Renaud L. A 5-y follow-up of the radiation exposure to in-room personnel during cardiac catheterization. Health Phys. 1992;62:10-5.

This study documents the radiation doses received by all in-room personnel of three cardiac catheterization laboratories where more than 15,000 cardiac procedures have been performed over a 5-y period. It is shown that all in-room personnel was exposed to a body dose equivalent well below any regulatory limits. However, some workers may have exceeded the occupational 150 mSv y-1 recommended limit for the lens of the eye. The physicians-in-training and the staff physicians are the two groups more likely to reach this limit. It is also demonstrated that a low correlation exists between the annual number of procedures and the annual head dose equivalent of a physician, but more variation is likely to originate from his/her working attitude and techniques. The mean dose equivalent at the collar level of the physicians is estimated to be 0.04 +/- 0.02 mSv per procedure.

Rehani MM, et al. ICRP Publication 117. Radiological Protection In Fluoroscopically Guided Procedures Performed Outside The Imaging Department. Ann ICRP. 2010 Dec;40(6):1-102.

A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepatobiliary system, and anaesthetics and pain management.

Sailer AM, Vergoossen L, Paulis L, et al. Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring. Cardiovasc Intervent Radiol. 2017;40:1756–1762.

Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04–0.50) µSv/Gy cm2 versus (phase 2) 0.08 (0.02–0.24) µSv/Gy cm2, p = 0.002].

Renaud L. A 5-y follow-up of the radiation exposure to in-room personnel during cardiac catheterization. Health Phys. 1992;62:10-5.

This study documents the radiation doses received by all in-room personnel of three cardiac catheterization laboratories where more than 15,000 cardiac procedures have been performed over a 5-y period. It is shown that all in-room personnel was exposed to a body dose equivalent well below any regulatory limits. However, some workers may have exceeded the occupational 150 mSv y-1 recommended limit for the lens of the eye. The physicians-in-training and the staff physicians are the two groups more likely to reach this limit. It is also demonstrated that a low correlation exists between the annual number of procedures and the annual head dose equivalent of a physician, but more variation is likely to originate from his/her working attitude and techniques. The mean dose equivalent at the collar level of the physicians is estimated to be 0.04 +/- 0.02 mSv per procedure.

Rehani MM, et al. ICRP Publication 117. Radiological Protection In Fluoroscopically Guided Procedures Performed Outside The Imaging Department. Ann ICRP. 2010 Dec;40(6):1-102.

A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepatobiliary system, and anaesthetics and pain management.

Zhong X, Gao W, Huang D, et al. Utilization Of An Optimized Radiation Strategy In Primary Percutaneous Coronary Intervention For Patients With ST-Segment-Elevation Myocardial Infarction. Cardiol Res Pract. 2019 Sep 2;2019:6094806.

A total of 214 STEMI patients undergoing P-PCI were retrospectively analyzed.Results. Patient groups were well matched for baseline characteristics. There were no differences in terms of age, body mass index, radial artery access, nonculprit vessel PCI, and fluoroscopy time between 2 groups. With optimized radiation strategy, a 40.9% radiation dose reduction (901.2 ± 628.7 mGy versus 1524.0 ± 866.6 mGy,) was obtained for total air kerma.

Werner GS, Glaser P, Coenen A, et al. Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates. Catheter Cardiovasc Interv. 2017 May;89(6):1005-1012.

The increasing complexity of percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) leads to a significant increase of radiation exposure for both patient and operator. To study the potential of modified settings of the X-ray equipment combined with operator protocols to reduce radiation dose despite increasing procedural complexity.

Weisz W, Metzger DC, Caputo RP, et al. Safety And Feasibility Of Robotic Percutaneous Coronary Intervention: PRECISE (Percutaenous Robotically-Enhanced Coronary Intervention) Study. J Am Coll Cardiol. 2013 Apr 16:61(15):1596-1600.

The aim of this study was to evaluate the safety as well as the clinical and technical effectiveness of robotic-assisted percutaneous coronary intervention. A total of 164 patients were enrolled at 9 sites. Percutaneous coronary intervention was completed successfully without conversion to manual operation, and device technical success was achieved in 162 of 164 patients (98.8%). There were no device-related complications. Clinical procedural success was achieved in 160 of 164 patients (97.6%), whereas 4 (2.4%) had periprocedural non–Q-wave myocardial infarctions. No deaths, strokes, Q-wave myocardial infarctions, or revascularization occurred in the 30 days after the procedures. Radiation exposure for the primary operator was 95.2% lower than the levels found at the traditional table position.

Wassef AWA, Hiebert B, Rvandi A, et al. Radiation Dose Reduction In The Cardiac Catheterization Laboratory Utilizing A Novel Protocol. JACC Cardiovasc Intervv. 2014 May; 7(5):550-557.

This study reports the results a novel radiation reduction protocol (RRP) system for coronary angiography and interventional procedures and the determinants of radiation dose. A total of 605 patients underwent coronary angiography (309 before RRP and 296 after RRP), with 129 (42%) and 122 (41%) undergoing percutaneous coronary interventions before and after RRP, respectively. With RRP, a 48% dose reduction (1.07 ± 0.05 Gy vs. 0.56 ± 0.03 Gy, p < 0.0001) was obtained, 35% with 15 FPS RRP (0.70 ± 0.05 Gy, p < 0.0001) and 62% with 7.5 FPS RRP (0.41 ± 0.03 Gy, p < 0.001). Similar dose reductions for diagnostic angiograms and percutaneous coronary interventions were noted.

Walters D, Omran J, Patel M, et al. Robotic-Assisted Percutaneous Coronary Intervention: Concept, Data, and Clinical Application. Interv Cardiol Clin. 2019 Apr;8(2):149-159.

The occupational hazards for interventional cardiologists include the risk of cataracts, malignancy, and orthopedic injury. Robotic technology is now available with the introduction of platforms for performing percutaneous coronary and peripheral interventions. The original remote navigation system has evolved into the current CorPath robotic system, now approved for robotic-assisted cardiovascular interventions. The system removes the operator from the tableside and has been validated for safety, feasibility, and efficacy in coronary and peripheral vascular disease.