Villemain O, Malekzadeh-Milani S, Sitefane F, et al. Radiation exposure in transcatheter patent ductus arteriosus closure: time to tune? Cardiol Young. 2018 May;28(5):653-660.

The aims of this study were to describe radiation level at our institution during transcatheter patent ductus arteriosus occlusion and to evaluate the components contributing to radiation exposure. A total of 324 patients were included (median age=1.51 [Q1–Q3: 0.62–4.23] years; weight=10.3 [6.7–17.0]kg). In all, 322/324 (99.4%) procedures were successful. The median radiation doses were as follows: total air kerma: 26 (14.5–49.3)mGy; dose area product: 1.01 (0.56–2.24)Gy.cm2; dose area product/kg: 0.106 (0.061–0.185)Gy.cm2/kg; and fluoroscopic time: 2.8 (2–4)min. In multivariate analysis, a weight >10kg, a ductus arteriosus width <2mm, complications during the procedure, and a high frame rate (15 frames/ second) were risk factors for an increased exposure.

Vañó E, Miller DL, Dauer L. Implications In Medical Imaging Of The New ICRP Thresholds For Tissue Reactions. Ann ICRP. 2015 Jun;44(1 Suppl): 118-128.

More research is needed to understand the biological effects of cumulative incident air kerma and the instantaneous air kerma rates currently used in medical imaging. The new thresholds, and the need for specific occupational dosimetry related to lens doses, should be considered in radiation protection programmes, and should be included in the education and training of professionals involved in fluoroscopy guided procedures and computed tomography.

Tsapaki V, Papastergiou V, Giannakopoulos A, et al. Management of difficult bile duct stones and indeterminate bile duct structures: Reduced ERCP radiation exposure with adjunct use of digital single-operator cholangioscopy. Phys Med. 2019;64:69-73.

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is an well-established endoscopic procedure for the management of biliary diseases. The use of fluoroscopy during ERCP has often raised concerns regarding potential risks from radiation exposure, particularly in complex cases. We investigated whether a new digital single-operator cholangioscopy (D-SOC) system, used adjunctively to ERCP, actually reduces patient radiation exposure.

Tao AT, Miller D, Hindal M, Fetterly KA. Technical Note: Assessment Of Scatter Originating From The X‐Ray Tube Collimator Assembly Of Modern Angiography Systems. Med Phys. 2019 Oct;46(10):4371-4380.

The purpose of this work was to survey clinical x‐ray angiography systems to assess the potential contribution of collimator assembly scatter on occupational radiation dose. Considering all x‐ray systems and only the PA projection, collimator assembly scatter contributed 20–50% to total scatter. For x‐ray projection angles of −90º to 90º, the relative contribution of collimator assembly to total scatter was dependent on projection angle and ranged from 5% to 56%. X‐ray systems with kerma‐area product meters demonstrated higher collimator assembly scatter than those without. Considering all projection angles, the addition of 0.5 mm Pb to the inside of the collimator assembly cover reduced collimator assembly scatter from 28% to 16% of total scatter for both systems.

Subramanian S, Waller BR, Winders N, et al. Clinical evaluation of a radio-protective cream for the hands of the pediatric interventional cardiologist. Catheter Cardiovasc Interv. 2017 Mar 1;89(4):709-716.

The aim of this study was to evaluate the effectiveness of UltraBLOX™ radiation attenuating hand cream during lengthy cardiac catheterization procedures in children. The hands of interventional cardiologists receive high doses of radiation due to their proximity to the X-ray beam. Radiation attenuating gloves have about a 26% attenuation rate, but reduce dexterity and tactile sensation. The UltraBLOX™ cream is a new FDA-approved X-ray attenuating cream that can be applied to the operator’s hands for radio-protection.

Spink C, Avanesov M, Schmidt T, et al. Radiation dose reduction during transjugular intrahepatic portosystemic shunt implantation using a new imaging technology. Eur J Radiol. 2017 Jan;86:284-288.

To compare patient radiation dose in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation before and after an imaging-processing technology upgrade. n our retrospective single-center-study, cumulative air kerma (AK), cumulative dose area product (DAP), total fluoroscopy time and contrast agent were collected from an age- and BMI-matched collective of 108 patients undergoing TIPS implantation. 54 procedures were performed before and 54 after the technology upgrade.

Spink C, Avanesov M, Schmidt T, et al. Noise reduction angiographic imaging technology reduces radiation dose during bronchial artery embolization. Eur J Radiol. 2017 Dec;97:115-118.

Comparison of radiation doses in patients undergoing angiographic bronchial artery embolization (BAE) before and after a noise reduction imaging technology upgrade. We performed a retrospective study of 70 patients undergoing BAE. Procedures were performed before (n=32) and after (n=38) the technology upgrade containing additional filters and improved image-processing. Cumulative air kerma (AK), cumulative dose area product (DAP), number of exposure frames, total fluoroscopy time and amount of contrast agent were recorded.

Sommer CM, Voigt W, Oliger MK, et al. Radiation Exposure During Uterine Fibroid Embolization (UFE): A Confounder-Controlled Comparison Between A State-Of-The-Art Angiography Unit And A Conventional Angiography Unit. Rofo. 2018 Mar;190(3):250-258.

To compare radiation exposure of a state-of-the-art and a conventional angiography unit in patients undergoing uterine fibroid embolization (UFE). The dose-area product was significantly lower in Group 1 than in Group 2 (1159.0 cGycm2 vs. 3123.5 cGycm2; p < 0.001), while major complication rates (both groups 0 %) and dominant fibroid devascularization (both groups 100 %) were equal (p > 0.99).

Seo D, Kim KH, Kim JS, et al. Evaluation of radiation doses in patient and medical staff during endoscopic retrograde cholangiopancreatography procedures. Radiat Prot Dosimetry. 2016 Mar;168(4):516-22.

The radiation exposure dose must be optimised because the hazard resulting from an interventional radiology procedure is long term depending on the patient. The aim of this study was to measure the radiation doses received by the patients and medical staff during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Data were collected during 126 ERCP procedures, including the dose-area product (DAP), entrance dose (ED), effective dose (E), fluoroscopy time (T) and number of digital radiographs (F). The medical staff members each wore a personal thermoluminescence dosemeter to monitor exposure during ERCP procedures.