Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: Insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report

Venneri, Lucia; Rossi, Francesco; Botto, Nicoletta; Andreassi, Maria Grazia; Salcone, Nicoletta; Emad, Ahmed; Lazzeri, M.; Gori, C.; Vañó, Eliseo; Picaño, Eugenio

doi:10.1016/j.ahj.2008.08.009

Cited by 298 publications

(214 citation statements)

References 43 publications

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“…Radioprotective caps of 0.3-0.5 mm lead equivalence have been shown to significantly attenuate the radiation dose to the operator's head [43,44]. The prevalence of breast cancer has also been shown to be higher among female interventionists [3,45]. Lead-equivalent garments providing snug fit, full chest coverage (sleeved aprons) or dedicated breast shields are recommended for female operators to protect the breast tissue and axillary region.…”

Section: Discussionmentioning

confidence: 99%

“…Ionizing radiation carries potential health hazards for the patient and staff [1][2][3]. Education and training play an important role in balancing minimization of these risks and prevention of 'radiation phobia' which may affect decisions to provide effective diagnostic and treatment options for the patient or preclude the physicians themselves from pursuing carrier in invasive cardiology [4].…”

Section: Background/introductionmentioning

confidence: 99%

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Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

2016

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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 optim ization 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 Practical Matter Society for Radiological ProtectionOriginal content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI. 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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Section: Discussionmentioning

confidence: 99%

Section: Background/introductionmentioning

confidence: 99%

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

2016

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“…34 Concern for damaging effects of radiation from interventional cardiac procedures is typically directed at patients; 35 however, impact on cardiologists is not as often addressed. 36 Eye lens cataracts are common and stochastic effects from radiation are also becoming a concern for interventional cardiologists. Cumulative radiation exposure from a working lifetime has been reportedly high enough to increase the cardiologist risk of cancer to 51% 37,38 from the baseline risk of 25%.…”

Section: Discussionmentioning

confidence: 99%

Impact of latest generation cardiac interventional X-ray equipment on patient image quality and radiation dose for trans-catheter aortic valve implantations

Gislason‐Lee¹,

Keeble²,

Malkin³

et al. 2016

BJR

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Objectives: This study aimed to determine the impact on radiation dose and image quality of a new cardiac interventional X-ray system for trans-catheter aortic valve implantation (TAVI) patients compared to the previously-used cardiac X-ray system. Methods: Patient dose and image data were retrospectively collected from a Philips AlluraClarity (new) and Siemens Axion Artis (reference) X-ray system. Patient dose area product (DAP) and fluoroscopy duration of 41 patient cases from each X-ray system were compared using a Wilcoxon test. Ten patient aortograms from each X-ray system were scored by 32 observers on a continuous scale to assess the clinical image quality at the given phase of the TAVI procedure. Scores were dichotomised by acceptability and analysed using a Chi-squared test. Results: Significant reductions in patient dose (p ,, 0.001) were found for the new system with no significant change in fluoroscopy duration (p 5 0.052); procedure DAP reduced by 55%, fluoroscopy DAP by 48% and "cine" acquisition DAP by 61%. There was no significant difference between image quality scores of the two X-ray systems (p 5 0.06). Conclusions:The new cardiac X-ray system demonstrated a very significant reduction in patient dose with no loss of clinical image quality. Advances in Knowledge: The huge growth of TAVI may impact on the radiation exposure of cardiac patients and particularly on operators including anaesthetists; cumulative exposure of interventional cardiologists performing high volume TAVI over 30-40 years may be harmful. The Phillips Clarity upgrade including improved image enhancement and optimised X-ray settings significantly reduced radiation without reducing clinically acceptable image quality.

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“…(14)(15)(16) We can indirectly estimate the effective radiation doses for the present study by converting the DAP values in the present study using the recommended conversion factor for cardiac ablation procedures. (17) When this conversion was done, we obtained an estimated effective radiation dose of 3.1 millisieverts (mSv) for patients with AVNRT who underwent ablation using CF.…”

Section: Discussionmentioning

confidence: 99%

Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

See

Amora

Sheldon

et al. 2016

smedj

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INTRODUCTIONRadiofrequency catheter ablation (RFCA) is a first-line therapeutic option for supraventricular tachycardia (SVT).(1) It is conventionally performed under fluoroscopy. The amount of exposure to fluoroscopy is highly dependent on multiple variables, such as operator experience and the complexity of the arrhythmia substrate.(2) As exposure to radiation during such procedures increases the lifetime risk of fatal malignancies, skin injuries and cataract, it poses a palpable hazard to both patients and medical staff.(3) This emphasises the importance of employing all possible measures to minimise exposure to ionising radiation.Recent advances in technology have led to the development of non-fluoroscopic three-dimensional (3D) mapping systems to guide ablation during prolonged electrophysiological procedures, such as pulmonary vein isolation for atrial fibrillation and mapping of atypical atrial flutter and ventricular tachycardia. These 3D mapping systems help physicians to better comprehend complex arrhythmias and develop appropriate ablation strategies. These systems have also been proven to substantially reduce ionising radiation exposure. Data on the use of non-fluoroscopic systems (NFS) in Singapore is limited. Therefore, the aim of the present study was to determine the consistency and applicability of the aforementioned latest findings in our local setting. The specific aims of the present study were (a) to determine the procedure and fluoroscopy times, and ionising radiation exposure of patients who underwent RFCA for SVT using NFS as compared to those using conventional fluoroscopy (CF); and (b) to compare atrioventricular nodal reentrant tachycardia (AVNRT) ablation and atrioventricular reentrant tachycardia (AVRT) ablation. METHODSThe present study was a prospective analysis of patients who underwent electrophysiology (EP) study of paroxysmal SVT at our institution from January 2012 to March 2014. Patients with AVNRT and AVRT were enrolled and a total of 200 consecutive patients, aged 11-86 years, who underwent RFCA were included in this study. All patients (or parents, if the patient was underage) gave informed consent.Each patient underwent RFCA in the fasted and non-absorptive state, and under intravenous sedation with midazolam and fentanyl. Local anaesthetic with lignocaine was administered at the vascular access sites, which were the femoral venous site for all patients. Some patients also had femoral arterial access if the operator selected a retrograde aortic approach to obtain access to the left side of the heart. The decision for NFS usage was operator-dependent and made before the EP study. The choice of NFS, either EnSite TM NavX

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Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: Insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report

Cited by 298 publications

References 43 publications

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

Impact of latest generation cardiac interventional X-ray equipment on patient image quality and radiation dose for trans-catheter aortic valve implantations

Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

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