Reduction in exposure of interventional cardiologists to ionising radiation over a 10-year period

Faroux, Laurent; Blanpain, Thierry; Nazeyrollas, Pierre; Tassan-Mangina, Sophie; Heroguelle, Virginie; Tourneux, Christophe; Baudin, Florian; Metz, Damien

doi:10.1016/j.ijcard.2018.02.026

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…Interventional radiology and cardiology are widespread used techniques for diagnosis and treatment of various heart, vascular and hepatobiliary pathologies, for tumor therapy (embolisation procedures) and pain management (vertebroplasty). Being minimally invasive, they avoid the majority of the side-effects associated with surgical treatments but are known to increase the radiation exposure to patient and operators (Williams 1997, Vañó et al 1998, Covens et al 2007, Morrish and Goldstone 2008, Martin 2009, Olgar et al 2009, Faroux et al 2018, Vano et al 2018.…”

Section: Introductionmentioning

confidence: 99%

Simulation of H _p(10) and effective dose received by the medical staff in interventional radiology procedures

et al. 2019

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Interventional radiology and cardiology are widespread employed techniques for diagnosis and treatment of several pathologies because they avoid the majority of the side-effects associated with surgical treatments, but are known to increase the radiation exposure to patient and operators. In recent years many studies treated the exposure of the operators performing cardiological procedures. The aim of this work is to study the exposure condition of the medical staff in some selected interventional radiology procedures. The Monte Carlo simulations have been employed with anthropomorphic mathematical phantoms reproducing the irradiation scenario of the medical staff with two operators and the patient. A personal dosemeter, put on apron, was modelled for comparison with measurements performed in hospitals, done with electronic dosemeters, in a reduced number of interventional radiology practices. Within the limits associated to the use of numerical anthropomorphic models to mimic a complex interventional procedure, the personal dose equivalent, Hp(10), was evaluated and normalised to the simulated Kerma-Area Product, KAP, value, indeed the effective dose has been calculated. The Hp(10)/KAPvalue of the first operator is about 10 μSv/Gy.cm2, when ceiling shielding is not used. This value is calculated on the trunk and it varies of +/−30% moving the dosemeter to the waist or to the neck. The effective dose, normalised to the KAP value, varies between 0.03 and 0.4 μSv/Gy.cm2. Considering all the unavoidable approximation of this kind of investigations, the comparisons with hospital measurement and literature data showed a good agreement allowing to use of the present results for dosimetric characterisation of interventional radiology procedures.

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Section: Introductionmentioning

confidence: 99%

Simulation of H _p(10) and effective dose received by the medical staff in interventional radiology procedures

et al. 2019

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“…The dose collection was not computerised and required the intervention of the cardiologist wearing the dosimeter, so there was uncertainty as to the accuracy of the data. However, our medical team has been using these dosimeters for clinical research purposes for several years [12,20,23], and therefore has significant experience with dose collection.…”

Section: Discussionmentioning

confidence: 99%

Impact of cardiac resynchronisation therapy on cardiologists’ exposure to radiation during implantation of pacemakers and implantable cardioverter-defibrillators

et al. 2019

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Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no recent study quantifying overexposure of physicians during cardiac resynchronisation therapy (CRT) procedures compared to ‘classical’ implantation of pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). We aimed to measure and compare operator exposure to radiation during implantation of PM and ICD with or without CRT. The study population comprised all PMs and ICDs implanted in a large referral centre over a six months period. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on operator’s chest. In total, 169 PM/ICD implantations were analysed, 19 of which included CRT. Compared with ‘classical’ implantation, cardiologist radiation exposure was 9-fold greater during CRT procedures (p < 0.001). Physician exposure was related to dose-area product (R2 = 0.21 during ‘classical’ implantations and R2 = 0.57 during CRT procedures). Our study shows that cardiologists’ exposure to radiation during CRT implantation was 9-fold greater than during procedures without CRT.

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“…Although prior studies have elaborated on the radiation reduction during PCI, 27,28 this study demonstrates separate characterization of radiation parameters of both fluoroscopy and acquisition modes using a large sample size from a high‐volume center. Physicians were allowed to choose radiation packages within the scope of the initiative based on their preferences.…”

Section: Strengths and Limitationsmentioning

confidence: 96%

“…These changes along with regular feedback from the operators were effective in keeping radiation practices in check over a long period of time. Several organizations like International Commission for Radiation Protection and International Atomic Energy Agency are involved in spreading knowledge of radiation reduction and carry recommendations to reduce the radiation to the lowest possible level without hampering any diagnostic information.STRENGTHS AND LIMITATIONSAlthough prior studies have elaborated on the radiation reduction during PCI,27,28 this study demonstrates separate characterization of radiation parameters of both fluoroscopy and acquisition modes using a large sample size from a high-volume center. Physicians were allowed to choose radiation packages within the scope of the initiative based on their preferences.…”

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confidence: 95%

Radiation reduction in a modern catheterization laboratory: A single‐center experience

Shekhar

Ajay

Agrawal

et al. 2022

Cathet Cardio Intervent

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Background Measures were undertaken at the Cleveland Clinic to reduce radiation exposure to patients and personnel working in the catheterization laboratories. We report our experience with these improved systems over a 7‐year period in patients undergoing diagnostic catheterization (DC) and percutaneous coronary interventions (PCIs). Methods Patients were categorized into preinitiative (2009–2012) and postinitiative (2013–2019) groups in the DC and PCI cohorts. Propensity score matching was done between the pre‐ and postinitiative groups for both cohorts based on age, sex, body surface area, total fluoroscopy time, and total acquisition time. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (Ka,r), and fluoroscopy‐ and acquisition‐mode air kerma in patients in the two groups. Results In the DC cohort, there was a significant reduction in Ka,r in the postinitiative group in comparison to the preinitiative group (median, 396 vs. 857 mGy; p < 0.001). In the PCI cohort, Ka,r in the postinitiative group was 1265 mGy, which was significantly lower than the corresponding values in the preinitiative group (1994 mGy; p < 0.001). We also observed a significant reduction in fluoroscopy‐ and acquisition‐based air kerma rates, and air kerma area product in the postinitiative group in comparison to the preinitiative group in both matched and unmatched DC and PCI cohorts after the institution of radiation reduction measures. Conclusion There was a significant and sustained reduction in radiation exposure to patients in the catheterization laboratory with the implementation of advanced protocols. Similar algorithms can be applied in other laboratories to achieve a similar reduction in radiation exposure.

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Reduction in exposure of interventional cardiologists to ionising radiation over a 10-year period

Cited by 8 publications

References 14 publications

Simulation of H _p(10) and effective dose received by the medical staff in interventional radiology procedures

Simulation of H _p(10) and effective dose received by the medical staff in interventional radiology procedures

Impact of cardiac resynchronisation therapy on cardiologists’ exposure to radiation during implantation of pacemakers and implantable cardioverter-defibrillators

Radiation reduction in a modern catheterization laboratory: A single‐center experience

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Reduction in exposure of interventional cardiologists to ionising radiation over a 10-year period

Cited by 8 publications

References 14 publications

Simulation of H p (10) and effective dose received by the medical staff in interventional radiology procedures

Simulation of H p (10) and effective dose received by the medical staff in interventional radiology procedures

Impact of cardiac resynchronisation therapy on cardiologists’ exposure to radiation during implantation of pacemakers and implantable cardioverter-defibrillators

Radiation reduction in a modern catheterization laboratory: A single‐center experience

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Simulation of H _p(10) and effective dose received by the medical staff in interventional radiology procedures

Simulation of H _p(10) and effective dose received by the medical staff in interventional radiology procedures