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Ramos-Avasola S, Ponce L, Leon K, Cuellar-Fritis C, Querales M. Efficacy of radiation attenuating caps in reducing radiation doses received at the cerebral level in interventional physicians: a systematic review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:031001. [PMID: 38959875 DOI: 10.1088/1361-6498/ad5e8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/03/2024] [Indexed: 07/05/2024]
Abstract
Background.Anecdotal reports are appearing in the scientific literature about cases of brain tumors in interventional physicians who are exposed to ionizing radiation. In response to this alarm, several designs of leaded caps have been made commercially available. However, the results reported on their efficacy are discordant.Objective.To synthesize, by means of a systematic review of the literature, the capacity of decreasing radiation levels conferred by radiation attenuating devices (RADs) at the cerebral level of interventional physicians.Methodology.A systematic review was performed including the following databases: MEDLINE, SCOPUS, EBSCO, Science Direct, Cochrane Controlled Trials Register (CENTRAL), WOS, WHO International Clinical Trials Register, Scielo and Google Scholar, considering original studies that evaluated the efficacy of RAD in experimental or clinical contexts from January 1990 to May 2023. Data selection and extraction were performed in triplicate, with a fourth author resolving discrepancies.Results.Twenty articles were included in the review from a total of 373 studies initially selected from the databases. From these, twelve studies were performed under clinical conditions encompassing 3801 fluoroscopically guided procedures, ten studies were performed under experimental conditions with phantoms, with a total of 88 procedures, four studies were performed using numerical calculations with a total of 63 procedures. The attenuation and effectiveness of provided by the caps analyzed in the present review varying from 12.3% to 99.9%, and 4.9% to 91% respectively.Conclusion.RAD were found to potentially provide radiation protection, but a high heterogeneity in the shielding afforded was found. This indicates the need for local assessment of cap efficiency according to the practice.
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Affiliation(s)
- Sergio Ramos-Avasola
- Universidad Viña del Mar, Viña del Mar, Chile, Facultad de Ciencias de La Salud, Escuela de Tecnología Médica, Agua Santa 7055, sector Rodelillo, Viña del Mar, Chile
| | - Lusin Ponce
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina Humana, Escuela Profesional de Tecnología Médica, Lima, Peru
| | - Karla Leon
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina Humana, Escuela Profesional de Tecnología Médica, Lima, Peru
| | | | - Marvin Querales
- Facultad de Medicina, Escuela de Tecnología Médica, Universidad de Valparaíso, Chile
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Shbeer A. Assessment of the Occupational Radiation Exposure of Anesthesia Staff in Interventional Cardiology. Risk Manag Healthc Policy 2024; 17:1093-1100. [PMID: 38707521 PMCID: PMC11068050 DOI: 10.2147/rmhp.s460054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction This research seeks to evaluate the occupational radiation dose, quantified as the whole-body Annual Mean Effective Dose (AMED), received by anesthesia personnel in interventional cardiology. Methods Thermoluminescent dosimetry data was collected over five years (2019-2023) for a total of 175 anesthesia staff. Technologists comprised approximately 72.4% of the participants (55% male and 45% female), while consultants accounted for 27.6% (70% male and 30% female). Statistical tests, including Independent Samples T-Test and One-Way ANOVA, compared AMED across genders, job titles, and years. Results The study's findings on AMED across all staff from 2019 to 2023 showed marked variability in AMED. There was a significant rise in AMED from 0.72 mSv in 2019 to 0.92 mSv in 2020, then a decline to 0.82 mSv in 2021, with further decreases to 0.67 mSv in 2022 and finally to 0.65 mSv in 2023 (p < 0.001). The average AMED over the five-year span (2019-2023) was 0.76 ± 0.4 mSv. In terms of gender, the overall AMED for males was 0.73 ± 0.36 mSv and for females 0.79 ± 0.45 mSv, showing no significant statistical difference (p = 0.272). Significant differences in exposure were observed between the technologists who experienced a higher overall AMED (0.8 ± 0.43 mSv) compared to consultants (0.63 ± 0.29 mSv, p = 0.008). Discussion Despite these variations, AMED values remained lower than the annual occupational dose limit of 20 mSv, indicating generally low radiation exposure for anesthesia staff. This study emphasizes the importance of ongoing monitoring and enhanced protective measures to safeguard the health of medical professionals working with radiation.
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Affiliation(s)
- Abdullah Shbeer
- Department of Surgery, College of Medicine, Jazan University, Jazan, Saudi Arabia
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Rizik DG, Burke RF, Klassen SR, Nigoghosian AM, Riley RD, Gosselin KP, Goldstein JA. Comprehensive Shielding System Enhances Radiation Protection for Structural Heart Procedures. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101110. [PMID: 39131971 PMCID: PMC11307704 DOI: 10.1016/j.jscai.2023.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2024]
Abstract
Background This study of radiation exposure (RE) to physicians performing structural heart procedures evaluated the efficacy of a novel comprehensive radiation shield compared to those of traditional shielding methods. A novel comprehensive shielding system (Protego, Image Diagnostics Inc) has been documented to provide superior RE protection during coronary procedures compared to that provided by a standard "drop down" shield. The purpose of this study was to assess the efficacy of this shield in transcatheter aortic valve replacement (TAVR) procedures, which are associated with disproportionate RE to operators. Methods This single-center, 2-group cohort, observational analysis compared RE to the primary physician operator performing TAVR using the Protego shield (n = 25) with that using a standard drop-down shield with personal leaded apparel (n = 25). RE was measured at both thyroid and waist levels with a real-time dosimetry system (RaySafe i3, RaySafe) and was calculated on a mean per case basis. Data were collected on additional procedural parameters, including access site(s) for device implantation, per case fluoroscopy time, air kerma, and patient factors, including body mass index. Between-group comparisons were conducted to evaluate RE by group and measurement sites. Results The Protego system reduced operator RE by 99% compared to that using standard protection. RE was significantly lower at both the thyroid level (0.08 ± 0.27 vs 79.2 ± 62.4 μSv; P < .001) and the waist level (0.70 ± 1.50 vs 162.0 ± 91.0 μSv, P < .001). "Zero" total RE was documented by RaySafe in 60% (n = 15) of TAVR cases using Protego. In contrast, standard protection did not achieve zero exposure in a single case. Conclusions The Protego shield system provides superior operator RE protection during TAVR procedures. This shield allows operators to work without the need for personal lead aprons and has potential to reduce catheterization laboratory occupational health hazards.
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Affiliation(s)
- David G. Rizik
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Robert F. Burke
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Sabrina R. Klassen
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | | | - Robert D. Riley
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Kevin P. Gosselin
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - James A. Goldstein
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
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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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Kataoka A, Takata T, Yanagawa A, Kito K, Arakawa M, Ishibashi R, Katayama T, Mitsui M, Nagura F, Kawashima H, Hioki H, Watanabe Y, Kozuma K, Kotoku J. Body Surface Radiation Exposure in Interventional Echocardiographers During Structural Heart Disease Procedures. JACC. ASIA 2023; 3:301-309. [PMID: 37181397 PMCID: PMC10167512 DOI: 10.1016/j.jacasi.2022.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 05/16/2023]
Abstract
Background The distribution of radiation exposure on the body surface of interventional echocardiographers during structural heart disease (SHD) procedures is unclear. Objectives This study estimated and visualized radiation exposure on the body surface of interventional echocardiographers performing transesophageal echocardiography by computer simulations and real-life measurements of radiation exposure during SHD procedures. Methods A Monte Carlo simulation was performed to clarify the absorbed dose distribution of radiation on the body surface of interventional echocardiographers. The real-life radiation exposure was measured during 79 consecutive procedures (44 transcatheter edge-to-edge repairs of the mitral valve and 35 transcatheter aortic valve replacements [TAVRs]). Results The simulation demonstrated high-dose exposure areas (>20 μGy/h) in the right half of the body, especially the waist and lower body, in all fluoroscopic directions caused by scattered radiation from the bottom edge of the patient bed. High-dose exposure occurred when obtaining posterior-anterior and cusp-overlap views. The real-life exposure measurements were consistent with the simulation estimates: interventional echocardiographers were more exposed to radiation at their waist in transcatheter edge-to-edge repair than in TAVR procedures (median 0.334 μSv/mGy vs 0.053 μSv/mGy; P < 0.001) and in TAVR with self-expanding valves than in those with balloon-expandable valves (median 0.067 μSv/mGy vs 0.039 μSv/mGy; P < 0.01) when the posterior-anterior or the right anterior oblique angle fluoroscopic directions were used. Conclusions During SHD procedures, the right waist and lower body of interventional echocardiographers were exposed to high radiation doses. Exposure dose varied between different C-arm projections. Interventional echocardiographers, especially young women, should be educated regarding radiation exposure during these procedures. (The development of radiation protection shield for catheter-based treatment of structural heart disease [for echocardiologists and anesthesiologists]; UMIN000046478).
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Affiliation(s)
- Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Takeshi Takata
- Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan
| | - Ayaka Yanagawa
- Department of Anesthesia, Teikyo University, Tokyo, Japan
| | - Kento Kito
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Masataka Arakawa
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
- Department of Cardiovascular Medicine, Asahi General Hospital, Tokyo, Japan
| | - Ruri Ishibashi
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Taiga Katayama
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Miho Mitsui
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Fukuko Nagura
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hideyuki Kawashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Jun’ichi Kotoku
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
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Yanagawa A, Takata T, Onimaru T, Honjo T, Sajima T, Kakinuma A, Kataoka A, Kotoku J. New perforated radiation shield for anesthesiologists: Monte Carlo simulation of effects. JOURNAL OF RADIATION RESEARCH 2023; 64:379-386. [PMID: 36702614 PMCID: PMC10036102 DOI: 10.1093/jrr/rrac106] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/15/2022] [Indexed: 06/18/2023]
Abstract
Catheterization for structural heart disease (SHD) requires fluoroscopic guidance, which exposes health care professionals to radiation exposure risk. Nevertheless, existing freestanding radiation shields for anesthesiologists are typically simple, uncomfortable rectangles. Therefore, we devised a new perforated radiation shield that allows anesthesiologists and echocardiographers to access a patient through its apertures during SHD catheterization. No report of the relevant literature has described the degree to which the anesthesiologist's radiation dose can be reduced by installing radiation shields. For estimating whole-body doses to anesthesiologists and air dose distributions in the operating room, we used a Monte Carlo system for a rapid dose-estimation system used with interventional radiology. The simulations were performed under four conditions: no radiation shield, large apertures, small apertures and without apertures. With small apertures, the doses to the lens, waist and neck surfaces were found to be comparable to those of a protective plate without an aperture, indicating that our new radiation shield copes with radiation protection and work efficiency. To simulate the air-absorbed dose distribution, results indicated that a fan-shaped area of the dose rate decrease was generated in the area behind the shield, as seen from the tube sphere. For the aperture, radiation was found to wrap around the backside of the shield, even at a height that did not match the aperture height. The data presented herein are expected to be of interest to all anesthesiologists who might be involved in SHD catheterization. The data are also expected to enhance their understanding of radiation exposure protection.
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Affiliation(s)
- Ayaka Yanagawa
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Takeshi Takata
- Advanced Comprehensive Research Organization, Teikyo University, Tokyo 173-8605, Japan
| | - Taichi Onimaru
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Takahiro Honjo
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Takeyuki Sajima
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Akihito Kakinuma
- Department of Anesthesia, Teikyo University, Tokyo 173-8605, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo 173-8605, Japan
| | - Jun’ichi Kotoku
- Corresponding author. Graduate School of Medical Care and Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan. Tel: +81-3-3964-1211; Fax: +81-3-3964-6022;
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7
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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Asgar AW. Editorial: Ionizing Radiation-The Unseen Enemy of Structural Heart Disease Interventions. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100007. [PMID: 37273479 PMCID: PMC10236860 DOI: 10.1016/j.shj.2022.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 06/06/2023]
Affiliation(s)
- Anita W. Asgar
- Montreal Heart Institute, Department of Cardiology, Universite de Montreal, Montreal, Canada
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Guni E, Hellmann I, Wucherer M, Knappe-Kagan P, Hartmann J, Lell M, Adamus R. Effectiveness of Radiation Protection Caps for Lowering dose to the Brain and the Eye Lenses. Cardiovasc Intervent Radiol 2021; 44:1260-1265. [PMID: 33987693 DOI: 10.1007/s00270-021-02831-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This work was designed to study the effectiveness of radiation protection caps in lowering the dose to the brain and the eye lens during fluoroscopically guided interventions. MATERIALS AND METHODS Two types of radiation protection caps were examined with regards to their capacity to lower the radiation dose. One cap is equipped with lateral flaps, the other one is not. These caps were fitted to the head of an anthropomorphic Alderson-Rando (A.-R.) phantom. The phantom was positioned aside an angiographic table simulating the position of the first operator during a peripheral arterial intervention. One of the brain slices and both eyes of the A.-R. phantom were equipped with thermoluminescence dosimeters (TLDs). RESULTS The analysis of the data showed that the cap without lateral flaps reduced the dose to the brain by 11,5-27,5 percent depending on the position within the brain. The cap with lateral protection flaps achieved a shielding effect between 44,7 and 78,9 percent. When evaluating the dose to the eye, we did see an increase of dose reduction from 63,3 to 66,5 percent in the left eye and from 45,8 to 46,8 percent in the right eye for the cap without lateral protection. When wearing the cap with lateral protection we observed an increase of dose reduction from 63,4 to 67,2 percent in the left eye and from 45,8 to 50,0 percent in the right eye. CONCLUSION Radiation protection caps can be an effective tool to reduce the dose to the brain and the eyes.
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Affiliation(s)
- Ewald Guni
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
| | - Ingo Hellmann
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Michael Wucherer
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Petra Knappe-Kagan
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Josefin Hartmann
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Michael Lell
- Institute of Radiology and Nuclear Medicine, Nuremberg General Hospital, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, Nuremberg, Germany
| | - Ralf Adamus
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Maximiliansplatz 3, 91054, Erlangen, Germany
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Sánchez RM, Vano E, Fidalgo J, Fernández JM. Percutaneous structural cardiology: are anaesthesiologists properly protected from ionising radiation? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:1420-1428. [PMID: 33236721 DOI: 10.1088/1361-6498/abc4d7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During transcatheter aortic valve implantations (TAVI) and other percutaneous structural procedures, some patients may need close anesthesiological care, thus exposing the anaesthesiologist to x-rays. This work aims to investigate the radiation dose received by anaesthesiologists during these specific procedures in order to improve their radiological protection. Occupational radiation doses were measured prospectively during percutaneous structural procedures in several health professionals using electronic dosimeters worn over the apron at chest level. A sample of 49 procedures were recorded, where the anaesthesiologists' average dose per procedure resulted 13 times higher than that of interventional cardiologists. The average dose per procedure received over the protection apron during TAVIs by the anaesthesiologist was 0.13 mSv, with a maximum value of 0.69 mSv. Taking these figures as a conservative estimation of the eye lens dose, an anaesthesiologist could participate in around 150 procedures before reaching the regulatory annual dose limit for the lens of the eye in Europe (20 mSv). In those clinical procedures where patients need close anesthesiological care, the anaesthesiologists might receive high radiation doses increasing the risk for cataracts and the risk of stochastic radiation effects. The proper use of occupational dosimeters will help identify these situations. It is recommended to use a mobile shielding barrier to reduce radiation exposure to acceptable levels in these situations.
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Affiliation(s)
- Roberto M Sánchez
- Medical Physics, Hospital Clínico San Carlos, 28040 Madrid, Spain. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain. Radiology Department, Medicine Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain
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11
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Effectiveness of a radiation protective device for anesthesiologists and transesophageal echocardiography operators in structural heart disease interventions. Cardiovasc Interv Ther 2020; 36:523-531. [PMID: 32935276 DOI: 10.1007/s12928-020-00708-9] [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: 04/27/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
In structural heart disease (SHD) interventions, the exposure of staff other than the first operator such as anesthesiologists and transesophageal echocardiography (TEE) operators to the radiation can also pose the risks of cancer and cataracts in the long term. This study was conducted to test our new radiation protective device (RPD) for anesthesiologists and TEE operators in SHD interventions. The RPD, which consists of a head side shield and a cradle shield, was mounted on a 0.25 mm Pb-equivalent unleaded radiation protection sheet on a self-made J-shaped acrylic table, and it was placed on the head side and cradle on the operating table. A CT human body phantom was placed on the operating table, and the C-arm was set in five directions: posteroanterior, right anterior oblique 30°, left anterior oblique 30°, caudal 30°, and cranial 30°. The ambient dose equivalent rate at the usual positions of the anesthesiologist and TEE operator were measured under a fluoroscopic sequence with and without the RPD, and the dose reduction rate was obtained. The height of each measurement point was set to 100, 130 or 160 cm. The reduction rates at the positions of the anesthesiologist and the TEE operator were 82.6-86.4% and 77.9-89.5% at the height of 100 cm, 48.5-68.4% and 83.3-91.0% at 130 cm, and 23.6-62.9% and 72.9-86.1% at 160 cm, respectively. The newly developed RPD can thus effectively reduce the radiation exposure of anesthesiologists and TEE operators during SHD interventions.
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