Occupational radiation dose during transcatheter aortic valve implantation

Sauren, Loes D C; Garsse, Leen van; Ommen, Vincent van; Kemerink, Gerrit J.

doi:10.1002/ccd.23116

Cited by 29 publications

(25 citation statements)

References 21 publications

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“…13,15,24–26 Operator exposure (particularly hands) is of greater concern for the TA procedure relative to the TF approach. 26 One option to reduce radiation would be to perform valve deployment under fluoroscopy and store the sequence. Also, more significant utilisation of adjunctive modalities such as TEE for positioning of the valve has been shown to reduce contrast volume.…”

Section: Discussionmentioning

confidence: 99%

Patient radiation exposure during transcatheter aortic valve replacement procedures

Daneault¹,

Balter²,

Kodali³

et al. 2012

EuroIntervention

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Aims To describe patient radiation utilisation during transcatheter aortic valve replacement (TAVR) on a series of consecutive patients. Methods and results Data on radiation exposure were prospectively collected for consecutive patients undergoing TAVR and percutaneous coronary interventions at our centre. Radiation dose during the procedure was recorded using the US Food and Drug Administration (FDA) reference point (Ka,r) and the dose area product (PKA). In addition to quantifying overall radiation doses during TAVR, radiation exposure during transfemoral (TF) (n=79) and transapical (TA) (n=26) cases was compared. The median radiation dose during TAVR was 1,639 mGy (983–2,420), or 188 (106–321) Gy*cm2. Radiation dose was significantly lower among TA patients using either the reference point (TA: 946 [777–1,261] vs. TF: 1,932 [1,383–2,614] mGy; p<0.001) or the dose area product (TA: 89 [60–115] vs. TF: 236 [164–338] Gy*cm2; p<0.001). Fluoroscopy time was lower for TA patients (TA: 10 [8–11] vs. TF: 30 [24–34] minutes; p<0.001). Operators experience did not affect radiation exposure for TF cases. Conclusions Radiation exposure during TAVR appears similar to other percutaneous coronary interventions of moderate complexity. Radiation doses were significantly lower for TA procedures. A higher dose of radiation in TF patients may be related to additional imaging requirements to optimise percutaneous vascular access and closure.

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Section: Discussionmentioning

confidence: 99%

Patient radiation exposure during transcatheter aortic valve replacement procedures

Daneault¹,

Balter²,

Kodali³

et al. 2012

EuroIntervention

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“…The single dose per procedure of the operator is on the order of magnitude of one thousandth of the exposure of the patient [13] (Figure 1a). Effective occupational doses per procedure range from 0.02 to 38 microSv for diagnostic catheterization, 0.2 to 31.2 microSv for percutaneous coronary intervention, 0.2–9.6 microSv for ablation, 0.3–17.4 microSv for pacemaker or intracardiac defibrillation implantations [14] and may reach even higher values per procedure up to 50 microSv for dilation of chronic total occlusion and up to 100 microSv transcutaneous aortic valve [15] and up to 200 microSv per single procedure of endovascular thoraco-abdominal aneurysm repair [16]. The measurement over personal protective devices ranged from 0.4–1,100 microSv at the eye level, 1.2–580 microSv at the thyroid level, 32–750 microSv at the trunk level, and 0.4–790 microSv at head level, whereas measurements under the apron at the trunk levels ranged from 0 to 23 microSv [14].…”

Section: Reviewmentioning

confidence: 99%

Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure

et al. 2012

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BackgroundAccording to a fundamental law of radiobiology (“Law of Bergonié and Tribondeau”, 1906), the brain is a paradigm of a highly differentiated organ with low mitotic activity, and is thus radio-resistant. This assumption has been challenged by recent evidence discussed in the present review.ResultsIonizing radiation is an established environmental cause of brain cancer. Although direct evidence is lacking in contemporary fluoroscopy due to obvious sample size limitation, limited follow-up time and lack of focused research, anecdotal reports of clusters have appeared in the literature, raising the suspicion that brain cancer may be a professional disease of interventional cardiologists. In addition, although terminally differentiated neurons have reduced or mild proliferative capacity, and are therefore not regarded as critical radiation targets, adult neurogenesis occurs in the dentate gyrus of the hippocampus and the olfactory bulb, and is important for mood, learning/memory and normal olfactory function, whose impairment is a recognized early biomarker of neurodegenerative diseases. The head doses involved in radiotherapy are high, usually above 2 Sv, whereas the low-dose range of professional exposure typically involves lifetime cumulative whole-body exposure in the low-dose range of < 200 mSv, but with head exposure which may (in absence of protection) arrive at a head equivalent dose of 1 to 3 Sv after a professional lifetime (corresponding to a brain equivalent dose around 500 mSv).ConclusionsAt this point, a systematic assessment of brain (cancer and non-cancer) effects of chronic low-dose radiation exposure in interventional cardiologists and staff is needed.

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“…The reviewers determined that the operator's fingers frequently receive the highest amount of radiation of all body areas 6 . Three other descriptive studies by Sauren et al, 4 Ginjaume et al, 7 and Häusler et al 8 also found that an operator's fingers receive larger doses of radiation than other areas of the body.…”

Section: Wearing Ring Dosimetersmentioning

confidence: 97%

“…Without the use of a ring dosimeter, hand and finger radiation exposure cannot be accurately recorded. This exposure level is important in determining the maximum allowable radiation dose recommended by the Occupational Safety and Health Administration (OSHA) for health care workers 4,5 . A ring dosimeter is intended to measure only the amount of radiation received by the fingers of the individual wearing it; therefore, it should be worn in addition to, and not in place of, other required dosimeters.…”

Section: Wearing Ring Dosimetersmentioning

confidence: 99%

Clinical Issues‐July 2016

Burlingame¹

2016

AORN Journal

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Wearing ring dosimeters Key words: dosimeter, ring dosimeters, finger dosimeters. Reporting a retained surgical item (RSI) Key words: reportable event, retained surgical item, RSI, retained foreign object, counts. Definition of an implant Key words: implant, implant documentation. Determining whether RN first assistants (RNFAs) must maintain CNOR certification to practice Key words: CNOR, CRNFA, RNFA, first assistant, RN first assistant. Definition of personal protective equipment (PPE) Key words: personal protective equipment, PPE, surgical attire, removing PPE.

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Occupational radiation dose during transcatheter aortic valve implantation

Cited by 29 publications

References 21 publications

Patient radiation exposure during transcatheter aortic valve replacement procedures

Patient radiation exposure during transcatheter aortic valve replacement procedures

Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure

Clinical Issues‐July 2016

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