fluoroscopy times are consistent with those observed in European studies, but P(KA) is higher in the U.S. CONCLUSIONS Sufficient data exist to suggest possible initial benchmarks for patient radiation dose for certain interventional cardiology procedures in the U.S. Our data suggest that patient radiation dose in these procedures is not optimized in U.S. practice.
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Affiliation(s)
- Donald L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA.
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Navarro VCC, Navarro MVT, Maia AF, Oliveira ADD, Oliveira ADSP. Avaliação de exposições médicas em procedimentos pediátricos de radiologia intervencionista. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000400006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar as exposições pediátricas de radiologia intervencionista em dois hospitais do Estado da Bahia, visando contribuir para a construção de um cenário estadual e nacional, possibilitando o conhecimento das exposições e da necessidade de sua otimização, visto que as peculiaridades que envolvem a radiologia e a pediatria se potencializam quando se trata de procedimentos de radiologia intervencionista, em razão das doses elevadas de radiação. MATERIAIS E MÉTODOS: Foram avaliados 32 procedimentos em quatro salas nos dois principais hospitais que realizam procedimentos de radiologia intervencionista pediátrica na Bahia. Foram avaliados os valores de kerma no ar incidente e o produto kerma-área no ar de 27 procedimentos cardiológicos e 5 procedimentos cerebrais. RESULTADOS: Os valores máximos de produto kerma-área e kerma obtidos para procedimentos cardiológicos foram, respectivamente, 129,9 Gy.cm² e 947,0 mGy, e para procedimentos cerebrais, 83,3 Gy.cm² e 961,0 mGy. CONCLUSÃO: Os resultados deste estudo mostraram valores de exposições superiores em até 14 vezes os obtidos em estudos realizados em outros países, chegando próximos de resultados obtidos para procedimentos em adultos. Isto revela quão elevadas podem ser as exposições pediátricas, indicando a necessidade de constante otimização dos procedimentos e avaliação das exposições.
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Seierstad T, Friberg EG, Lervåg C, Widmark A, Wilhelmsen N, Stranden E. Radiation doses to Norwegian heart-transplanted patients undergoing annual coronary angiography. RADIATION PROTECTION DOSIMETRY 2012; 149:403-409. [PMID: 21775318 DOI: 10.1093/rpd/ncr311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Heart-transplanted patients in Norway undergo annual coronary angiography (CA). The aims of this study were to establish a conversion factor between dose-area product and effective dose for these examinations and to use this to evaluate the accumulated radiation dose and risks associated with annual CA. An experienced cardiac interventionist performed a simulated examination on an Alderson phantom loaded with thermoluminescence dosemeters. The simulated CA examination yielded a dose-area product of 17 Gy cm(2) and an effective dose of 3.4 mSv: the conversion factor between dose-area product and effective dose was 0.20 mSv Gy cm(-2). Dose-area product values from 200 heart-transplanted patients that had undergone 906 CA examinations between 2001 and 2008 were retrieved from the institutional database. Mean dose-area product from annual CA was 25 Gy cm(2), ranging from 2 to 140 Gy cm(2). Mean number of CA procedure was 8 (range, 1-23). Mean accumulated effective dose for Norwegian heart-transplanted patients between 2001 and 2008 was 34 mSv (range, 5-113 mSv). Doses and radiation risks for heart-transplanted patients are generally low, because most heart transplantations are performed on middle-aged patients with limited life expectancy. Special concern should however be taken to reduce doses for young heart-transplanted patients who are committed to lifelong follow-up of their transplanted heart.
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Affiliation(s)
- Therese Seierstad
- Faculty of Health Sciences, Buskerud University College, Kongsberg, PO Box 7053, N-3007 Drammen, Norway.
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Samara ET, Aroua A, De Palma R, Stauffer JC, Schmidt S, Trueb PR, Stuessi A, Treier R, Bochud F, Verdun FR. An audit of diagnostic reference levels in interventional cardiology and radiology: are there differences between academic and non-academic centres? RADIATION PROTECTION DOSIMETRY 2012; 148:74-82. [PMID: 21335331 DOI: 10.1093/rpd/ncq600] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A wide variation in patient exposure has been observed in interventional radiology and cardiology. The purpose of this study was to investigate the patient dose from fluoroscopy-guided procedures performed in non-academic centres when compared with academic centres. Four procedures (coronary angiography, percutaneous coronary intervention, angiography of the lower limbs and percutaneous transluminal angioplasty of the lower limbs) were evaluated. Data on the dose-area product, fluoroscopy time and number of images for 1000 procedures were obtained from 23 non-academic centres and compared with data from 5 academic centres. No differences were found for cardiology procedures performed in non-academic centres versus academic ones. However, significantly lower doses were delivered to patients for procedures of the lower limbs when they were performed in non-academic centres. This may be due to more complex procedures performed in the academic centres. Comparison between the centres showed a great variation in the patient dose for these lower limb procedures.
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Affiliation(s)
- E T Samara
- Institute of Radiation Physics, University Hospital Centre and University of Lausanne, Grand-Pré 1, 1007 Lausanne, Switzerland.
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Miller DL, Balter S, Schueler BA, Wagner LK, Strauss KJ, Vañó E. Clinical radiation management for fluoroscopically guided interventional procedures. Radiology 2010; 257:321-32. [PMID: 20959547 DOI: 10.1148/radiol.10091269] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The primary goal of radiation management in interventional radiology is to minimize the unnecessary use of radiation. Clinical radiation management minimizes radiation risk to the patient without increasing other risks, such as procedural risks. A number of factors are considered when estimating the likelihood and severity of patient radiation effects. These include demographic factors, medical history factors, and procedure factors. Important aspects of the patient's medical history include coexisting diseases and genetic factors, medication use, radiation history, and pregnancy. As appropriate, these are evaluated as part of the preprocedure patient evaluation; radiation risk to the patient is considered along with other procedural risks. Dose optimization is possible through appropriate use of the basic features of interventional fluoroscopic equipment and intelligent use of dose-reducing technology. For all fluoroscopically guided interventional procedures, it is good practice to monitor radiation dose throughout the procedure and record it in the patient's medical record. Patients who have received a clinically significant radiation dose should be followed up after the procedure for possible deterministic effects. The authors recommend including radiation management as part of the departmental quality assurance program.
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Affiliation(s)
- Donald L Miller
- Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889-5600, USA.
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15
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Local skin and eye lens equivalent doses in interventional neuroradiology. Eur Radiol 2009; 20:725-33. [DOI: 10.1007/s00330-009-1598-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 07/13/2009] [Indexed: 11/26/2022]
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Pantos I, Patatoukas G, Katritsis DG, Efstathopoulos E. Patient radiation doses in interventional cardiology procedures. Curr Cardiol Rev 2009; 5:1-11. [PMID: 20066141 PMCID: PMC2803281 DOI: 10.2174/157340309787048059] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/01/2008] [Accepted: 08/01/2008] [Indexed: 11/22/2022] Open
Abstract
Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography, percutaneous coronary interventions, diagnostic electrophysiology studies and radiofrequency catheter ablation. Patient radiation dose in these procedures can be assessed either by measurements on a series of patients in real clinical practice or measurements using patient-equivalent phantoms. In this article we review the derived doses at non-pediatric patients from 72 relevant studies published during the last 22 years in international scientific literature. Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. Discrepancies of the derived results are patient-, procedure-, physician-, and fluoroscopic equipmentrelated. Nevertheless, interventional cardiology procedures can subject patients to considerable radiation doses. Efforts to minimize patient exposure should always be undertaken.
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Affiliation(s)
- Ioannis Pantos
- Department of Cardiology, Athens Euroclinic, Athens, Greece
- 2 Department of Radiology, Medical Physics Unit, University of Athens, Athens, Greece
| | - Georgios Patatoukas
- 2 Department of Radiology, Medical Physics Unit, University of Athens, Athens, Greece
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Mesbahi A, Aslanabadi N. A study on patients' radiation doses from interventional cardiac procedures in Tabriz, Iran. RADIATION PROTECTION DOSIMETRY 2008; 132:375-380. [PMID: 19106178 DOI: 10.1093/rpd/ncn310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Interventional cardiac procedures produce a large amount of X-ray exposures to the patients in comparison with other conventional X-ray imaging procedures. In the current study, the exposure parameters of 580 patients referred to a cardiac angiography department were recorded. The mean values of total kerma-area product (KAP) were 18.6 Gy cm2 for coronary angiography (CA) and 55 Gy cm2 for percutaneous transluminal coronary angioplasty (PTCA). The mean fluoroscopy time was 3.2 and 11.6 min, respectively, for CA and PTCA. The patients' exposure parameters during electrophysiological studies were 15.5 min for mean fluoroscopy time and 33.9 Gy cm2 for total KAP. For paediatrics, the mean fluoroscopy time of 5.4 min and total KAP of 2 Gy cm2 were recorded. Comparing the proposed reference values, the authors think that the exposure level of patients in their department is at an acceptable level.
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Affiliation(s)
- Asghar Mesbahi
- Medical Physics Department, Medical School, Tabriz University of Medical Sciences, and Radiation Oncology Department, Imam Khomeini Hospital, Tabriz, Iran.
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Mesbahi A, Aslanabadi N, Mehnati P. A study on the impact of operator experience on the patient radiation exposure in coronary angiography examinations. RADIATION PROTECTION DOSIMETRY 2008; 132:319-323. [PMID: 19088105 DOI: 10.1093/rpd/ncn300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of the current study was to investigate the effect of cardiologists' experience on the patient received dose during coronary angiography. The exposure parameters including fluoroscopy time, total kerma-area product (KAP), total air-kerma, fluoroscopy and cine acquisition KAP and air-kerma for five senior cardiologists with the experience of 6-10 y were recorded. The range of values for fluoroscopy time and total KAP were 2.17- 4.19 min and 12.06-21.06 Gy cm(2), respectively, in our diagnostic coronary examinations, which was below the recommended reference values. The differences among cardiologists were analysed statistically using one-way ANOVA test. The fluoroscopy KAP and air-kerma results showed statistically significant differences between cardiologists. However, the experience of the cardiologists showed no relation with patient received dose. According to the results, training in radiation protection as a requisite for interventional cardiologists was recommended.
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Affiliation(s)
- Asghar Mesbahi
- Medical Physics Department, Tabriz University of Medical Sciences, Iran.
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Abstract
Interventional fluoroscopy procedures are increasingly important in medical practice. As new procedures are introduced and validated, they tend to replace the equivalent surgical procedure. There is wide variation in patient dose, both among procedures and for a specific procedure. Stochastic risk is present, but interventional fluoroscopy procedures may also present deterministic risk. Radiation risk/benefit analyses are different for interventional fluoroscopy procedures than they are for diagnostic imaging procedures. The radiation risk component of an interventional fluoroscopy procedure is substantially less than the other procedural risks, and there is always clear and measurable benefit to the patient from a successful procedure. Optimizing patient dose will require both improvements in equipment technology and greater attention from regulators, accrediting bodies and medical organizations. Ensuring adequate operator training is essential.
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Affiliation(s)
- Donald L Miller
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD 20814, USA.
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Mohan I, Hitos K, White G, Harris J, Stephen M, May J, Swinnen J, Fletcher J. Improved Outcomes with Endovascular Stent Grafts for Thoracic Aorta Transections. Eur J Vasc Endovasc Surg 2008; 36:152-157. [DOI: 10.1016/j.ejvs.2008.03.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 03/28/2008] [Indexed: 11/30/2022]
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KAWABE A, TAKEDA Y, NAKAGIRI Y. Reduction in patient skin dose during interventional radiology with the use of an air gap substitute. Br J Radiol 2008; 81:474-8. [DOI: 10.1259/bjr/32192801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bogaert E, Bacher K, Thierens H. Interventional cardiovascular procedures in Belgium: effective dose and conversion factors. RADIATION PROTECTION DOSIMETRY 2008; 129:77-82. [PMID: 18385181 DOI: 10.1093/rpd/ncn021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Effective dose (E), representing the risk of late radiation-induced effects, can be estimated by the use of conversion factors (CF), converting direct measurable quantities such as dose-area-product into E. Eight Belgian hospitals participated in the study with a total number of 318 procedures. E-values, calculated with PCXMC, were compared for the different hospitals for diagnostic and therapeutic procedures separately. E-values varied significantly depending on the hospital where the procedure was performed (P < 0.001), on filtration insertion (P < 0.001), on whether a centre is a training centre or not, the dose conscious action of the cardiologists and the complexity of the procedure (P < 0.001). Hospital-specific CF were calculated. An average CF of 0.185 mSv Gycm(-2) was obtained with a satisfactory correlation (r = 0.966, P < 0.001). The differences in CF between hospitals were due to, a large extent, the availability of additional filtration in cinegraphy mode (P < 0.001) and not to the differences in irradiation geometries in the clinical protocol of the interventional procedures.
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Affiliation(s)
- E Bogaert
- Department of Medical Physics and Radiation Protection, University of Ghent, Proeftuinstraat 86, B-9000 Gent, Belgium.
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Antoniou PE, Bousbouras P, Sandaltzopoulos R, Kaldoudi E. Investigating the potential of polymer gel dosimetry for interventional radiology: first results. Phys Med Biol 2008; 53:N127-36. [DOI: 10.1088/0031-9155/53/8/n02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Malisan MR, Padovani R, Faulkner K, Malone JF, Vaño E, Jankowski J, Kosunen A. Proposal for a patient database on cardiac interventional exposures for epidemiological studies. RADIATION PROTECTION DOSIMETRY 2008; 129:96-99. [PMID: 18287190 DOI: 10.1093/rpd/ncn036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Relatively high organ doses absorbed by patients in interventional cardiology suggest the opportunity to define these patients as a cohort to be followed forward in time in an epidemiological study of the cancer risks associated with exposure to low-dose ionising radiation. In this paper, the UNSCEAR 2000 Report risk estimates for the most exposed organs/tissues in cardiac interventional procedures are reviewed, as well as the critical features of such an epidemiological study that is anticipated to have an intrinsically low statistical power because of the low levels of risk and possible confounding factors. To overcome these limitations, data collected in different institutions can be combined provided that a common design and conduct are used for dose assessment. A minimum dataset to be collected on a patient basis is proposed that can be implemented routinely in most facilities. This data should be linked to the local patient information system in order to retrieve all the exposures of a given patient.
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Affiliation(s)
- M R Malisan
- Medical Physics Department, University Hospital, Udine, Italy.
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