Ragosta M, Singh KP. Robotic-Assisted Percutaneous Coronary Intervention: Rationale, Implementation, Case Selection, and Limitations of Current Technology. J Clin Med. 2018 Feb;7(2):23.

Interventional cardiologists have witnessed an explosive growth in the field. A wide array of percutaneous procedures allow us to treat numerous cardiac conditions less invasively. However, the way we work has changed very little over the past decades. We continue to stand at the tableside for prolonged periods of time, exposing ourselves to the very real risks of radiation exposure as well as to the associated orthopedic injuries from radiation protection. The precision of our procedures is limited by the distance from the fluoroscopic images and, furthermore, patients are potentially at risk from operator fatigue caused by a physician standing at the table for prolonged periods while wearing cumbersome radiation protection gear. Robotic-assisted coronary intervention removes the operator from the radiation field and has been shown to markedly reduce operator exposure as well as allow for more precise positioning of balloons and stents. This technology holds great promise for making interventional procedures safer and more comfortable for the operators as well as reducing fatigue, potentially improving patient outcomes.

Maor E, Eleid MF, Gulati R, et al. Current and Future Use of Robotic Devices to Perform Percutaneous Coronary Interventions: A Review. J Am Heart Assoc. 2017 Jul 24;6(7):e006239.

This review article discusses potential benefits associated with robotic-assisted PCI, including reduced musculoskeletal injury for the operating physician and enhanced accuracy of lesion coverage. Clinical data for robotic-assisted PCI are examined, along with future directions, including remote telestenting.

Mangels DR, Giri J, Hirshreld J, Wilensky RL. Robotic-Assisted Percutaneous Coronary Intervention. Catheter Cardiovasc Interv. 2017 Nov 15;90(6):948-955.

Performance of percutaneous coronary intervention (PCI) is associated with several occupational hazards including radiation exposure and musculoskeletal injury. Current methods to mitigate these risks range from suspended radiation suits to adjustable lead-lined glass shields. Robotic-assisted PCI is a novel approach to PCI that utilizes remote-controlled technology to manipulate catheters thereby significantly reducing radiation exposure to the operator and catheterization laboratory staff. Although limited, current evidence indicates that robotic-assisted PCI is associated with a high technical success rate and may have additional advantages over conventional PCI, such as a decreased incidence of geographical miss.

Mahmud E, Pourdjabbar A, Ang L, et al. Robotic Technology in Interventional Cardiology: Current Status and Future Perspectives. Catheter Cardiovasc Interv. 2017 Nov 15;90(6):956-962.

Robotic technology has been utilized in cardiovascular medicine for over a decade, and over that period, its use has been expanded to percutaneous coronary and peripheral vascular interventions. The safety and feasibility of robotically assisted percutaneous cardiovascular interventions has been demonstrated in studies including simple to complex coronary lesions, and both iliac and femoropopliteal lesions. These reports have shown that robotically assisted PCI significantly reduces operator exposure to harmful ionizing radiation without a detrimental effect on procedural success or clinical efficacy.

Kuon E, Weitmann K, Hoffmann W, et al. Role Of Experience, Leadership And Individual Protection In The Cath Lab – A Multicenter Questionnaire And Workshop On Radiation Safety. Rofo. 2015 Oct;187(10):899-905.

Radiation exposure in invasive cardiology remains considerable. We evaluated the acceptance of radiation protective devices and the role of operator experience, team leadership, and technical equipment in radiation safety efforts in the clinical routine. Mini-course participants achieved significant median decreases in patient dose area products (DAP: from 26.6 to 13.0 Gy × cm2), number of radiographic frames (– 29 %) and runs (– 18 %), radiographic DAP/frame (– 32 %), fluoroscopic DAP/s (– 39 %), and fluoroscopy time (– 16 %).

Klein LW, Tra Y, Garratt K, et al. Occupational health hazards of interventional cardiologists in the current decade: Results of the 2014 SCAI membership survey. Catheter Cardiovasc Interv. 2015 Nov;86(5):913-24.

Interventional cardiologists and staff are subject to unique physical demands that predispose them to distinct occupational health hazards not seen in other medical disciplines. To characterize the prevalence of these occupational health problems, The Society for Cardiovascular Angiography and Interventions (SCAI) surveyed its members by email. Inquiries included age, years of invasive practice, and diagnostic and interventional cases per year. Questions focused on orthopedic (spine, hips, knees, and ankles) and radiation-associated problems (cataracts and cancers).

Klein LW, Miller DL, Balter S, et al. Occupational Health Hazards In The Interventional Laboratory: Time For A Safer Environment. Catheter Cardiovasc Interv. 2009 Jan 4;73(3):432-438.

This document is a consensus statement by the major American societies of physicians who work in the interventional laboratory environment. It reviews available data on the prevalence of occupational health risks and summarizes ongoing epidemiologic studies designed to further elucidate these risks. Its purpose is to affirm that the interventional laboratory poses workplace hazards that must be acknowledged, better understood, and mitigated to the greatest extent possible. Vigorous efforts are advocated to reduce these hazards. Interventional physicians and their professional societies, working together with industry, should strive toward minimizing operator radiation exposure, eliminating the need for personal protective apparel, and ending the orthopedic and ergonomic consequences of the interventional laboratory work environment.

Kizina K, Stolte B, Totzeck A, et al. Clinical Implication of Dosimetry of Computed Tomography- and Fluoroscopy-Guided Intrathecal Therapy With Nusinersen in Adult Patients With Spinal Muscular Atrophy. Front Neurol. 2019 Nov 5;10:1166.

As nusinersen is administered over a long term, it is important to give attention to the short- and long-term risks of procedure-related radiation exposure. Herein, we have reported the dosimetric data of CT- and fluoroscopy-guided lumbar punctures associated with the treatment of SMA with nusinersen.

Khoury H, Garzon W, Andrade G, et al. Radiation exposure to patients and medical staff in hepatic chemoembolisation interventional procedures in Recife, Brazil. Radiat Protect Dosimetry. 2015 Jul;165(1-4):263-267.

The purpose of this study was to evaluate patient and medical staff absorbed doses received from transarterial chemoembolisation of hepatocellularcarcinoma, which is the most common primary liver tumour worldwide. The results showed that the mean value of the total PKA was 267.49, 403.83 and 479.74 Gycm2 for Hospitals A, B and C, respectively. With regard to the physicians, the average effective dose per procedurewas 17 mSv, and the minimum and maximum values recorded were 1 and 41 mSy, respectively. The results showed that the feet received the highest doses followed by the hands and lens of the eye, since the physicians did not use leaded glasses and the equipment had no lead curtain.