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Veillette JB, Carrier MA, Rinfret S, Mercier J, Arsenault J, Paradis JM. Occupational Risks of Radiation Exposure to Cardiologists. Curr Cardiol Rep 2024:10.1007/s11886-024-02056-z. [PMID: 38625456 DOI: 10.1007/s11886-024-02056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE OF REVIEW Invasive cardiologists are exposed to large amounts of ionizing radiation. This review aims to summarize the main occupational risks in a radiation-exposed cardiology practice. RECENT FINDINGS We carried out a literature review on the subject. The studies reviewed allowed us to list six main health risk categories possibly associated with radiation exposure among cardiologists: deoxyribonucleic acid (DNA) and biochemical damages; cancers; ocular manifestations; olfaction, vascular, and neuropsychological alterations; musculoskeletal problems; and reproductive risks. Our descriptive analysis demonstrates higher risks of DNA damage and lens opacities among radiation-exposed cardiology staff. Surveys and questionnaires have demonstrated a higher risk of musculoskeletal disease in exposed workers. Studies reported no difference in cancer frequency between radiation-exposed workers and controls. Changes in olfactory performance, neuropsychological aspects, and vascular changes have also been reported. Limited literature supports the security of continuing radiation-exposed work during pregnancy. Therefore, there is an urgent need to increase knowledge of the occupational risks of radiation exposure and to adopt technologies to reduce them.
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Affiliation(s)
- Jean-Benoît Veillette
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Marc-Antoine Carrier
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Stéphane Rinfret
- Department of Interventional Cardiology, Georgia Heart Institute, Gainesville, GA, USA
| | - Julien Mercier
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jean Arsenault
- Department of Engineering, Quebec Heart and Lung Institute, Quebec City, QC, Canada
| | - Jean-Michel Paradis
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada.
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Soether C, Boehmer AA, Dobre BC, Kaess BM, Ehrlich JR. Zero-fluoro atrioventricular-nodal reentrant tachycardia ablation. Herzschrittmacherther Elektrophysiol 2023; 34:305-310. [PMID: 37950109 DOI: 10.1007/s00399-023-00977-w] [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: 07/27/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Atrioventricular-nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia, particularly in younger patients. The treatment of choice is radiofrequency catheter ablation (RFCA), traditionally necessitating ionizing radiation for catheter guidance. OBJECTIVE The authors aimed to demonstrate the feasibility and safety of zero-fluoroscopy RFCA of AVNRT using EnSite™ NavX™ as a three-dimensional (3D) electroanatomical mapping system (EAM). METHODS The authors retrospectively analyzed 68 patients that underwent AVNRT-RFCA. One group was a priori allocated to conventional fluoroscopy mapping (convFluoro, n = 30). In 38 cases, the electrophysiologist chose to use 3D-EAM for ablation. Of these patients, 20 could be ablated without fluoroscopy use (zeroFluoro). In 18 cases that were initially intended as 3D-EAM, additional fluoroscopy use was necessary due to difficult anatomic conditions (convertedFluoro). Procedure duration, fluoroscopy duration and dose, as well as complications were analyzed. RESULTS Procedure duration was similar for the convFluoro and zeroFluoro groups (74 ± 24 min vs. 80 ± 26 min, p = ns). The convertedFluoro group showed longer procedure duration compared to the convFluoro group (94 ± 30 min vs. 74 ± 24 min, p < 0.05). The use of 3D-EAM significantly reduced fluoroscopy duration comparing the convFluoro with the convertedFluoro group (12 ± 9 min vs. 7 ± 6 min, p < 0.05). The difference in fluoroscopy dose between convFluoro and convertedFluoro did not reach significance (169 ± 166 cGycm2 vs. 134 ± 137 cGycm2, p = ns). In zeroFluoro cases, no radiation was used at all. 3D-EAM-guided RFCA was primarily successful in all patients. Overall, there were only few minor complications in the different groups. No major complications occurred. CONCLUSION Zero-fluoro RFCA in patients with AVNRT is feasible and safe. 3D-EAM can reduce radiation exposure in the majority of patients without prolonging procedure duration or increasing complications.
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Affiliation(s)
- Christina Soether
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Andreas A Boehmer
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Bianca C Dobre
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Bernhard M Kaess
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany.
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Iqbal AM, Li KY, Mahmood M, Gautam S. Safety of fluoroless radiofrequency catheter ablation for atrial fibrillation in patients with pre-existing cardiac implantable electronic device: A single-center study. Pacing Clin Electrophysiol 2023; 46:1387-1392. [PMID: 37713192 DOI: 10.1111/pace.14818] [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: 05/14/2023] [Revised: 07/27/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Radiofrequency catheter ablation (RFA) for atrial fibrillation (AF) is being increasingly performed without fluoroscopy. This study aims to determine the safety of fluoroless RFA for patients with pre-existing cardiac implantable electronic devices (CIED). METHODS This is a single-center, single-operator, retrospective, observational study of 225 consecutive fluoroless RFA procedures for AF from June 1, 2019 to June 1, 2022. All procedures were performed with intracardiac echocardiography (ICE) support. Patients with pre-existing CIED were extracted from the database. Each CIED was interrogated at the start and end of each procedure and at 30-day follow-up. Pre- and post-procedure CIED interrogations were compared for any change in device or lead parameters. Patients were tracked for any subsequent device malfunction. RESULTS Out of 225 fluoroless AF ablations, 25 (10.2%) had pre-existing CIED (14 dual-chamber pacemakers, three dual-chamber defibrillators, three single-chamber defibrillators, one single chamber pacemaker, and four biventricular devices). Mean patient age was 71 ± 6 years. The mean duration of indwelling CIED was 1804 ± 1645 days (range: 78-6267 days). One (4%) patient had lead-related fibrin on ICE imaging. There was no significant difference in lead(s) threshold, impedance, or sensing post procedure or at 30-day follow-up compared to pre procedure. None of the patients required lead revision. There were no intra- or post-op thromboembolic events or subsequent device infection. One patient underwent CIED extraction after 11 months for an unrelated secondary device infection. CONCLUSIONS Radiofrequency catheter ablation for AF can be safely performed without fluoroscopy in patients with pre-existing CIED.
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Affiliation(s)
- Arshad Muhammad Iqbal
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kai Yu Li
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Mobasser Mahmood
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandeep Gautam
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
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Ma J, Liu K, Chen W, Wang T, Xu Z, Li Y, Zhao B, Zhou L, Wang F, Li C. A dual-centre study on the radioprotective effect of a novel X-ray protection device during coronary intervention. Clin Radiol 2023; 78:e758-e763. [PMID: 37419771 DOI: 10.1016/j.crad.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/04/2023] [Accepted: 06/04/2023] [Indexed: 07/09/2023]
Abstract
AIM To investigate the shielding efficiency of a novel X-ray protection device (NPD) compared with the traditional lead clothing (TLC) during coronary intervention. MATERIALS AND METHODS This study was performed prospectively in two centres. A total of 200 coronary interventions were included and assigned equally into the NPD or TLC group. The NPD is a floor-standing X-ray protection device, which mainly composes of a barrel-like frame and two layers of lead rubber. Thermoluminescent dosimeters (TLDs) were adopted to detect the cumulative absorbed doses, and were attached outside the NPD or TLC or body of the first operator at four different height levels in four directions during the procedure. RESULTS The cumulative doses outside the NPD were comparable to that of the TLC (2,398.33 ± 2,341.64 versus 1,624.09 ± 1,732.20 μSv, p=0.366), and the cumulative doses inside the NPD were significantly lower than those inside the TLC (40 ± 0 versus 732.28 ± 919.83 μSv, p<0.001). As the TLC did not cover the calf segment of the operator, the area at 50 cm height from the floor in the TLC group was unshielded. The shielding efficiency of NPD was significantly higher than that of the TLC (98.2 ± 0.63% versus 52.11 ± 38.97%, p=0.021). CONCLUSION The NPD has a significantly higher shielding efficacy than that of the TLC, in particular, it protects the operators' lower limb, liberates their lower body from wearing heavy lead apron, and may consequently reduce the radiation or body-load associated complications.
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Affiliation(s)
- J Ma
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - K Liu
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Cardiology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - W Chen
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, Jiangsu, China
| | - T Wang
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Cardiology, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Z Xu
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Y Li
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - B Zhao
- Department of Cardiology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - L Zhou
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - F Wang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, Jiangsu, China.
| | - C Li
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Schoff K, Chan A, Karuparthi PR, Hirai T. Techniques to Overcome the Pushability of Robotic-Assisted PCI. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S267-S270. [PMID: 35697642 DOI: 10.1016/j.carrev.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Robotic-assisted percutaneous coronary intervention (PCI) was developed with a safety system that limits pushability as compared to manual PCI, thus preventing inadvertent deep delivery of the device and avoiding complications. This safety feature may limit robotic completion when performing intervention to more complex lesions that may require device delivery through calcified or previously stented lesions. In this article, we report three cases that highlight techniques to overcome this limited pushability, resulting in successful robotic completion of the procedures.
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Affiliation(s)
- Krista Schoff
- University of Missouri, Columbia, MO, United States of America
| | - Albert Chan
- University of Missouri, Columbia, MO, United States of America; Harry S Truman Memorial Veterans' Hospital, Columbia, MO, United States of America
| | - Poorna R Karuparthi
- University of Missouri, Columbia, MO, United States of America; Harry S Truman Memorial Veterans' Hospital, Columbia, MO, United States of America
| | - Taishi Hirai
- University of Missouri, Columbia, MO, United States of America.
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Huet C, Dabin J, Domienik-Andrzejewska J, Hebre A, Honorio da Silva E, Lombardo P, Tamborino G, Vanhavere F. Effectiveness of staff radiation protection devices for interventional cardiology procedures. Phys Med 2023; 107:102543. [PMID: 36780792 DOI: 10.1016/j.ejmp.2023.102543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/13/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of currently available radioprotective (RP) devices in reducing the dose to interventional cardiology staff, especially to the eye lens and brain. METHODS The performances of five RP devices (masks, caps, patient drapes, staff lead and lead-free aprons and Zero-Gravity (ZG) suspended radiation protection system) were assessed by means of Monte Carlo (MC) simulations. A geometry representative of an interventional cardiology setup was modelled and several configurations, including beam projections and staff distance from the source, were investigated. In addition, measurements on phantoms were performed for masks and drapes. RESULTS An average dose reduction of 65% and 25% to the eyes and the brain respectively was obtained for the masks by MC simulations but a strong influence of the design was observed. The cap effectiveness for the brain ranges on average between 13% and 37%. Nevertheless, it was shown that only some upper parts of the brain were protected. There was no significant difference between the effectiveness of lead and lead-free aprons. Of all the devices, the ZG system offered the highest protection to the brain and eye lens and a protection level comparable to the apron for the organs normally covered. CONCLUSION All investigated devices showed potential for dose reduction to specific organs. However, for masks, caps and drapes, it strongly depends on the design, exposure conditions and staff position. Therefore, for a clinical use, it is recommended to evaluate their effectiveness in the planned conditions of use.
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Affiliation(s)
- Christelle Huet
- Institut de radioprotection et de sûreté nucléaire, Pôle santé et environnement, Service de recherche en dosimétrie, Fontenay-aux-Roses, France.
| | - Jérémie Dabin
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium
| | | | - Alexandre Hebre
- Institut de radioprotection et de sûreté nucléaire, Pôle santé et environnement, Service de recherche en dosimétrie, Fontenay-aux-Roses, France
| | | | - Pasquale Lombardo
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium
| | - Giulia Tamborino
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium
| | - Filip Vanhavere
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium
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Kataria V, Yaduvanshi I, Singal G, Nair M. Establishing a diagnostic reference level of radiation dose in coronary angiography and intervention: A prospective evaluation. Indian Heart J 2021; 73:725-728. [PMID: 34861982 PMCID: PMC8642644 DOI: 10.1016/j.ihj.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Invasive Coronary Angiography (CAG) leads to significant radiation exposure to the patients. Guidelines suggest that a local landmark or Diagnostic Reference Level (DRL) for these procedures should be established for every region and country. This study attempts to create a DRL for a tertiary care hospital, acting as an interim DRL for the country/region. METHODS Radiation exposure data for all coronary procedures done at a tertiary care hospital between October 2016 to September 2018 were collected. Data was segregated into diagnostic Coronary Angiography (CAG) and single-vessel Percutaneous Intervention (PCI). The parameters collected include dose surface product (PKA), skin surface entry dose (KAR), and fluoroscopy time (FT). The 75th percentile of the PKA was used to define the DRL. RESULTS 500 Patients were included in the CAG group, in which the Median KAR was 412.05 mGy, Median PKA was 2635.7 μGysqm, and median FT was 2.25 min. The DRL for coronary angiography was calculated as 3695.1 μGysqm. Two hundred fifty patients were in the PCI group, the Median KAR was 1649 mGy, Median PKA was 8822.1 μGysqm, the median FT being 8.2 min. The DRL for single-vessel coronary intervention was calculated as 11038 μGysqm. CONCLUSION This study establishes a benchmark for radiation dose for diagnostic coronary angiography and single-vessel coronary intervention at a tertiary care hospital in NCR. It establishes an interim DRL that can be used for future studies in other institutions in the region and country and to compare with other countries.
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Affiliation(s)
- Vikas Kataria
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Ishita Yaduvanshi
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Gautam Singal
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Mohan Nair
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India.
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Prevalence of Breast Cancer in Female Physicians Performing Procedures With Significant Fluoroscopy Exposure: Survey. J Comput Assist Tomogr 2021; 45:704-710. [PMID: 34469902 DOI: 10.1097/rct.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess self-reported breast cancer prevalence potentially associated with occupational radiation exposure from fluoroscopy-guided procedures in female physicians using current standard protection measures. METHODS An institutional review board-approved survey was shared as a link to self-identified female physicians. We compared self-reported prevalence of breast cancer among women physicians with longer than 10 years of postfellowship practice in specialties with heavy fluoroscopy exposure versus specialties with low fluoroscopy exposure. We compared the distribution of breast cancer risk factors and personal radiation safety measures. RESULTS A total of 303 women physicians participated in the survey. There were 8 (16%) of 49 from the first study group and 8 (18%) of 44 from the second study group who self-reported a diagnosis of breast cancer. There were no differences in the distribution of breast cancer risk factors between the 2 groups or prevalence of breast cancer (P = 0.81). CONCLUSIONS Self-reported breast cancer prevalence is similar between women physicians who are practicing fluoroscopically heavy and light medical specialties.
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Werner GS, Yaginuma K, Koch M, Tischer K, Silber M, Werner J, Keuser T, Moehlis H. Reducing fluoroscopic and cineangiographic contribution to radiation exposure for chronic total coronary occlusion interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:58-64. [PMID: 33931375 DOI: 10.1016/j.carrev.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The treatment of chronic total coronary occlusions (CTO) carries the highest radiation exposure among percutaneous coronary interventions (PCI). In order to minimize radiation damage, we need to understand and optimize the contribution of all components of radiation exposure. METHODS A total of 1000 CTO procedures performed between 2011 and 2020 were compared according to implemented radiation modifications. Group 1 used the original set-up of the X-ray equipment (Artis Zee, Siemens). In group 2 a modified protocol aimed at reducing the fluoroscopy exposure, in group 3 further modifications aimed at reducing cineangiographic exposure. RESULTS Despite an increased lesion complexity, Air Kerma (AK) was reduced from 2619 mGy (1653-4574) in group 1 to 2178 mGy (1332-3500; p < 0.001) in group 2 by mainly reducing fluoroscopic contribution by 54.1%, the cineangiographic contribution was lowered by only 6.6%. In group 3 AK dropped drastically to 746 mGy (480-1225; p < 0.001) mainly by reducing the cineangiographic contribution by 53.4%, still there was a further reduction of fluoroscopy contribution of 8.2%. This also led to a reduction of the skin entry dose from 1038 mGy (690-1589) in group 2 to 359 mGy (204-591; p < 0.001) in group 3. This was achieved both in normal weight and obese patients, and both in antegrade and retrograde procedures. CONCLUSIONS The present study demonstrates that by modifying both the fluoroscopic and cineangiographic contribution to radiation exposure a drastic reduction of radiation risk can be achieved, even in obese patients. Currently accepted radiation thresholds may no longer be a limit for CTO PCI.
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Affiliation(s)
- Gerald S Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany.
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Tokyo, Japan
| | - Matthias Koch
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | - Martin Silber
- Institut für Radioonkologie und Strahlentherapie, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Juliane Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Thomas Keuser
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Hiller Moehlis
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
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Cheney AE, Vincent LL, McCabe JM, Kearney KE. Pregnancy in the Cardiac Catheterization Laboratory: A Safe and Feasible Endeavor. Circ Cardiovasc Interv 2021; 14:e009636. [PMID: 33877865 DOI: 10.1161/circinterventions.120.009636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Concerns over radiation exposure are ubiquitous to all interventional cardiologists; however, fear of exposure during childbearing years disproportionately deters women from entering the field. This review summarizes the available data on occupational radiation exposure during pregnancy with an emphasis on radiation quantification, the impact of exposure at various stages of fetal development, societal recommendations for safe levels of exposure during gestation, threshold levels necessary to induce fetal harm, and safe practices for the pregnant interventionalist. Reconciling the available information, we conclude that pregnancy in the cardiac catheterization laboratory is both safe and feasible. This review also highlights new technologies that may augment standard radiation safety techniques and are of particular interest to the pregnant interventional cardiologist. Finally, we propose steps to improve female representation in this field, underscoring the importance of a sex-balanced workforce.
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Affiliation(s)
- Amy E Cheney
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle
| | - Logan L Vincent
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle
| | - James M McCabe
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle
| | - Kathleen E Kearney
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle
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Ko S, Kim KP, Cho SB, Bang YJ, Ha YW, Lee WJ. Occupational Radiation Exposure and Validity of National Dosimetry Registry among Korean Interventional Radiologists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084195. [PMID: 33921003 PMCID: PMC8071388 DOI: 10.3390/ijerph18084195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
The national dose registry (NDR) contains essential information to help protect radiation workers from radiation-related health risks and to facilitate epidemiological studies. However, direct validation of the reported doses has not been considered. We investigated the validity of the NDR with a personal dosimeter monitoring conducted among Korean interventional radiologists. Among the 56 interventional radiologists, NDR quarterly doses were compared with actively monitored personal thermoluminescent dosimeter (TLD) doses as standard measures of validation. We conducted analyses with participants categorized according to compliance with TLD badge-wearing policies. A correlation between actively monitored doses and NDR doses was low (Spearman ρ = 0.06), and the mean actively monitored dose was significantly higher than the mean NDR dose (mean difference 0.98 mSv) in all participants. However, interventional radiologists who wore badges irregularly showed a large difference between actively monitored doses and NDR doses (mean difference 2.39 mSv), and participants who wore badges regularly showed no apparent difference between actively monitored doses and NDR doses (mean difference 0.26 mSv). This study indicated that NDR data underestimate the actual occupational radiation exposure, and the validity of these data varies according to compliance with badge-wearing policies. Considerable attention is required to interpret and utilize NDR data based on radiation workers’ compliance with badge-wearing policies.
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Affiliation(s)
- Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (Y.J.B.); (Y.W.H.)
- Graduate School of Public Health, Korea University, Seoul 02841, Korea
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Gyeonggi-do 02447, Korea;
| | - Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (Y.J.B.); (Y.W.H.)
- Graduate School of Public Health, Korea University, Seoul 02841, Korea
| | - Yae Won Ha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (Y.J.B.); (Y.W.H.)
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (Y.J.B.); (Y.W.H.)
- Graduate School of Public Health, Korea University, Seoul 02841, Korea
- Correspondence:
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Attanasio P, Huemer M, Kaehler N, Keller T, Schreiber T, Niehues R, Katsani-Potempa D, Klein RM, Landmesser U, Deisenhofer I, Tutdibi O, Bourier F. Safe procedures despite ultra low radiation doses during catheter ablations of atrial and ventricular arrhythmias-A multicenter experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:807-813. [PMID: 33665850 DOI: 10.1111/pace.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/05/2021] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite the development of non-fluoroscopic catheter visualization options, fluoroscopy is still used in most ablation procedures. The aim of this multicenter study was to evaluate the safety and efficacy of a new ultra-low dose radiation protocol for EP procedures in a large number of patients. METHODS AND RESULTS A total of 3462 consecutive patients (male 1926 (55.6%), age 64.4 ± 14.0 years, BMI 26.65 ± 4.70) undergoing radiofrequency ablation (left atrial (n = 2316 [66.9%], right atrial (n = 675 [19.5%], or ventricular (n = 471 [13.6%]) in three German centers were included in the analysis. Procedures were performed using a new ultra-low dose protocol operating at 8nGy for fluoroscopy and 36nGy for cine-loops. Additionally a very low framerate (2-3FPS) was used. Using the new protocol very low Air kerma-area product (KAP) values were achieved for left atrial ablations (104.25 ± 84.22 μGym2 ), right atrial ablations (70.98 ± 94.79 μGym2 ) and ablations for ventricular tachycardias or PVCs (78.62 ± 66.59 μGym2 ). Acute procedural success was achieved in 3289/3388 (97.1%) while the rate of major complications was very low compared to previously published studies not using low dose settings (n = 20, 0.6%). CONCLUSION The ultra-low dose, low framerate protocol leads to very low radiation doses for all EP procedures while neither procedural time, fluoroscopy time nor success or complication rates were compromised. When compared to current real-world Air KAP data the new ultra-low dose fluoroscopy protocol reduces radiation exposure by more than 90%.
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Affiliation(s)
- Philipp Attanasio
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Nora Kaehler
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Theresa Keller
- Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Schreiber
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Reinhard Niehues
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Dimitra Katsani-Potempa
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Rolf Michael Klein
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany.,Department of Cardiology, University Hospital Witten/Herdecke, Witten, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Munich, Germany
| | - Osman Tutdibi
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Munich, Germany
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Purtell CS, Kipp RT, Eckhardt LL. Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology. Curr Cardiol Rep 2021; 23:28. [PMID: 33655436 PMCID: PMC7925460 DOI: 10.1007/s11886-021-01461-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
Purpose of Review There are risks to both patients and electrophysiology providers from radiation exposure from fluoroscopic imaging, and there is increased interest in fluoroscopic reduction. We review the imaging tools, their applications, and current uses to eliminate fluoroscopy. Recent Findings Multiple recent studies provide supporting evidence for the transition to fluoroscopy-free techniques for both ablations and device implantation. The most frequently used alternative imaging approaches include intracardiac echocardiography, cardiac MRI guidance, and 3D electroanatomic mapping systems. Electroanatomic mapping and intracardiac echocardiography originally used to augment fluoroscopy imaging are now replacing the older imaging technique. The data supports that the future of electrophysiology can be fluoroscopy-free or very low fluoroscopy for the vast majority of cases. Summary As provider and institution experience grows with these techniques, many EP labs may choose to completely forego the use of fluoroscopy. Trainees will benefit from early experience with these techniques.
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Affiliation(s)
- Christopher S Purtell
- Department of Medicine, Division of Cardiovascular Medicine, Electrophysiology Service, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53792, USA
| | - Ryan T Kipp
- Department of Medicine, Division of Cardiovascular Medicine, Electrophysiology Service, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53792, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Lee L Eckhardt
- Department of Medicine, Division of Cardiovascular Medicine, Electrophysiology Service, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53792, USA. .,Cellular and Molecular Arrhythmia Research Program, Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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Non-fluoroscopic radiofrequency catheter ablation of right- and left-sided ventricular arrhythmias. Adv Cardiol 2021; 16:321-329. [PMID: 33597998 PMCID: PMC7863801 DOI: 10.5114/aic.2020.99268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/13/2020] [Indexed: 01/15/2023]
Abstract
Introduction Radiofrequency catheter ablation (RFCA) is an important method of treatment of ventricular arrhythmias (VAs). In the majority of RFCA, fluoroscopy is used, exposing patients and medical staff to all related side effects. Current experience of non-fluoroscopic (NF)-RFCA in VAs from the left side is limited. Aim Analysis of safety and effectiveness of NF-RFCA of VAs from left- and right-sided cardiac chambers. Material and methods From 2014 to 2018, a group of 128 patients who underwent RFCA of VAs were retrospectively divided into two groups: NF-RFCA and fluoroscopic (F)-RFCA. Patients in each group were then subsequently subdivided into two groups based on VAs localization - left- (LS-Va) and right-sided (RS-Va) VAs. In all patients the CARTO Biosense Webster mapping system was used. Results In group 1 (NF-RFCA n = 88) 66 (75%) patients underwent RFCA of RS-Va and 22 (25%) of LS-Va. Early success was achieved in 89.8% (n = 79) and long term success in 81.8% (n = 72). In group 2 (F-RFCA n = 40) 19 patients (47.5%) had RFCA of RS-Va and 21 (52.5%) patients of LS-Va. Acute procedural success rate was 80% (n = 32) and long-term success 72.5% (n = 29). There were 4 (4.6%) perioperative complications in NF-RFCA and 2 (5%) in F-RFCA. Success rate, procedure time and complications were not significantly different between groups and subgroups in follow-up. Conclusions NF-RFCA in VAs from the right and left cardiac chamber is safe and equally effective as F-RFCA, and it should be implemented as often as possible for protection of patients and electrophysiology staff.
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Bernelli C, Cerrato E, Ortega R, Piccaluga E, Ricottini E, Chieffo A, Masiero G, Mattesini A, La Manna A, Musumeci G, Tarantini G, Mehran R. Gender Issues in Italian Catheterization Laboratories: The Gender-CATH Study. J Am Heart Assoc 2021; 10:e017537. [PMID: 33618540 PMCID: PMC8174252 DOI: 10.1161/jaha.120.017537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022]
Abstract
Background Women represent an increasing percentage of interventional cardiologists in Italy compared with other countries. However, gaps exist in understanding and adapting to the impact of these changing demographics. Methods and Results We performed a national survey to analyze demographics, gender-based professional difference, needs in terms of catheterization laboratory (Cath-Lab) abstention, and radiation safety issues in Italian Cath-Lab settings. A survey supported by the Italian Society of Interventional Cardiology (Società Italiana di Cardiologia Interventistica-Gruppo Italiano di Studi Emodinamici SICI-GISE) was mailed to all SICI-GISE members. Categorical data were compared using the χ2 test. P<0.05 was considered significant. There were 326 respondents: 20.2% were <35 years old, and 64.4% had >10 years of Cath-Lab experience. Notably, 26.4% were women. Workload was not gender-influenced (women performed "on-call" duty 69.8% versus men 68.3%; P=0.97). Women were more frequently unmarried (22.1% women versus 8.7% men; P=0.002) and childless (43.9% versus 56.1%; P<0.001). Interestingly, 69.8% of women versus 44.6% of men (P<0.001) argued that pregnancy/breastfeeding negatively impacts professional skill development and career advancement. For Cath-Lab abstention, 38.9% and 69.6% of respondents considered it useful to perform percutaneous coronary intervention robotic simulations and "refresh-skill" sessions while they were absent or on return to work, respectively, without gender differences. Overall, 80% of respondents described current radioprotection counseling efforts as inadequate and not gender specific. Finally, 26.7% faced some type of job discrimination, a significantly higher proportion of whom were women. Conclusions Several gender-based differences exist or are perceived to exist among interventional cardiologists in Italian Cath-Labs. Joint strategies addressing Cath-Lab abstention and radiation exposure education should be developed to promote gender equity in interventional cardiologists.
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Affiliation(s)
- Chiara Bernelli
- Cardiology DepartmentInterventional Cardiology Unit Santa Corona HospitalPietra LigureItaly
| | - Enrico Cerrato
- Interventional Cardiology Unit San Luigi Gonzaga University HospitalOrbassano and Infermi HospitalRivoli TurinItaly
| | | | - Emanuela Piccaluga
- Interventional Cardiology Unit ASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | | | - Alaide Chieffo
- Interventional Cardiology Unit San Raffaele Hospital of Milan (IRCCS)MilanItaly
| | - Giulia Masiero
- Interventional Cardiology UnitUniversity Hospital of PadovaPaduaItaly
| | - Alessio Mattesini
- Interventional Cardiology Unit Careggi University Hospital (AOUC)FlorenceItaly
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Monaco MGL, Carta A, Tamhid T, Porru S. Anti-X Apron Wearing and Musculoskeletal Problems Among Healthcare Workers: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165877. [PMID: 32823627 PMCID: PMC7459898 DOI: 10.3390/ijerph17165877] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
Interventional radiology activities and other medical practices using ionising radiation have become increasingly prevalent. In this context, the use of anti-X aprons, in association with awkward postures and non-ergonomic working conditions, might cause the onset of musculoskeletal disorders (MSDs). This research aims to evaluate the evidence about the correlation between wearing anti-X aprons and work-related MSDs. A systematic scoping review of articles published between 1990 and 2020 was conducted by searching the PubMed, Scopus, Embase, and Web of Science databases. Twelve cross-sectional studies, conducted among interventional physicians, nurses, and technicians, were finally included. Five studies primarily investigated the association between use of anti-X aprons and MSDs, showing that a higher prevalence of disorders was not always associated with the use of protective aprons. No studies investigated the impact of anti-X aprons on fitness for work assessment, particularly in subjects with MSDs. There is no complete agreement about the correlation between anti-X apron-wearing and the occurrence of MSDs, although the possible discomfort of workers using anti-X aprons appears more evident. Further studies are needed to objectify the role of these protective devices in the genesis of MSDs and to offer specific ergonomic solutions for healthcare workers.
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Affiliation(s)
- Maria Grazia Lourdes Monaco
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Correspondence: ; Tel.: +39-045-812-3946
| | - Angela Carta
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Health, University of Verona, 37134 Verona, Italy
| | - Tishad Tamhid
- Postgraduate School of Occupational Medicine, University of Verona, 37134 Verona, Italy;
| | - Stefano Porru
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (A.C.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Health, University of Verona, 37134 Verona, Italy
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Manzo-Silberman S, Piccaluga E, Radu MD, James SK, Schüpke S, Vaquerizo B, Kunadian V, Capranzano P, Mehilli J, Buchanan GL, Chieffo A, Mauri J. Radiation protection measures and sex distribution in European interventional catheterisation laboratories. EUROINTERVENTION 2020; 16:80-82. [PMID: 30888957 DOI: 10.4244/eij-d-18-01044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Werner GS, Yaginuma K, Koch M, Tischer K, Silber M, Werner J, Keuser T, Moehlis H. Modulated radiation protocol achieves marked reduction of radiation exposure for chronic total coronary occlusion intervention. Catheter Cardiovasc Interv 2020; 97:1196-1206. [DOI: 10.1002/ccd.29132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 11/05/2022]
Affiliation(s)
| | - Kenji Yaginuma
- Department of Cardiology Juntendo University Urayasu Hospital Tokyo Japan
| | - Matthias Koch
- Medizinische Klinik I Klinikum Darmstadt GmbH Darmstadt Germany
| | | | - Martin Silber
- Institut für Radioonkologie und Strahlentherapie Klinikum Darmstadt GmbH Darmstadt Germany
| | - Juliane Werner
- Medizinische Klinik I Klinikum Darmstadt GmbH Darmstadt Germany
| | - Thomas Keuser
- Medizinische Klinik I Klinikum Darmstadt GmbH Darmstadt Germany
| | - Hiller Moehlis
- Medizinische Klinik I Klinikum Darmstadt GmbH Darmstadt Germany
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Operator learning curve and clinical outcomes of zero fluoroscopy catheter ablation of atrial fibrillation, supraventricular tachycardia, and ventricular arrhythmias. J Interv Card Electrophysiol 2020; 61:165-170. [PMID: 32529314 DOI: 10.1007/s10840-020-00798-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the learning curve for atrial fibrillation (AF), supraventricular tachycardia (SVT), and premature ventricular contraction (PVC) radiofrequency ablation (RFA) using zero fluoroscopy. METHODS This is a retrospective, single-center study of 167 patients undergoing ablation between 2016 and 2019. Minimal fluoroscopy approach was initiated after the first 20 cases of PVI and SVT RFA. Procedures were divided consecutively into increments of 10 cases to determine operator learning curve. RESULTS A total of 64 (38%) had SVT ablations, 26 (16%) had PVC ablations, and 77 (46%) had AF and underwent PVI. For SVT RFA, fluoroscopy time improved from 4.1 ± 3.5 min during the first 10 cases to 0.8 ± 1.2 min after 50 cases (p = 0.0001). Sixty-two out of 64 (97%) of cases were successful. In PVC RFA, fluoroscopy time was 7.7 ± 5.5 min for the first 5, 2.3 ± 3.4 min after 15, and 0 min after 20 cases (p = 0.0008). Twenty-four out of 26 (92%) of cases were acutely successful with recurrence in 2/26 (8%) of patients over 9 ± 9 months. In PVI, fluoroscopy time was 9.9 ± 3.3 min over the first 20 cases, 2.6 ± 2.3 min after 40 cases, and 0.1 min after 50 cases (p < 0.0001). PVI procedure time was 170 ± 34 min after 60 cases from 235 ± 41 min initially (p 0.001). Six out of 77 (8%) had AF recurrence at 12 months. CONCLUSIONS Zero fluoroscopy ablation for AF, SVT, and PVC can be safely achieved without increasing procedure time. The steepest learning curve occurs over the first 20, 15, and 40 cases for SVT, PVC, and PVI ablation respectively.
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Salam T, Wilson L, Bohannan S, Morin M. Safety and Effectiveness of a Novel Fluoroless Transseptal Puncture Technique for Lead-free Catheter Ablation: A Case Series. J Innov Card Rhythm Manag 2020; 11:4079-4085. [PMID: 32368383 PMCID: PMC7192152 DOI: 10.19102/icrm.2020.110405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 01/07/2023] Open
Abstract
Increasing awareness of the health risks associated with the exposure of patients and staff in the catheterization laboratory to radiation has encouraged the pursuit of efforts to reduce the use of fluoroscopy during catheter ablation procedures. Although nonfluoroscopic guidance of ablation catheters has been previously described, transseptal access is still perceived as the last remaining barrier to completely fluoroless ablations. This study examined the safety and effectiveness of transseptal puncture and radiofrequency (RF) catheter ablation using a completely fluoroless approach. Three hundred eighty-two consecutive cases that had undergone completely nonfluoroscopic RF catheter ablation were evaluated. Ablation procedures were performed for atrial fibrillation, atrial flutter, atrioventricular reentry tachycardia, and pulmonary vein complex/ventricular tachycardia. Transseptal puncture and RF ablation were conducted under three-dimensional electroanatomic mapping and intracardiac echocardiography image guidance. Fluoroless transseptal puncture and catheter ablation were completed successfully in all cases, with no intraoperative complications. One patient required minimal use of fluoroscopy to visualize sheath advancement through an existing inferior vena cava filter. Procedural time was approximately 2.2 hours from transvenous access until case conclusion; transseptal access was obtained within 28 minutes of procedure initiation. Arrhythmia was found to recur in 27% of cases on average three months after the procedure. We demonstrate the safety and effectiveness of a completely fluoroless transseptal puncture and RF ablation technique that eliminates radiation exposure and enables complex electrophysiology procedures to be performed in a lead-free environment.
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Affiliation(s)
- Tariq Salam
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Lane Wilson
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Sara Bohannan
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Michael Morin
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
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Goya M, Frame D, Gache L, Ichishima Y, Tayar DO, Goldstein L, Lee SHY. The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta-analysis of efficiency, effectiveness, and safety outcomes. J Cardiovasc Electrophysiol 2020; 31:664-673. [PMID: 31976603 PMCID: PMC7078927 DOI: 10.1111/jce.14367] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
Aims The optimal use of intracardiac echocardiography (ICE) may reduce fluoroscopy time and procedural complications during endocardial ablation of cardiac arrhythmias. Due to limited evidence in this area, we conducted the first systematic literature review and meta‐analysis to evaluate outcomes associated with the use of ICE. Methods and Results Studies reporting the use of ICE during ablation procedures vs without ICE were searched using PubMed/MEDLINE. A meta‐analysis was performed on the 19 studies (2186 patients) meeting inclusion criteria, collectively representing a broad range of arrhythmia mechanisms. Use of ICE was associated with significant reductions in fluoroscopy time (Hedges' g −1.06; 95% confidence interval [CI] −1.81 to −0.32; P < .01), fluoroscopy dose (Hedges' g −1.27; 95% CI −1.91 to −0.62; P < .01), and procedure time (Hedges' g −0.35; 95% CI −0.64 to −0.05; P = .02) vs ablation without ICE. A 6.95 minute reduction in fluoroscopy time and a 15.2 minute reduction in procedure time was observed between the ICE vs non‐ICE groups. These efficiency gains were not associated with any decreased effectiveness or safety. Sensitivity analyses limiting studies to an atrial fibrillation (AF) only population yielded similar results to the main analysis. Conclusion The use of ICE in the ablation of cardiac arrhythmias is associated with significantly lower fluoroscopy time, fluoroscopy dose, and shorter procedure time vs ablation without ICE. These efficiency improvements did not compromise the clinical effectiveness or safety of the procedure.
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Affiliation(s)
- Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Diana Frame
- Real World Evidence, CTI Clinical Trial & Consulting, Covington, Kentucky
| | - Larry Gache
- Real World Evidence, CTI Clinical Trial & Consulting, Covington, Kentucky
| | | | | | - Laura Goldstein
- Health Economics & Market Access, Johnson & Johnson Medical Devices, Irvine, California
| | - Stephanie Hsiao Yu Lee
- Health Economics & Market Access, Johnson & Johnson Medical Asia Pacific, Singapore, Singapore
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Is trans-radial approach related to an increased risk of radiation exposure in patients who underwent diagnostic coronary angiography or percutaneous coronary intervention? (The SAKARYA study). Anatol J Cardiol 2020; 22:5-12. [PMID: 31264653 PMCID: PMC6683214 DOI: 10.14744/anatoljcardiol.2019.06013] [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] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. METHODS All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). RESULTS Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. CONCLUSION In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.
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Association between Radiation Exposure and Endothelium-Dependent Vasodilation: Results from Clinical and Experimental Studies. J Vasc Interv Radiol 2020; 31:42-48. [PMID: 31831324 DOI: 10.1016/j.jvir.2019.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/09/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023] Open
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Utilization of a Radiation Safety Time-Out Reduces Radiation Exposure During Electrophysiology Procedures. JACC Clin Electrophysiol 2019; 5:626-634. [DOI: 10.1016/j.jacep.2018.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/21/2022]
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Boveda S, Chalbia TE, Jacob S, Combes S, Combes N, Cardin C, Laborie G, Sousa MJ, Jebberi Z, Mzoughi S, Albenque JP, Providencia R. Duration of hospital admission, need of on-demand analgesia and other peri-procedural and short-term outcomes in sub-cutaneous vs. transvenous implantable cardioverter-defibrillators. Int J Cardiol 2018; 258:133-137. [PMID: 29544919 DOI: 10.1016/j.ijcard.2017.11.104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/16/2017] [Accepted: 11/29/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Post-procedural recovery following sub-cutaneous ICD (S-ICD) implantation is feared to be more painful and to require more prolonged hospital admission. The purpose of this study was to compare peri-procedural and short clinical outcomes of the S-ICD vs. the Transvenous ICD (TV-ICD). METHODS We conducted a single-center cross-sectional study including all consecutive patients who underwent S-ICD implantation by the same operator since January 2016 and a gender and age-matched control group with all single chamber TV-ICD implanted patients over a contemporary time period. RESULTS Thirty-one patients (sex ratio 1/5; mean age 58.7±13.2years) with S-ICD were compared to 31 matched TV-ICD patients. Duration of the implant procedure was significantly longer for the S-ICD (58.0±24.4min vs 41.7±20.8min TV-ICD, p<0.01). Mean fluoroscopy time for the TV-ICD was 3.5±3.6min vs 0.1±0.01min for all S-ICD patients (p<0.01). Requirement of on-demand analgesia administration, and duration of hospitalization (1.5days for both groups; p=NS) were similar in the two groups. No peri-procedural events were reported, and after a mean follow-up of 6months, the only complication was a pocket infection requiring reintervention in the TV-ICD group. CONCLUSIONS The S-ICD appears to be as effective and safe as the conventional single chamber TV-ICD. Duration of hospital admission and need of on-demand analgesia are also comparable for S-ICD patients.
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Affiliation(s)
- Serge Boveda
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France.
| | - Tej Elbanet Chalbia
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Sophie Jacob
- IRSN, Laboratory of Epidemiology, PSE-SANTE, SESANE, LEPID, BP17, 92262 Fontenay-aux-Roses, France
| | - Stéphane Combes
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Nicolas Combes
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Christelle Cardin
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Guillaume Laborie
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Maria Joao Sousa
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Zeynab Jebberi
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Sophia Mzoughi
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Jean-Paul Albenque
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, 31300 Toulouse, France
| | - Rui Providencia
- St. Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
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Sadek MM, Ramirez FD, Nery PB, Golian M, Redpath CJ, Nair GM, Birnie DH. Completely nonfluoroscopic catheter ablation of left atrial arrhythmias and ventricular tachycardia. J Cardiovasc Electrophysiol 2018; 30:78-88. [DOI: 10.1111/jce.13735] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/27/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Mouhannad M. Sadek
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - F. Daniel Ramirez
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - Pablo B. Nery
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - Mehrdad Golian
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - Calum J. Redpath
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - Girish M. Nair
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - David H. Birnie
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
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Rolf S, Schoene K, Kircher S, Dinov B, Bertagnolli L, Bollmann A, Richter S, Arya A, Hindricks G, Sommer P. Catheter ablation of atrial fibrillation with nonfluoroscopic catheter visualization-a prospective randomized comparison. J Interv Card Electrophysiol 2018; 54:35-42. [PMID: 30229406 DOI: 10.1007/s10840-018-0446-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The application of a novel platform for nonfluoroscopic catheter sensor tracking within pre-recorded x-ray loops in the context of catheter ablation of atrial fibrillation (AF) demonstrated significant potential for reduction of fluoroscopy. We sought to provide the first prospective randomized comparison of fluoroscopy needs, procedure times, and complications in AF catheter ablation with or without additional use of nonfluoroscopic catheter visualization (NFCV). METHODS Patients with AF were randomized into two groups before scheduled radiofrequency ablation: (1) using established mapping systems and fluoroscopy as needed (CONV group) or (2) with additional NFCV (NFCV group). All procedures were performed in the same lab using the same ablation catheter tip technology and the same mapping and ablation strategies. Primary endpoints were radiation time and dose. Secondary endpoints were procedural parameters, complications, and long-term success. RESULTS A total of 80 patients (48 male patients, mean age 60 years, 46 patients with paroxysmal AF) were randomized into the two groups. Clinical parameters between both groups were similar. NFCV use reduced mean fluoroscopy time (1.9 vs. 13.2 min, p < 0.001) and mean dose (510 vs. 1549 Gycm2, p < 0.001) significantly. Procedural parameters were similar in the two groups. One conservatively treated groin complication occurred (1.3%). CONCLUSIONS Radiation exposure can be significantly reduced by using the novel NFCV technology in addition to standard AF ablation technologies without negative effects on procedure durations, success rates, or complication rates. With the use of the technology, abandonment of lead protection for EP staff is possible following transseptal puncture.
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Affiliation(s)
- Sascha Rolf
- Department of Cardiology, DRK Kliniken Berlin Westend, Spandauer Damm 130, 14050, Berlin, Germany.
| | | | - Simon Kircher
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Boris Dinov
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
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29
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Werner GS. Reducing radiation exposure during PCI of chronic total occlusions – better is not good enough. EUROINTERVENTION 2018; 14:e496-e498. [DOI: 10.4244/eijv14i5a88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ko S, Kang S, Ha M, Kim J, Jun JK, Kong KA, Lee WJ. Health Effects from Occupational Radiation Exposure among Fluoroscopy-Guided Interventional Medical Workers: A Systematic Review. J Vasc Interv Radiol 2018; 29:353-366. [PMID: 29306599 DOI: 10.1016/j.jvir.2017.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/30/2017] [Accepted: 10/09/2017] [Indexed: 01/06/2023] Open
Abstract
A systematic review was conducted to provide an overview of the health effects of occupational radiation exposure from interventional fluoroscopy procedures on medical radiation workers. Among the 34 studies that met the inclusion criteria, most studies were cross-sectional (76%) and published after 2011 (65%) in a handful of countries. Although diverse outcomes were reported, most studies focused on cataracts. Radiation health effects were rarely assessed by risk per unit dose. Interventional radiation medical workers represent a small subset of the population studied worldwide. Further epidemiologic studies should be conducted to evaluate health outcomes among interventional radiation medical workers.
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Affiliation(s)
- Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02855, South Korea; Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Seonghoon Kang
- Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea; Department of Occupational and Environmental Medicine, Korea University Ansan Hospital, Gyeonggi-do, South Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea
| | - Jaeyoung Kim
- Department of Preventive Medicine, Keimyung University College of Medicine, Daegu, South Korea
| | - Jae Kwan Jun
- National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do, South Korea
| | - Kyoung Ae Kong
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02855, South Korea; Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea.
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31
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Goyal SK, Stambler BS. Fluoroless Catheter Ablation of Cardiac Arrhythmias. US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2018.12.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Catheter ablation is the mainstay of cardiac arrhythmia management, and the number of these procedures carried out is continuing to grow. Fluoroscopy has been integral to these procedures to ensure safe catheter manipulation. Unfortunately, exposure to ionizing radiation is associated with several health risks to patients and personnel. The personal protective equipment used to reduce these risks is associated with incomplete protection and orthopedic risks to physicians and other staff. 3D mapping systems and intracardiac echocardiography, if used properly, can significantly reduce the use of fluoroscopy. The study describes a zero-fluoroscopy approach to cardiac ablation of AF and other arrhythmias using 3D mapping and intracardiac echocardiography to reduce or eliminate exposure to ionizing radiation and orthopedic risks to personnel.
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Harrison J, Ang L, Naghi J, Behnamfar O, Pourdjabbar A, Patel MP, Reeves RR, Mahmud E. Robotically-assisted percutaneous coronary intervention: Reasons for partial manual assistance or manual conversion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:526-531. [PMID: 29221959 DOI: 10.1016/j.carrev.2017.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Robotically-assisted percutaneous coronary intervention (R-PCI) is feasible for simple coronary lesions. OBJECTIVES To determine the frequency and reasons for partial manual assistance or manual conversion during R-PCI in clinical practice. METHODS The CorPath 200 System (Corindus, Waltham, MA) enables the operator to sit in a radiation-shielded cockpit and remotely control intracoronary devices including guidewires, balloons, and stents. Consecutive R-PCI procedures performed over 18months were analyzed to identify reasons for planned or unplanned manual assistance or manual conversion, and categorized as due to 1) adverse event; 2) technical limitation of the robotic platform; or 3) limited guide catheter/wire support. RESULTS During the study period, 108 R-PCI procedures (68.1±11.0years, 77.8% men, 69.4% elective PCI, 78.3% type B2/C lesions, and 50.3% left anterior descending/left main target lesion segment) were performed. High robotic technical success (91.7%) and clinical procedural success (99.1%) were achieved. Twenty procedures (18.5%) required either planned partial manual assistance (3.7%), unplanned partial manual assistance (7.4%), or manual conversion (7.4%). Among these procedures, manual assistance/conversion was required in 3 procedures for an adverse event (15%), 8 for technical limitation of the robotic platform (40%), and 9 for guide catheter/wire support issues (45%). CONCLUSIONS High clinical success with R-PCI for a complex lesion cohort is possible with only occasional partial manual assistance or manual conversion. The majority of procedures requiring manual assistance/conversion were due to limited guide catheter/wire support or robotic platform limitations, rather than occurrence of adverse events.
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Affiliation(s)
- Jonathan Harrison
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, United States
| | - Lawrence Ang
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, United States
| | - Jesse Naghi
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, United States
| | - Omid Behnamfar
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, United States
| | - Ali Pourdjabbar
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, United States
| | - Mitul P Patel
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, United States
| | - Ryan R Reeves
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, United States
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, United States.
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Mangels DR, Giri J, Hirshfeld J, Wilensky RL. Robotic-assisted percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 90:948-955. [DOI: 10.1002/ccd.27205] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/15/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel R. Mangels
- Department of Medicine; University of Pennsylvania, 3400 Spruce Street, 100 Centrex; Philadelphia Pennsylvania
| | - Jay Giri
- Division of Cardiovascular Medicine; University of Pennsylvania, 3400 Civic Center Blvd, 11th Floor, South Pavilion; Philadelphia Pennsylvania
| | - John Hirshfeld
- Division of Cardiovascular Medicine; University of Pennsylvania, 3400 Civic Center Blvd, 11th Floor, South Pavilion; Philadelphia Pennsylvania
| | - Robert L. Wilensky
- Division of Cardiovascular Medicine; University of Pennsylvania, 3400 Civic Center Blvd, 11th Floor, South Pavilion; Philadelphia Pennsylvania
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34
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Mahmud E, Naghi J, Ang L, Harrison J, Behnamfar O, Pourdjabbar A, Reeves R, Patel M. Demonstration of the Safety and Feasibility of Robotically Assisted Percutaneous Coronary Intervention in Complex Coronary Lesions. JACC Cardiovasc Interv 2017; 10:1320-1327. [DOI: 10.1016/j.jcin.2017.03.050] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/19/2017] [Accepted: 03/23/2017] [Indexed: 11/29/2022]
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Capranzano P, Kunadian V, Mauri J, Petronio AS, Salvatella N, Appelman Y, Gilard M, Mikhail GW, Schüpke S, Radu MD, Vaquerizo B, Presbitero P, Morice MC, Mehilli J. Motivations for and barriers to choosing an interventional cardiology career path: results from the EAPCI Women Committee worldwide survey. EUROINTERVENTION 2017; 12:53-9. [PMID: 26151955 DOI: 10.4244/eijy15m07_03] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Very few women become interventional cardiologists, although a substantial proportion of cardiologists and the majority of medical students are women. In accordance with the EAPCI Women Committee mission of attaining gender equality at the professional level, a worldwide survey was recently conducted aiming to understand better the motivations and the barriers for women in selecting interventional cardiology (IC) as a career path. METHODS AND RESULTS A total of 1,787 individuals (60.7% women) responded to the survey. Women compared to men were less frequently married (women vs. men, 57.0% vs. 79.8%, p<0.001) and more frequently childless (46.6% vs. 20.5%, p<0.002). The most prevalent reason for choosing IC was passion (83.3% vs. 76.1%, p=0.12), while those for not choosing were, sequentially, lack of opportunity (29.0% vs. 45.7%), radiation concerns (19.9% vs. 11.6%) and preference (16.2% vs. 29.5%), p<0.001. According to 652 men replying to why, in their opinion, women do not choose IC, on-calls and long working hours were the most frequent reasons (35.3%). CONCLUSIONS Several barriers preclude women from choosing IC, including lack of opportunity, concerns regarding radiation exposure and the prejudices of their male colleagues. This highlights the need to develop new strategies for future training, education, and support of women in order to choose IC.
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Affiliation(s)
- Piera Capranzano
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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Ahmed TA, Taha S. Radiation exposure, the forgotten enemy: Toward implementation of national safety program. Egypt Heart J 2017; 69:55-62. [PMID: 29622955 PMCID: PMC5839352 DOI: 10.1016/j.ehj.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 10/08/2016] [Indexed: 01/05/2023] Open
Abstract
Radiation safety is an important counterpart in all facilities utilizing ionizing radiations. The concept of radiation safety has always been a hot topic, especially with the late reports pointing to increased hazards with chronic radiation exposure. Adopting a nationwide radiation safety program is considered one of the most urging topics, and is a conjoint responsibility of multiple disciplines within the health facility.
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Affiliation(s)
- Tarek A.N. Ahmed
- Interventional Cardiology, Department of Cardiovascular Medicine, Asyut University Hospital, Egypt
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37
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Dixon RG, Khiatani V, Statler JD, Walser EM, Midia M, Miller DL, Bartal G, Collins JD, Gross KA, Stecker MS, Nikolic B. Society of Interventional Radiology: Occupational Back and Neck Pain and the Interventional Radiologist. J Vasc Interv Radiol 2016; 28:195-199. [PMID: 27993508 DOI: 10.1016/j.jvir.2016.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Robert G Dixon
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
| | - Vishal Khiatani
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - John D Statler
- Virginia Interventional and Vascular Associates, Fredericksburg, Virginia
| | - Eric M Walser
- Department of Radiology, University of Texas Medical Branch, Galveston, Texas
| | - Mehran Midia
- Department of Interventional Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Donald L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring
| | - Gabriel Bartal
- Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Kathleen A Gross
- Department of Interventional Radiology, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Michael S Stecker
- Division of Angiography Interventional Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
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38
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Simulator training to minimize ionizing radiation exposure in the catheterization laboratory. Int J Cardiovasc Imaging 2016; 33:303-310. [DOI: 10.1007/s10554-016-1009-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/24/2016] [Indexed: 10/24/2022]
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39
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Vautrin E, Marlière S, Bellemain-Appaix A, Gilard M, Manzo-Silberman S. Women in interventional cardiology: The French experience. Ann Cardiol Angeiol (Paris) 2016; 65:468-471. [PMID: 27817851 DOI: 10.1016/j.ancard.2016.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Exploring the discrepancy in sex-ratio among interventional cardiologists by analysing the population of the female interventionalist. BACKGROUND Despite an increase number of women who graduate from medical school in France during the last generation today, women represent only 24% of all cardiologists and 3% are interventional cardiologists. To face this international gender-based issue of interventional cardiology, committees were established in US (WIN) and recently within the EAPCI: the Women EAPCI chaired by Drs Mehilli and Mauri. In France, the Intervention'Elles committee emerged in order to participate in this concern. METHODS As a first initiative, the Intervention'Elles group launched an e-survey to obtain information on the population of French female interventional cardiologists, focused on demography, work patterns, maternity and radiation exposure. RESULTS Mean age is 40 years old (±7,4), 68% are working in large volume center, 28% have also structural interventional activity. Only 40% have left arm coverage. Despite 80% of French female interventional cardiologists wear personal dosimeters only 45% of them have a dosimetry feedback. Interestingly, even if 54% of women have children (mean: 1.9±1) 28% of them report that childbearing had interfered with their career plan. CONCLUSION This questionnaire identifies for the first time the women population in interventional cardiology in France and highlights some of the issues encountered in more detail. This first descriptive step would help to develop strategies for attaining gender equality in interventional cardiology.
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Affiliation(s)
- E Vautrin
- Cardiology department, university hospital, 38700 Grenoble, France
| | - S Marlière
- Cardiology department, university hospital, 38700 Grenoble, France
| | | | - M Gilard
- Cardiology department, Brest-university, 29609 Brest, France
| | - S Manzo-Silberman
- Inserm U942, cardiology department, Paris Diderot university, 75010 Paris, France.
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40
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Yamagata K, Aldhoon B, Kautzner J. Reduction of Fluoroscopy Time and Radiation Dosage During Catheter Ablation for Atrial Fibrillation. Arrhythm Electrophysiol Rev 2016; 5:144-9. [PMID: 27617094 DOI: 10.15420/aer.2016.16.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Radiofrequency catheter ablation has become the treatment of choice for atrial fibrillation (AF) that does not respond to antiarrhythmic drug therapy. During the procedure, fluoroscopy imaging is still considered essential to visualise catheters in real-time. However, radiation is often ignored by physicians since it is invisible and the long-term risks are underestimated. In this respect, it must be emphasised that radiation exposure has various potentially harmful effects, such as acute skin injury, malignancies and genetic disease, both to patients and physicians. For this reason, every electrophysiologist should be aware of the problem and should learn how to decrease radiation exposure by both changing the setting of the system and using complementary imaging technologies. In this review, we aim to discuss the basics of X-ray exposure and suggest practical instructions for how to reduce radiation dosage during AF ablation procedures.
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Affiliation(s)
- Kenichiro Yamagata
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Bashar Aldhoon
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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41
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Valuckiene Z, Jurenas M, Cibulskaite I. Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:695-708. [PMID: 27556787 DOI: 10.1088/0952-4746/36/3/695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ionizing radiation management is among the most important safety issues in interventional cardiology. Multiple radiation protection measures allow the minimization of x-ray exposure during interventional procedures. Our purpose was to assess the utilization and effectiveness of radiation protection and optimization techniques among interventional cardiologists in Lithuania. Interventional cardiologists of five cardiac centres were interviewed by anonymized questionnaire, addressing personal use of protective garments, shielding, table/detector positioning, frame rate (FR), resolution, field of view adjustment and collimation. Effective patient doses were compared between operators who work with and without x-ray optimization. Thirty one (68.9%) out of 45 Lithuanian interventional cardiologists participated in the survey. Protective aprons were universally used, but not the thyroid collars; 35.5% (n = 11) operators use protective eyewear and 12.9% (n = 4) wear radio-protective caps; 83.9% (n = 26) use overhanging shields, 58.1% (n = 18)-portable barriers; 12.9% (n = 4)-abdominal patient's shielding; 35.5% (n = 11) work at a high table position; 87.1% (n = 27) keep an image intensifier/receiver close to the patient; 58.1% (n = 18) reduce the fluoroscopy FR; 6.5% (n = 2) reduce the fluoro image detail resolution; 83.9% (n = 26) use a 'store fluoro' option; 41.9% (N = 13) reduce magnification for catheter transit; 51.6% (n = 16) limit image magnification; and 35.5% (n = 11) use image collimation. Median effective patient doses were significantly lower with x-ray optimization techniques in both diagnostic and therapeutic interventions. Many of the ionizing radiation exposure reduction tools and techniques are underused by a considerable proportion of interventional cardiology operators. The application of basic radiation protection tools and techniques effectively reduces ionizing radiation exposure and should be routinely used in practice.
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Affiliation(s)
- Zivile Valuckiene
- Department of Cardiology, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania
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Kastrati M, Langenbrink L, Piatkowski M, Michaelsen J, Reimann D, Hoffmann R. Reducing Radiation Dose in Coronary Angiography and Angioplasty Using Image Noise Reduction Technology. Am J Cardiol 2016; 118:353-6. [PMID: 27344273 DOI: 10.1016/j.amjcard.2016.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
This study sought to quantitatively evaluate the reduction of radiation dose in coronary angiography and angioplasty with the use of image noise reduction technology in a routine clinical setting. Radiation dose data from consecutive 605 coronary procedures (397 consecutive coronary angiograms and 208 consecutive coronary interventions) performed from October 2014 to April 2015 on a coronary angiography system with noise reduction technology (Allura Clarity IQ) were collected. For comparison, radiation dose data from consecutive 695 coronary procedures (435 coronary angiograms and 260 coronary interventions) performed on a conventional coronary angiography system from October 2013 to April 2014 were evaluated. Patient radiation dosage was evaluated based on the cumulative dose area product. Operators and operator practice did not change between the 2 evaluated periods. Patient characteristics were collected to evaluate similarity of patient groups. Image quality was evaluated on a 5-grade scale in 30 patients of each group. There were no significant differences between the 2 evaluated groups in gender, age, weight, and fluoroscopy time (6.8 ± 6.1 vs 6.9 ± 6.3 minutes, not significant). The dose area product was reduced from 3195 ± 2359 to 983 ± 972 cGycm(2) (65%, p <0.001) in coronary angiograms and from 7123 ± 4551 to 2431 ± 1788 cGycm(2) (69%, p <0.001) in coronary interventions using the new noise reduction technology. Image quality was graded as similar between the evaluated systems (4.0 ± 0.7 vs 4.2 ± 0.6, not significant). In conclusion, a new x-ray technology with image noise reduction algorithm provides a substantial reduction in radiation exposure without the need to prolong the procedure or fluoroscopy time.
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Mahmud E, Dominguez A, Bahadorani J. First-in-human robotic percutaneous coronary intervention for unprotected left main stenosis. Catheter Cardiovasc Interv 2016; 88:565-570. [DOI: 10.1002/ccd.26550] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/25/2016] [Accepted: 03/11/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Ehtisham Mahmud
- Division of Cardiovascular Medicine; Sulpizio Cardiovascular Center, University of California; San Diego California
| | - Arturo Dominguez
- Division of Cardiovascular Medicine; Sulpizio Cardiovascular Center, University of California; San Diego California
| | - John Bahadorani
- Division of Cardiovascular Medicine; Sulpizio Cardiovascular Center, University of California; San Diego California
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Nagaraju L, Menon D, Aziz PF. Use of 3D Electroanatomical Navigation (CARTO-3) to Minimize or Eliminate Fluoroscopy Use in the Ablation of Pediatric Supraventricular Tachyarrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:574-80. [PMID: 26873564 DOI: 10.1111/pace.12830] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/08/2016] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiation exposure related to medical procedures carries known medical risk. Electrophysiology (EP) and catheter ablation procedures are traditionally performed under fluoroscopic guidance. Three-dimensional (3D) electroanatomical navigation systems decrease or eliminate fluoroscopy use in EP procedures. OBJECTIVE The aim of this study was to assess the efficacy and outcome of a minimal or no fluoroscopic electroanatomical mapping approach for catheter ablations for supraventricular tachycardia (SVT) in the pediatric population. METHODS Patients were identified through our EP database. A retrospective chart review was performed at a single institution. RESULTS Sixty-three pediatric patients underwent catheter ablations with a minimal fluoroscopic and 3D electroanatomical mapping using CARTO-3 system (Biosense Webster, Diamond Bar, CA, USA) between October 2012 and March 2015. We selected 20 age-matched patients who underwent ablations for SVT by the same operator prior to October 2012 with fluoroscopy use as our control group. The mean age in the study and control group was 13.9 years and 13.7 years, respectively. Mean procedure time was 208.7 minutes and 217.2 minutes in the study and control group (P = NS). Thirty-four (54%) in the study group had no fluoroscopy use. Mean fluoroscopy time was 4.1 minutes versus 35.4 minutes between the study and the control group (P < 0.001). Radiation dose was 6.7 mGy versus 209.3 mGy between the study and the control group (P < 0.001). Acute procedural success was achieved in 95% and 90% of patients in the study and control groups, respectively. On follow-up, the recurrence rate was 5.3% in the study group and 5.6% in the control group. CONCLUSION Catheter ablation for SVT in children can be successfully performed in patients with normal cardiac anatomy using minimal or no fluoroscopy with favorable outcomes.
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Affiliation(s)
- Lakshmi Nagaraju
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio
| | - Dipika Menon
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio
| | - Peter F Aziz
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio
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Klein LW, Tra Y, Garratt KN, Powell W, Lopez-Cruz G, Chambers C, Goldstein JA. Occupational health hazards of interventional cardiologists in the current decade: Results of the 2014 SCAI membership survey. Catheter Cardiovasc Interv 2015; 86:913-24. [PMID: 25810341 DOI: 10.1002/ccd.25927] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/08/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Interventional cardiologists and staff are subject to unique physical demands that predispose them to distinct occupational health hazards not seen in other medical disciplines. METHODS To characterize the prevalence of these occupational health problems, The Society for Cardiovascular Angiography and Interventions (SCAI) surveyed its members by email. Inquiries included age, years of invasive practice, and diagnostic and interventional cases per year. Questions focused on orthopedic (spine, hips, knees, and ankles) and radiation-associated problems (cataracts and cancers). RESULTS There were 314 responses. Responders were on average busy and experienced, performing a mean of 380±249 diagnostic and 200±129 interventional cases annually. Of the responders, 6.9% of operators have had to limit their caseload because of radiation exposure and 9.3% have had a health-related period of absence. Furthermore, 153 (49.4%) operators reported at least one orthopedic injury: 24.7% cervical spine disease, 34.4% lumbar spine problems, and 19.6% hip, knee or ankle joint problems. Age was most significantly correlated with orthopedic illnesses: cervical injuries (χ2=150.7, P<0.0001); hip/knee or ankle injuries (χ2=80.9, P<0.0001); lumbar injuries (χ2=147.0, P<0.0001); and any orthopedic illness (χ2= 241.2, P<0.0001). Annual total caseload was also associated: the estimated change in the odds of orthopedic illness for each additional total caseload quintile is 1.0013 (1.0001, 1.0026). There is a small but substantial incidence of cancer. CONCLUSIONS These findings are consistent with, and extend the findings, of a prior 2004 SCAI survey, in documenting a substantial prevalence of orthopedic complications among active interventional cardiologists, which persists despite increased awareness.
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Affiliation(s)
- Lloyd W Klein
- Department of Cardiology, Advocate Illinois Medical Center, Chicago, Illinois
| | - Yolande Tra
- Maryland Poison Center, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Kirk N Garratt
- Department of Cardiology, Lenox Hill Hospital, New York, New York
| | | | | | - Charles Chambers
- Department of Cardiology, Penn State University, Hershey, Pennsylvania
| | - James A Goldstein
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
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Ploux S, Jesel L, Eschalier R, Amraoui S, Ritter P, Haïssaguerre M, Bordachar P. Performance of a radiation protection cabin during extraction of cardiac devices. Can J Cardiol 2014; 30:1602-6. [PMID: 25418216 DOI: 10.1016/j.cjca.2014.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Operators who extract cardiac devices are exposed to considerable irradiation and excess risk of radiation-induced disorders. A dedicated radioprotection cabin was developed to offer complete protection against radiation. This randomized study was designed to ascertain the protection against radiation conferred by a radioprotection cabin and the safety during extraction of cardiac devices. METHODS Thirty-seven consecutive patients who presented with an indication for extraction of a cardiac device were randomly assigned to a standard extraction technique (n = 19), vs extraction with the use of a radiation protection cabin (n = 18). Fluoroscopic exposure was compared using electronic dosimeters placed on the thorax, back, foot, and head of the operator. RESULTS The procedural times and total fluoroscopic exposure times and the complication rates were not significantly different between the 2 groups. The mean dose of radiation delivered to the thorax and back was similar in both groups (P = 0.3 and P = 0.8, respectively). In contrast, the mean doses of radiation delivered to the head and to the feet were respectively 68 and 390 times less in the cabin group than in the control group (P < 0.001). CONCLUSIONS The cabin offers nearly full body radioprotection and eliminates the need to wear a lead apron, without increasing procedural time or complication rate during cardiac device extraction.
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Affiliation(s)
- Sylvain Ploux
- Hôpital Cardiologique Haut Leveque, University Bordeaux 2, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Bordeaux-Pessac, France.
| | - Laurence Jesel
- Hôpital Cardiologique Haut Leveque, University Bordeaux 2, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Bordeaux-Pessac, France
| | - Romain Eschalier
- Hôpital Cardiologique Haut Leveque, University Bordeaux 2, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Bordeaux-Pessac, France; Clermont Université, ISIT-CaVITI, UMR6284, and CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France
| | - Sana Amraoui
- Hôpital Cardiologique Haut Leveque, University Bordeaux 2, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Bordeaux-Pessac, France
| | - Philippe Ritter
- Hôpital Cardiologique Haut Leveque, University Bordeaux 2, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut Leveque, University Bordeaux 2, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Bordeaux-Pessac, France
| | - Pierre Bordachar
- Hôpital Cardiologique Haut Leveque, University Bordeaux 2, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Bordeaux-Pessac, France
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Crowhurst JA, Whitby M, Thiele D, Halligan T, Westerink A, Crown S, Milne J. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals. J Med Radiat Sci 2014; 61:135-41. [PMID: 26229649 PMCID: PMC4175852 DOI: 10.1002/jmrs.67] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/05/2014] [Accepted: 07/16/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Methods Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (PKA), skin surface entrance dose (KAR), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the PKA. Results 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median KAR = 581 mGy (374–876). Median PKA = 3908 uGym2 (2489–5865) DRL = 5865 uGym2. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median KAR = 1501 mGy (928–2224). Median PKA = 8736 uGym2 (5449–12,900) DRL = 12,900 uGym2. Conclusion This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.
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Affiliation(s)
- James A Crowhurst
- The Prince Charles Hospital Chermside, Queensland, Australia ; School of Medicine, University of Queensland St. Lucia, Brisbane, Queensland, Australia
| | - Mark Whitby
- The Prince Charles Hospital Chermside, Queensland, Australia ; Biomedical Technology Services, Health Services Support Agency, Queensland Health Herston, Queensland, Australia
| | - David Thiele
- Biomedical Technology Services, Health Services Support Agency, Queensland Health Herston, Queensland, Australia
| | - Toni Halligan
- Allied Health Professions' Office of Queensland Brisbane, Queensland, Australia
| | - Adam Westerink
- Royal Brisbane and Women's Hospital Herston, Queensland, Australia
| | - Suzanne Crown
- Princess Alexandra Hospital Woolloongabba, Queensland, Australia
| | - Jillian Milne
- Cardiac Clinical Informatics Unit - Queensland Health Herston, Queensland, Australia
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Heidbuchel H, Wittkampf FHM, Vano E, Ernst S, Schilling R, Picano E, Mont L, Jais P, de Bono J, Piorkowski C, Saad E, Femenia F. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace 2014; 16:946-64. [PMID: 24792380 DOI: 10.1093/europace/eut409] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more complex procedures have the risk to increase the radiation exposure, both for the patients and the operators. The professional lifetime attributable excess cancer risk may be around 1 in 100 for the operators, the same as for a patient undergoing repetitive complex procedures. Moreover, recent reports have also hinted at an excess risk of brain tumours among interventional cardiologists. Apart from evaluating the need for and justifying the use of radiation to assist their procedures, physicians have to continuously explore ways to reduce the radiation exposure. After an introduction on how to quantify the radiation exposure and defining its current magnitude in electrophysiology compared with the other sources of radiation, this position paper wants to offer some very practical advice on how to reduce exposure to patients and staff. The text describes how customization of the X-ray system, workflow adaptations, and shielding measures can be implemented in the cath lab. The potential and the pitfalls of different non-fluoroscopic guiding technologies are discussed. Finally, we suggest further improvements that can be implemented by both the physicians and the industry in the future. We are confident that these suggestions are able to reduce patient and operator exposure by more than an order of magnitude, and therefore think that these recommendations are worth reading and implementing by any electrophysiological operator in the field.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiovascular Medicine, University Hospital Gasthuisberg, University of Leuven, 3000 Leuven, Belgium
| | - Fred H M Wittkampf
- Heart Lung Center, Department of Cardiology, University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Eliseo Vano
- Radiology Department, Medicine School, Complutense University and San Carlos Hospital, IdISSC, Madrid 28040, Spain
| | - Sabine Ernst
- NIHR Biomedical Research Unit and Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, SW3 6NP, London, UK
| | - Richard Schilling
- Biomedical Research Unit, Bart's Health NHS Trust and the William Harvey Research Institute, London EC1A 7BE, UK
| | - Eugenio Picano
- CNR Biomedical Sciences Department, Institute of Clinical Physiology, 56124, Pisa, Italy
| | - Lluis Mont
- Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia 08036, Spain
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Joseph de Bono
- Queen Elizabeth Medical Centre, Department of Cardiology, Birmingham, United Kingdom
| | | | - Eduardo Saad
- Hospital Pró-Cardíaco, Setor de Arritmia Invasiva, Rio de Janeiro, Brazil
| | - Francisco Femenia
- Biomedical Research Unit, Bart's Health NHS Trust and the William Harvey Research Institute, London EC1A 7BE, UK
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Influence of fracture type and surgeon experience on the emission of radiation in distal radius fractures. Arch Orthop Trauma Surg 2013; 133:941-6. [PMID: 23589065 DOI: 10.1007/s00402-013-1739-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ionising radiation is a potential risk for potentially exposed personnel. Only a few studies have examined the factors contributing to the emission of radiation in orthopaedic trauma procedures. We hypothesize that the experience of the surgeon and the fracture type influence the emission of radiation intraoperatively. METHODS In a retrospective analysis, we examined 100 consecutive distal radius fractures receiving a volar plate osteosynthesis. The following parameters were documented: demographic data, plate system, fracture type, duration of the surgical procedure and duration of the emission of radiation, the experience level of the surgeon and the first assisting surgeon. RESULTS Of all included patients (74 female), 48 had a type A, 7 a type B and 45 a type C fracture. The duration of radiation was longer for type C fractures [1.04 min (min)] in comparison to type A fractures (0.88 min) (P = 0.8152). In the type C subgroup, the highest amount of radiation was required for type C3 fractures (1.6 min), which was significantly more in comparison to type A (P = 0.0460) and type C1 fractures (P = 0.0089). The intraoperative emission of radiation (P = 0.00141) and the procedure time (P = 0.0006) depended on the experience of the surgical team. CONCLUSION The emission of radiation during this procedure depends on the fracture type and the experience of the surgical team. Operating theatre personnel should be aware of the higher emission rates during the treatment of type C fractures and in teaching hospitals with inexperienced team members.
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