Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers

Nguyen, Patricia K.; Lee, Won Hee; Li, Yong Fuga; Hong, Wan Xing; Hu, Shijun; Chan, Charles; Liang, Grace; Nguyen, Ivy; Ong, Sang Ging; Churko, Jared M.; Wang, Jia; Altman, Russ B.; Fleischmann, Dominik; Wu, Joseph C.

doi:10.1016/j.jcmg.2015.04.016

Cited by 66 publications

(40 citation statements)

References 38 publications

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“…27 Emerging data suggest, however, that there is variability in tissue response to radiation, the safe threshold may vary between individuals, and the risk relationship is not linear. 14,28 The present study aimed to (1) study the biological effect of radiation exposure in operators by measuring pATM and γ-H2AX expression in circulating lymphocytes after EVAR, (2) examine individual operator sensitivity to radiation exposure using γ-H2AX levels as a biomarker, and (3) evaluate the protective effect of wearing lower leg lead shielding.…”

mentioning

confidence: 99%

Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair

El-Sayed¹,

Patel²,

Cho³

et al. 2018

Journal of Vascular Surgery

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BACKGROUND:Radiation exposure during fluoroscopically guided interventions such as endovascular aortic repair (EVAR) is a growing concern for operators. This study aimed to measure DNA damage/repair markers in operators perfoming EVAR. METHODS:Expression of the DNA damage/repair marker, γ-H2AX and DNA damage response marker, phosphorylated ataxia telangiectasia mutated (pATM), were quantified in circulating lymphocytes in operators during the peri-operative period of endovascular (infrarenal, branched, and fenestrated) and open aortic repair using flow cytometry. These markers were separately measured in the same operators but this time wearing leg lead shielding in addition to upper body protection and compared with those operating with unprotected legs. Susceptibility to radiation damage was determined by irradiating operators' blood in vitro.RESULTS: γ-H2AX and pATM levels increased significantly in operators immediately after branched endovascular aortic repair/fenestrated endovascular aortic repair (P<0.0003 for both). Only pATM levels increased after infrarenal endovascular aortic repair (P<0.04). Expression of both markers fell to baseline in operators after 24 hours (P<0.003 for both). There was no change in γ-H2AX or pATM expression after open repair. Leg protection abrogated γ-H2AX and pATM response after branched endovascular aortic repair/fenestrated endovascular aortic repair. The expression of γ-H2AX varied significantly when operators' blood was exposed to the same radiation dose in vitro (P<0.0001).CONCLUSIONS: This is the first study to detect an acute DNA damage response in operators performing fluoroscopically guided aortic procedures and highlights the protective effect of leg shielding. Defining the relationship between this response and cancer risk may better inform safe levels of chronic low-dose radiation exposure. 1,2 The growing number and complexity of procedures means that interventionists are exposed to higher amounts of radiation, a subject that is becoming increasingly topical. Radiation-Induced3-7 A recently published 15-year follow-up study of the EVAR trial, comparing endovascular and open aortic repair, reported an increased incidence of malignancy in patients treated by EVAR. 8 There is, rightly so, a significant focus currently on reducing the patients' exposure to radiation, but mounting evidence suggests that recurrent lowdose exposure to the practitioner is equally as important. Robust data collection to assess the risks posed to the interventionist is in its infancy, but a number of studies suggest a link to adverse health effects, including a higher risk of posterior subcapsular lens changes and malignancy.9-11 One recent study found a higher incidence of malignancy, including brain cancer, breast cancer, and melanoma, in interventionists who performed fluoroscopically guided procedures compared with those who had never performed these.12 A better understanding of the hazards of occupational radiation exposure requires sensitive tools to measure exposure at an individu...

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mentioning

confidence: 99%

Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair

El-Sayed¹,

Patel²,

Cho³

et al. 2018

Journal of Vascular Surgery

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“…An obvious but often overlooked drawback of microCT is the use of X-ray sources and the potential tissue damage caused by the ionizing radiation (Han & Yu, 2009;Daly, 2012). Although this has been considered a minor issue because of short scan times, some studies on animal organisms indicated irreversible cellular damage even by exposure to very low X-ray doses (Rothkamm & L€ obrich, 2003;Nguyen et al, 2015). However, respective X-rays effects on plant samples have never been investigated in detail, although previous studies indicated damage of plant tissues after microCT scans.…”

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confidence: 99%

The pitfalls of in vivo imaging techniques: evidence for cellular damage caused by synchrotron X‐ray computed micro‐tomography

et al. 2018

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Synchrotron X-ray computed micro-tomography (microCT) has emerged as a promising noninvasive technique for in vivo monitoring of xylem function, including embolism build-up under drought and hydraulic recovery following re-irrigation. Yet, the possible harmful effects of ionizing radiation on plant tissues have never been quantified. We specifically investigated the eventual damage suffered by stem living cells of three different species exposed to repeated microCT scans. Stem samples exposed to one, two or three scans were used to measure cell membrane and RNA integrity, and compared to controls never exposed to X-rays. Samples exposed to microCT scans suffered serious alterations to cell membranes, as revealed by marked increase in relative electrolyte leakage, and also underwent severe damage to RNA integrity. The negative effects of X-rays were apparent in all species tested, but the magnitude of damage and the minimum number of scans inducing negative effects were species-specific. Our data show that multiple microCT scans lead to disruption of fundamental cellular functions and processes. Hence, microCT investigation of phenomena that depend on physiological activity of living cells may produce erroneous results and lead to incorrect conclusions.

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“…However, no increase in cancer risk is present in atomic bomb survivors who received less than 5 mSv [4]. A recent paper evaluating the effects of radiation on protein and genetic biomarkers in patients undergoing cardiac computed tomography showed no abnormalities in patients who received less than 7.5 mSv [5]. These findings suggest that computed tomography for cardiac function as it can be practiced today poses no measureable radiation exposure risk.…”

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confidence: 97%

Cardiac CTA for evaluation of cardiac function in patients with congenital heart disease: the good, the bad and the ugly

Greenberg

2015

Int J Cardiovasc Imaging

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The report by Dr. Han et al. [1] illustrates the spectrum of practice concerning the evaluation of cardiac function using computed tomography angiography over a 7 year span. Innovations during that time led to disparate radiation exposure results in the study groups which can be classified as the good, the bad and the ugly.First the ugly: practices that predominantly image adults often do not adequately adjust technique to image children. Three children imaged at a facility that performed studies predominantly on adults had their CTA examinations performed using 120 kVp energy. The result was a much higher radiation dose than necessary and no doubt inferior image contrast than would have been achieved if 80 or 100 kVp energy was utilized. The routine use of 120 kVp or greater energy at institutions that predominantly image adults continues today despite the recommendations of the Image Gently campaign [2]. In my experience in Arkansas, about 85 % of pediatric abdomen examinations performed in community hospitals use 120 kVp or greater energy as opposed to the pediatric hospital in which 85 % of studies use 100 kVp or less.The bad is the wide range of radiation doses for patients performed at the different institutions. Mean effective radiation dose ranged from 3.6 to 9.2 mSv. The highest radiation doses were in the institution that performed all studies on older equipment than was available at the other two institutions. Although some dose reduction strategies were employed, iterative reconstruction was not available.Not all institutions can be on the leading edge of technology. The other two institutions had a combination of first generation dual source scanner cases without iterative reconstruction and later second generation dual source scanner cases performed with iterative reconstruction. Iterative reconstruction allows for significant radiation dose reduction [3].The good news is that one of the three institutions reduced the mean effective dose for studies to 3.6 mSv with fully 75 % of their cases performed using less than 6 mSv. An increased cancer risk due to ionizing radiation exposure in atomic bomb survivors is frequently cited as a reason to limit the use of computed tomography. However, no increase in cancer risk is present in atomic bomb survivors who received less than 5 mSv [4]. A recent paper evaluating the effects of radiation on protein and genetic biomarkers in patients undergoing cardiac computed tomography showed no abnormalities in patients who received less than 7.5 mSv [5]. These findings suggest that computed tomography for cardiac function as it can be practiced today poses no measureable radiation exposure risk.

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Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers

Cited by 66 publications

References 38 publications

Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair

Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair

The pitfalls of in vivo imaging techniques: evidence for cellular damage caused by synchrotron X‐ray computed micro‐tomography

Cardiac CTA for evaluation of cardiac function in patients with congenital heart disease: the good, the bad and the ugly

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