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Costa H, Vinhas H, Calé R, Pereira E, Santos J, Paulo G, Jorge E, Brochado B, Melica B, Baptista Gonçalves R, Infante de Oliveira E. A report on a survey among Portuguese Association of Interventional Cardiology associates regarding ionizing radiation protection practices in national interventional cath-labs. Rev Port Cardiol 2024; 43:177-185. [PMID: 37952927 DOI: 10.1016/j.repc.2023.07.008] [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: 04/30/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Concerns surrounding the consequences of ionizing radiation (IR) have increased in interventional cardiology (IC). Despite this, the ever-growing complexity of diseases as well as procedures can lead to greater exposure to radiation. The aim of this survey, led by Portuguese Association of Interventional Cardiology (APIC), was to evaluate the level of awareness and current practices on IR protection among its members. METHODS An online survey was emailed to all APIC members, between August and November 2021. The questionnaire consisted of 50 questions focusing on knowledge and measures of IR protection in the catheterization laboratory. Results were analyzed using descriptive statistics. RESULTS From a response rate of 46.9%, the study obtained a total sample of 159 responses (156 selected for analysis). Most survey respondents (66.0%) were unaware of the radiation exposure category, and only 60.4% reported systematically using a dosimeter. A large majority (90.4%) employed techniques to minimize exposure to radiation. All participants used personal protective equipment, despite eyewear protection only being used frequently by 49.2% of main operators. Ceiling suspended shields and table protectors were often used. Only two-thirds were familiar with the legally established limit on radiation doses for workers or the dose that should trigger patient follow-up. Most of the survey respondents had a non-certified training in IR procedures and only 32.0% had attended their yearly occupational health consultation. CONCLUSIONS Safety methods and protective equipment are largely adopted among interventional cardiologists, who have shown some IR awareness. Despite this, there is room for improvement, especially concerning the use of eyewear protection, monitoring, and certification.
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Affiliation(s)
- Hugo Costa
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal.
| | - Hugo Vinhas
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | - Rita Calé
- Cardiology Department, Hospital Garcia de Orta, Portugal
| | | | - Joana Santos
- Escola Superior de Tecnologia da Saúde de Coimbra, Portugal
| | - Graciano Paulo
- Escola Superior de Tecnologia da Saúde de Coimbra, Portugal
| | | | | | - Bruno Melica
- Centro Hospitalar de Vila Nova de Gaia, Portugal
| | | | - Eduardo Infante de Oliveira
- Cardiology Department, Centro Hospitalar de Lisboa Ocidental, Portugal; Cardiology Department, Lisbon Lusiadas Hospital, Portugal; Institute of Physiology, Faculty of Medicine, University of Lisbon, Portugal
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Costa H, Espírito-Santo M, Bispo J, Guedes J, Paulo G, Mimoso J, Palmeiro H, Baptista Gonçalves R, Vinhas H. Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratory. Rev Port Cardiol 2024:S0870-2551(24)00014-3. [PMID: 38336222 DOI: 10.1016/j.repc.2023.10.010] [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: 02/14/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs). METHODS This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (PKA) and cumulative air kerma (Ka,r). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (Ka,r). RESULTS A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9±11.2 years and mostly male (81.4%). DRLs were set in Ka,r (3012 mGy) and PKA (162 Gy cm2) for complex PCI. ADs were also set in Ka,r (1917 mGy) and PKA (101 Gy cm2). Independent predictors of Ka,r with a positive correlation were PKA (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001). CONCLUSIONS This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in Ka,r (3012 mGy) and PKA (162 Gy cm2). ADs, values to be achieved in future assessment, were set to Ka,r (1917 mGy) and PKA (101 Gy cm2).
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Affiliation(s)
- Hugo Costa
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
| | | | - João Bispo
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - João Guedes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Coimbra, Portugal
| | - Jorge Mimoso
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Hugo Palmeiro
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Hugo Vinhas
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
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Gomes DA, Madeira S, Mesquita Gabriel H. Minimizing ionizing radiation exposure in interventional cardiology: Still a long way to go. Rev Port Cardiol 2024:S0870-2551(24)00013-1. [PMID: 38316180 DOI: 10.1016/j.repc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Affiliation(s)
- Daniel A Gomes
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
| | - Sérgio Madeira
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Kim CL, Jeong HC, Kim JH. Radiation shielding effects of lead equivalent thickness of a radiation protective apron and distance during C-arm fluoroscopy-guided pain interventions: A randomized trial. Medicine (Baltimore) 2023; 102:e36447. [PMID: 38050291 PMCID: PMC10695529 DOI: 10.1097/md.0000000000036447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the degree of radiation shielding effects according to lead equivalent thickness and distance during C-arm fluoroscopy-guided lumbar interventions. METHODS The exposure time and air kerma were recorded using a fluoroscope. The effective dose (ED) was measured with and without the shielding material of the lead apron using 2 dosimeters at 2 positions. According to the lead equivalent thickness of the shielding material and distance from the side of the table, the groups were divided into 4 groups: group 1 (lead equivalent thickness 0.6 mm, distance 0 cm), group 2 (lead equivalent thickness 0.6 mm, distance 5 cm), group 3 (lead equivalent thickness 0.3 mm, distance 0 cm), and group 4 (lead equivalent thickness 0.3 mm, distance 5 cm). Mean differences such as air kerma, exposure time, ED, and ratio of EDs (ED with protector/ED without protector) were analyzed. RESULTS A total of 400 cases (100 cases in each group) were collected. The ratio of ED was significantly lower in groups 1 and 2 (9.18 ± 2.78% and 9.56 ± 3.29%, respectively) when compared to that of groups 3 and 4 (21.93 ± 4.19% and 21.53 ± 4.30%, respectively). The reductive effect of a 5-cm distance was 33.3% to 36.1% when comparing the ED between groups 1 and 2 and groups 3 and 4. CONCLUSIONS The 0.3- and 0.6-mm lead equivalent thickness protectors have a radiation attenuation effect of 78.1% to 78.5% and 90.4% to 90.8%, respectively. The 5-cm distance from the side of the table reduces radiation exposure by 33.3% to 36.1%.
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Affiliation(s)
- Cho Long Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
- Department of Clinical Science, Konkuk University Graduate School of Medicine, Konkuk University School Seoul, Seoul, Republic of Korea
| | - Hae Chang Jeong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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Szegedi N, Kroptkin E, Traykoc V, Abdrakhmanov A, Lorgat F, Sapelnikov O, Simons S, Amin M. Routine use of a 3D mapping system in the ablation of supraventricular arrhythmias with as low as reasonably achievable X-ray exposure (AALARA): protocol for a prospective, observational, multicentre, multinational, open-label registry study. BMJ Open 2023; 13:e072181. [PMID: 37541748 PMCID: PMC10407390 DOI: 10.1136/bmjopen-2023-072181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming standard of care in many parts of the world. While observational studies in the USA and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real-world data for this technique and generalisability of outcome in other economic regions. METHODS AND ANALYSIS The arrhythmias with as low as reasonably achievable X-ray exposure study is a prospective, observational, multicentre and multinational open-label registry study. Up to 700 patients undergoing catheter ablation for right-sided supraventricular arrhythmias (according to national guidelines) will be enrolled for the routine use of the EnSite Precision 3D mapping system. Participating sites are distributed in 13 countries from Central Eastern Europe, North and South Africa, the Middle East and the CIS (Commonwealth of Independent States), with different levels of expertise using minimal fluoroscopic exposure techniques. After electrophysiological procedure, patients will be followed up for 6 months either in-clinic or via telephone interview. Patients will be asked to complete a study questionnaire at enrolment and 6 months after the invasive procedure to assess quality of life changes secondary to the procedure. The study's primary objective is to describe ionising radiation exposure during catheter ablation when the EnSite Precision 3D mapping system is used in supraventricular tachycardia ablation. The study's secondary objective is to assess the safety and efficacy of this method. Furthermore, fluoroscopy timing, total procedure time, success rate and complications will be reported. ETHICS AND DISSEMINATION The study was approved by the ethics committee at Mohammed Bin Khalifa Specialist Cardiac Centre (BDF/R&REC/2020-504) and the medical ethics committees of all participating sites. Participants will be required to provide informed consent before enrolment in the study. The study results will be published and presented at conferences. TRIAL REGISTRATION NUMBER NCT04716270.
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Affiliation(s)
- Nandor Szegedi
- Semmelweis University Heart and Vascular Centre, Budapest, Hungary
| | - Evgeniy Kroptkin
- Federal Center for Cardiovascular Surgery, Krasnoyarsk region, Russian Federation
| | - Vassil Traykoc
- Federal Center for Cardiovascular Surgery, Krasnoyarsk region, Russian Federation
| | | | - Faizel Lorgat
- Christian Barnard Memorial Hospital, Cape Town, South Africa
| | - Oleg Sapelnikov
- Institute of Clinical Cardiology, Moscow, Russian Federation
| | | | - Mohammad Amin
- Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
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Sattar Y, Sengodan PM, Cheema MS, Javed N, Ashraf S, Fakhra S, Alharbi A, Syed M, Alam M, Elgendy IY, Haleem A, Kawsara A, Alraies MC, Daggubati R. Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory? Interv Cardiol 2023; 18:e18. [PMID: 37435603 PMCID: PMC10331561 DOI: 10.15420/icr.2023.10] [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: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 07/13/2023] Open
Abstract
Background: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health consequences. Personal protective equipment, including lead jackets and glasses, is common, but the use of radiation protective lead caps is inconsistent. Methods: A systematic review qualitative assessment of five observational studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines protocol was performed. Results: It was concluded that lead caps significantly reduce radiation exposure to the head, even when a ceiling-mounted lead shield was present. Conclusion: Although newer protective systems are being studied and introduced, tools, such as lead caps, need to be strongly considered and employed in the catheterisation laboratory as mainstay personal protective equipment.
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Affiliation(s)
- Yasar Sattar
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | | | - Mustafa Sajjad Cheema
- Department of Medicine, CMH Lahore Medical College and Institute of DentistryLahore, Punjab, Pakistan
| | - Nismat Javed
- Department of Internal Medicine, BronxCare Health SystemNew York, NY, US
| | - Shoaib Ashraf
- Department of Cardiology, Hackensack University Medical CentreNJ, US
| | - Sadaf Fakhra
- Department of Internal Medicine, University of Nevada, Kirk Kerkorian School of MedicineLas Vegas, NV, US
| | - Anas Alharbi
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - Moinuddin Syed
- Department of Cardiology, Boston UniversityBoston, MA, US
| | - Mahboob Alam
- Department of Cardiology, Baylor College of MedicineHouston, TX, US
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of KentuckyLexington, KT, US
| | - Affan Haleem
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - Akram Kawsara
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - M Chadi Alraies
- Detroit Medical Centre, Wayne State UniversityDetroit, MI, US
| | - Ramesh Daggubati
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
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Derda AA, Marquardt MM, Martens A, Mirena E, Vogel-Claussen J, Kempf T, Haverich A, Bauersachs J, Napp LC. Cinefluoroscopy for assessment of mechanical heart valves with suspected dysfunction. Front Cardiovasc Med 2022; 9:952255. [PMID: 36148066 PMCID: PMC9486207 DOI: 10.3389/fcvm.2022.952255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mechanical heart valves (MHVs) are preferred prosthesis types in many, especially younger patients who need surgical valve replacement. Although echocardiography is most frequently performed for prosthesis assessment during follow-up, ultrasound artifacts usually preclude a precise investigation of prosthesis function. Cinefluoroscopy (CF) is a simple and effective method to analyze and quantify opening and closing of prosthesis leaflets but requires careful visualization of the valve using optimal viewing angles. Here, we investigated the quality of CF studies in clinical routine and their suitability for quantitative analysis of prosthesis function. Methods and results We retrospectively identified 94 patients with 118 cinefluoroscopies performed by 31 different investigators in one tertiary center from 2012 to 2021. Of 150 MHVs (98% bi-leaflet prostheses), 87 (58%) were aortic, 53 (34%) mitral, 7 (5%) tricuspid, and 5 (3%) pulmonary valve prostheses, respectively. CF studies were categorized by their suitability to quantitatively assess opening and closing angles. Visualization of valve function was “sufficient” in 23%, “suboptimal” in 46%, and “unsuitable” in 31% of the cases. Conclusion In clinical routine, only one-fourth of CF studies allow for a complete assessment of leaflet motion of MHVs. Although this may be in part due to the varying experience of operators, the high number of unsuitable studies suggests that optimal viewing angles may not be achievable in all patients. Further research is required to investigate standard viewing angles and anatomy after MHV implantation to improve the quality of CF studies and reduce radiation exposure of patients and operators.
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Affiliation(s)
- Anselm A. Derda
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Marvin M. Marquardt
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elion Mirena
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- *Correspondence: L. Christian Napp,
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Ponnusamy SS, Vijayaraman P. Electroanatomical mapping assisted conduction system pacing. Indian Pacing Electrophysiol J 2022; 22:186-187. [PMID: 35777856 PMCID: PMC9813858 DOI: 10.1016/j.ipej.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Thirumal R, Vanchiere C, Bhandari R, Jiwani S, Horswell R, Chu S, Chamaria S, Katikaneni P, Boerma M, Gopinathannair R, Olshansky B, Bailey S, Dominic P. The Inverse Correlation Between the Duration of Lifetime Occupational Radiation Exposure and the Prevalence of Atrial Arrhythmia. Front Cardiovasc Med 2022; 9:863939. [PMID: 35711353 PMCID: PMC9196104 DOI: 10.3389/fcvm.2022.863939] [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: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Advancements in fluoroscopy-assisted procedures have increased radiation exposure among cardiologists. Radiation has been linked to cardiovascular complications but its effect on cardiac rhythm, specifically, is underexplored. Methods Demographic, social, occupational, and medical history information was collected from board-certified cardiologists via an electronic survey. Bivariate and multivariable logistic regression analyses were performed to assess the risk of atrial arrhythmias (AA). Results We received 1,478 responses (8.8% response rate) from cardiologists, of whom 85.4% were male, and 66.1% were ≤65 years of age. Approximately 36% were interventional cardiologists and 16% were electrophysiologists. Cardiologists > 50 years of age, with > 10,000 hours (h) of radiation exposure, had a significantly lower prevalence of AA vs. those with ≤10,000 h (11.1% vs. 16.7%, p = 0.019). A multivariable logistic regression was performed and among cardiologists > 50 years of age, exposure to > 10,000 radiation hours was significantly associated with a lower likelihood of AA, after adjusting for age, sex, diabetes mellitus, hypertension, and obstructive sleep apnea (adjusted OR 0.57; 95% CI 0.38-0.85, p = 0.007). The traditional risk factors for AA (age, sex, hypertension, diabetes mellitus, and obstructive sleep apnea) correlated positively with AA in our data set. Cataracts, a well-established complication of radiation exposure, were more prevalent in those exposed to > 10,000 h of radiation vs. those exposed to ≤10,000 h of radiation, validating the dependent (AA) and independent variables (radiation exposure), respectively. Conclusion AA prevalence may be inversely associated with radiation exposure in Cardiologists based on self-reported data on diagnosis and radiation hours. Large-scale prospective studies are needed to validate these findings.
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Affiliation(s)
- Rithika Thirumal
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, United States
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Catherine Vanchiere
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States
- Department of Internal Medicine, Temple University, Philadelphia, PA, United States
| | - Ruchi Bhandari
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV, United States
| | - Sania Jiwani
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Ronald Horswell
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - San Chu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | | | - Pavan Katikaneni
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States
- Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Marjan Boerma
- Department of Pharmaceutical Sciences, University of Arkansas Medical Center, Little Rock, AK, United States
| | - Rakesh Gopinathannair
- Department of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, KS, United States
| | - Brian Olshansky
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Steven Bailey
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States
- Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Paari Dominic
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States
- Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center, Shreveport, LA, United States
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Debreceni D, Janosi K, Vamos M, Komocsi A, Simor T, Kupo P. Zero and Minimal Fluoroscopic Approaches During Ablation of Supraventricular Tachycardias: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:856145. [PMID: 35479287 PMCID: PMC9037593 DOI: 10.3389/fcvm.2022.856145] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Catheter ablations for cardiac arrhythmias are conventionally performed under fluoroscopic guidance. To guide these procedures, zero/minimal fluoroscopy (Z/MF) approaches have become available, using three-dimensional electroanatomical mapping systems. Our aim was to conduct a meta-analysis comparing these two different methods for the treatment of paroxysmal supraventricular tachycardia (SVT). Methods Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of conventional, fluoroscopy-guided vs. Z/MF approaches in patients undergoing electrophysiology (EP) procedures for SVTs. The random-effects model was used to derive mean difference (MD) and risk ratios (RRs) with 95% confidence interval (CI). Results Twenty-four studies involving 9,074 patients met our inclusion criteria. There was no difference between the groups in terms of acute success rate (RR = 1.00, 95% CI, 0.99–1.01; p = 0.97) and long-term success rate (RR: 1.01, 95% CI, 1.00–1.03; p = 0.13). Compared to the conventional method, zero-and-minimal fluoroscopy (Z/MF) ablation significantly reduced fluoroscopic time [MD: −1.58 min (95% CI, −2.21 to −0.96 min; p < 0.01)] and ablation time [MD: −25.23 s (95% CI: −42.04 to −8.43 s; p < 0.01)]. No difference could be detected between the two groups in terms of the procedure time [MD: 3.06 min (95% CI: −0.97 to 7.08; p = 0.14)] and the number of ablation applications [MD: 0.13 (95% CI: −0.86 to 1.11; p = 0.80)]. The complication rate was 1.59% in the entire study population and did not differ among the groups (RR: 0.68, 95% CI: 0.45–1.05; p = 0.08). Conclusions The Z/MF approach for the catheter ablation of SVTs is a feasible method that reduces radiation exposure and ablation time without compromising the acute and long-term success or complication rates.
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Affiliation(s)
- Dorottya Debreceni
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
- *Correspondence: Dorottya Debreceni
| | - Kristof Janosi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Andras Komocsi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Tamas Simor
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Peter Kupo
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
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Reduced Radiation Exposure Protocol during Computer Tomography of the Left Atrium Prior to Catheter Ablation in Patients with Atrial Fibrillation. Diagnostics (Basel) 2022; 12:diagnostics12030612. [PMID: 35328165 PMCID: PMC8947727 DOI: 10.3390/diagnostics12030612] [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: 01/18/2022] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: Computer tomography (CT) is an imaging modality used in the pre-planning of radiofrequency catheter ablation (RFA) procedure in patients with cardiac arrhythmias. However, it is associated with a considerable ionizing radiation dose for patients. This study aims to develop and validate low-dose CT scanning protocols of the left atrium (LA) for RFA guidance. (2) Methods: 68 patients scheduled for RFA of atrial fibrillation were sequentially assigned to four groups of ECG-gated scanning protocols, based on the set tube current (TC): Group A (n = 20, TC = 33 mAs), Group B (n = 18, TC = 67 mAs), Group C (n = 10, TC = 135 mAs), and control Group D (n = 20, TC = 600 mAs). We used a 256-row multidetector CT with body weight-dependent tube voltage of 80 kVp (<70 kg), 100 kVp (70−90 kg), and 120 kVp (>90 kg). We evaluated scanning parameters including radiation dose, total scanning procedure time and signal-to-noise ratio (SNR). (3) Results: The average effective radiation dose (ED) was lower in Group A in comparison to Group B, C and D (0.83 (0.76−1.10), 1.55 (1.36−1.67), 2.91 (2.32−2.96) and 9.35 (8.00−10.04) mSv, p < 0.05). The total amount of contrast media was not significantly different between groups. The mean SNR was 6.5 (5.8−7.3), 7.1 (5.7−8.2), 10.8 (10.1−11.3), and 12.2 (9.9−15.7) for Group A, B, C and D, respectively. The comparisons of SNR in group A vs. B and C vs. D were without significant differences. (4) Conclusions: Optimized pre-ablation CT scanning protocols of the LA can reduce an average ED by 88.7%. Three dimensional (3D) models created with the lowest radiation protocol are useful for the integration of electro-anatomic-guided RFA procedures.
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Coronary Angioplasty and Stenting in Acute Coronary Syndromes Using Very Low Contrast Volume and Radiation Dosage Improves Renal and Cardiovascular Outcomes. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Aim: To demonstrate that in patients with acute coronary syndrome (ACS), using Cordis 6F Infiniti diagnostic catheters for angioplasty may represent a safe alternative associated with lower contrast volume and radiation dosage, improving cardiovascular and renal outcomes.
Material and Methods: In 1,800 patients with ACS (2,331 lesions/2,603 stents), angioplasty was performed with Cordis 6F Infiniti Thrulumen diagnostic catheters. Primary angioplasty was performed in 545 cases, and only balloon angioplasty in 67 patients. All procedures were performed through the femoral route, and switch-over to the radial route was made in 5 cases due to associated aortic/iliac obstructive lesions. Iodixanol was used in 76% of cases, and tirofiban in 99% of cases with adjusted dosages based on creatinine values. The mean contrast volume used per patient was 28 mL (± 6 mL) including the angiogram prior to the angioplasty.
Results: The median fluoroscopy time was 4.4 min (IQR 3–6.8), the mean fluoroscopy time was 5.59 min (± 0.28), the median dose-area product or kerma-area product was 1,507 µGym2 (IQR 918–2,611), median total or cumulative dose including backscatter was 2,702 µGym2 (IQR 1,805–4,217), and the median cumulative skin dose was 468 mGy (IQR 296–722). Groin hematoma was seen in 7 cases, proximal mild edge dissection in the deployed stent in 3 cases, and acute in-hospital stent thrombosis in 7 cases. In total, 33 deaths were registered and 19 of these patients had cardiogenic shock, of which 11 subjects were late presenters. Three patients died after discharge due to possible acute stent thrombosis.
Conclusions: Angioplasty and stenting can be performed safely in patients with acute coronary syndromes using Cordis 6F diagnostic catheters. The procedure was associated with a very low volume of contrast and radiation dose, leading to improved clinical outcomes..
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13
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Kanake S, Chitturi K, Karuparthi PR, Hirai T. Totally robotic three-vessel percutaneous coronary intervention with total occlusion using robotic automation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40S:288-292. [PMID: 35115274 DOI: 10.1016/j.carrev.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
Robotic-assisted percutaneous coronary intervention (PCI) has emerged as an alternative to manual PCI to mitigate the risk of occupational hazards for operators, and to increase precision of device placement. Previous studies have reported the safety and efficacy of robotic-assisted PCI in simpler lesions, and recently the safety and efficacy of robotic-assisted chronic total occlusion PCI have been reported. Herein, we report two cases with three-vessel disease, including total occlusions, successfully treated robotically utilizing newer guidewire and device automation.
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Affiliation(s)
- Shubham Kanake
- University of Missouri, Columbia, MO, United States of America
| | - Kalyan Chitturi
- University of Missouri, Columbia, MO, United States of America
| | - Poorna R Karuparthi
- University of Missouri, Columbia, MO, United States of America; Truman VA Medical Center, Columbia, MO, United States of America
| | - Taishi Hirai
- University of Missouri, Columbia, MO, United States of America.
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14
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Chen H, Shan LY, Ma T, Wang Y, Feng Z, Dong DH, Lv Y, Zhu HY. Remote-controlled cholangiography injection device: first clinical study in China. BMC Gastroenterol 2022; 22:12. [PMID: 34996384 PMCID: PMC8742431 DOI: 10.1186/s12876-021-02087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND X-ray cholangiography is of great value in the imaging of biliary tract diseases; however, occupational radiation exposure is unavoidable. Moreover, clinicians must manually inject the contrast dye, which may result in a relatively high incidence of adverse reactions due to unstable injection pressure. Thus, there is a need to develop a novel remote-controlled cholangiography injection device. METHODS Patients with external biliary drainage requiring cholangiography were included. A remote-controlled injection device was developed with three major components: an injection pump, a pressure sensor, and a wireless remote-control panel. Image quality, adverse reactions, and radiation dose were evaluated. RESULTS Different kinds of X-ray cholangiography were successfully and smoothly performed using this remote-controlled injection device in all patients. The incidence of adverse reactions in the device group was significantly lower than that in the manual group (4.17% vs. 13.9%, P = 0.001), and increasing the injection pressure increased the incidence of adverse reactions. In addition, the device helped operators avoid ionizing radiation completely. CONCLUSIONS With good control of injection pressure (within 10 kPa), the remote-controlled cholangiography injection device could replace the need for the doctor to inject contrast agent with good security and effectivity. It is expected to be submitted for clinical application.
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Affiliation(s)
- Huan Chen
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Li-Yu Shan
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Tao Ma
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yue Wang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhe Feng
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ding-Hui Dong
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Hao-Yang Zhu
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China. .,Department of Anesthesiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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15
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Feghali JA, Delépierre J, Belac OC, Dabin J, Deleu M, De Monte F, Dobric M, Gallagher A, Hadid-Beurrier L, Henry P, Hršak H, Kiernan T, Kumar R, Knežević Ž, Maccia C, Majer M, Malchair F, Noble S, Obrad D, Merce MS, Sideris G, Simantirakis G, Spaulding C, Tarantini G, Van Ngoc Ty C. Establishing a priori and a posteriori predictive models to assess patients' peak skin dose in interventional cardiology. Part 2: results of the VERIDIC project. Acta Radiol 2021; 64:125-138. [PMID: 34935520 DOI: 10.1177/02841851211062089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Optimizing patient exposure in interventional cardiology is key to avoid skin injuries. PURPOSE To establish predictive models of peak skin dose (PSD) during percutaneous coronary intervention (PCI), chronic total occlusion percutaneous coronary intervention (CTO), and transcatheter aortic valve implantation (TAVI) procedures. MATERIAL AND METHODS A total of 534 PCI, 219 CTO, and 209 TAVI were collected from 12 hospitals in eight European countries. Independent associations between PSD and clinical and technical dose determinants were examined for those procedures using multivariate statistical analysis. A priori and a posteriori predictive models were built using stepwise multiple linear regressions. A fourfold cross-validation was performed, and models' performance was evaluated using the root mean square error (RMSE), mean absolute percentage error (MAPE), coefficient of determination (R²), and linear correlation coefficient (r). RESULTS Multivariate analysis proved technical parameters to overweight clinical complexity indices with PSD mainly affected by fluoroscopy time, tube voltage, tube current, distance to detector, and tube angulation for PCI. For CTO, these were body mass index, tube voltage, and fluoroscopy contribution. For TAVI, these parameters were sex, fluoroscopy time, tube voltage, and cine acquisitions. When benchmarking the predictive models, the correlation coefficients were r = 0.45 for the a priori model and r = 0.89 for the a posteriori model for PCI. These were 0.44 and 0.67, respectively, for the CTO a priori and a posteriori models, and 0.58 and 0.74, respectively, for the TAVI a priori and a posteriori models. CONCLUSION A priori predictive models can help operators estimate the PSD before performing the intervention while a posteriori models are more accurate estimates and can be useful in the absence of skin dose mapping solutions.
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Affiliation(s)
- Joelle Ann Feghali
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Julie Delépierre
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Olivera Ciraj Belac
- Department of Radiation and Environmental Protection, Vinca Institute of Nuclear Sciences-National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jérémie Dabin
- SCK CEN Belgian Nuclear Research Center, Mol, Belgium
| | - Marine Deleu
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Milan Dobric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aoife Gallagher
- Department of Medical Physics, University Hospital Limerick, Limerick, Ireland
| | - Lama Hadid-Beurrier
- Department of Radiation Protection and Medical Physics, Lariboisière University Hospital, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Tom Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Rajesh Kumar
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | | | - Carlo Maccia
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | | | - Françoise Malchair
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | - Stéphane Noble
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | | | - Marta Sans Merce
- Department of Radiology, Geneva University Hospital, Geneva, Switzerland
| | - Georgios Sideris
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Christian Spaulding
- Department of Cardiology, European Georges Pompidou University Hospital, Paris, France
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Claire Van Ngoc Ty
- Department of Radiology, European Georges Pompidou Hospital, Paris, France
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16
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Olschewski M, Ullrich H, Brandt M, Steven S, Ahoopai M, Blessing R, Petrescu A, Wenzel P, Munzel T, Gori T. Effectiveness of a Real-Time X-ray Dosimetry Monitor in Reducing Radiation Exposure in Coronary Procedures: The ESPRESSO-Raysafe Randomized Trial. J Clin Med 2021; 10:jcm10225350. [PMID: 34830632 PMCID: PMC8621135 DOI: 10.3390/jcm10225350] [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: 10/27/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background—Several methods to reduce radiation exposure in the setting of coronary procedures are available on the market, and we previously showed that additional radiation shields reduce operator exposure during radial interventions. We set out to examine the efficacy of real-time personal dosimetry monitoring in a real-world setting of radial artery catheterization. Methods and Results—In an all-comer prospective, parallel study, consecutive coronary diagnostic and intervention procedures were performed with the use of standard radiation shield alone (control group) or with the addition of a real-time dosimetry monitoring system (Raysafe, Billdal, Sweden, monitoring group). The primary outcome was the difference in exposure of the primary operator among groups. Additional endpoints included patient, nurse, second operator exposure and fluoroscopy time. A total of 700 procedures were included in the analysis (n = 369 in the monitoring group). There were no differences among groups in patients’ body mass index (p = 0.232), type of procedure (intervention vs. diagnostic, p = 0.172), and patient sex (p = 0.784). Fluoroscopy time was shorter in the monitoring group (5.6 (5.1–6.2) min vs. 7.0 (6.1–7.7) min, p = 0.023). Radiation exposure was significantly lower in the monitoring group for the patient (135 (115–151) µSv vs. 208 (176–245) µSv, p < 0.0001) but not for the first operator (9 (7–11) µSv vs. 10 (8–11), p = 0.70) and the assistant (2 (1–2) µSv vs. 2 (1–2) µSv, p = 0.121). Conclusions—In clinical daily practice, the use of a real-time dosimetry monitoring device reduces patient radiation exposure and fluoroscopy time without an effect on operator radiation exposure.
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17
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Sharkey AR, Gambhir P, Saraskani S, Walker R, Hajilou A, Bassett P, Sandhu N, Croasdale P, Honey I, Diamantopoulos A, Goh V. Occupational radiation exposure in doctors: an analysis of exposure rates over 25 years. Br J Radiol 2021; 94:20210602. [PMID: 34538079 PMCID: PMC8553192 DOI: 10.1259/bjr.20210602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Healthcare professionals' occupational exposure to ionising radiation may be increasing due to increasing use of imaging and image-guided intervention. This study aims to assess the occupational exposure of doctors over a 25-year period at an NHS teaching hospital. METHODS Dosemeter measurements were collected prospectively from 1995 to 2019. Two retrospective analyses were performed over time (first including all measurements, second excluding "zero-dose" measurements), and by speciality. Group comparisons were undertaken using multilevel linear regression; a p-value <0.05 was deemed significant. RESULTS 8,892 measurements (3,983 body, 1,514 collar, 649 eye, 2,846 hand), of which 3,350 were non-zero measurements (1,541 body, 883 collar, 155 eye, 771 hand), were included. Whole dataset analysis found a significant decrease in exposure for radiologists and cardiologists, as measured by body, hand and collar dosemeters over the last 25 years (p < 0.01 for all). The non-zero readings reflect the whole cohort analysis except in the case of eye dosemeters, which showed a significant decrease in exposure for cardiologists (p < 0.01), but a significant increase for radiologists and surgeons/anaesthetists (p < 0.01 for both). CONCLUSIONS Whilst ionising radiation remains an occupational risk for doctors, the overall decreasing trend in occupational exposure is reassuring. However, a significant rise in eye dose for radiologists, surgeons and anaesthetists is concerning, and close monitoring is required to prevent future issues. ADVANCES IN KNOWLEDGE This paper is one of few evaluating the occupational radiation exposure to doctors over a 25-year period, showing that although most dosemeter measurements reflect decreasing exposure, the increase in eye exposure warrants caution.
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Affiliation(s)
- Amy R Sharkey
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | | | - Ross Walker
- King's College London, London, United Kingdom
| | | | - Paul Bassett
- Statsconsultancy Ltd, Buckinghamshire, United Kingdom
| | - Navneet Sandhu
- Department of Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Peter Croasdale
- Department of Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ian Honey
- Department of Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Vicky Goh
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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18
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Anselmino M, Ballatore A, Giaccardi M, Agresta A, Chieffo E, Floris R, Racheli M, Scaglione M, Casella M, Maines M, Marini M, De Ferrari GM, De Ponti R, Del Greco M. X-ray management in electrophysiology: a survey of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). J Cardiovasc Med (Hagerstown) 2021; 22:751-758. [PMID: 34009182 DOI: 10.2459/jcm.0000000000001210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Radiation use in medicine has significantly increased over the last decade, and cardiologists are among the specialists most responsible for X-ray exposure. The present study investigates a broad range of aspects, from specific European Union directives to general practical principles, related to radiation management among a national cohort of cardiologists. METHODS AND RESULTS A voluntary 31-question survey was run on the Italian Arrhythmology and Pacing Society (AIAC) website. From June 2019 to January 2020, 125 cardiologists, routinely performing interventional electrophysiology, participated in the survey. Eighty-seven (70.2%) participants are aware of the recent European Directive (Euratom 2013/59), although only 35 (28.2%) declare to have read the document in detail. Ninety-six (77.4%) participants register the dose delivered to the patient in each procedure, in 66.1% of the cases both as fluoroscopy time and dose area product. Years of exposition (P = 0.009) and working in centers performing pediatric procedures (P = 0.021) related to greater degree of X-ray equipment optimization. The majority of participants (72, 58.1%) did not recently attend radioprotection courses. The latter is related to increased awareness of techniques to reduce radiation exposure (96% vs. 81%, P = 0.022), registration of the delivered dose in each procedure (92% vs. 67%, P = 0.009), and X-ray equipment optimization (50% vs. 36%, P = 0.006). CONCLUSION Italian interventional cardiologists show an acceptable level of radiation awareness and knowledge of updated European directives. However, there is clear space for improvement. Comparison to other health professionals, both at national and international levels, is needed to pursue proper X-ray management and protect public health.
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Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin
| | - Andrea Ballatore
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin
| | - Marzia Giaccardi
- Cardiology and Electrophysiology Unit, Department of Medicine, 'Santa Maria Nuova' Hospital, Florence
| | | | | | - Roberto Floris
- Ospedale di Nostra Signora di Bonaria, San Gavino Monreale
| | | | - Marco Scaglione
- Division of Cardiology, 'Cardinal Massaia' Hospital, Asti, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital, Ancona
| | | | | | - Gaetano Maria De Ferrari
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
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19
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Wen KK, Roy S, Grumbach IM, Wu M. A "Failed" Assay Development for the Discovery of Rescuing Small Molecules from the Radiation Damage. SLAS DISCOVERY 2021; 26:1315-1325. [PMID: 34151632 DOI: 10.1177/24725552211020678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With improving survival rates for cancer patients, the side effects of radiation therapy, especially for pediatric or more sensitive adult patients, have raised interest in preventive or rescue treatment to overcome the detrimental effects of efficient radiation therapies. For the discovery of rescuing small molecules for radiation damage to the endothelium, we have been developing a 96-well microplate-based in vitro assay for high-throughput compatible measurement of radiation-induced cell damage and its rescue by phenotypic high-content imaging. In contrast to traditional radiation assays with detached cells for clonogenic formation, we observed cells with live-cell imaging in two different kinds of endothelial cells, up to three different cell densities, two gamma-infrared radiation dose rates, more than four different radiation doses, and acute (within 24 h with one to two h intervals) and chronic (up to 7 days) responses by phenotypic changes (digital phase contrast) and functional assays (nuclear, live-cell, and dead-cell staining) at the end of the assay. Multiple potential small molecules, which have been reported for rescuing radiation damage, have been tested as assay controls with dose responses. At the end, we did not move ahead with the pilot screening. The lessons learned from this "failed" assay development are shared.
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Affiliation(s)
- Kuo-Kuang Wen
- University of Iowa High Throughput Screening (UIHTS) Core, University of Iowa, Iowa City, IA, USA
| | - Stephen Roy
- Division of Cardiovascular Medicine, Department of Internal Medicine, Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Isabella M Grumbach
- Division of Cardiovascular Medicine, Department of Internal Medicine, Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Meng Wu
- University of Iowa High Throughput Screening (UIHTS) Core, University of Iowa, Iowa City, IA, USA.,Department of Biochemistry, Carver College of Medicine, University of Iowa Iowa City, IA, USA.,Department of Pharmaceutical Sciences and Experimental Therapeutics, Division of Medicinal and Natural Products Chemistry, College of Pharmacy, University of Iowa, Iowa City, IA, USA
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20
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Gutierrez-Barrios A, Angulo-Pain E, Noval-Morillas I, Cañadas-Pruaño D, de la Lastra IA, Gheorghe L, Zayas-Rueda R, Calle-Perez G, Vázquez-García R. The radioprotective effect of the Cathpax® AIR cabin during interventional cardiology procedures. Catheter Cardiovasc Interv 2021; 98:E523-E530. [PMID: 33979479 DOI: 10.1002/ccd.29773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/02/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The use of ionizing radiation during cardiac catheterization interventions adversely impacts the medical staff. Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has proven to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real-world procedures. METHODS AND RESULTS In this nonrandomized all-comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n = 59) and the non-RPC group (n = 60). No significant changes in the characteristics of patients and procedures, average contrast volume, air kerma (AK), dose area-product (DAP) and fluoroscopy time between both groups were apparent. In the RPC group, the first-operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures. CONCLUSIONS Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real-world setting.
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Affiliation(s)
| | - Esther Angulo-Pain
- Radiophysics and Radioprotection Department, Hospital Puerta del Mar (Cádiz), Spain
| | | | | | | | - Livia Gheorghe
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain
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21
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Schreiber T, Kähler N, Biewener S, Tscholl V, Nagel P, Attanasio P, Landmesser U, Huemer M. Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings. Herzschrittmacherther Elektrophysiol 2021; 32:244-249. [PMID: 33977306 PMCID: PMC8166725 DOI: 10.1007/s00399-021-00762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
Background Three-dimensional mapping systems and the use of ultra-low dose radiation protocols have supported minimization of radiation dose during left atrial ablation procedures. By using optimal shielding, scattered radiation reaching the operator can be further reduced. This prospective study was designed to determine the remaining operator radiation exposure during left atrial catheter ablations using real-time dosimetry. Methods Radiation dose was recorded using real-time digital dosimetry badges outside the lead apron during 201 consecutive left atrial fibrillation ablation procedures. All procedures were performed using the same X‑ray system (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Germany) programmed with ultra-low dose radiation settings including a low frame rate (two frames per second), maximum copper filtration, and an optimized detector dose. To reduce scattered radiation to the operators, table-suspended lead curtains, ceiling-suspended leaded plastic shields, and radiation-absorbing shields on the patient were positioned in an overlapping configuration. Results The 201 procedures included 139 (69%) pulmonary vein isolations (PVI) (20 cryoballoon ablations, 119 radiofrequency ablations, with 35 cases receiving additional ablation of the cavotricuspid isthmus) and 62 (31%) PVI plus further left atrial substrate ablation. Mean radiation dose measured as dose area product for all procedures was 128.09 ± 187.87 cGy ∙ cm2 with a mean fluoroscopy duration of 9.4 ± 8.7 min. Real-time dosimetry showed very low average operator doses of 0.52 ± 0.10 µSv. A subanalysis of 51 (25%) procedures showed that the radiation burden for the operator was highest during pulmonary vein angiography. Conclusion The use of ultra-low dose radiation protocols in combination with optimized shielding results in extremely low scattered radiation reaching the operator.
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Affiliation(s)
- T Schreiber
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 3, 12203, Berlin, Germany.
| | - N Kähler
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 3, 12203, Berlin, Germany
| | - S Biewener
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 3, 12203, Berlin, Germany
| | - V Tscholl
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 3, 12203, Berlin, Germany
| | - P Nagel
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 3, 12203, Berlin, Germany
| | - P Attanasio
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 3, 12203, Berlin, Germany
| | - U Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 3, 12203, Berlin, Germany
| | - M Huemer
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 3, 12203, Berlin, Germany
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22
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Hammami R, Jmaa AB, Bahloul A, Charfeddine S, Ellouze T, Mallek S, Mrad IB, Abid L, Kammoun S, Jdidi J. [Assessment of the practices and knowledge among cardiologists regarding radiation protection in Tunisia]. Pan Afr Med J 2021; 38:300. [PMID: 34178219 PMCID: PMC8197064 DOI: 10.11604/pamj.2021.38.300.24254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction les procédures de cardiologie interventionnelle sont devenues complexes et chronophages avec un sur-risque d´exposition aux rayonnements ionisants. L’objectif de notre étude était d’évaluer le niveau des connaissances et des pratiques en radioprotection des cardiologues Tunisiens exposés au rayon X. Méthodes notre étude est descriptive analytique réalisée en octobre 2019, organisée sous forme de questionnaire anonyme des connaissances et pratiques en radioprotection et envoyé à tous les Cardiologues Tunisiens exposés aux rayons X. Résultats parmi 126 cardiologues exposés aux rayons X et ayant reçu le questionnaire, 58 médecins ont répondu au questionnaire (48%), avec une prédominance masculine (72%, n=42). Trente-huit médecins (65%) exerçaient dans le secteur public. L´expérience professionnelle était en moyenne de 12,02 ans (ET 6,88 ans). La moitié des médecins avaient un score de connaissances inférieur à 50%. La moyenne du score des pratiques était de 43,83 (ET 13,95%). Le port du tablier en plomb, de la cache thyroïde, du dosimètre, des lunettes en plomb, du calot en plomb était respectivement de 100% (n=58), 86,2% (n=50), 30,7% (n=18), 12,1% (n=7) et 1,7% (n=1). Il n´y avait pas de corrélation entre les scores et l´âge du médecin ainsi que la durée de l´expérience professionnelle. Les scores de connaissances ne différaient pas statistiquement entre les 2 sexes (p=0,06) ni entre le secteur public et le secteur privé (p=0,9). Le score de pratique était significativement plus élevé chez les hommes (0.007) et les cardiologues interventionnels comparés aux rythmologues et cardiopédiatres (p<0.001). Conclusion le niveau des connaissances et des pratiques des cardiologues Tunisiens en radioprotection est globalement insuffisant. Ce qui interpelle les autorités sanitaires à organiser un plan de formation régulier pour cette population.
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Affiliation(s)
- Rania Hammami
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Abdelhamid Ben Jmaa
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Amine Bahloul
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Selma Charfeddine
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Tarek Ellouze
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Souad Mallek
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | | | - Leila Abid
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie, Hôpital Hedi Chaker, Sfax, Tunisie.,Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie
| | - Jihen Jdidi
- Unité de Recherche UR 17ES37, Faculté de Médecine de Sfax, Université de Sfax, Sfax, Tunisie.,Service de Médecine Préventive, Hôpital Hedi Chaker, Sfax, Tunisie
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23
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Affiliation(s)
- Alice Wood
- Cardiology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shazia T Hussain
- Cardiology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
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24
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Kosiuk J, Fiedler L, Ernst S, Duncker D, Pavlović N, Guarguagli S, Stegmann C, Miskowiec D, Garcia R, Russo V, Yakushev A, Szegedi N, De Potter T. Fluoroscopy usage in contemporary interventional electrophysiology: Insights from a European registry. Clin Cardiol 2020; 44:36-42. [PMID: 33220000 PMCID: PMC7803367 DOI: 10.1002/clc.23411] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x‐ray exposure nor recommendation how to achieve them have been proposed. Hypothesis Current norms and quality markers required for optimal clinical routine can be identified. Methods Centers participating in this Europe‐wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases. Results Twenty‐five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old). Mean dose area product (DAP) and time was 304 ± 608 cGy*cm2, 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm2, 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm2, 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm2, 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy. Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257‐2.318, P = .001), in higher‐volume center (OR 1.001 per one additional procedure, 95%CI 1.000‐1.001, P = .002), with the use of 3D‐mapping system (OR 2.622, 95%CI 2.053‐3.347, P < .001) and monoplane x‐ray system (OR 2.945, 95%CI 2.149‐4.037, P < .001). Conclusion Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.
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Affiliation(s)
- Jedrzej Kosiuk
- Rhythmology Department, Helios Clinic Koethen, Koethen, Germany
| | - Lucas Fiedler
- Department of Internal Medicine II, General Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | | | - David Duncker
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Nikola Pavlović
- Department of Cardiology, Univeristy Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | | | - Clara Stegmann
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | - Dawid Miskowiec
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | - Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Andriy Yakushev
- Amosov National Institute of Cardiovascular Surgery, Kyiv, Ukraine
| | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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25
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Anadol R, Brandt M, Merz N, Knorr M, Ahoopai M, Geyer M, Krompiec D, Wenzel P, Münzel T, Gori T. Effectiveness of additional X-ray protection devices in reducing scattered radiation in radial intervention: the ESPRESSO randomised trial. EUROINTERVENTION 2020; 16:663-671. [PMID: 32338611 DOI: 10.4244/eij-d-19-00945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS We aimed to examine the impact of three different radiation protection devices in a real-world setting of radial artery catheterisation. METHODS AND RESULTS In an all-comer randomised trial, consecutive coronary radial diagnostic and intervention procedures were assigned in a 1:1:1 ratio to shield-only protection (shield group), shield and overlapping 0.5 mm Pb panel curtain (shield+curtain group) or shield, curtain and additional 75x40 cm, 0.5 mm Pb drape placed across the waist of the patient (shield+curtain+drape group). A total of 614 radial procedures were randomised (n=193 shield, n=220 shield+curtain, n=201 shield+curtain+drape). There were no differences among the groups in patient or procedural characteristics. The primary endpoint (relative exposure ratio between the operators' exposure in μSv and the patient's exposure, dose area product in cGy·cm2) was significantly lower in the shield+curtain+drape group for both the first operator (20% reduction vs shield, 16% vs shield+curtain, p=0.025) and the assistant (39% reduction vs shield, 25% vs shield+curtain, p=0.009). CONCLUSIONS The use of an additional drape reduced the radiation exposure of both the first operator and the second operator during routine radial procedures; a shield-attached curtain alone was only partially effective. ClinicalTrials.gov identifier: NCT03634657
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Affiliation(s)
- Remzi Anadol
- Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin Mainz and DZHK Standort Rhein-Main, Mainz, Germany
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26
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil.,Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil.,Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil.,Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil,Hospital Barão de Lucena, Recife, PE – Brazil,Hospital EMCOR, Recife, PE – Brazil,Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil.,Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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27
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Matsubara TJ, Fujiu K, Shimizu Y, Oshima T, Matsuda J, Matsunaga H, Oguri G, Hasumi E, Kojima T, Komuro I. Fluoroless and contrast-free catheter ablation without a lead apron in routine clinical practice. Sci Rep 2020; 10:17096. [PMID: 33051503 PMCID: PMC7553968 DOI: 10.1038/s41598-020-74165-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
The technique of catheter ablation has been improved within the past few decades, especially by three-dimensional (3D) mapping system. 3D mapping system has reduced radiation exposure but ablation procedures still require fluoroscopy. Our previous study showed the safety and efficacy of catheter ablation based on intracardiac echogram combined with CARTOSOUND/CARTO3 system, however fluoroscopy use for an average of 16 min is required for this procedure. The present study was aimed to reduce radiation exposure to zero and establish a radiation free catheter ablation method with the goal of utilizing it in routine clinical practice. We conducted single center, retrospective study during 2019 April to 2020 February. Consecutive 76 patients were enrolled. In the first 18 cases, the previously reported procedure (CARTOSOUND/CARTO3 method) was used. The remaining 58 cases were transitioned to fluoroless catheter ablation. The procedure time, success rates and complication rates were analyzed. Not only AF patients but atrial flutter (AFL), paroxysmal supraventricular tachycardia (PSVT) and ventricular arrhythmia patients were included. Catheter positioning, catheter visualization and collecting the geometry of each camber of the heart were conducted by using contact force and ICE based geometry on CARTO system without either prior computed tomography (CT) or magnetic resonance image (MRI). In fluoroless group, all catheter ablations were successfully performed without lead aprons. No complications occurred in either group. There were no significant differences in procedure time in any type of procedure (Total procedure time Fluoro-group; 149 ± 51 min vs. Fluoroless-group; 162 ± 43 min, N.S.), (PSVT 170 ± 53 min vs. 162 ± 29 min, N.S.), (AFL 110 ± 70 min vs. 123 ± 43 min, N.S.), (AF 162 ± 43 min vs. 163 ± 32 min, N.S.). The total radiation time was reduced to zero in fluoroless group. Catheter ablation with ICE and 3D mapping system guide without fluoroscopy could be safely performed with a high success rate, without any prior CT/MRI 3D images. Radiation was reduced completely for patients and staff, negating the need for protective wear for operators.
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Affiliation(s)
- Takumi J Matsubara
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan. .,Department of Cardiovascular Medicine, IMS Katsushika Heart Center, 3-30-1, Horikiri, Katsushika, Tokyo, 123-0006, Japan.
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan. .,Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Yu Shimizu
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Jun Matsuda
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Hiroshi Matsunaga
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Gaku Oguri
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
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28
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Wilson-Stewart KS, Fontanarosa D, Li D, Drovandi CC, Anderson RK, Trapp JV. Taller staff occupationally exposed to less radiation to the temple in cardiac procedures, but risk higher doses during vascular cases. Sci Rep 2020; 10:16103. [PMID: 32999372 PMCID: PMC7528059 DOI: 10.1038/s41598-020-73101-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/11/2020] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the effect of nurse and doctor height on occupational dose to the temple during fluoroscopically guided cardiovascular procedures. Additionally, an evaluation of the relationship between doctor height and table height was performed. Staff exposed during fluoroscopic procedures may be at elevated risk of cardiovascular damage or oncogenesis and have demonstrated a higher incidence of subscapular cataracts. The heads of taller staff may be exposed to reduced levels of radiation due to the increased distance from the area of highest intensity X-ray scatter. Limited research has been performed investigating height as a predictor of head dose to nursing staff. The level of radiation dose at the level of the temple to the doctor (n = 25), scrub (n = 28), and scout nurse (n = 29) was measured in a prospective single-center, observational study using Philips DoseAware badges. Procedural characteristics were recorded for vascular and cardiac cases performed in three dedicated angiography suites. Data were also collected to investigate relationships between doctor height and table height. Data were collected for 1585 cardiac and 294 vascular procedures. Staff height was a statistically significant predictor of temple dose for doctors, scrub, and scout nurses when considering the full data sample. The log temple dose demonstrated an inverse relationship to staff height during cardiac procedures, but a positive relationship for scrub and scout nurses during vascular studies. This observational study has demonstrated that taller staff are exposed to less cranial exposure dose during fluoroscopically guided cardiac examinations but has revealed a positive correlation between height and temple dose during vascular procedures. It was also determined that doctor height was correlated with average procedural table height and that vascular access point influences the choice of table elevation.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia. .,Cardiovascular Suites, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, Australia.
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Q Block, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia
| | - Dan Li
- School of Mathematical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Centre for Data Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Chris C Drovandi
- School of Mathematical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Centre for Data Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Rebecca K Anderson
- Cardiovascular Suites, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
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29
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Shimizu T, Toyota S, Nakagawa K, Murakami T, Kumagai T, Mori K, Taki T. Reduction of radiation exposure using low pulse rate fluoroscopy during neuroendovascular surgery. Interv Neuroradiol 2020; 27:314-320. [PMID: 32772623 DOI: 10.1177/1591019920949319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endovascular surgery is minimally invasive, but the radiation exposure can be problematic. There is no report assessing whether radiation exposure can be reduced by using a low pulse rate during carotid artery stenting (CAS). The aim of this study was to evaluate whether reducing the pulse rate from 7.5 to 4 frames per second (f/s) can reduce the radiation exposure while maintaining safety during CAS procedure. METHODS We retrospectively reviewed the radiation data and clinical features of all 100 patients who underwent CAS between 2014 and 2019. We changed the pulse rate from 7.5 to 4 f/s in 2017. The fluoroscopic time (FT), dose area product (DAP), and total air kerma (AK) were collected. Statistical analyses were performed between the pulse rate and clinical outcomes, including radiation exposure.
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Affiliation(s)
- Takeshi Shimizu
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Shingo Toyota
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Kanji Nakagawa
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tomoaki Murakami
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tetsuya Kumagai
- Department of Neurosurgery, Wakakusa-Daiichi Hospital, Higashiosaka, Japan
| | - Kanji Mori
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Takuyu Taki
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
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30
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Abdelrahman M, Lombardo P, Vanhavere F, Seret A, Phillips C, Covens P. First steps towards online personal dosimetry using computational methods in interventional radiology: Operator's position tracking and simulation input generation. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Predictors of zero X ray procedures in supraventricular arrhythmias ablation. Int J Cardiovasc Imaging 2020; 36:1599-1607. [PMID: 32447632 DOI: 10.1007/s10554-020-01884-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/14/2020] [Indexed: 01/01/2023]
Abstract
To evaluate predictors of zero-X ray procedures for supraventricular arrhythmias (SVT) using minimally fluoroscopic approach (MFA). Patients referred for RF catheter ablation of SVT were admitted for a MFA with an electro-anatomical navigation system or a conventional fluoroscopic approach (ConvA). Exclusion criterion was the need to perform a transseptal puncture. 206 patients (98 men, age 53 ± 19 years) underwent an EP study, 93 (45%) with an MFA and 113 (55%) with a ConvA. Fifty-five had no inducible arrhythmias (EPS). Fifty-four had AV nodal reentrant tachycardia (AVNRT), 49 patients had typical atrial flutter (AFL), 37 had AV reciprocating tachycardia (AVRT/WPW), 11 had focal atrial tachycardia (AT), and underwent a RF ablation. X-ray was not used at all in 51/93 (58%) procedures (zero X ray). MFA was associated with a significant reduction in total fluoroscopy time (5.5 ± 10 vs 13 ± 18 min, P = 0.01) and operator radiation dose (0.8 ± 2.5 vs 3 ± 8.2 mSV, P < 0.05). The greatest absolute dose reduction was observed in AVNRT (0.1 ± 0.3 vs 5.1 ± 10 mSV, P = 0.01, 98% relative dose reduction) and in AFL (1.3 ± 3.6 vs 11 ± 16 mSV, P = 0.003, 88% relative dose reduction) groups. Both AVNRT or AFL resulted the only statistically significant predictors of zero x ray at multivariate analysis (OR 4.5, 95% CI 1.5-13 and OR 5, 95% CI 1.7-15, P < 0.001, respectively). Success and complication rate was comparable between groups (P = NS). Using MFA for SVT ablation, radiological exposure is significantly reduced. Type of arrhythmia is the strongest predictor of zero X ray procedure.
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32
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Zucca S, Solla I, Boi A, Loi S, Rossi A, Sanna F, Loi B. The role of a commercial radiation dose index monitoring system in establishing local dose reference levels for fluoroscopically guided invasive cardiac procedures. Phys Med 2020; 74:11-18. [PMID: 32388465 DOI: 10.1016/j.ejmp.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The primary goal was to evaluate local dose level for fluoroscopically guided invasive cardiac procedures in a high-volume activity catheterization laboratory, using automatic data registration with minimal impact on operator workload. The secondary goal was to highlight the relationship between dose indices and acquisition parameters, in order to establish an effective strategy for protocols optimization. METHODS From September 2016 to December 2018, a dosimetric survey was conducted in the 2 rooms of the catheterization laboratory of our institution. Data collection burden was minimized using a commercial Radiation Dose Index Monitoring System (RDIMs) that analyzes dicom files automatically sent by the x-ray equipment. Data were combined with clinical information extracted from the HIS records reported by the interventional cardiologist. Local dose levels were established for different invasive cardiac procedures. RESULTS A total of 3029 procedures performed for 2615 patients were analyzed. Median KAP were 21 Gycm2 for invasive coronary angiography (ICA) procedures, 61 Gycm2 for percutaneous coronary intervention (PCI) procedures, 59 Gycm2 for combined (ICA+PCI) procedures, 87 Gycm2 for structural heart intervention (TAVI) procedures. A significant dose reduction (51% for ICA procedures and 58% for PCI procedures) was observed when noise reduction acquisition techniques were applied. CONCLUSIONS RDIMs are effective tools in the establishment of local dose level in interventional cardiology, as they mitigate the burden to collect and register extensive dosimetric data and exposure parameters. Systematic review of data support the multi-disciplinary team in the definition of an effective strategy for protocol management and dose optimization.
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Affiliation(s)
- Sergio Zucca
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy.
| | - Ignazio Solla
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Alberto Boi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Stefano Loi
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Angelica Rossi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Francesco Sanna
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Bruno Loi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
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Kim JS, Lee BK, Ryu DR, Chun K, Kwon HS, Nam SR, Kim DI, Lee SY, Jeong JO, Bae JW, Park JS, Ahn Y, Chae JK, Yoon MH, Lee SH, Yoon J, Gwon HC, Choi D, Kwon SM, Roh YH, Cho BR. Occupational radiation exposure in femoral artery approach is higher than radial artery approach during coronary angiography or percutaneous coronary intervention. Sci Rep 2020; 10:7104. [PMID: 32346022 PMCID: PMC7188817 DOI: 10.1038/s41598-020-62794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
Medical radiation exposure is a significant concern for interventional cardiologists (IC). This study was aimed at estimating the radiation exposure of IC operators and assistants in real clinical practice. The radiation exposure of the operator and assistant was evaluated by conducting two types of procedures via coronary angiography (CAG) and percutaneous coronary intervention (PCI) on 1090 patients in 11-cardiovascular centers in Korea. Radiation exposure was measured using an electronic personal dosimeter (EPD). EPD were attached at 3 points on each participant: on the apron on the left anterior chest (A1), under the apron on the sternum (A2), and on the thyroid shield (T). Average radiation exposure (ARE) of operators at A1, A2, and T was 19.219 uSv, 4.398 uSv, and 16.949 uSv during CAG and 68.618 uSv, 15.213 uSv, and 51.197 uSv during PCI, respectively. ARE of assistants at A1, A2, and T was 4.941 uSv, 0.860 uSv, and 5.232 uSv during CAG and 20.517 uSv, 4.455 uSv, and 16.109 uSv during PCI, respectively. AED of operator was 3.4 times greater during PCI than during CAG.
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Affiliation(s)
- Jung-Su Kim
- Department of Radiologic technology, Daegu Health College, Daegu, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Dong-Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Kwangjin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Ho-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - So-Ra Nam
- Department of Health and Safety Convergence Science, College of Health Science, Korea University, Seoul, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Korea
| | - Sung-Yun Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Inje University, College of Medicine, Goyang, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University, School of Medicine, Daegu, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University, School of Medicine, Chonnam, Korea
| | - Je-Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospita, Chonbuk National University, School of Medicine, Chonbuk, Korea
| | - Myeong-Ho Yoon
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Ajou University, School of Medicine, Kyeonggi, Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju, College of Medicine, Wonju, Korea
| | - Jeonghan Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju, College of Medicine, Wonju, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon-Mu Kwon
- Department of Radiologic technology, Daegu Health College, Daegu, Korea
| | - Young-Hoon Roh
- Department of Health and Safety Convergence Science, College of Health Science, Korea University, Seoul, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea.
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Tumores cerebrales y lesiones encefálicas por radiación ionizante. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Control de calidad en equipos de rayos X en intervencionismo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Schreiber T, Kähler N, Tscholl V, Nagel P, Landmesser U, Huemer M, Attanasio P. [Update on radiation exposure in catheter ablation of atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2019; 31:84-90. [PMID: 31758249 DOI: 10.1007/s00399-019-00660-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 02/03/2023]
Abstract
The rising number of catheter ablations of atrial fibrillation increases radiation exposure for both patients and surgeons. Fortunately, this trend is counteracted by the development of measures to reduce total fluoroscopy time using non-fluoroscopic catheter visualization. Since even low-dose radiation can cause serious injury, all options to reduce radiation burden must be utilized (ALARA, "as low as reasonably achievable"). Dose reduction protocols with low-dose settings, which include reduced framerates, pulse duration, detector entrance dose and increased beam hardening, play a decisive role in this regard. This review provides a state-of-the-art summary of non-fluoroscopic catheter visualization and dose reduction protocols for catheter ablation of atrial fibrillation.
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Affiliation(s)
- Tobias Schreiber
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - Nora Kähler
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Verena Tscholl
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Patrick Nagel
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Ulf Landmesser
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Martin Huemer
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Philipp Attanasio
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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Gutiérrez-Barrios A, Camacho-Galán H, Medina-Camacho F, Cañadas-Pruaño D, Jimenez-Moreno A, Calle-Perez G, Vázquez-García R. Effective Reduction of Radiation Exposure during Cardiac Catheterization. Tex Heart Inst J 2019; 46:167-171. [PMID: 31708696 DOI: 10.14503/thij-17-6548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Exposure to ionizing radiation during cardiac catheterization can have harmful consequences for patients and for the medical staff involved in the procedures. Minimizing radiation doses during the procedures is essential. We investigated whether fine-tuning the radiation protocol reduces radiation doses in the cardiac catheterization laboratory. In January 2016, we implemented a new protocol with reduced radiation doses in the Hospital de Jerez catheterization laboratory. We analyzed 170 consecutive coronary interventional procedures (85 of which were performed after the new protocol was implemented) and the personal dosimeters of the interventional cardiologists who performed the procedures. Overall, the low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%-70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%-90.1%; P <0.001) during percutaneous coronary interventions. We also found that the annual deep (79%, P=0.026) and shallow (62.2%, P=0.035) radiation doses to which primary operators were exposed decreased significantly under the low-radiation protocol. These dose reductions were achieved without increasing the volume of contrast media, fluoroscopy time, or rates of procedural complications, and without reducing the productivity of the laboratory. Optimizing the radiation safety protocol effectively reduced radiation exposure in patients and operators during cardiac catheterization procedures.
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Ison GR, Allahwala U, Weaver JC. Radiation Management in Coronary Angiography: Percutaneous Coronary Intervention for Chronic Total Occlusion at the Frontier. Heart Lung Circ 2019; 28:1501-1509. [DOI: 10.1016/j.hlc.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/10/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
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Santoro A, Di Clemente F, Baiocchi C, Zacà V, Bianchi C, Bellini C, Falciani F, Valente S, Gaspardone A, Lamberti F. From near-zero to zero fluoroscopy catheter ablation procedures. J Cardiovasc Electrophysiol 2019; 30:2397-2404. [PMID: 31424119 DOI: 10.1111/jce.14121] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 11/28/2022]
Abstract
AIMS The use of electroanatomical mapping (EAM) systems can reduce radiation exposure (RX) and it can also completely eliminate the use of RX. Radiation exposure related to conventional radiofrequency ablation procedures can have a stochastic and deterministic effect on health. The main aim of this study was to evaluate the safety and feasibility of an entirely nonfluoroscopic approach to catheter ablation (CA) using EAM CARTO3. METHODS In 2011 we started an RX-minimization programme in all procedures using the CARTO system with the deliberate intention to not resort to the aid of RX unless strictly necessary. We divided procedures into two groups (group 1: from 2011 to 2013; group 2: from 2014 to 2017). The only exclusion criteria were the need for transseptal puncture, and nonidiopathic ventricular tachycardia (VT). RESULTS From a total of 525 procedures, we performed CA entirely without RX in 78.5% of cases. From 2011 to 2013, we performed CA without RX in 38.5% of cases; from 2014 to 2017, we performed 96.2% of cases with zero RX. The use of RX was significantly reduced in group 2 (group 2: 1.4 ± 19.6 seconds vs group 1: 556.92 ± 520.76 seconds; P < .001). These differences were irrespective of arrhythmia treatment. There were no differences between the two groups in acute success, complications, or duration of procedures. CONCLUSION CA of supraventricular tachycardia and VT entirely without RX, guided by the CARTO system, is safe, feasible, and effective. After an adequate learning curve, CA can be performed entirely without RX.
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Affiliation(s)
- Amato Santoro
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Claudia Baiocchi
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Valerio Zacà
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Claudio Bianchi
- Department of Medicine, Cardiovascular Section, San Eugenio Hospital, Rome, Italy
| | - Cesare Bellini
- Department of Medicine, Cardiovascular Section, San Eugenio Hospital, Rome, Italy
| | - Francesca Falciani
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Serafina Valente
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Achille Gaspardone
- Department of Medicine, Cardiovascular Section, San Eugenio Hospital, Rome, Italy
| | - Filippo Lamberti
- Department of Medicine, Cardiovascular Section, San Eugenio Hospital, Rome, Italy
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Anadol R, Brandt M, Merz N, Knorr M, Ahoopai M, Geyer M, Krompiec D, Wenzel P, Münzel T, Gori T. Effectiveness of additional X-ray protection devices in reducing Scattered radiation in radial interventions: protocol of the ESPRESSO randomised trial. BMJ Open 2019; 9:e029509. [PMID: 31272982 PMCID: PMC6615829 DOI: 10.1136/bmjopen-2019-029509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A number of devices have been developed to minimise operator radiation exposure in the setting of cardiac catheterisation. The effectiveness of these devices has traditionally been explored in transfemoral coronary procedures; however, less is known for the transradial approach. We set out to examine the impact of three different radiation protection devices in a real-world setting. METHODS AND DESIGN Consecutive coronary diagnostic and intervention procedures are randomised in a 1:1:1 ratio to a shield-only protection (shield group), shield and overlapping 0.5 mm Pb panel curtain (curtain group) or shield, curtain and additional 75×40 cm, 0.5 mm Pb drape placed across the waist of the patient (drape group).The primary outcome is the difference in relative exposure of the primary operator among groups. Relative exposure is defined as the ratio between operator's exposure (E in μSv) and patient exposure (dose area product in cGy·cm2). ETHICS AND DISSEMINATION The protocol complies with good clinical practice and the ethical principles described in the Declaration of Helsinki and is approved by the local ethics committee. The results of the trial will be published as original article(s) in medical journals and/or as presentation at congresses. TRIAL REGISTRATION NUMBER NCT03634657.
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Affiliation(s)
- Remzi Anadol
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
- DZHK, Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Moritz Brandt
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Nico Merz
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Majid Ahoopai
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Martin Geyer
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Damian Krompiec
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Phillip Wenzel
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
- DZHK, Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Tommaso Gori
- Kardiologie I, University Medical Center Mainz, Mainz, Germany
- DZHK, Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
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Massalha S, Almufleh A, Small G, Marvin B, Keidar Z, Israel O, Kennedy JA. Strategies for Minimizing Occupational Radiation Exposure in Cardiac Imaging. Curr Cardiol Rep 2019; 21:71. [PMID: 31227929 DOI: 10.1007/s11886-019-1157-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Radiation safety has been at the center of interest of both researchers and healthcare institutions. This review will summarize and shed light on the various techniques adapted to reduce staff exposure to ionizing radiation (IR) in the field of cardiac imaging. RECENT FINDINGS In the last years, with the advance of awareness and the development of new technologies, there have been several tools and techniques adapted. The breakthrough of several technologies to lower radiation dose and shorten the duration of diagnostic tests associated with IR, the use of protection devices by staff members, and mostly the awareness of exposure to IR are the hallmark of these advances. Using all these measures has led to a significant decrease in staff exposure to IR. Reducing staff exposure to meet the "As Low As Reasonably Achievable" principle is feasible. This review introduces the most important strategies applied in cardiac imaging.
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Affiliation(s)
- Samia Massalha
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada. .,Department of Cardiology, Rambam Health Care Campus, Haifa, Israel. .,Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.
| | - Aws Almufleh
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Garry Small
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Brian Marvin
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - John A Kennedy
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.,Faculty of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
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Luani B, Rauwolf T, Genz C, Schmeißer A, Wiemer M, Braun-Dullaeus RC. Intracardiac echocardiography versus fluoroscopy for endovascular and endocardial catheter navigation during cryo-ablation of the slow pathway in AVNRT patients. Cardiovasc Ultrasound 2019; 17:12. [PMID: 31186001 PMCID: PMC6560740 DOI: 10.1186/s12947-019-0162-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background A new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients. Methods Clinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution. Results Slow pathway ablation or modulation was successful in all patients. Fluoroscopy time and radiation dose in the fluoroscopy group were 11.2 ± 9.0 min and 20.3 ± 16.2Gycm2, whereas no fluoroscopy was used in the opposite group (p < 0.001, respectively). EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.). Conclusions Zero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques. Trial registration (German Clinical Trials Register ID: DRKS00011360; Registration Date 14.12.2016) Electronic supplementary material The online version of this article (10.1186/s12947-019-0162-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Blerim Luani
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429, Minden, Germany.
| | - Thomas Rauwolf
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Conrad Genz
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Alexander Schmeißer
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429, Minden, Germany
| | - Rüdiger C Braun-Dullaeus
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
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Musa AE, Shabeeb D. Radiation-Induced Heart Diseases: Protective Effects of Natural Products. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E126. [PMID: 31075882 PMCID: PMC6572037 DOI: 10.3390/medicina55050126] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 12/11/2022]
Abstract
Cardiovascular diseases (CVDs) account for the majority of deaths worldwide. Radiation-induced heart diseases (RIHD) is one of the side effects following exposure to ionizing radiation (IR). Exposure could be from various forms such as diagnostic imaging, radiotherapy for cancer treatment, as well as nuclear disasters and nuclear accidents. RIHD is mostly observed after radiotherapy for thoracic malignancies, especially left breast cancer. RIHD may affect the supply of blood to heart muscles, leading to an increase in the risk of heart attacks to irradiated persons. Due to its dose-limiting consequence, RIHD has a negative effect on the therapeutic efficacy of radiotherapy. Several methods have been proposed for protection against RIHD. In this paper, we review the use of natural products, which have shown promising results for protection against RIHD.
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Affiliation(s)
- Ahmed Eleojo Musa
- Department of Medical Physics, Tehran University of Medical Sciences (TUMS), International Campus, Tehran 1416753955, Iran.
- Research Center for Molecular and Cellular Imaging, TUMS, Tehran 1416753955, Iran.
| | - Dheyauldeen Shabeeb
- Department of Physiology, College of Medicine, University of Misan, Misan 62010, Iraq.
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Barbosa AHP, Medeiros RB, Corpa AMR, Higa FS, Souza MTD, Barbosa PL, Moreira AC, Quadros ASD, Lemke VDMG, Cantarelli MJDC. Prevalence of Lens Opacity in Interventional Cardiologists and Professional Working in the Hemodynamics in Brazil. Arq Bras Cardiol 2019; 112:392-399. [PMID: 30810610 PMCID: PMC6459427 DOI: 10.5935/abc.20190028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/15/2018] [Indexed: 11/20/2022] Open
Abstract
Background Posterior subcapsular cataract is a tissue reaction commonly found among
professionals exposed to ionizing radiation. Objective To assess the prevalence of cataract in professionals working in hemodynamics
in Brazil. Methods Professionals exposed to ionizing radiation (group 1, G1) underwent slit lamp
examination with a biomicroscope for lens examination and compared with
non-exposed subjects (group 2, G2). Ophthalmologic findings were described
and classified by opacity degree and localization using the Lens Opacities
Classification System III. Both groups answered a questionnaire on work and
health conditions to investigate the presence of risk factors for cataract.
The level of significance was set at 5% (p < 0.05). Results A total of 112 volunteers of G1, mean age of 44.95 (±10.23) years, and
88 volunteers of G2, mean age of 48.07 (±12.18) years were evaluated;
75.2% of G1 and 85.2% of G2 were physicians. Statistical analysis between G1
and G2 showed a prevalence of posterior subcapsular cataract of 13% and 2%
in G1 and G2, respectively (0.0081). Considering physicians only, 38% of G1
and 15% of G2 had cataract, with the prevalence of posterior subcapsular
cataract of 13% and 3%, respectively (p = 0.0176). Among non-physicians, no
difference was found in the prevalence of cataract (by types). Conclusions Cataract was more prevalent in professionals exposed to ionizing radiation,
with posterior subcapsular cataract the most frequent finding.
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Affiliation(s)
| | | | | | - Fabiana Shinzato Higa
- Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, SP - Brazil
| | - Marco Túlio de Souza
- Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, SP - Brazil
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Comments on “Physician Knowledge of Radiation Exposure and Risk in Medical Imaging”. J Am Coll Radiol 2018; 15:379-380. [DOI: 10.1016/j.jacr.2017.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 11/19/2022]
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First experience with zero-fluoroscopic ablation for supraventricular tachycardias using a novel impedance and magnetic-field-based mapping system. Clin Res Cardiol 2018; 107:578-585. [PMID: 29476203 PMCID: PMC6002461 DOI: 10.1007/s00392-018-1220-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022]
Abstract
AIMS Zero- and near-zero-fluoroscopic ablation techniques reduce the harmful effects of ionizing radiation during invasive electrophysiology procedures. We aimed to test the feasibility and safety of a zero-fluoroscopic strategy using a novel integrated magnetic and impedance-based electroanatomical mapping system for radiofrequency ablation (RFA) of supraventricular tachycardias (SVTs). METHODS We retrospectively studied 92 consecutive patients undergoing electrophysiology studies with/without RFA for supraventricular tachycardia (SVT) performed by a single operator at a single center. The first 42 (Group 1) underwent a conventional fluoroscopic-guided approach and the second 50 (Group 2) underwent a zero-fluoroscopic approach using the Ensite Precision™ 3-D magnetic and impedance-based mapping system (Abbott Inc). RESULTS Group 1 comprised 14 AV-nodal re-entrant tachycardia (AVNRT), 12 typical atrial flutter, 4 accessory pathway (AP), 2 atrial tachycardia (AT), and 9 diagnostic EP studies (EPS). Group 2 comprised 16 AVNRT, 17 atrial flutter, 6 AP, 3 AT, 2 AV-nodal ablations, and 7 EPS. A complete zero-fluoroscopic approach was achieved in 94% of Group 2 patients. All procedures were acutely successful, and no complications occurred. There was a significant reduction in fluoroscopy dose, dose area product, and time (p < 0.0001, for all), with no difference in procedure times. Ablation time for typical atrial flutter was shorter in Group 2 (p = 0.006). CONCLUSIONS A zero-fluoroscopic strategy for diagnosis and treatment of SVTs using this novel 3D-electroanatomical mapping system is feasible in majority of patients, is safe, reduces ionizing radiation exposure, and does not compromise procedural times, success rates, or complication rates.
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Menchik DA. Interdependent Career Types and Divergent Standpoints on the Use of Advanced Technology in Medicine. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:488-502. [PMID: 29172765 DOI: 10.1177/0022146517738088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper uses the case of the uneven use of a robotic technology to explain how physicians with similar training come to engage in different medical practices. I develop a conceptual framework in which their decisions to use advanced technologies are informed by "interdependent career types," a concept that incorporates features of the professional social context of physicians' work and the expertise they use, and reflects how medicine distributes expertise via formal and informal referral structures. I draw on data regarding specialized physicians' differentiated use of this technology over five years as well as interviews with those who continue to use the technology and those who have abandoned it. I argue that interdependent career types stratify physicians' standpoints on multiple dimensions of medical work-including those related to their concerns about reputation, inclinations toward risk, and preferences regarding the use of their bodies.
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Vlastra W, Delewi R, Sjauw KD, Beijk MA, Claessen BE, Streekstra GJ, Bekker RJ, van Hattum JC, Wykrzykowska JJ, Vis MM, Koch KT, de Winter RJ, Piek JJ, Henriques JP. Efficacy of the RADPAD Protection Drape in Reducing Operators’ Radiation Exposure in the Catheterization Laboratory. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.006058. [DOI: 10.1161/circinterventions.117.006058] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/15/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Wieneke Vlastra
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Ronak Delewi
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Krischan D. Sjauw
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Marcel A. Beijk
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Bimmer E. Claessen
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Geert J. Streekstra
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Robbert J. Bekker
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Juliette C. van Hattum
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Joanna J. Wykrzykowska
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Marije M. Vis
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Karel T. Koch
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Robbert J. de Winter
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - Jan J. Piek
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
| | - José P.S. Henriques
- From the Heart Center (W.V., R.D., K.D.S., M.A.B., B.E.C., R.J.B., J.C.v.H., J.J.W., M.M.V., K.T.K., R.J.d.W., J.J.P., J.P.S.H.), Department of Biomedical Engineering and Physics and Radiology and Nuclear Medicine (G.J.S.), Academic Medical Center, University of Amsterdam, the Netherlands
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Gould R, McFadden SL, Hughes CM. Radiation dose in paediatric cardiac catheterisation: A systematic literature review. Radiography (Lond) 2017; 23:358-364. [PMID: 28965901 DOI: 10.1016/j.radi.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES It is believed that children are more sensitive to ionising radiation than adults. This work reviewed the reported radiation dose estimates for paediatric cardiac catheterisation. A systematic literature review was performed by searching healthcare databases for studies reporting radiation dose using predetermined key words relating to children having cardiac catheterisation. The quality of publications was assessed using relevant Critical Appraisal Skills Programme questions and their reported radiation exposures were evaluated. KEY FINDINGS It is only in recent years that larger cohort observations have been undertaken. Although radiation dose from paediatric cardiac catheterisation has decreased in recent years, the literature indicated that it remains varied and potentially substantial. CONCLUSION Standardisation of weight categories and procedure types such as those recommended by the PiDRL project could help compare current and future radiation dose estimates.
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Affiliation(s)
- R Gould
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, BT37 OQB, United Kingdom.
| | - S L McFadden
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, BT37 OQB, United Kingdom
| | - C M Hughes
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, BT37 OQB, United Kingdom
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Abstract
OBJECTIVE Recent articles discussing cases of brain cancer in interventionalists have raised concerns regarding the hazards of occupational exposure to ionizing radiation. We review the basics of radiation dose and the potential radiation effects, particularly as they pertain to the operator. Then we present the data regarding the risk of each type of radiation effect to the fluoroscopy operator and staff, with special attention on cancer induction, radiation-induced cataracts, and the pregnant operator. CONCLUSION Although the evidence overwhelmingly shows that exposure to higher doses of radiation carries a risk of cancer and tissue reactions, the risks of chronic exposure to low-level radiation are less clear. Many studies examining occupational exposure to radiation fail to show an increased risk of stochastic effects of radiation, but the positive results raise concern that the studies are underpowered to consistently detect the small risk. The lack of information in these studies about radiation doses and adherence to radiation protection further confound their interpretation. Large prospective studies of populations with occupational exposure to low-level radiation might clarify this issue. More clearly established are the risks of radiation to the fetus and the risk of cataracts in interventional cardiologists and interventional radiologists. Interventionalists can mitigate these risks by following established radiation safety practices.
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