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.

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.

Wilson DJ, Scully WF, Rawlings JM. Evolving Role Of Ultrasound In Therapeutic Injections Of The Upper Extremity. Orthopedics. 2015 Nov;38(11): e1017-24.

Ultrasound provides the benefit of real-time, dynamic imaging without the radiation exposure of fluoroscopy, and ultrasound-guided injections can be performed in the office, as opposed to the operating room, which is frequently required when using fluoroscopy. Many locations for diagnostic and/or therapeutic injections in the upper extremities have improved accuracy and benefit with the use of ultrasound vs blind techniques, although a few have not been shown to have a significant difference in the literature. The educational and professional implications can be significant, but these potential benefits need to be carefully weighed against costs by each orthopedic practice.

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.

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.

Stewart FA, Akleyev AV, Hauer-Jensen M, et al. ICRP PUBLICATION 118: ICRP Statement on Tissue Reactions and Early and Late Effects of Radiation in Normal Tissues and Organs — Threshold Doses for Tissue Reactions in a Radiation Protection Context. Ann ICRP. 2012 Feb;41(1-2):1–322.

This report provides a review of early and late effects in normal tissue and organs with respect to radiation protection. The organ systems comprise the haematopoietic, immune, reproductive, circulatory, respiratory, musculoskeletal, endocrine, and nervous systems; the digestive and urinary tracts; the skin;and the eye.

Smilowitz NR, Balter S, Weisz G. Occupational hazards of interventional cardiology. Cardiovasc Revasc Med. 2013 Jul-Aug;14(4):223-8.

Complex catheter-based interventions and rising case volumes confer occupational risks to interventional cardiologists. Despite advances in technology, modern interventional procedures are performed in a manner remarkably similar to the techniques pioneered decades ago. Percutaneous interventions are associated with operator orthopedic injuries, exposures to blood borne pathogens, and the effects of chronic radiation exposure from fluoroscopy. This review highlights the occupational hazards of interventional procedures and provides a glimpse at the technologies and techniques that may reduce risks to operators in the catheterization laboratory.

Simon SL, Linet MS. Radiation-Exposed Populations: Who, Why, and How to Study. Health Phys. 2014 Feb;106(2):182-195.

This paper describes a wide range of populations exposed to radiation and the motivation and key methodological criteria that drive the rationale and priority of studying such populations. Also, discussed are alternative methods for evaluating radiation-related health risks in these populations, with a major focus on epidemiologic approaches. This paper concludes with a short summary of major highlights from radiation epidemiologic research and important unanswered questions.Introduction of Exposed Populations (Video 1:29, http://links.lww.com/HP/A22)

Shah B, Mai X, Tummala L, et al. Effectiveness Of Fluorography Versus Cineangiography At Reducing Radiation Exposure During Diagnostic Coronary Angiography. Am J Cardiol. 2014 Apr 1:1093-1098.

Coronary angiography is the gold standard for defining obstructive coronary disease. However, radiation exposure remains an unwanted hazard. Patient radiation exposure (158.2 mGy [76.5 to 210.2] vs 272.5 mGy [163.3 to 314.0], p=0.001), kerma-area product (1,323 μGy·m2 [826 to 1,765] vs 3,451 μGy·m2 [2,464 to 4,818], p<0.001), and Ka,r (175 mGy [112 to 252] vs 558 mGy [313 to 621], p<0.001) were significantly lower in the fluorography compared with cineangiography group (42%, 62%, and 69% relative reduction, respectively). Operator radiation exposure trended in the same direction, although statistically nonsignificant (fluorography 2.35 μGy [1.24 to 6.30] vs cineangiography 5.03 μGy [2.48 to 7.80], p=0.059).

Reeves RR, Ang L, Bahadorani J, et al. Invasive Cardiologists Are Exposed To Greater Left Sided Cranial Radiation. JACC Cardiovasc Interv. 2015 Aug 17;8(9):1197-1206.

This study sought to determine radiation exposure across the cranium of cardiologists and the protective ability of a nonlead, XPF (barium sulfate/bismuth oxide) layered cap (BLOXR, SaltLake City, Utah) during fluoroscopically guided, invasive cardiovascular (CV) procedures. There was significantly greater total radiation exposure at the outside left and outside center (106.133.6 mrad and 83.118.9 mrad) versus outside right (50.2  16.2 mrad; p < 0.001 for both) locations of the cranium. After subtracting ambient radiation, exposure at the outside left was 16 times higher than the inside left (p < 0.001) and 4.7 times higher than the outside right (p < 0.001). Exposure at the outside center location was 11 times higher than the inside center (p < 0.001), whereas no difference was observed on the right side.