Kar S, Taleb M, Albaghdadi A, et al. Efficacy of Low Dose Compared With Standard Dose Radiation for Cardiac Catheterization and Intervention. J Invasive Cardiol. 2019 Jun;31(6):187-194.

We evaluated the efficacy of low-dose (LD) radiation (≤7.5 frames/second [f/s]) compared with standard-dose (SD) radiation (≥10 f/s) in cardiac catheterization (CC) and percutaneous coronary intervention (PCI). Compared with SD radiation, LD radiation was associated with a significant reduction in air kerma, DAP , and contrast use (100 mL [IQR, 60-150 mL] vs 115 mL [IQR, 80-180 mL]; P<.03). No difference in fluoroscopy time was noted (13.33 min.

Kallinikou Z, Puricel SG, Ryckx N, et al. Radiation Exposure of the Operator During Coronary Interventions (from the RADIO Study). Am J Cardiol. 2016 Jul 15;188(2):188-194.

We sought to compare operator radiation exposure during procedures using right femoral access (RFA), right radial access (RRA), and left radial access (LRA) during coronary angiography (CA) and percutaneous coronary intervention (PCI). There were no significant differences in DAP among the 3 access sites. FT was similar for the 3 groups (RFA 7 ± 7, RRA 5 ± 5, LRA 6 ± 5 minutes, RFA vs RRA: p = 1, RFA vs LRA: p = 0.16, RRA vs LRA: p = 0.52).

Heo YC, Cho JH, Han DK. Dose-Decreasing Effect of the First Reversed Laser Beam Collimator for C-Arm Type Angiographic Equipment. J Korean Med Sci. 2017 Jul;32(7):1083-1090.

This is a study on the dose-decreasing effect of the first reversed laser beam collimator (RLBC) for C-arm type angiographic equipment. The results showed that the time needed for location fixing, the time needed for fluoroscopy, and DAP decreased, both in the first test and the second test. This study confirmed that the use of a RLBC for C-arm type angiographic equipment decreases both the time needed to perform the procedure and the radiation dose received.

Hasan F, Bonatti J. Robotically Assisted Percutaneous Coronary Intervention: Benefits to the Patient and to the Cardiologist. Expert Rev Cardiovasc Ther. 2015 Nov;13(11):1165-8.

Robotic percutaneous interventional systems represent the future of interventional cardiology. Robotic technology significantly reduces operator exposure to ionizing radiation, and improves ergonomics in the cardiac catheterization laboratory, thereby preventing orthopedic injuries. It may enable more accurate stent implantation and reduce the incidence of contrast-induced nephropathy. Robotics has the potential of converting the current ‘high-risk’ catheterization laboratory into a safe, physician- and patient-friendly environment.

Guo P, Qiu J, Wang Y, et al. Zero-Fluoroscopy Permanent Pacemaker Implantation Using Ensite NavX System: Clinical Viability or Fanciful Technique? Pacing Clin Electrophysiol. 2018 Feb;41(2):122–127.

Our aim is to evaluate the feasibility and safety of permanent pacemaker implantation without fluoroscopy. Total implantation procedure time for single‐chamber pacemaker was 51.3 ± 13.1 minutes in the zero‐fluoroscopy group and 42.6 ± 7.4 minutes in the fluoroscopy group (P = 0.155). The implantation procedural time for a dual‐chamber pacemaker was 88.3 ± 19.6 minutes and 67.3 ± 7.6 minutes in the zero‐fluoroscopy and fluoroscopy groups (P = 0.013), respectively. No complications were observed during the procedure and the follow‐up in the two groups, and all pacemakers worked with satisfactory parameters.

Dusad T, Kundani V, Dutta S, et al. Comparative Prospective Study Reporting Intraoperative Parameters, Pedicle Screw Perforation, and Radiation Exposure in Navigation-Guided versus Non-navigated Fluoroscopy-Assisted Minimal Invasive Transforaminal Lumbar Interbody Fusion. Asian Spine J. 2018 Apr;12(2):309-316.

To compare intraoperative parameters, radiation exposure, and pedicle screw perforation rate in navigation-guided versus non-navigated fluoroscopy-assisted minimal invasive transforaminal lumbar interbody fusion (MIS TLIF).

Dehmer GJ. Occupational Hazards For Interventional Cardiologists. Catheter Cardiovasc Interv. 2006;68(6):974-976.

The hazards of accumulated radiation exposure have been known for years, but the other potential risks have been ill‐defined and under‐appreciated. The physical stresses inherent in this career choice also appear to be associated with a predilection to orthopedic injuries, attributable in great part to the cumulative adverse effects of bearing the weight of leaded apparel.

Cousins C, et al. ICRP Publication 120: Radiological Protection In Cardiology. Ann ICRP. 2013 Feb;42(1): 1-125.

This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes the discussion of the biologicall effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention.

Best PJM, Skelding KA, Mehran R, et al. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. Catheter Cardiovasc Interv. 2011 Feb 1;77(2):232-241.

The Women in Innovations group of Cardiologists with endorsement of the Society for Cardiovascular Angiography and Interventions aim to provide guidance in this publication by describing the risk of radiation exposure to pregnant physicians and cardiac catheterization personnel, to educate on appropriate radiation monitoring and to encourage mechanisms to reduce radiation exposure. Current data do not suggest a significant increased risk to the fetus of pregnant women in the cardiac catheterization laboratory and thus do not justify precluding pregnant physicians from performing procedures in the cardiac catheterization laboratory. However, radiation exposure among pregnant physicians should be properly monitored and adequate radiation safety measures are still warranted.

Artschan RE, Brettle DS, Chase K, et al. An investigation of the radiation doses to the lower legs and feet of staff undertaking interventional procedures. Br J Radiol. 2014 Jun;87(1038):20130746.

This study further considers whether protection is adequate for the lower leg and foot and the extent to which these doses can be reduced. The use of protective curtains effectively reduced the exposure to most of the lower extremities. Toe doses were found to be high and increased with increase in couch height. In situ monitoring indicated annual toe doses of 110 mSv for two of the four radiologists monitored.