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.

Kuon E, Felix SB, Weitmann K, et al. Long-Term Strategies Support Autonomy In Radiation Safety In Invasive Cardiology. J Cardiol. 2016 Jul;68(1):43-48.

We analyzed long-term radiation-reducing strategies for an experienced interventionalist from 1997 to 2012, for the target intervention of CA. Patients’ median overall DAP decreased from 33.8 Gy cm2 at baseline to 2.4 and 0.6 Gy cm2 for CA in conventional (C) and electrocardiogram-gated (E) modes – one diastolic radiographic frame per heartbeat at 77% of the RR interval.

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.

Zedira A, Greffier J, Brunet X, et al. Decreased Operator X-Ray Exposure By Optimized Fluoroscopy During Radiofrequency Ablation Of Common Atrial Flutter. Diagn Interv Imaging. 2018 Oct;99(10):625-632.

To evaluate operator and patient irradiation during radiofrequency ablation (RFA) of common atrial flutter (AF) using three different fluoroscopy settings. No differences in procedure time and radiation exposure were found between the three groups. In the low dose group, mean operator X-ray exposures of eye-lens (4.7 ± 2.9 [SD] μSv/h; range: 0.9–10.5 μSv/h), whole body (1.6 ± 1.2 [SD] μSv/h; range 0.5–3.6 μSv/h) and hand skin (11.1 ± 10.8 [SD] μSv/h; range 2.4–35.4 μSv/h) were significantly lower than those in the standard dose group (P < 0.001).

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.

Wang Y, Chen GZ, Yao Y, et al. Ablation of idiopathic ventricular arrhythmia using zero-fluoroscopy approach with equivalent efficacy and less fatigue: A multicenter comparative study. Medicine (Baltimore). 2017 Feb;96(6): e6080.

The aim of this study was to compare the safety and efficacy of a completely ZF approach with those of the conventional F approach in the ablation of idiopathic VAs .Eligible participants were assigned to either a ZF (n = 163) or F (n = 326) approach at a ratio of 1:2. The completely ZF approach was successful in 163 (100%) patients for electrophysiological study, and in 151 patients (94.4%) for arrhythmia ablation with 9 cases having to switch to the F approach due to the need for coronary angiography. The medical staffs using the ZF approach did not wear heavy protective apparels, thus experienced significantly less fatigue compared with those using the F approach (2.1 ± 0.7 vs 3.9 ± 1.6, P < 0.05).

Walters TE, Kistler PM, Morton JB, et al. Impact Of Collimation On Radiation Exposure During Interventional Electrophysiology. Europace. 2012 Nov;14(11): 1670-1673.

Fluoroscopy remains a cornerstone imaging technique in contemporary electrophysiology practice. We evaluated the impact of collimation to the ‘minimal required field size’ on clinically significant parameters of radiation exposure. Significant reductions in radiation exposure were seen with the practice of routine maximal collimation. The largest reductions were seen during ‘simple’ ablation procedures.

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.

Vlastra W, Delewi R, Sjaw K, et al. Efficacy Of The RADPAD Protection Drape In Reducing Operators’ Radiation Exposure In The Catheterization Laboratory. Circu Cardiovasc Interv. 2017 Nov;10(11):e006058.

The objective of the trial was to examine the RADPAD’s efficacy in a real-world situation. The primary outcome was the difference in relative exposure of the primary operator between the RADPAD and NOPAD arms and was defined as the ratio between operator’s exposure (E in µSv) and patient exposure (dose area product in mGy·cm2), measured per procedure. A total of 766 consecutive coronary procedures were randomized to the use of RADPAD (N=255), NOPAD (N=255), or SHAMPAD (N=256). The use of RADPAD was associated with a 20% reduction in relative operator exposure compared with that of NOPAD (P=0.01) and a 44% relative exposure reduction compared with the use of a SHAMPAD (P<0.001). Use of the SHAMPAD was associated with a 43% higher relative radiation exposure than procedures with NOPAD (P=0.009).