Fluoroscopically guided vascular and cardiac transcatheter procedures: a comparison of occupational and patient dose by anatomical region

Abstract

X-ray guided procedures are being performed by an increasing variety of medical specialties. Due to improvements in vascular transcatheter therapies, there is an increasing overlap of imaged anatomy between medical specialties. There is concern that non-radiology fluoroscopic operators may not have sufficient training to be well informed of the potential implications of radiation exposure and mitigation strategies to reduce dose. This was a prospective, observational, single center study to compare occupational and patient dose levels when imaging different anatomical regions during fluoroscopically guided cardiac and endovascular procedures. Occupational radiation dose was measured at the level of the temple of 24 cardiologists and 3 vascular surgeons (n = 1369), 32 scrub nurses (n = 1307) and 35 circulating nurses (n = 885). The patient dose was recorded for procedures (n = 1792) performed in three angiography suites. Abdominal imaging during endovascular aneurysm repair (EVAR) procedures was associated with a comparatively high average patient, operator and scrub nurse dose despite additional table-mounted lead shields. Air kerma was relatively high for procedures performed in the chest, and chest + pelvis. Higher dose area product and staff eye dose were recorded during procedures of the chest + pelvis due to the use of digital subtraction angiography to evaluate access route prior to/during transaortic valve implantation. Scrub nurses were exposed to higher average radiation levels than the operator during some procedures. Staff should be cognizant of the potentially higher radiation burden to patients and exposed personnel during EVAR procedures and cardiac procedures using digital subtraction angiography.

Anti-radiation efficacy of face mask in interventional cardiology: a phantom study

“…It is a recognized fact that interventional cardiologists work in hemodynamic units several hours a day for many years, which causes significant cumulative exposure to doses of ionizing radiation 10,[13][14][15] . However, it is necessary to specify that this exposure is chronic in nature and at low doses, which, in the case of the brain, are usually in a range of 20-30 mSv per year, around 10 times more than the entire body exposure 9,10 .…”

Eficacia antirradiación de la máscara facial en cardiología intervencionista: un estudio con fantomas

“…Es un hecho reconocido que los cardiólogos intervencionistas trabajan en las unidades de hemodinamia varias horas al día durante muchos años, lo que provoca una significativa exposición acumulada a dosis de radiación ionizante 10,[13][14][15] . Sin embargo, es necesario precisar que esta exposición es de carácter crónico y a bajas dosis, las cuales, en el caso del cerebro, usualmente están en un rango de 20 a 30 mSv por año, alrededor de 10 veces más que toda la exposición del cuerpo 9,10 .…”

Performance of elastic x‐ray shield made by embedding Bi2O3 particles in porous polyurethane

“…As a precaution when using x‐rays, it has been known that carcinogenesis increases with the exposure dose 1 . In addition, we should pay attention to the fact that medical staff who perform fluoroscopic procedures are exposed to scattered x‐rays 2–6 . Moreover, as the number of x‐ray examinations increases, corresponding radiation exposure has increased 7,8 .…”