Sustainability in the cardiac cath lab

Picaño, Eugenio; Santoro, Gennaro; Vañó, Eliseo

doi:10.1007/s10554-006-9148-x

Cited by 37 publications

(24 citation statements)

References 25 publications

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“…Low dose exposures are also related to biological damage 8 . It has been estimated that an interventional cardiologists presents a median radiation exposure per year equivalent to approximately 250 chest X-rays (5mSv), a two to three times higher dose compared to a typical radiologists 9 and this has, recently been related to an increased risk of cognitive impairment and brain malignancy (in particular on the left side) 10,11 . For these reasons, in the attempt to avoid an uncontrolled increase in radiation exposure and consequent risks, the American College of Cardiology stated that the risk of radiation exposure always needs to be balanced by the benefits of the imaging/procedure itself.…”

Section: Biological Effects Of Radiation and Evidence Of Harmmentioning

confidence: 99%

The dream of near-zero X-rays ablation comes true

et al. 2016

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Abstract:While radiation exposure related to natural sources plays a minor role, medicine-related exposure, represents, to date, a major exposure source. Within this exposure interventional electrophysiology is a relevant contributor. Unfortunately no safe dose in radioprotection exists, the negative acute and long term effects of radiological exposure may emerge at any radiation exposure dose. For this reason patients and physicians should be aware of the risk of radiation exposure and the benefits of the imaging/procedure balanced by the required radiation exposure. Given this, performing a near to zero x-rays transcatheter ablation procedure should therefore represent an aim for all electrophysiological lab. Fortunately, the introduction of electroanatomic mapping systems, have provided the possibility to perform simple and complex electrophysiological procedures avoiding, or at least, limiting the use of radiations. The present review summarizes state of the art of feasibility and safety of the near to zero approach for the main electrophysiological procedures, highlighting the potential health benefits.3

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Section: Biological Effects Of Radiation and Evidence Of Harmmentioning

confidence: 99%

The dream of near-zero X-rays ablation comes true

et al. 2016

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“…Improvements in catheters, guidewires and stents have contributed to worldwide popularity and expansion of IR [2,3]. Similarly, the number of interventional cardiology (IC) procedures over the last 10 years has also increased rapidly [4]. The main reason is that IC permits specialists to avoid complicated invasive surgery, which some patients might not tolerate because of age factors or pathology, and this results in a reduced length of hospital stay in comparison with coronary artery bypass grafting [5].…”

mentioning

confidence: 99%

Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures

Efstathopoulos

Pantos²,

Andreou³

et al. 2011

BJR

124

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Objectives: The aim of this study was to determine occupational dose levels in interventional radiology and cardiology procedures. Methods: The study covered a sample of 25 procedures and monitored occupational dose for all laboratory personnel. Each individual wore eight thermoluminescent dosemeters next to the eyes, wrists, fingers and legs during each procedure. Radiation protection shields used in each procedure were recorded. Results: The highest doses per procedure were recorded for interventionists at the left wrist (average 485 mSv, maximum 5239 mSv) and left finger (average 324 mSv, maximum 2877 mSv), whereas lower doses were recorded for the legs (average 124 mSv, maximum 1959 mSv) and the eyes (average 64 mSv, maximum 1129 mSv). Doses to the assisting nurses during the intervention were considerably lower; the highest doses were recorded at the wrists (average 26 mSv, maximum 41 mSv) and legs (average 18 mSv, maximum 22 mSv), whereas doses to the eyes were minimal (average 4 mSv, maximum 16 mSv). Occupational doses normalised to kerma area product (KAP) ranged from 11.9 to 117.3 mSv/1000 cGy cm 2 and KAP was poorly correlated to the interventionists' extremity doses. Conclusion: Calculation of the dose burden for interventionists considering the actual number of procedures performed annually revealed that dose limits for the extremities and the lenses of the eyes were not exceeded. However, there are cases in which high doses have been recorded and this can lead to exceeding the dose limits when bad practices are followed and the radiation protection tools are not properly used.

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“…1 With this technological advancement and an overwhelming increase in the number of cardiac catheterizations, there has been a rise in the amount of radiation exposure to physicians and personnel working in the cardiac catheterization laboratories. [2][3][4] Recent reports of left-sided brain tumors in interventional cardiologists and radiologists have raised occupational safety concerns in the interventional community. 5 Furthermore, several studies have demonstrated significant DNA damage in physicians exposed to low doses of radiation on a chronic basis.…”

mentioning

confidence: 99%

Measures to Reduce Radiation in a Modern Cardiac Catheterization Laboratory

Agarwal

Parashar

Ellis

et al. 2014

Circ: Cardiovascular Interventions

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Background— X-ray use in the catheterization laboratory is guided by the principle of as low as reasonably achievable . In accordance with this principle, we reduced the default fluoroscopic frame rate from 10 to 7.5 frames/s and increased the emphasis on the use of low-dose acquisition starting January 1, 2013. We aimed to study the impact of these measures on the total air kerma during diagnostic catheterization (DC) and percutaneous interventions (PCI). Methods and Results— Propensity matching based on age, sex, body surface area, total fluoroscopy time, and total acquisition time was used to select matched patients for 2012 and 2013, further stratified by DC or PCI. The total air kerma was subsequently compared between 2012 and 2013, separately for DC and PCI. Median total air kerma during DC in 2013 was 625 mGy, which was significantly lower than the corresponding values in 2012 (median, 798 mGy; P <0.001). Similarly, median total air kerma during PCI in 2013 was 1675 mGy, which was significantly less than corresponding values in 2012 (median 2463 mGy, P <0.001). On comparison of air kerma rates between corresponding projections in 2 years, we observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates in 2013, after institution of radiation reduction measures in all projections. Conclusions— With reduction in the default fluoroscopic frame rate and a greater use of low-dose acquisition, there has been a marked reduction in the total air kerma and air kerma rates for DC and PCI.

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Sustainability in the cardiac cath lab

Cited by 37 publications

References 25 publications

The dream of near-zero X-rays ablation comes true

The dream of near-zero X-rays ablation comes true

Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures

Measures to Reduce Radiation in a Modern Cardiac Catheterization Laboratory

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