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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: 0] [Impact Index Per Article: 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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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Comparison of patient and staff temple dose during fluoroscopically guided coronary angiography, implantable cardiac devices, and electrophysiology procedures. Phys Med 2021; 90:142-149. [PMID: 34649045 DOI: 10.1016/j.ejmp.2021.09.011] [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: 09/03/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022] Open
Abstract
There is a paucity of literature comparing patient and staff dose during coronary angiography (CA), implantable cardiac devices, permanent pacemakers (PPM) and electrophysiology (EP) procedures and little noting dose to staff other than cardiologists. This study sought to compare patient and occupational dose during a range of fluoroscopically guided cardiac procedures. Radiation dose levels for the patients (n = 1651), cardiologists (n = 24), scrub (n = 32) and scout nurses (n = 35) were measured in a prospective single-centre study between February 2017 and August 2019. A comparison of dose during CA, device implantation, PPM insertion and EP studies was performed. Three angiographic units were used, with dosimeters worn on the temple of staff. Results indicated that occupational dose during PPM was significantly higher than other procedures. The cardiologist had the highest mean dose during biventricular implantable cardioverter-defibrillators; levels were approximately five times that of 'normal' pacemaker insertions. Transcatheter aortic valve implantations (TAVI) were associated with relatively high mean doses for both staff and patients and had a statistically significant higher (>2 times) mean patient dose area product than all other categories. TAVI workups were also related to higher mean cardiologist and scrub nurse dose. It was observed that the mean scrub nurse dose can exceed that of the cardiologist. The highest mean dose for Scout nurses were recorded during EP studies. Given the significantly higher temple dose associated with PPM insertion, cardiologists should consider utilizing ceiling mounted lead shields, lead glasses and/or skull caps where possible. Efforts should also be made to minimize the use of DSA during TAVI and TAVI workups to reduce cardiologist, nurse and patient dose.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faulty of Science, Queensland Univeristy 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, 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, Queensland Univeristy of Technology, 2 George Street, Brisbane, QLD 4000, Australia
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Bohari A, Hashim S, Ahmad NE, Ghoshal SK, Mohd Mustafa SN. Fluoroscopy-guided intervention procedure norms for occupational eye radiation dose: An overall evaluation. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.108909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cantone MC, Ginjaume M, Martin CJ, Hamada N, Yokoyama S, Bordy JM, Dauer L, Durán A, Jeffries C, Harris W, Kashirina O, Koteng AO, Michelin S, Sudchai W. Report of IRPA task group on issues and actions taken in response to the change in eye lens dose limit. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:1508-1533. [PMID: 33226005 DOI: 10.1088/1361-6498/abb5ec] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
In 2018, the International Radiation Protection Association (IRPA) established its third task group (TG) on the implementation of the eye lens dose limit. To contribute to sharing experience and raising awareness within the radiation protection community about protection of workers in exposure of the lens of the eye, the TG conducted a questionnaire survey and analysed the responses. This paper provides an overview of the results of the questionnaire.
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Affiliation(s)
| | - Merce Ginjaume
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Colin J Martin
- University of Glasgow, Gartnavel Royal Hospital, Glasgow, United Kingdom
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | | | - Jean-Marc Bordy
- CEA, LIST, Laboratoire National Henri Becquerel, F-91191, Gif-sur-Yvette, France
| | - Lawrence Dauer
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States of America
| | - Ariel Durán
- University Hospital, Montevideo School of Medicine, Montevideo, Uruguay
| | - Cameron Jeffries
- Flinders Medical Centre, Flinders Drive, South Australia, Australia
| | - Willie Harris
- Exelon Nuclear, 200 Exelon Way, United States of America
| | - Olga Kashirina
- Burnazyan Federal Medical Biophysical Centre, Federal Medical Biological Agency, Moscow, Russia
| | - Arthur Omondi Koteng
- Kenia Radiation Protection Board, RPB, Eastern Africa Association for Radiation Protection, EAARP, Nairobi, Kenya
| | | | - Waraporn Sudchai
- TINT, Thailand Institute of Nuclear Technology, Bangkok, Thailand
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Theilig D, Mayerhofer A, Petschelt D, Elkilany A, Hamm B, Gebauer B, Geisel D. Impact of interventionalist's experience and gender on radiation dose and procedural time in CT-guided interventions-a retrospective analysis of 4380 cases over 10 years. Eur Radiol 2020; 31:569-579. [PMID: 32851446 PMCID: PMC8263432 DOI: 10.1007/s00330-020-07185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/30/2020] [Accepted: 08/12/2020] [Indexed: 11/09/2022]
Abstract
Objectives To investigate the impact of the interventionalist’s experience and gender on radiation dose and procedural time in CT-guided interventions. Methods We retrospectively analyzed 4380 CT-guided interventions performed at our institution with the same CT scanner from 2009 until 2018, 1287 (29%) by female and 3093 (71%) by male interventionalists. Radiation dose, number of CT fluoroscopy images taken per intervention, total procedural time, type of intervention, and degree of difficulty were derived from the saved dose reports and images. All 16 interventionalists included in this analysis performed their first CT-guided interventions during the study period, and interventions performed by each interventionalist were counted to assess the level of experience for each intervention in terms of the number of prior interventions performed by her or him. The Mann-Whitney U test (MWU test), multivariate regression, and linear mixed model analysis were performed. Results Assessment of the impact of gender with the MWU test revealed that female interventionalists took a significantly smaller number of images (p < 0.0001) and achieved a lower dose-length product per intervention (p < 0.0001) while taking more time per intervention (p = 0.0001). This finding was confirmed for most types of interventions when additionally accounting for other possible impact factors in multivariate regression analysis. In linear mixed model analysis, we found that radiation dose, number of images taken per intervention, and procedural time decreased statistically significantly with interventionalist’s experience. Conclusions Radiation doses of CT-guided interventions are reduced by interventionalist’s experience and, for most types of interventions, when performed by female interventionalists. Key Points • Radiation doses in CT-guided interventions are lower when performed by female interventionalists. • Procedural times of CT-guided interventions are longer when performed by female interventionalists. • Radiation doses of CT-guided interventions decrease with the interventionalist’s experience. Electronic supplementary material The online version of this article (10.1007/s00330-020-07185-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorothea Theilig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Anna Mayerhofer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - David Petschelt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Aboelyazid Elkilany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd Hamm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
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Struelens L, Dabin J, Carinou E, Askounis P, Ciraj-Bjelac O, Domienik-Andrzejewska J, Berus D, Padovani R, Farah J, Covens P. Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses. Radiat Res 2018; 189:399-408. [DOI: 10.1667/rr14970.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- L. Struelens
- Radiation Protection Dosimetry and Calibration Group, Belgian Nuclear Research Centre (SCK•CEN), Belgium
| | - J. Dabin
- Radiation Protection Dosimetry and Calibration Group, Belgian Nuclear Research Centre (SCK•CEN), Belgium
| | - E. Carinou
- Dosimetry and Calibration Department, Greek Atomic Energy Commission (EEAE), Agia Paraskevi, Greece
| | - P. Askounis
- Dosimetry and Calibration Department, Greek Atomic Energy Commission (EEAE), Agia Paraskevi, Greece
| | - O. Ciraj-Bjelac
- Vinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - J. Domienik-Andrzejewska
- Radiation Protection Department, Nofer Institute of Occupational Medicine (NIOM), 91-348 Lodz, Poland
| | - D. Berus
- Department of Radiation Protection, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - R. Padovani
- Department of Medical Physics, Abdus Salam International Centre for Theoretical Physics (ICTP), 34151 Trieste, Italy
| | | | - P. Covens
- Department of Radiation Protection, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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