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Journal Citations

1]

Aarsnes A, Dahle G, Fosse E, et al. EVALUATION OF OCCUPATIONAL RADIATION DOSE IN TRANSCATHETER AORTIC VALVE IMPLANTATION. Radiat Prot Dosimetry. 2018 Apr 1;179(1):9-17.

CATEGORIES:

Abstract

In transcatheter aortic valve implantation, the operators’ positions and use of radiation shielding are particularly related to the entry choice on the patient’s heart. This study evaluates how occupational doses depend on operator positioning during transfemoral and transaortal access. Occupational dosimetric readings were collected with electronic dosemeters on two cardiothoracic surgeons and one cardiologist during 31 procedures. The findings were significantly higher body doses and eye lens doses to the surgeons during transaortal access compared to transfemoral access.

2]

Abdelaal E, Plourde G, MacHaalany J, et al. Effectiveness of Low Rate Fluoroscopy at Reducing Operator and Patient Radiation Dose During Transradial Coronary Angiography and Interventions. JACC Cardiovasc Interv. 2014 May;7(5):567-74.

Abstract

In this study, we aimed to evaluate the efficacy of low rate fluoroscopy at 7.5 frames/s (FPS) compared with conventional 15 FPS, in reducing operator and patient radiation dose during TRA diagnostic coronary angiography (DCA) and percutaneous coronary interventions (PCI).

3]

Abuzid W, Abunassar J, Leis JA, et al. Radiation Safety In The Cardiac Catheterization Lab: A Time Series Quality Improvement Initiative. Cardiovasc Revasc Med. Jul-Aug 2017;18(5S1):S22-S26.

CATEGORIES:

Abstract

This study sought to reduce the frequency of radiation exposure, for PCI procedures, above 1.5Gy in labs utilizing a Phillips system at our local institution by 40%, over a 12-month period. There was a significant reduction (91%, p<0.05) in the frequency of radiation exposure above 1.5Gy after utilizing a novel software (AlluraClarity©) in a new Phillips lab. Process measures of use of collimation (95.0% to 98.0%), use of magnification (20.0% to 14.0%) and completion of online modules (62%) helped track implementation.

4]

Agarwal S, Parashar A, Bajaja NS, et al. Relationship of Beam Angulation and Radiation Exposure in the Cardiac Catheterization Laboratory. J Am Coll Cardiol Intv. 2014 May;7(5):558-566.

CATEGORIES:

Abstract

The aim of this study was to analyze the relationship between beam angulation and air kerma in a modern cardiac catheterization laboratory. Median air kerma during DCs and PCIs was 677 and 2,188 mGy, respectively. Fluoroscopy contributed to 66.3% of total dose during PCIs compared with 39.7% during DCs (p < 0.001). Fluoroscopy was more sensitive to changes in angulation with a rapid increase in total air kerma on small increases in beam angulation. Complex spatial maps were created to study the impact of angulation and other covariates on total air kerma. Besides beam angulation, body surface area was the strongest predictor of the total air kerma.

5]

Agarwal S, Parashar A, Ellis SG, et al. Measures to reduce radiation in a modern cardiac catheterization laboratory. Circ Cardiovasc Interv. 2014 Aug;7(4):447-55.

CATEGORIES:

Abstract

X-ray use in the catheterization laboratory is guided by the principle of as low as reasonably achievable. In accordance with this principle, we reduced the default fluoroscopic frame rate from 10 to 7.5 frames/s and increased the emphasis on the use of low-dose acquisition starting January 1, 2013. We aimed to study the impact of these measures on the total air kerma during diagnostic catheterization (DC) and percutaneous interventions (PCI).

6]

Ahmad W, Hasselmann HC, Galas N, et al. Image fusion using the two-dimensional-three-dimensional registration method helps reduce contrast medium volume, fluoroscopy time, and procedure time in hybrid thoracic endovascular aortic repairs. J Vasc Surg. 2019 Apr;69(4):1003-1010.

CATEGORIES:

Abstract

The objective of this study was to evaluate the effect of image fusion (IF) technology in thoracic endovascular aortic repair (TEVAR) on reducing radiation exposure (dose and time), amount of injected iodinated contrast medium needed, and procedure time.

7]

Ahmad W, Obeidi Y, Majd P, Brunkwall JS. The 2D-3D Registration Method in Image Fusion Is Accurate and Helps to Reduce the Used Contrast Medium, Radiation, and Procedural Time in Standard EVAR Procedures. Ann Vasc Surg. 2018 Aug;51:177-186.

CATEGORIES:

Abstract

This study aimed to evaluate the accuracy and the effectiveness of 2D-3D registration method of image fusion (IF) technology in endovascular aneurysm repair (EVAR).

8]

Aizer A, Qiu J, Cheng A, et al. Utilization of a Radiation Safety Time-Out Reduces Radiation Exposure During Electrophysiology Procedures. JACC: Clinical Electrophysiology. 2019;5(5):626-634.

Abstract

This study sought to determine whether a radiation safety time-out reduces radiation exposure in electrophysiology procedures. Results of 1,040 patient cases were included. The median dose area product prior to time-out was 18.7 Gy∙cm2, and the median during the time-out was 14.7 Gy∙cm2, representing a 21% reduction (p = 0.007). The median reference point dose prior to time-out was 163 mGy, and during the time-out was 122 mGy (p = 0.011). The use of sterile disposable protective shields and ultrasound imaging for access increased significantly during the time-out.

9]

Akbulak RÖ, Schäffer B, Jularic M, et al. Reduction of Radiation Exposure in Atrial Fibrillation Ablation Using a New Image Integration Module: A Prospective Randomized Trial in Patients Undergoing Pulmonary Vein Isolation. J Cardiovasc Electrophysiol. 2015 Jul;26(7):747-53.

CATEGORIES:

Abstract

Recently, a new image integration module (IIM, CartoUnivu Module) has been introduced to combine and merge fluoroscopy images with 3-dimensional-(3D)-electroanatomical maps (Carto® 3 System) into an accurate 3D view. The aim of the study was to investigate the influence of IIM on the fluoroscopy exposure during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial.

10]

Akkus NI, Mina GS, Abdulbaki A, et al. Using 7.5 frames per second reduces radiation exposure in lower extremity peripheral vascular interventions. Vascular. 2015 Jun;23(3):240-4.

CATEGORIES:

Abstract

Peripheral vascular interventions can be associated with significant radiation exposure to the patient and the operator.

11]

Al Kharji S, Connell T, Bernier M, Eisenberg MJ. Ionizing Radiation in Interventional Cardiology and Electrophysiology. Can J Cardiol. 2019 Apr;35(4):535-538.

CATEGORIES:

Abstract

Fluoroscopy-guided procedures constitute a major part in the practice of cardiology. These procedures are also a source of human-made ionizing radiation. Although the benefits of performing the procedure surpass the radiogenic risks in most cases, the risks are not negligible. Exposure to ionizing radiation may lead to tissue injuries and potential increase in risk of cancer. Both patients and operating physicians are exposed to these risks in variable degrees.

12]

Aldoss O, Patel S, Harris K, Divekar A. The lateral plane delivers higher dose than the frontal plane in biplane cardiac catheterization systems. Pediatr Cardiol. 2015 Jun;36(5):912-7.

CATEGORIES:

Abstract

The objective of the study is to compare radiation dose between the frontal and lateral planes in a biplane cardiac catheterization laboratory. Tube angulation progressively increases patient and operator radiation dose in single-plane cardiac catheterization laboratories. This retrospective study captured biplane radiation dose in a pediatric cardiac catheterization laboratory between April 2010 and January 2014.

13]

Alejo L, Koren C, Corredoira E, et al. Eye lens dose correlations with personal dose equivalent and patient exposure in paediatric interventional cardiology performed with a fluoroscopic biplane system. Phys Med. 2017 Apr;36:81-90.

Abstract

To analyse the correlations between the eye lens dose estimates performed with dosimeters placed next to the eyes of paediatric interventional cardiologists working with a biplane system, the personal dose equivalent measured on the thorax and the patient dose.

14]

Allan JM. Genetic susceptibility to radiogenic cancer in humans. Health Phys. 2009;95:677-86.

CATEGORIES:

Abstract

The clinical benefits associated with the use of ionizing radiation for diagnostic and therapeutic purposes are well established, particularly in cancer medicine. Unfortunately, it is now clear that prior exposure to radiation is associated with an excess risk of developing malignancy in the exposure field. Indeed, the development of a second primary malignancy is a devastating side effect that can often be attributed to radiotherapy for a first cancer. Research has focused on elucidating the relationship between therapeutic radiation dose and site-specific cancer risk, and how this relationship is affected by host factors such as age, sex, and exposure to other potential carcinogens. By contrast, there is a relative paucity of data on host genetic susceptibility to cancer following cytotoxic and mutagenic radiation exposure.

15]

Amis E, Butler P, Applegate K, et al. American College of Radiology White Paper on Radiation Dose in Medicine. J Am Coll Radiol. 2007 May;4(5):272-84.

Abstract

This white paper details a proposed action plan for the college derived from the deliberations of that panel.

16]

Andrade G, Khoury HJ, Garzón WJ, Dubourcq F, et al. Radiation Exposure of Patients and Interventional Radiologists during Prostatic Artery Embolization: A Prospective Single-Operator Study. J Vasc Interv Radiol. 2017 Apr;28(4):517-521.

CATEGORIES:

Abstract

To prospectively analyze the radiation exposure of patients and interventional radiologists during prostatic artery embolization (PAE)

17]

Andreassi M, Piccaluga E, Guagliumi G, et al. Occupational Health Risks in Cardiac Catheterization Laboratory Workers. Circ Cardiovasc Interv. 2016 Apr;9(4):e003273.

Abstract

The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure.

18]

Andreassi MG, Piccaluga E, Gargani L, et al. Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff. JACC Cardiovasc Interv. 2015 Apr 20;8(4):616-27.

CATEGORIES:

Abstract

This study sought to assess the association between long-term radiation exposure in the catheterization laboratory (cath lab) and early signs of subclinical atherosclerosis. Left and right carotid intima-media thickness (CIMT) was measured in 223 cath lab personnel (141 male; age, 45 ± 8 years) and 222 unexposed subjects (113 male; age, 44±10 years). Leukocyte telomere length (LTL) was evaluated by quantitative reverse transcriptase polymerase chain reaction. The DNA repair gene XRCC3 Thr241Met polymorphism was also analyzed to explore the possible interaction with radiation exposure. The occupational radiological risk score (ORRS) was computed for each subject on the basis of the length of employment, individual caseload, and proximity to the radiation source. A complete lifetime effective dose (mSv) was recorded for 57 workers.

19]

Andreassi MG, Venneri L, Picano E. The biological effects of diagnostic cardiac imaging on chronically exposed physicians: The importance of being non-ionizing. Prog Biophys Mol Bio. Jan-Apr 2007;91(1-3):399-410.

Abstract

This paper reviewed the available information on occupational risk of the cardiologists who perform, every day, cardiac imaging procedures. At the moment, there are noconsistent evidence that exposure to medical ultrasound is capable of inducing genetic effects, and representing a serious health hazard for clinical staff. In contrast, exposure to ionizing radiation mayresult in adverse health effect on clinical cardiologists. Although the current risk estimates are clouded by approximations and extrapolations, most data from cytogenetic studies have reported a detrimental effect on somatic DNA of professionally exposed personnel to chronic low doses of ionizing radiation. Since interventional cardiologists and electro-physiologists have the highest radiation exposure among health professionals, a major awareness is crucial for improving occupational protection. Furthermore, the use of a biological dosimeter could be a reliable tool for the risk quantification on an individual basis.

20]

Anselmino M, Sillano D, Casolati D, et al. A new electrophysiology era: zero fluoroscopy. J Cardiovasc Med (Hagerstown). 2013 Mar;14(3):221-7.

Abstract

Catheter ablations are traditionally performed under fluoroscopic guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic and deterministic effects on health. These effects are cumulative and lifelong and raise great concerns especially in the younger population. A document of the American College of Cardiology recommends that all catheterization laboratories adopt the principles of ‘ALARA’ (radiation doses ‘As Low As Reasonably Achievable’), making radiation reduction an ethical issue. In electrophysiology, thanks to the recent development of electroanatomic navigation systems, we are witnessing the birth of a new era in which almost all arrhythmias may be treated without the use of fluoroscopy. In the present review, we start by describing risks to health due to radiation exposure for conventional transcatheter ablations and we continue by reporting the current state of art of the zero fluoroscopy approach.

21]

Antoniou GA, Senior Y, Iazzolino L, et al. Endovascular Aneurysm Sealing Is Associated With Reduced Radiation Exposure and Procedure Time Compared With Standard Endovascular Aneurysm Repair. J Endovasc Ther. 2016 Apr;23(2):285-9.

CATEGORIES:

Abstract

To compare indirect measures of radiation exposure and operating time between endovascular aneurysm sealing (EVAS) and endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA).

22]

Arif S, Bartus D, Rakowski T, et al. Comparison of radiation dose exposure in patients undergoing percutaneous coronary intervention vs. peripheral intervention. Postepy w kardiologii interwencyjnej. 2014;10(4):308-13.

Abstract

To compare the radiation dose in percutaneous coronary vs. peripheral interventions in one centre with a uniform system of protection methods. The total procedural time was significantly higher in PTA (PCI vs. PTA: 60 (45–85) min vs. 75 (50–100) min), p < 0.001. The radiation dose for PCI procedures was significantly higher in comparison to PTA (PCI vs. PTA: 1.36 (0.83–2.23) Gy vs. 0.27 (0.13–0.46) Gy), p < 0.001. There was no significant difference in the fluoroscopy time (PCI vs. PTA: 12.9 (8.2–21.5) min vs. 14.4 (8.0–22.6) min), p = 0.6.

23]

Arrivi A, Pucci G, Vaudo G, et al. Operators’ radiation exposure reduction during cardiac catheterization using a removable shield. Cardiovasc Interv Ther. 2020 Feb 7. doi: 10.1007/s12928-020-00646-6. [Epub ahead of print]

CATEGORIES:

Abstract

Cardiac catheterization through radial access is associated with significant ionizing radiation exposure for the operator. We aimed at evaluating whether a removable shield placed upon the patient could impact favorably on annual radiation exposure for the operator.

24]

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.

Abstract

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.

25]

Attanasio P, Mirdamadi M, Wielandts JY, et al. Safety and efficacy of applying a low-dose radiation fluoroscopy protocol in device implantations. Europace. 2017 Aug 1;19(8):1364-1368.

Abstract

We conducted a retrospective chart review of 584 patients undergoing CIED implantation or revision in our hospital. Of these patients, 280 (48%) underwent the implantation prior to and 304 (52%) after the DRP introduction. The DRP included various changes for optimized image processing and exposure system settings to enable dose reduction, as well as a reduced frame rates (4 FPS for fluoroscopy and 7.5 FPS for cinematographic images).

26]

Attanasio P, Schreiber I, Pieske B, et al. Pushing the limits: establishing an ultra-low framerate and antiscatter grid-less radiation protocol for left atrial ablations. Europace. 2018 Apr;20(4):604–607.

CATEGORIES:

Abstract

The purpose of this study was to assess the feasibility of using an ultra-low frame rate and antiscatter grid-less radiation protocol during complex left atrial ablations to minimize radiation exposure for the patient and staff.

27]

Attigah N, Oikonomou K, Hinz U, et al. Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms. J Vasc Surg. 2016 Jan;63(1):198-203.

Abstract

The purpose of this study was to evaluate the radiation exposure of vascular surgeons’ eye lens and fingers during complex endovascular procedures in modern hybrid operating rooms. Interventions were classified into six treatment categories: endovascular repair of infrarenal abdominal aneurysm (n = 65), thoracic endovascular aortic repair (n = 32), branched endovascular aortic repair for thoracoabdominal aneurysms (n = 17), fenestrated endovascular aortic repair for complex abdominal aortic aneurysm, (n = 25), iliac branched device (n = 8), and peripheral interventions (n = 24). There was a significant correlation in DAP between both lens (P < .01; r = 0.55) and finger (P < .01; r = 0.56) doses.

28]

Badawy M, Scott M, Farouque O, et al. Feasibility of using ultra-low pulse rate fluoroscopy during routine diagnostic coronary angiography. J Med Radiat Sci. 2018 Dec;65(4):252-258.

CATEGORIES:

Abstract

This study aims to assess the feasibility of using ultra‐low pulse rate (3 pulses per second(pps)) fluoroscopy during routine diagnostic coronary angiogram procedures and the effect it has on fluoroscopy time, diagnostic clarity and radiation dose. Results demonstrated no reduction of diagnostic clarity, up to a 58% reduction in Dose Area Product and no increase in fluoroscopy time with the 3 pps setting.

29]

Bai J, Wang F, Yang H, Lu Y, Wu L. Reducing radiation dose in paediatric interventional cardiac catheterisation. Cardiol Young. 2019;29:967-971.

CATEGORIES:

Abstract

Radiation exposure during paediatric cardiac catheterisation procedures should be minimised to “as low as reasonably achievable”. The aim of this study was to evaluate the effectiveness of a modified radiation safety protocol in reducing patient dose during paediatric interventional cardiac catheterisation.

30]

Ballesteros G, Ramos Ardanaz P, et al. Mediguide-Assisted Transseptal Puncture without Echocardiographic Guidance. Pacing Clin Electrophysiol. 2017 May;40(5):545-550.

CATEGORIES:

Abstract

First description of a technique for left atrium transseptal puncture (TSP) with minimal radiation exposure by using the nonfluoroscopic MediGuide tracking system (MG; St. Jude Medical, St. Paul, MN, USA) without the assistance of intracardiac echocardiography.

31]

Balter S, Brinkman M, Kalra S, et al. Novel radiation dose reduction fluoroscopic technology facilitates chronic total occlusion percutaneous coronary interventions. EuroIntervention. 2017 Dec 8;13(12):e1468-e1474.

CATEGORIES:

Abstract

This study aimed to assess the impact of radiation dose-limiting equipment on radiation dosage and fluoroscopic time in chronic total occlusion (CTO) percutaneous coronary interventions (PCI). Retrospective clinical and dosimetric data from diagnostic catheterisations (DXC) and CTO-PCI procedures performed on one of three variants of interventional fluoroscopic equipment were collected. Fluoroscopic time, air kerma, kerma area product and contrast utilisation were stratified by procedure type and compared among equipment types.

32]

Baptista M, Figueira C, Teles P, et al. Assessment of the occupational exposure in real time during interventional cardiology procedures. Radiat Prot Dosimetry. 2015 Jul;165(1-4):304-9.

CATEGORIES:

Abstract

Interventional cardiology (IC) procedures can be complex, requiring the operators to work near the patient, during long exposure times. Owing to scattered radiation in the patient and the fluoroscopic equipment, the medical staff are exposed to a non-uniform radiation field and can receive high radiation doses. In this study, it is proposed to analyse staff doses obtained in real time, during IC procedures. A system for occupational dosimetry in real time was used.

33]

Barakat MT, Thosani NC, Huang RJ, et al. Effects of a Brief Educational Program on Optimization of Fluoroscopy to Minimize Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography. Clin Gastroenterol Hepatol. 2018 Apr;16(4):550-557.

CATEGORIES:

Abstract

We aimed to evaluate whether a 20-minute educational intervention for endoscopists would improve use of fluoroscopy and decrease ERCP-associated exposure to radiation for patients. At baseline, total radiation dose and dose area product were significantly higher for LVEs, but there was no significant difference between HVEs and LVEs following education. Education was associated with significant reductions in median fluoroscopy time (48% reduction for HVEs vs 30% reduction for LVEs), total radiation dose (28% reduction for HVEs vs 52% for LVEs) and dose area product (35% reduction for HVEs vs 48% reduction for LVEs). All endoscopists significantly increased their use of low magnification and collimation following education.

34]

Barbero U, Budano C, Golzio PG, et al. Combining electromagnetic navigation and 3-D mapping to reduce fluoroscopy time and achieve optimal CRT response. Pacing Clin Electrophysiol. 2018 May;41(5):557-560.

CATEGORIES:

Abstract

Implantation of cardiac resynchronization therapy (CRT) devices can be challenging, time consuming, and associated with high-dose x-ray exposure. We present the technique in which an electromagnetic navigation system (MediGuideTM, St. Jude Medical) and an electroanatomical three-dimensional mapping system (EnSite NavX, St Jude Medical) are usefully combined for implanting implantable cardioverter defibrillator CRT devices with strong reduction of x-ray exposure, and for targeting the most delayed regions in the activation maps avoiding scars for optimal CRT response

35]

Barral PA, Demasi-Jacquier MA, Bal L, et al. Fusion Imaging to Guide Thoracic Endovascular Aortic Repair (TEVAR): A Randomized Comparison of Two Methods, 2D/3D Versus 3D/3D Image Fusion. Cardiovasc Intervent Radiol. 2019;42:1522-1529.

CATEGORIES:

Abstract

To compare the accuracy of two-dimensional (2D) versus three-dimensional (3D) image fusion for thoracic endovascular aortic repair (TEVAR) image guidance.

36]

Basheerudeen SAS, Kanagaraj K, Jose MT, et al. Entrance surface dose and induced DNA damage in blood lymphocytes of patients exposed to low-dose and low-dose-rate X-irradiation during diagnostic and therapeutic interventional radiology procedures. Mutat Res. 2017 Jun;818:1-6.

CATEGORIES:

Abstract

The ionizing radiation received by patients and health workers due to radiological imaging may increase the risks of radiation effects, such as cancer and cataracts. We have investigated the dose received by specific areas around the head and related this to DNA damage in the blood lymphocytes of subjects exposed to interventional imaging.

37]

Batlivala SP, Magill D, Felice MA, et al. THE EFFECT OF RADIATION SHIELDS ON OPERATOR EXPOSURE DURING CONGENITAL CARDIAC CATHETERISATION. Radiat Prot Dosimetry. 2016 Dec;171(4):520-526.

CATEGORIES:

Abstract

Cardiac catheterisation personnel are exposed to occupational radiation and its health risks. Little data exist regarding the efficacy of radiation-protective equipment from congenital catheterisation laboratories (CLs). The authors retrospectively reviewed data in which CL operators wore a radiation dosemeter during catheterizations on patients of >20 kg. A leaded under-table skirt was present in all cases. Three additional radiation-protective devices were utilised at operator discretion: a top extension to the under-table skirt, a ceiling-mounted shield and a disposable patient drape.

38]

Beathard GA, Urbanes A, Litchfield T. Radiation dose associated with dialysis vascular access interventional procedures in the interventional nephrology facility. Semin Dial. 2013 Jul-Aug;26(4):503-10.

CATEGORIES:

Abstract

The number of dialysis access procedures performed by interventional nephrologists using a mobile C-arm fluoroscopy machine in freestanding centers continues to rise. With this activity comes the risk of radiation exposure to patients being treated and staff. This study was conducted to assess the levels of radiation dosage involved with these procedures. Dosimetry information including kerma area product (KAP), reference point air kerma (RPAK) and fluoroscopy time (FT) was collected prospectively.

39]

Behnamfar O, Pourdjabbar A, Yalvac E, et al. First Case of Robotic Percutaneous Vascular Intervention for Below-the-Knee Peripheral Arterial Disease. J Invasive Cardiol. 2016 Nov;28(11):E128-E131.

CATEGORIES:

Abstract

Although the feasibility and safety of robotically assisted peripheral vascular intervention (PVI) for iliac and femoral peripheral arterial disease (PAD) have been demonstrated, robotic PVI for below-the-knee disease has never been reported. We present the first description of robotic PVI with the CorPath Vascular Robotic System (Corindus) for treating below-the-knee PAD. After contralateral sheath placement in the affected lower extremity, the entire procedure was performed robotically with remote control of the guidewire and angioplasty balloon. This feasibility report provides the opportunity to initiate further studies specifically focused on robotic PVI for below-the-knee PAD.

40]

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.

Abstract

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.

41]

Bezerra HG, Simon DI. Robotic Percutaneous Coronary Intervention: Time to Focus on the Patient. JACC Cardiovasc Interv. 2017 Jul 10;10(13):1328-1331.

CATEGORIES:

Abstract

Robotic-assisted technologies for cardiovascular application offer the promise of reduced radiation exposure to the operator and enhanced catheter precision. This review examines clinical data for robotic systems used in PCI.

42]

Blockhaus C, Schmidt J, Kurt M, et al. Reduction of Fluoroscopic Exposure Using a New Fluoroscopy Integrating Technology in a 3D-Mapping System During Pulmonary Vein Isolation With a Circular Multipolar Irrigated Catheter. Int Heart J. 2016 May 25;57(3):299-303.

Abstract

Here, we report our first experiences with a new fluoroscopy integrating technology in addition to a current 3D-mapping system. The new fluoroscopy integrating system (FIS) with 3D-mapping was used prospectively in 15 patients with AF. Control PVI cases (n = 37) were collected retrospectively as a complete series. Total procedure time (skin to skin), fluoroscopic time, and dose-area-product (DAP) data were analyzed.

43]

Blockhaus C, Schmidt J, Muhammed K, et al. Fluoroscopy integrating technology in a 3D mapping system during ablation of atrial arrhythmias: first experiences. Arch Med Sci. 2018 Jun;14(4):794-800.

Abstract

Here, we report on our first experiences with a new fluoroscopy integrating system (FIS) integrated into a current 3D mapping system (3DMS). All procedures were successfully completed without major complications. Employing FIS in the PVI group, FT and DAP were both significantly reduced after completing a short learning curve of 6 cases (respectively 361.6 ±181 s vs. 530.3 ±156.7 s, p = 0.039; 801.9 ±439.15 cGycm² vs. 1495 ±435.2 cGycm², p = 0.002). Mean PT was not significantly affected (121 ±26.7 min vs. 135.6 ±23.2 min, p = 0.21). The same holds true for CTI ablation: FT (99.29 ±51.4 s vs. 153.9 ±76.6 s, p = 0.022) and DAP (269 ±128.7 cGycm² vs. 524.3 ±288.4 cGycm², p = 0.002) were significantly reduced, leaving PT not significantly affected (29.5 ±10 min vs. 35.2 ±16.3 min, p = 0.23).

44]

Boddu SR, Abramson DH, Marr BP, et al. Selective ophthalmic artery chemosurgery (SOAC) for retinoblastoma: fluoroscopic time and radiation dose parameters. A baseline study. J Neurointerv Surg. 2017 Nov;9(11):1107-1112.

CATEGORIES:

Abstract

To evaluate fluoroscopic time and radiation dose parameters, and factors affecting these parameters, during selective ophthalmic artery chemosurgery (SOAC) for retinoblastoma.

45]

Boland J, Wang L, Love B, et al. Impact of New-Generation Hybrid Imaging Technology on Radiation Dose during Percutaneous Coronary Interventions and Trans-femoral Aortic Valve Implantations: A Comparison with Conventional Flat-Plate Angiography. Heart Lung Circ. 2016 Jul;25(7):668-675.

Abstract

This study compares differences in case time, fluoroscopy time, dose area product and ±air kerma for percutaneous coronary interventions (PCI) and two types of transcatheter aortic valve implantation (TAVI) between one of the new generation X-ray machines (Artis Zeego, Siemens, Munich) and a previous-generation flat-plate angiography model (Allura X-PER FD20, Philips, Amsterdam, The Netherlands) with flat-plate technology that is still in common use.

46]

Borik S, Devadas S, Mroczek D, et al. Achievable radiation reduction during pediatric cardiac catheterization: How low can we go? Catheter Cardiovasc Interv. 2015 Nov;86(5):841-8.

CATEGORIES:

Abstract

To assess the effectiveness of radiation-reduction measures implemented during pediatric catheterization, and provide data on the radiation doses for common interventional and diagnostic procedures, indexed to body weight.

47]

Borota L, Jangland L, Åslund P, et al. Spot fluoroscopy: a novel innovative approach to reduce radiation dose in neurointerventional procedures. Acta Radiol. 2017 May;58(5):600-608.

Abstract

To evaluate the effect of SF on the radiation dose. The use of SF led to a reduction of 50% of the total fluoroscopic dose-area product (CF = 106.21 Gycm2, SD = 99.06 Gycm2 versus SF = 51.80 Gycm2, SD = 21.03 Gycm2, p = 0.003884) and significant reduction of the total fluoroscopic dose-area product rate (CF = 1.42 Gycm2/min, SD = 0.57 Gycm2/s versus SF = 0.83 Gycm2/min, SD = 0.37 Gycm2/min, p = 0.00106). The use of SF did not lead to an increase in fluoroscopy time or an increase in total fluoroscopic cumulative air kerma, regardless of collimation.

48]

The aim of this study was to describe a new functionality aimed at X-ray dose reduction, referred to as spot region of interest (Spot ROI) and to compare it with existing dose-saving functionalities, spot fluoroscopy (Spot F), and conventional collimation (CC). The results for all FOVs were the following: for the fluoroscopy, all measured parameters … Continue reading Borota L, Patz A. SPOT REGION OF INTEREST IMAGING: A NOVEL FUNCTIONALITY AIMED AT X-RAY DOSE REDUCTION IN NEUROINTERVENTIONAL PROCEDURES. Radiat Prot Dosimetry. 2020 Jun 24;188(3):322-331.

Abstract

The aim of this study was to describe a new functionality aimed at X-ray dose reduction, referred to as spot region of interest (Spot ROI) and to compare it with existing dose-saving functionalities, spot fluoroscopy (Spot F), and conventional collimation (CC). The results for all FOVs were the following: for the fluoroscopy, all measured parameters for Spot ROI and Spot F were lower than corresponding values for CC. For DSA and DSA plus fluoroscopy, all measured parameters for Spot ROI were lower than corresponding parameters for Spot F and CC.

49]

Boudjemline Y. Effects of reducing frame rate from 7.5 to 4 frames per second on radiation exposure in transcatheter atrial septal defect closure. Cardiol Young. 2018 Nov;28(11):1323-1328.

CATEGORIES:

Abstract

The aim of this study was to evaluate the reduction of frame rate from 7.5 to 4 frames per second on radiation exposure and to provide new standards of radiation exposure. Frame rate is a large contributor to radiation exposure. The use of 4 frames per second for closure of atrial septal defects has been reported not to affect the level of radiation exposure.

50]

Bracken JA, Mauti M, Kim MS, et al. A Radiation Dose Reduction Technology to Improve Patient Safety During Cardiac Catheterization Interventions. J Interv Cardiol. 2015 Oct;28(5):493-497.

CATEGORIES:

Abstract

A novel radiation dose reduction technology was evaluated in a cardiac catheterization laboratory during routine clinical care to determine if it could reduce radiation dose to patients undergoing coronary angiography and percutaneous coronary intervention. These results were compared to patients undergoing similar procedures in a cardiac catheterization laboratory without this technology.

51]

Brambilla M, Occhetta E, Ronconi M, et al. Reducing operator radiation exposure during cardiac resynchronization therapy. Europace. 2010 Dec;12(12):1769–1773.

Abstract

To quantify the reduction in equivalent dose at operator’s hand that can be achieved by placement of a radiation-absorbing drape (RADPAD) during long-lasting cardiac resynchronization therapy (CRT) procedures. This is a prospective observational study that included 22 consecutive patients with drug-refractory heart failure who underwent implantation of a CRT device. The cases were randomly assigned to Group A (11 cases), performed without RADPAD, and to Group B (11 cases), performed using RADPAD. Dose equivalent at the examiner’s hand was measured as Hp(0.07) and as a time-adjusted Hp(0.07) rate (mGy/min) with a direct reading dosimeter. The mean fluoroscopy time was 20.8 ± 7.7 min and the mean dose area product (DAP) was 118.6 ± 45.3 Gy cm2. No significant differences were found between body mass index, fluoroscopy time, and DAP between patients examined with or without RADPAD.

52]

Bru P, Dompnier A, Amara W, et al. Radiation exposure during cardiac device implantation: Lessons learned from a multicenter registry. Pacing Clin Electrophysiol. 2020 Jan;43(1):87– 92.

Abstract

This multicenter, prospective, observational study assesses patient and staff radiation exposure during cardiac device implantations, and aims at defining dose reference levels.

53]

Burdorf A, Figà-Talamanca I, Jensen T, et al. Effects of occupational exposure on the reproductive system: core evidence and practical implications. Occup Med (London). 2006 Dec;56(8):516-520.

Abstract

The main aims of this accompanying article are to present a summary of the core findings in the three reviews, to discuss important constraints in the interpretation of these results and then derive practical implications for research and practice in occupational health. The evidence on occupational risk factors for adverse effects on the reproductive system is consistent for a limited number of risk factors, most notably exposure to lead, glycol ethers, organic solvents, pesticides and ionizing radiation. It remains difficult to arrive at sound conclusions on the level of exposure and the specific chemicals within the groups of glycol ethers, organic solvents and pesticides that are associated with an increased risk.

54]

Cano Ó, Alonso P, Osca J, et al. Initial Experience with a New Image Integration Module Designed for Reducing Radiation Exposure During Electrophysiological Ablation Procedures. J Cardiovasc Electrophysiol. 2015 Jun;26(6):662-70.

CATEGORIES:

Abstract

Reduction of radiation exposure during cardiac arrhythmia ablation procedures is desirable. We sought to evaluate the utility of a new image integration module (CARTOUNIVU(TM) ) in reducing fluoroscopy times and dosages during left atrial arrhythmia (LAA) and ventricular tachycardia (VT) ablation procedures.

55]

Cao MQ, Zhang XB, Zhuang ZG, et al. Randomized Comparison Of Long And Short Vascular Sheaths In Reduction Of The Operator Radiation Exposure During Uterine Artery Embolization. Br J Radiol. 2016 Jun;89(1062):20140448.

Abstract

To introduce a method in which a long sheath is used instead of the traditional short sheath, to reduce the radiation exposure of operators in uterine artery embolization (UAE).

56]

Carl B, Bopp M, Pojskic M, et al. Standard navigation versus intraoperative computed tomography navigation in upper cervical spine trauma. Int J Comput Assist Radiol Surg. 2019 Jan;14(1):169-182.

CATEGORIES:

Abstract

In surgery of C1-C2 fractures, standard navigation for screw placement based on preoperative image data was compared with intraoperative imaging guidance applying intraoperative computed tomography (iCT) with a special focus on accuracy of screw placement, workflow, and radiation exposure.

57]

Casella M, Dello Russo A, Pelargonio G, et al. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial. Europace. 2016 Oct;18(10):1565–1572.

Abstract

Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients’ lifetime attributable risks associated with such exposure.

58]

Casella M, Dello Russo A, Russo E, et al. X‐Ray Exposure In Cardiac Electrophysiology: A Retrospective Analysis In 8150 Patients Over 7 Years Of Activity In A Modern, Large‐Volume Laboratory. J Am Heart Assoc. 2018 May 22;7(11):e008233.

CATEGORIES:

Abstract

Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x‐ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects.

59]

Casella M, Russo A, Pelargonio G, et al. Rationale and design of the NO-PARTY trial: Near-zero fluoroscopic exposure during catheter ablation of supraventricular arrhythmias in young patients. Cardiol Young. 2012 Oct;22(5):539-46.

Abstract

The primary objective of the study is to evaluate the reduction in patient exposure to ionising radiation, as assessed by dose–area product,obtained by the use of a non-fluoroscopic EnSiteNavXTMmapping system approach to guide radio-frequency catheter ablation of supraventricular tachyarrhythmias.

60]

Cevallos PC, Armstrong AK, Glatz AC, et al. Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi-center C3PO-QI study. Catheter Cardiovasc Interv. 2017 Aug 1;90(2):269-280.

CATEGORIES:

Abstract

This study sought to update benchmark values to use a quality measure prospectively. Congenital Cardiac Catheterization Outcomes Project – Quality Improvement (C3PO-QI), a multi-center registry, defined initial radiation dose benchmarks retrospectively across common interventional procedures. These data facilitated a dose metric endorsed by the American College of Cardiology in 2014.

61]

Chait J, Davis N, Ostrozhynskyy Y, et al. Radiation exposure during non-thrombotic iliac vein stenting. Vascular. 2019 Dec;27(6):617-622.

CATEGORIES:

Abstract

62]

Chambers CE. Mandatory Radiation Safety Training For Fluoroscopy Imaging: A Quality Improvement Priority or Unncessary Oversight? JACC Cardiovasc Interv. 2014 Apr;7(4):391-393.

CATEGORIES:

Abstract

Without question, radiation safety is an important issue for patient, staff, and physician safety, but what priority is it for the busy interventionalist?

63]

Chang CY, Simeone FJ, DeLorenzo MC, et al. Dose reduction for fluoroscopically guided injections: phantom simulation and patient procedures. Skeletal Radiol. 2018 Feb;47(2):223-231.

CATEGORIES:

Abstract

To demonstrate fluoroscopy dose reduction through both simulated injections on a phantom and patient injections. Simulation on a phantom was used to estimate effective dose, entrance dose, and organ doses for hip joint injections without and with dose minimization technique (DMT). Additionally, 1,094 joint, bursae, and tendon sheath injections performed by three operators in the same fluoroscopy suite were evaluated both before and after application of DMT. Fluoroscopy time (FT), dose, and dose area product (DAP) of injections were compared using unpaired t-tests with P > 0.05 considered statistically significant.

64]

Chen G, Wang Y, Proietti R, et al. Zero-fluoroscopy approach for ablation of supraventricular tachycardia using the Ensite NavX system: a multicenter experience. BMC Cardiovasc Disord. 2020 Feb 3:20(1);48.

Abstract

We aimed to investigate the safety, feasibility and efficacy of a completely zero-fluoroscopy approach for catheter ablation of supraventricular tachycardia using the Ensite NavX navigation system compared with a conventional fluoroscopy approach.

65]

Chen W, Yao Y, Zhang S, et al. Comparison of operator radiation exposure during coronary sinus catheter placement via the femoral or jugular vein approach. Europace. 2011 Apr 3;13(4): 539–542.

Abstract

To evaluate and compare operator radiation exposure during the catheter placement in the coronary sinus via the femoral vein with a steerable catheter or the jugular vein with a fixed curve catheter.

66]

Cheriachan D, Hughes AM, du Moulin WS, et al. Ionizing Radiation Doses Detected at the Eye Level of the Primary Surgeon During Orthopaedic Procedures. J Orthop Trauma. 2016 Jul;30(7):e230-5.

CATEGORIES:

Abstract

To evaluate the ionizing radiation dose received by the eyes of orthopaedic surgeons during various orthopaedic procedures. Secondary objective was to compare the ionizing radiation dose received between differing experience level.

67]

Choi MH, Jung SE, Oh SN, Byun JY. Educational Effects of Radiation Reduction During Fluoroscopic Examination of the Adult Gastrointestinal Tract. Acad Radiol. 2018 Feb;25(2):202-208.

CATEGORIES:

Abstract

This study aimed to evaluate the effects of educating radiology residents and radiographers about radiation exposure on reduction of dose area product (DAP) and fluoroscopy time in diagnostic fluoroscopy of the gastrointestinal (GI) tract in adult patients.

68]

Chon MK, Chun KJ, Lee DS, et al. Radiation reduction during percutaneous coronary intervention: A new protocol with a low frame rate and selective fluoroscopic image storage. Medicine (Baltimore). 2017 Jul;96(30):e7517.

Abstract

In this study, we evaluated the efficacy of a radiation reduction protocol that uses a lower frame rate and selective storage of fluoroscopic images in terms of its effect on reducing the radiation dose during PCI.

69]

Christopoulos G, Christakopoulos GE, Rangan BV, et al. Comparison of radiation dose between different fluoroscopy systems in the modern catheterization laboratory: Results from bench testing using an anthropomorphic phantom. Catheter Cardiovasc Interv. 2015 Nov;86(5):927-32.

CATEGORIES:

Abstract

Variations in radiation dose between various X-ray systems have received limited study. We examined the impact of X-ray system type on patient radiation dose during cardiac catheterization.

70]

Christopoulos G, Papayannis AC, Alomar M, et al. Determinants of operator and patient radiation exposure during cardiac catheterization: Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial. Catheter Cardiovasc Interv. 2016 Dec;88(7):1046-1055.

CATEGORIES:

Abstract

In the RadiCure study 505 catheterization procedures were 1:1 randomized to use or no use of real-time radiation monitoring. Use of the Bleeper Sv monitor resulted in a significant reduction in operator radiation exposure.

71]

Churrango G, Deutsch JK, Dinneen HS, et al. Minimizing Radiation Exposure During ERCP by Avoiding Live or Continuous Fluoroscopy. J Clin Gastroenterol. 2015 Nov-Dec;49(10):e96-100.

CATEGORIES:

Abstract

The aim of this study was to assess the cumulative radiation exposure incurred by patients when using single-frame fluoroscopy. Single-frame fluoroscopy is a technique that can be used instead of pulsed fluoroscopy or continuous live fluoroscopy to minimize radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP).

72]

Ciraj-Bjelac O, Antic V, Selakovic J, et al. EYE LENS EXPOSURE TO MEDICAL STAFF PERFORMING ELECTROPHYSIOLOGY PROCEDURES: DOSE ASSESSMENT AND CORRELATION TO PATIENT DOSE. Radiat Prot Dosimetry. 2016 Dec;172(4):475-482.

Abstract

The purpose of this study was to assess the patient exposure and staff eye dose levels during implantation procedures for all types of pacemaker therapy devices performed under fluoroscopic guidance and to investigate potential correlation between patients and staff dose levels. The mean eye dose during pacemaker/defibrillator implementation was 12 µSv for the first operator, 8.7 µSv for the second operator/nurse and 0.50 µSv for radiographer. Corresponding values for cardiac resynchronisation therapy procedures were 30, 26 and 2.0 µSv, respectively. Significant (p < 0.01) correlation between the eye dose and the kerma–area product was found for the first operator and radiographers, but not for other staff categories.

73]

Clark BC, Sumihara K, McCarter R, et al. Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation. J Interv Card Electrophysiol. 2016 Aug;46(2):183-9.

Abstract

Over the past several years, alternative imaging techniques including electroanatomic mapping systems such as CARTO®3 (C3) have been developed to improve anatomic resolution and potentially limit radiation exposure in electrophysiology (EP) procedures. We retrospectively examined the effect of the introduction of C3 on patient radiation exposure during EP studies and ablation procedures at a children’s hospital.

74]

Compagnone G, Campanella F, Domenichelli S, et al. Survey of the interventional cardiology procedures in Italy. Radiat Prot Dosimetry. 2012 Jul;150(3):316-24.

Abstract

As occupational doses are strongly related to patient doses, both patients and operators radiation dose data are reported. Ratios of maximum to minimum mean patient doses across the hospitals surveyed were 2.0, 3.9, 7.0, 1.8 and 1.4 for CA, ES, PI, PTCA and RA, respectively. The calculated rounded mean dose-area product values across all participating hospitals were comparable with other values reported in the literature. In general, specific radiation protection tools were used by all operators performing different procedures in all hospitals. A major issue in this survey was the absence of information about correlation between staff and patient doses in a single procedure: future studies could be more aimed to prospective goals where occupational exposures per procedure are monitored specifically.

75]

Corliss BM, Bennett J, Brennan MM, et al. The Patient Size Setting: A Novel Dose Reduction Strategy in Cerebral Endovascular Neurosurgery Using Biplane Fluoroscopy. World Neurosurg. 2018 Feb;110:e636-e641.

CATEGORIES:

Abstract

In some fluoroscopy machines, the dose-rate output of the fluoroscope is tied to a selectable patient size. Although patient size may play a significant role in visceral or cardiac procedures, head morphology is less variable, and high dose outputs may not be necessary even in very obese patients. We hypothesized that very small patient size setting can be used to reduce dose for cerebral angiography without compromising image quality.

76]

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

Abstract

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.

77]

Crowhurst J, Haqqani H, Wright D, et al. Ultra-low radiation dose during electrophysiology procedures using optimized new generation fluoroscopy technology. Pacing Clin Electrophysiol. 2017 Aug;40(8):947-954.

CATEGORIES:

Abstract

This study aimed to investigate any reduction in radiation dose between an older fluoroscopy system (Philips Integris H5000, Philips Healthcare, Einhoven, Netherlands) and one of the latest systems (Siemens Artis Q, Siemens Healthcare, Erlangen, Germany), optimized with dose-reduction strategies.

78]

Crowhurst J, Whitby M, Savage M, et al. Factors Contributing To Radiation Dose For Patients And Operators During Diagnostic Cardiac Angiography. J Med Radiat Sci. 2019 Mar;66(1):20-29.

Abstract

This study sought to identify which patient and procedural factors impact patient and operator dose the most during CA.

79]

Crowhurst J, Whitby M, Thiele D, et al. Radiation Dose In Coronary Angiography And Intervention: Initial Results From The Establishment Of A Multi-Centre Diagnostic Reference Level In Queensland Public Hospitals. J Med Radiat Sci. 2014 Sep;61(3): 135-141.

Abstract

This study sought to create a DRL for ICA procedures in Queensland public hospitals.

80]

Crowhurst J, Whitby M. Lowering Fluoroscopy Pulse Rates To Reduce Radiation Dose During Cardiac Procedures. J Med Radiat Sci. 2018 Dec;65(4):247-249.

Abstract

Radiation dose to patients undergoing cardiac imaging procedures in cardiac catheterisation laboratories (cath labs) can be relatively high, so implementing strategies to reduce dose is important. Lowering the fluoroscopy pulse rate is a simple, yet effective method to reduce radiation dose. Sensible, iterative changes made in this area have the potential for significant patient and staff radiation dose reduction.

81]

Datino T, Arenal A, Pelliza M, et al. Comparison Of The Safety And Feasibility Of Arrhythmia Ablation Using The Amigo Robotic Remote Catheter System Versus Manual Ablation. Am J Cardiol. 2014 Mar 1;113(5):827-831.

CATEGORIES:

Abstract

The aim of this study is to evaluate the safety and feasibility of using the Amigo Remote Catheter System (RCS) in arrhythmia ablation procedures. Acute ablation success was 96% with RCS and 98% in the manual group. In only 2 cases, the physician switched to manual ablation (1 ventricular tachycardia and 1 accessory pathway) to complete the procedure. There were no complications related to the use of RCS. No differences were observed in total procedure time, total fluoroscopy time, or total radiofrequency delivery compared with the manual group. In procedures performed with RCS, the operator’s fluoroscopy exposure time was reduced by 68 – 16%.

82]

De Ponti R. Reduction of radiation exposure in catheter ablation of atrial fibrillation: Lesson learned. World J Cardiol. 2015 Aug 26;7(8):442-8.

Abstract

Therefore, non-fluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy.

83]

de Ruiter QM, Gijsberts CM, Hazenberg CE, et al. Radiation Awareness For Endovascular Abdominal Aortic Aneurysm Repair In The Hybrid Operating Room. An Instant Patient Risk Chart For Daily Practice. J Endovasc Ther. 2017 Jun;24(3):425-434.

CATEGORIES:

Abstract

To determine which patient and C-arm characteristics are the strongest predictors of intraoperative patient radiation dose rates (DRs) during endovascular aneurysm repair (EVAR) procedures and create a patient risk chart. The strongest predictor of DRAK and DRDAP for fluoroscopy imaging was the radiation protocol, with an increase of 200% when changing from “low” to “medium” and 410% from “low” to “normal.” The strongest predictors of DRAK and DRDAP for DSA were C-arm angulation, with an increase of 47% per 30° of angulation, and body mass index (BMI), with an increase of 58% for every 5-point increase in BMI. While using comparable settings but switching the acquisition to a DSA with a “2 frames per second” protocol, the predicted DRAK will be 6.6 mGy/s (or 5.0 minutes until the 2-Gy threshold is reached).

84]

de Ruiter QM, Gijsberts GM, Hazenberg CE, et al. Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice. J Endovasc Ther. 2017 Jun;24(3):425-434.

CATEGORIES:

Abstract

To determine which patient and C-arm characteristics are the strongest predictors of intraoperative patient radiation dose rates (DRs) during endovascular aneurysm repair (EVAR) procedures and create a patient risk chart. Methods: A retrospective analysis was performed of 74 EVAR procedures, including 16,889 X-ray runs using fixed C-arm imaging equipment. Four multivariate log-linear mixed models (with patient as a random effect) were constructed. These models were used to predict the maximum radiation duration allowed before a 2-Gy skin threshold (for DRAK) or a 500-Gycm2 threshold (for DRDAP) was reached.

85]

de Ruiter QM, Moll FL, Gijsberts CM, van Herwaarden JA. AlluraClarity Radiation Dose-Reduction Technology in the Hybrid Operating Room During Endovascular Aneurysm Repair. J Endovasc Ther. 2016 Feb;23(1):130-8.

CATEGORIES:

Abstract

To evaluate the effect of radiation dose reduction with the Allura ClarityIQ image processing technology for fixed C-arms in comparison with a mobile C-arm and an Allura fixed C-arm without ClarityIQ technology during endovascular aneurysm repair (EVAR) procedures.

86]

de Ruiter QM, Reitsma JB, Moll FL, et al. Meta-analysis of Cumulative Radiation Duration and Dose During EVAR Using Mobile, Fixed, or Fixed/3D Fusion C-Arms. J Endovasc Ther. 2016 Dec;23(6):944-956.

CATEGORIES:

Abstract

To investigate the total fluoroscopy time and radiation exposure dose during endovascular aortic repairs using mobile, fixed, or fixed C-arms with 3-dimensional image fusion (3D-IF). A systematic search was performed to identify original articles reporting fluoroscopy time (FT) and the kerma area product (KAP) during endovascular aortic repairs.

87]

Degiorgio X, Gerasia R, Liotta F, et al. Radiation Doses To Operators In Hepatobiliary Interventional Procedures. Cardiovasc Intervent Radiol. 2018 May; 41(5): 772-780.

Abstract

The primary aim of this study is to provide a summary of operators’ radiation doses during hepatobiliary fluoroscopic guided procedures. In addition, patient dose in these procedures was also documented.

88]

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

Abstract

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.

89]

Dekker LRC, van der Voort PH, Simmers TA, et al. New Image Processing And Noise Reduction Technology Allows Reduction Of Radiation Exposure In Complex Electrophysiologic Interventions While Maintaining Optimal Image Quality: A Randomized Clinical Trial. Heart Rhythm. 2013 Nov;10(11):1678-1682.

Abstract

The purpose of this study was to evaluate the dose reduction and image quality of a novel X-ray technology using advanced image processing and dose reduction technology in an EP laboratory.

90]

Del Giudice C, Pellerin O, Nouri Neville M, et al. Comparison of Two Endovascular Steerable Robotic Catheters for Percutaneous Robot-Assisted Fibroid Embolization. Cardiovasc Intervent Radiol. 2018 Mar;41(3):483-488.

CATEGORIES:

Abstract

Twenty-one patients with a symptomatic uterine fibroid were prospectively enrolled in a single-center study to be treated with a percutaneous robot-assisted embolization using the Magellan system.

91]

DeLorenzo MC, Goode AR. Evaluation Of Skin Dose Calculation Factors In Interventional Fluoroscopy. J Appl Clin Med Phys. 2019 Dec;20(12):159-168.

CATEGORIES:

Abstract

The purpose of this study was to measure fluoroscopic dose calculation factors for modern fluoroscopy‐guided interventional (FGI) systems, and to fit to analytical functions for peak skin dose (PSD) calculation.

92]

Dias NV, Billberg H, Sonesson B, et al. The Effects Of Combining Fusion Imaging, Low-Frequency Pulsed Fluoroscopy, And Low-Concentration Contrast Agent During Endovascular Aneurysm Repair. J Vasc Surg. 2016 May;63(5):1147-1155.

CATEGORIES:

Abstract

This study evaluated the effects of a combined imaging protocol using low-frequency pulsed fluoroscopy, fusion imaging, and low-concentration iodine contrast for endovascular aneurysm repair (EVAR) of aortic aneurysms of varying complexity. Fluoroscopic frame rate reduction contributed to a median reduction of the dose area product by 22%. Only four of the group A patients (3.9%) showed a decrease in the glomerular filtration rate ≥30% after EVAR, although 32% of the entire group had at least moderately impaired renal function preoperatively..

93]

Dietrich TJ, Peterson CK, Zeimpekis KG, et al. Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and Outcomes. Radiology. 2019 Mar;290(3):752-759.

CATEGORIES:

Abstract

To compare the radiation exposure for participants and interventionalists as well as participant outcomes between fluoroscopy-guided versus CT-guided lumbar spinal injections.

94]

Dominici, Marcello et al. Operator Exposure To X-Ray In Left And Right Radial Access During Percutaneous Coronary Procedures: OPERA Randomised Study. Heart. 2013 Apr;99(7):480-484.

CATEGORIES:

Abstract

The aim of the present investigation is to evaluate in a randomised study, the dose of radiation absorbed by operators using either LRA or RRA.

95]

Döring M, Sommer P, Rolf S, et al. Sensor-based electromagnetic navigation to facilitate implantation of left ventricular leads in cardiac resynchronization therapy. J Cardiovasc Electrophysiol. 2015 Feb;26(2):167-75.

CATEGORIES:

Abstract

Implantation of cardiac resynchronization therapy (CRT) devices can be challenging, time consuming, and fluoroscopy intense. To facilitate placement of left ventricular (LV) leads, a novel electromagnetic navigation system (MediGuide™, St. Jude Medical, St. Paul, MN, USA) has been developed, displaying real-time 3-D location of sensor-embedded delivery tools superimposed on prerecorded X-ray cine-loops of coronary sinus venograms. We report our experience and advanced progress in the use of this new electromagnetic tracking system to guide LV lead implantation.

96]

Dou KF, Song CX, Mu CW, et al. Feasibility and safety of robotic PCI in China: first in man experience in Asia. J Geriatr Cardiol. 2019 May;16(5):401-405.

CATEGORIES:

Abstract

To evaluate the feasibility and safety of a second generation robotic percutaneous coronary intervention (R-PCI) system in China.

97]

Drago F, Grifoni G, Remoli R, et al. Radiofrequency Catheter Ablation of Left-Sided Accessory Pathways in Children Using a New Fluoroscopy Integrated 3D-Mapping System. Europace. 2017 Jul 1;19(7):1198–1203.

Abstract

The aim of this study was to evaluate a different catheter ablation approach in patients with left-sided accessory pathways (APs). The median procedure and fluoroscopy times were 130 min and 6 s, with a median fluoroscopy dose 0.5 mGy. An average of two catheters was used. Long-term success rate was 97% (29/30) at a median follow-up of 9.6 months. This approach reduced fluoroscopy time, dose and number of catheters used compared with manifest or concealed left-sided AP ablation using CARTO 3™ (P < 0.05).

98]

Duncan JR, Street M, Strother M, et al. Optimizing Radiation Use During Fluoroscopic Procedures: A Quality and Safety Improvement Project. J Am Coll Radiol. 2013 Nov;10(11):847–853.

Abstract

The ionizing radiation used during fluoroscopically guided medical interventions carries risk. The teams performing these procedures seek to minimize those risks while preserving each procedure’s benefits. This report describes a data-driven optimization strategy.

99]

Durán A, Hian SK, Miller DL, et al. A Summary of Recommendations for Occupational Radiation Protection in Interventional Cardiology. Catheter Cardiovasc Interv. 2012 Feb; 81(3):562–567.

Abstract

This document provides recommendations for occupational radiation protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational radiation dose include minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance program; and wearing personal dosimeters so that you know your dose

100]

Durán A, Hian SK, Miller DL, et al. Recommendations for occupational radiation protection in interventional cardiology. Catheter Cardiovasc Interv. 2013 Jul 1;82(1):29-42.

CATEGORIES:

Abstract

The radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational radiation protection for physicians and other staff in the interventional suite.

101]

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.

Abstract

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).

102]

Eichenlaub M, et al. Evaluation of a New Ultralow-Dose Radiation Protocol for Electrophysiological Device Implantation: A near-Zero Fluoroscopy Approach for Device Implantation. Heart Rhythm. 2020 Jan;17(1):90-97.

Abstract

The purpose of this study was to evaluate the impact of a new ultralow-dose radiation protocol on radiation doses, success rate, and safety of electrophysiological device implantations. With the ultralow-dose radiation protocol, effective doses could be reduced by 59% (median 0.25 [interquartile range: 0.11–0.63] vs median 0.10 [interquartile range: 0.03–0.28] mSv; P <.0001) per procedure without a significant change in procedure time (P = .5).

103]

Ekpo EU, et al. Operator Eye Doses during Computed Tomography Fluoroscopic Lung Biopsy. J Radiol Prot. 2016 Jun;36(2):290–298.

Abstract

To examine the peak entrance surface air kerma (peak ESAK) to the eyes during CT fluoroscopy lung biopsy, and the impact of lead glasses, exposure parameters, head rotation, and
height on peak ESAK to the eyes.

104]

EPA. Federal Guidance Report No. 14. Radiation protection guidance for diagnostic and interventional X-ray procedures. November 2014.

Abstract

Federal Guidance Report No. 14 provides federal facilities that use diagnostic and interventional x-ray equipment with recommendations for keeping patient doses as low as reasonably achievable without compromising the quality of patient care.

105]

Ephrem G, Lau JF, Meraj PM. The fluoro-less and contrast-less peripheral endovascular intervention: a concept for the future today. Cardiovasc Revasc Med. 2015 Jul-Aug;16(5):294-8.

CATEGORIES:

Abstract

Percutaneous endovascular revascularization requires fluoroscopic guidance and radiopaque contrast use. This approach becomes problematic, especially in patients with advanced renal disease or allergies to iodinated contrast medium. The direct (exposure) and indirect (lead garment) burden of radiation affects patients and operators alike. We propose a completely contrast-free, fluoroscopy-free approach to endovascular diagnostic arterial imaging and percutaneous intervention using available technologies, and outline a timeframe for its implementation.

106]

Ernst S, Castellano I. Radiation exposure and safety for the electrophysiologist. Curr Cardiol Rep. 2013 Oct;15(10):402.

Abstract

This review attempts to give practical advice for invasive electrophysiologists on personal radiation protection. Applying all measures of the “As low as reasonably achievable” ALARA concept should be a daily and indeed routine practice for all staff in the electrophysiology laboratory. A substantial number of technical options have been recently introduced which may enable the physician to lower the total radiation exposure significantly, but all require a substantial learning curve. Using these measures can arrive at very low or indeed close to ZERO fluoroscopy exposure even in complex ablation cases.

107]

Erskine BJ, Brady Z, Marshall EM. Local diagnostic reference levels for angiographic and fluoroscopic procedures: Australian practice. Australas Phys Eng Sci Med. 2014 Mar;37(1):75-82.

CATEGORIES:

Abstract

Although diagnostic and interventional fluoroscopic procedures are amongst the highest dose examinations performed in radiology, these procedures currently lack established national diagnostic reference levels (DRLs) in Australia. In this absence, local diagnostic reference levels (LDRLs) are proposed for a wide range of diagnostic and interventional angiographic and fluoroscopic procedures based upon data collected from 11,000 examinations, performed over a 2.5 year period at a major Australian public, teaching hospital. Each procedure type assessed included a minimum of 50 cases. LDRLs were defined for each procedure in terms of the 75th percentile of the dose area product and median fluoroscopic times have also been provided.

108]

Ertel A, Nadelson J, Shroff AR, et al. Radiation Dose Reduction during Radial Cardiac Catheterization: Evaluation of a Dedicated Radial Angiography Absorption Shielding Drape. ISRN Cardiology. 2012;2012:769167.

Abstract

We sought to investigate the impact on operator radiation exposure of various shielding drapes specifically designed for the radial approach. All drape designs led to substantial reductions in operator radiation exposure compared to control (P < 0.0001). The greatest decrease in radiation exposure (72%) was with the L-shaped design.

109]

Etard C, Bigand E, Salvat C, et al. Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France. Eur Radiol. 2017 Oct;27(10):4281-4290.

CATEGORIES:

Abstract

A national retrospective survey on patient doses was performed by the French Society of Medical physicists to assess reference levels (RLs) in interventional radiology as required by the European Directive 2013/59/Euratom. Fifteen interventional procedures in neuroradiology, vascular radiology and osteoarticular procedures were analysed. Kerma area product (KAP), fluoroscopy time (FT), reference air kerma and number of images were recorded for 10 to 30 patients per procedure. RLs were calculated as the 3rd quartiles of the distributions.

110]

Fan L, Luo Y, Chen Z, et al. A propensity score matched valuation on feasibility of low frame rate fluoroscopy during primary percutaneous coronary intervention for patients with STEMI. Int J Cardiovasc Imaging. 2019 Mar;35(3):393-399.

CATEGORIES:

Abstract

The present study aimed to evaluate the feasibility of low frame rate fluoroscopy during primary percutaneous coronary intervention (PPCI) for patients with acute ST elevation myocardial infarction (STEMI). From January 2016 to December 2017, 165 consecutive patients with STEMI who underwent PPCI were retrospectively divided into two groups: the 7.5-frame group (fluoroscopy at 7.5 frames/s) and the 15-frame group (fluoroscopy at 15 frames/s), according to the frame rate of fluoroscopy used in their treatment. Reduction of radiation and safety of fluoroscopy at 7.5 frames/s were compared by a method of propensity score matching (PSM) with fluoroscopy at 15 frames/s.

111]

Fardid R, Mirzadeh F, Rezaei H. Occupational doses of cardiologists in cath labs and simulation method. J Can Res Ther 2017;13:901-7.

Abstract

In this study, we have performed a mini review of the occupational radiation dose of cardiologists based on the previously conducted studies.

112]

Faroux L, Blanpain T, Nazeyrollas P, et al. Trends in Patient Exposure to Radiation in Percutaneous Coronary Interventions Over a 10-Year Period. Am J Cardiol. 2017 Sep 15;120(6):927-930.

CATEGORIES:

Abstract

This study aimed to compare the estimated dose of radiation received by patients in interventional cardiology at 10 years interval (2006 vs 2016). The study population included all patients who underwent interventional coronary procedures in one of the catheterization laboratories of our institution during 2 periods, namely, period 1 from October 2005 to March 2006, and period 2 from November 2015 to October 2016. The primary end point was the estimated dose of radiation received by the patient as assessed by dose area product. In 2016, the estimated dose of radiation received by patients who underwent interventional coronary procedures was on average 78% lower than that received in 2006 (p <0.0001), whereas the fluoroscopy time increased by 54% on average over the same period (p <0.0001)

113]

Fazel R, Curtis J, Wang Y, et al. Determinants of Fluoroscopy Time for Invasive Coronary Angiography and Percutaneous Coronary Intervention: Insights from the NCDR®. Catheter Cardiovasc Interv. 2013 Dec;82(7): 1091–1105.

Abstract

The purpose of this study was to Identify the distributions and determinants of fluoroscopy time for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). Our study included a total of 3,295,348 ICA and PCI procedures performed by 9,600 operators from January 2005 through June 2009. There was wide variation in fluoroscopy times for these procedures. After accounting for patient characteristics and procedure complexity, operator and hospital-level factors explained nearly 20% of the variation in fluoroscopy time.

114]

Fazel R, Gerber TC, Balter S, et al. Approaches to Enhancing Radiation Safety in Cardiovascular Imaging. Circulation. 2014 Nov 4;130(19): 1730–1748.

Abstract

The purpose of the present scientific statement is to outline practical and specific strategies for applying these principles to cardiovascular imaging. (1) Education, that is, ensuring that patients and clinicians understand the potential benefits and risks of medical imaging studies; (2) justification, that is, ensuring that the imaging procedure is clinically necessary and appropriate; and (3) optimization, that is, ensuring that radiation exposure from imaging is kept as low as reasonably achievable.

115]

Fetterly KA, Mathew V, Lennon R, et al. Radiation Dose Reduction in the Invasive Cardiovascular Laboratory: Implementing a Culture and Philosophy of Radiation Safety. JACC Cardiovas Interv. 2012Aug;5(8):866-873.

Abstract

This paper investigates the effects of sustained practice and x-ray system technical changes on the radiation dose administered to adult patients during invasive cardiovascular procedures.

116]

Fiorilli PN, Kobayashi T, Giri J, Hirshfeld JW Jr. Strategies for radiation exposure-sparing in fluoroscopically guided invasive cardiovascular procedures.Catheter Cardiovasc Interv. 2020 Jan;95(1):118-127.

CATEGORIES:

Abstract

Minimizing radiation exposure during x-ray fluoroscopically guided procedures is critical to patients and to medical personnel. Tableside adjustment of x-ray image acquisition parameters can vary the fluoroscopic radiation exposure rate. To determine the impact of adjusting four tableside controllable image acquisition parameters on x-ray fluoroscopic radiation exposure rate.

117]

Fischman AM, Ward TJ, Patel RS, et al. Prospective, Randomized Study of Coil Embolization versus Surefire Infusion System during Yttrium-90 Radioembolization with Resin Microspheres. J Vasc Interv Radiol. 2014 Nov;25(11):1709–1716.

CATEGORIES:

Abstract

To compare standard coil embolization versus the use of an antireflux microcatheter (ARM) in patients undergoing planning angiography before selective internal radiation therapy (SIRT). Over a 9-month period, 30 consecutive patients were randomized [it a 1:1 ratio between coil embolization and ARM groups. Mean fluoroscopy time was significantly reduced in the ARM group versus the coil embolization group (1.8 min [range, 0.4-4.9 min] vs 6.0 min [range, 1.9-15.7 min]; P = .002). There was no difference between groups in dose delivered on the day of SIRT( = .71). There were no major or minor adverse events at 30 days.

118]

Ge L, Zhong X, Ma J, et al. Safety and feasibility of a low frame rate protocol for percutaneous coronary intervention to chronic total occlusions: preliminary experience. EuroIntervention. 2018 Aug;14(5):e538-e545.

CATEGORIES:

Abstract

The present study aimed to evaluate the safety and feasibility of a low frame rate protocol for chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). A total of 192 consecutive patients who underwent CTO-PCI following the low frame rate protocol were analysed. The low frame rate protocol adopted reduced frame rates and the addition of copper and aluminium filters. Procedural outcomes, radiation dose and in-hospital outcomes were ascertained. Meanwhile, a phantom experiment was designed to measure the radiation dose reduction. In the phantom experiment, a remarkable radiation dose reduction could be achieved for AK, dose area product (DAP), simulated first and second operator radiation exposure (reduction of 72.5%, 69.8%, 60.9% and 59.6%, respectively) in cineangiography from this protocol.

119]

Georges JL et al. Time-Course Reduction in Patient Exposure to Radiation From Coronary Interventional Procedures. Circ Cardiovasc Interv. 2017 Aug;10(8):e005268.

CATEGORIES:

Abstract

This study sought to evaluate the temporal trends in patients’ exposure to radiation from CA and PCI. A continuous trend for a decrease in median [interquartile range] Kerma area product was observed, from 33 [19–55] Gy cm2 in 2009 to 27 [16–44] Gy cm2 in 2013 for CA (P<0.0001), and from 73 [41–125] to 55 [31–91] Gy cm2 for PCI (P<0.0001). Time-course differences in Kerma area product remained highly significant after adjustment on Fluoroscopy time, PCI procedure complexity, change of x-ray equipment, and other patient- and procedure-related covariates.

120]

Georges JL, Belle L, Etard C, et al. Radiation Doses to Patients in Interventional Coronary Procedures—Estimation of Updated National Reference Levels by Dose Audit. Radiat Prot Dosimetry. 2017 Jun 1;175(1):17–25.

CATEGORIES:

Abstract

The objective of this study was to estimate the French national updated reference levels (RLs) for coronary angiography (CA) and percutaneous coronary intervention (PCI) by a dose audit from a large data set of unselected procedures and in standardized patients.

121]

Georges JL, Belle L, Meunier L, et al. Radial versus Femoral Access for Coronary Angiography and Intervention Is Associated with Lower Patient Radiation Exposure in High-Radial-Volume Centres: Insights from the RAY’ACT-1 Study. Arch Cardiovasc Dis. 2017 Mar;110(3):179–187.

CATEGORIES:

Abstract

To compare patient radiation exposure during coronary angiography (CA) and percutaneous coronary intervention (PCI) with radial versus femoral access. Radial access was used in 71% of CAs and 69% of PCIs. Although median fluoroscopy times were longer for radial versus femoral access (CA, 3.8 vs 3.5 minutes [P < 0.001]; PCI, 10.4 vs 10.1 minutes [P = 0.001]), the Kerma-area product (KAP) was lower with radial access (CA, 26.8 vs 28.1 Gy·cm2; PCI, 55.6 vs 59.4 Gy·cm2; both P = 0.001). Differences in KAP remained significant in the multivariable analysis (P < 0.01), and in a propensity score-matched analysis (P = 0.01).

122]

Georges JL, Belle L, Ricard C, et al. Patient exposure to X-rays during coronary angiography and percutaneous transluminal coronary intervention: results of a multicenter national survey. Catheter Cardiovasc Interv. 2014 Apr 1;83(5):729-38.

CATEGORIES:

Abstract

To evaluate practices for the protection from radiation of patients during coronary angiography (CA) and percutaneous coronary intervention (PCI), and to update reference values for the main radiation dose parameters. RAY’ACT is a multicenter, nationwide French survey, with retrospective analysis of radiation parameters routinely registered in professional software from 33,937 CAs and 27,826 PCIs performed at 44 centers from January 1, through December 31, 2010. Kerma-area product (KAP) was registered in 91.7% (44/48) of centers and in 91.5% of procedures for CA (median, 27.2 Gy·cm(2) , interquartile range [IQR], 15.5-45.2) and 91.1% for PCI (median, 56.8 Gy·cm(2) , IQR, 32.8-94.6)

123]

Georges JL, Boueri Z, Bailler B, et al. Reduction of Radiation Exposure Associated with Renewal of the Radiologic Systems in Coronary Interventions. Ann Cardiol Angeiol (Paris). 2018 Nov;67(5):334–338.

CATEGORIES:

Abstract

This study sought to evaluate the effect of the renewal of the radiologic system on patient exposure during diagnostic coronary angiography (DCA) and percutaneous coronary interventions. A total of 2148 patients underwent DCA (1575 before and 573 after the system change), and 1563 underwent PCI (1196 before and 367 after). A change in the radiologic sytem was associated with a KAP reduction of 43% for DCA (median [interquartile range]: 18.1 Gy·cm2[10.2–34.0] versus 31.5 [19.0–49.0], P < 0.0001), and 38% for PCI (42.2 Gy·cm2 [23.8–] versus 70.1 [42.0–109.0], P < 0.0001). Fluoroscopy time did vary significantly, and the ratiio KAP to fluoroscopy time significantly decreased by 54%. The dose reduction was homogeneous between the three centres and between different manufacturer's systems.

124]

Ghelani SJ, Glatz AC, David S, et al. Radiation Dose Benchmarks During Cardiac Catheterization For Congenital Heart Disease In The United States. J Am Coll Cardiol. 2014 Sept 7;63(12):1060–1069.

Abstract

The aim of this study was to define age-stratified, procedure-specific benchmark radiation dose levels during interventional catheterization for congenital heart disease. Between January 2009 and July 2013, 2,713 cases were identified. Radiation dose benchmarks are presented including median, 75th percentile, and 95th percentile. Radiation doses varied widely between age groups and procedure types. Radiation exposure was lowest in patent ductus arteriosus closure and highest in transcatheter pulmonary valve placement. Total fluoroscopy time was a poor marker of radiation exposure and did not correlate well with total air kerma and dose area product.

125]

Gipson MG, Smith MT, Durham JD, et al. Intravascular US-Guided Portal Vein Access: Improved Procedural Metrics during TIPS Creation. J Vasc Interv Radiol. 2016 Aug;27(8):1140-7.

CATEGORIES:

Abstract

To evaluate transjugular intrahepatic portosystemic shunt (TIPS) outcomes and procedure metrics with the use of three different image guidance techniques for portal vein (PV) access during TIPS creation. retrospective review of consecutive patients who underwent TIPS procedures for a range of indications during a 28-month study period identified a population of 68 patients. Fluoroscopy time (P = .003), air kerma (P = .01), contrast agent volume (P = .003), and total procedural time (P = .02) were reduced with intravascular US guidance compared with fluoroscopic guidance.

126]

Gislason-Lee AJ, Keeble C, Malkin CJ, et al. Impact of Latest Generation Cardiac Interventional X-Ray Equipment on Patient Image Quality and Radiation Dose for Trans-Catheter Aortic Valve Implantations. Br J Radiol. 2016 Nov;89(1067):20160269.

Abstract

This study aimed to determine the impact on radiation dose and image quality of a new cardiac interventional X-ray system for trans-catheter aortic valve implantation (TAVI) patients compared to the previously-used cardiac X-ray system. Significant reductions in patient dose (p << 0.001) were found for the new system with no significant change in fluoroscopy duration (p = 0.052); procedure DAP reduced by 55%, fluoroscopy DAP by 48% and “cine” acquisition DAP by 61%. There was no significant difference between image quality scores of the two X-ray systems (p = 0.06).

127]

Goldsweig AM, Kennedy KF, Kolte D, et al. Predictors of patient radiation exposure during transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2018 Oct;92(4):768-774.

CATEGORIES:

Abstract

We sought to identify factors associated with higher radiation exposure and to quantify their relative influence, which may inform reduction of this hazard. All TAVR procedures at Rhode Island Hospital between March 20, 2012 and February 12, 2017 were included. Procedures were performed by two co-primary operators using a Siemens Artis Zeego system. Radiation metrics were generated by the imaging system. The primary metric was dose-area product (DAP, Gy*cm2 ), and secondary metrics were reference point air kerma (mGy) and fluoroscopy time (minutes). Data collected for the STS/ACC TVT Registry were utilized to develop a multivariable linear regression model predicting DAP.

128]

Goreczny S, Moszura T, Dryzek P, et al. Three-dimensional image fusion guidance of percutaneous pulmonary valve implantation to reduce radiation exposure and contrast dose: A comparison with traditional two-dimensional and three-dimensional rotational angiographic guidance. Neth Heart J. 2017 Feb;25(2):91–99.

CATEGORIES:

Abstract

In this retrospective review, patients were assigned to three groups according to the mode of imaging guidance: two-dimensional angiography (2DA), 3DRA and VesselNavigator (VN) assisted valve implantation. Between July 2012 and June 2016, 21 patients underwent PPVI: 8 with 2D guidance, 6 patients with 3DRA and most recently 7 patients with VN assistance. Patients in the 2DA group received a significantly higher total dose area product radiation dose and air kerma in comparison with patients with 3DRA and VN guided intervention.

129]

Granada JF, Delgado JA, Uribe MP. First-in-human evaluation of a novel robotic-assisted coronary angioplasty system. JACC Cardiovasc Interv. 2011 Apr;4(4):460-5.

CATEGORIES:

Abstract

We aimed to evaluate the safety and feasibility of a robotic angioplasty system in delivery and manipulation of coronary guidewires, balloons, and stents in patients undergoing elective percutaneous coronary intervention (PCI). Early clinical experience with a robotic-assisted angioplasty system demonstrated feasibility, safety, and procedural effectiveness comparable to manual operation. In addition, the total operator exposure to radiation was significantly low.

130]

Grelat M, Greffier J, Sabatier P, et al. Assessment of the Radiation Exposure of Surgeons and Patients During a Lumbar Microdiskectomy and a Cervical Microdiskectomy: A French Prospective Multicenter Study. World Neurosurg. 2016 May;89:329–336.

Abstract

Cervical and lumbar disk herniations are the most frequently carried out procedures in spinal surgery. Often, a few snapshots during the procedure are necessary to validate the level or to position the implant. The objective of this study is to quantitatively estimate the radiation received by a spine surgeon and patient during a low-dose radiation procedure.

131]

Guillou M, Maurel B, Necib H, et al. Comparison of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease with Flat-Panel Detectors on Mobile C-arm versus Fixed Systems. Ann Vasc Surg. 2018 Feb;47:104-113.

CATEGORIES:

Abstract

Flat-panel detectors on mobile C-arm (MC-arm) systems are currently challenging fixed C-arm (FC-arm) systems used in hybrid operating rooms. MC-arm systems offer an alternative to FC-arm systems in the endovascular treatment of peripheral arterial disease (PAD) but their efficiency has not been evaluated comparatively. Two series of patients undergoing arteriography with intention to treat were included. Each series consisted of 2 nonrandomized groups: an MC-arm group and an FC-arm group. Series 1 evaluated exposure to the patient (MC-arm, n = 113; FC-arm, n = 206) while series 2 evaluated exposure to patients and also health care personnel (MC-arm, n = 24; FC-arm, n = 76). The primary end points for evaluating exposure were air kerma (AK, in mGy) for patients and effective dose for health care personnel (in μSv).

132]

Guiu-Souto J, Otero-Martinez C, Perez-Fentes D, et al. Characterising Endourologist Learning Curve during Percutaneous Nephrolithotomy: Implications on Occupational Dose and Patients. J Radiol Prot. 2017 Nov 15;37(4):N49-N54.

CATEGORIES:

Abstract

In this study we have characterised the learning curve for percutaneous nephrolithotomy procedures over 301 cases for six years. Different surrogate parameters of clinical expertise have been used, such as dose area product, total procedure time, fluoroscopy time and personal equivalent doses. In addition, two different endourologists have been monitored; one of whom had specific Radiation Protection training (ICRP 85). Eye lens dose was estimated from thermoluminescent dosimeters. Significant differences were observed between both endourologists, especially in the fluoroscopy time.

133]

Gunja A, Pandey Y, Xie H, et al. Image noise reduction technology reduces radiation in a radial-first cardiac catheterization laboratory. Cardiovasc Revasc Med. 2017 Apr – May;18(3):197-201.

CATEGORIES:

Abstract

We performed a single-center, retrospective analysis of 400 consecutive patients who underwent diagnostic and interventional cardiac catheterizations in a predominantly TRA laboratory with traditional fluoroscopy (N=200) and a new image noise reduction fluoroscopy system (N=200). The primary endpoint was radiation dose (mGy cm2). Secondary endpoints were contrast dose, fluoroscopy times, number of cineangiograms, and radiation dose by operator between the two study periods

134]

Guo C, Xion Z, Vijayan S, et al. Developing a database of 3-D scattered radiation distributions for a C-arm fluoroscope as a function of exposure parameters and phantom. Proc SPIE Int Soc Opt Eng. 2018 Feb;10573:1057360.

CATEGORIES:

Abstract

The purpose of this work is to develop a database of 3D scattered radiation dose-rate distributions to estimate the staff dose by location around a C-Arm fluoroscopic system in an interventional procedure room. The results show that shape of the phantom will affect the dose-rate distribution at distances less than 100 cm, with a higher intensity for the super-ellipse. The scatter intensity per entrance air kerma is seen to be approximately proportional to field area and to increase with increasing kVp. The scatter changes proportionally with increases in primary entrance air kerma for factors such as pulse rate, mA and pulse width.

135]

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.

Abstract

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.

136]

Gutiérrez-Barrios A , Camacho-Galan H, Medina-Camacho F, et al. Effective Reduction of Radiation Exposure during Cardiac Catheterization. Tex Heart Inst J. 2019 Jun 1;46(3):167–171.

Abstract

Our objective was to investigate whether fine-tuning radiation safety protocols could reduce radiation doses without compromising the effectiveness of catheterization procedures in patients. The low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%–70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%–90.1%; P <0.001) during percutaneous coronary interventions. We also found that the annual deep (79%, P=0.026) and shallow (62.2%, P=0.035) radiation doses to which primary operators were exposed decreased significantly under the low-radiation protocol.

137]

Habib Geryes B, Bak A, Lachaux J, et al. Patient radiation doses and reference levels in pediatric interventional radiology. Eur Radiol. 2017 Sep;27(9):3983-3990.

Abstract

From January 2012 to March 2015, children scheduled for an interventional radiological procedure in two French tertiary centres were retrospectively included and divided into four groups according to age: children younger than 2 years (A1), aged 2-7 years (A5), 8-12 years (A10) and 13-18 years (A15). Three procedures were identified: cerebral digital subtraction angiography (DSA), brain arteriovenous malformation (bAVM) embolization, and head and neck superficial vascular malformation (SVM) percutaneous sclerotherapy. Demographic and dosimetric data, including dose area product (DAP), were collected.

138]

Hadjiconstanti AC, Messaris GA, Thomopoulos KC, Panayiotakis GS. Patient Radiation Doses in Therapeutic Endoscopic Retrograde Cholangiopancreatography in Patras and the Key Role of the Operator. Radiat Prot Dosimetry. 2017 Dec 1;177(3):243-249.

CATEGORIES:

Abstract

The aim of the present study was to obtain the patient radiation doses for the therapeutic ERCP procedures, performed in an academic hospital in Greece, to compare them with the corresponding values previously reported and to assess the key role of the operator, utilising FT, cumulative dose (Ka,r) and air kerma-area product (PKA). The values obtained could contribute in establishing local and national DRLs.

139]

Haegeli LM, Stutz L, Mohsen M, et al. Feasibility of Zero or near Zero Fluoroscopy during Catheter Ablation Procedures. Cardiol J. 2019;26(3):226–232.

Abstract

This study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a “real world” experience of a single tertiary care center.

140]

Hansen JW, Foy A, Schmidt T, et al. Fluoroscopy pulse rate reduction during diagnostic and therapeutic imaging in the cardiac catheterization laboratory: An evaluation of radiation dose, procedure complications and outcomes. Catheter Cardiovasc Interv. 2017 Mar 1;89(4):665-670.

CATEGORIES:

Abstract

To evaluate radiation reduction by reducing fluoroscopy pulse rate in diagnostic cardiac catheterizations and percutaneous coronary interventions (PCI) as well as outcomes at 30 days and six months. Fluoroscopy pulse rate was reduced from 10 pulses/sec (p/s) to 7.5 p/s as part of an internal quality improvement project. A retrospective analysis of all cardiac catheterizations was performed, evaluating Air KERMA at the interventional reference point (Ka, r ), Air KERMA area product (PKA ), procedural complications and major adverse cardiac events at 30 days and 6 months.

141]

Hardman J, Elvey M, Shah N, et al. Defining reference levels for intra-operative radiation exposure in orthopaedic trauma: A retrospective multicentre study. Injury. 2015 Dec;46(12):2457-60.

CATEGORIES:

Abstract

There is currently limited data to define reference levels for the use of ionising radiation in orthopaedic trauma surgery. In this multicentre study, we utilise methodology employed by the Health Protection Agency in establishing reference levels for diagnostic investigations in order to define analogous levels for common and reproducible orthopaedic trauma procedures. Four hundred ninety-five procedures were identified across four Greater London hospitals over a 1-year period. Exposure was defined in terms of both time and dose area product (DAP).

142]

Hartmann J, Distler F, Baumuller M, et al. Risk of Radiation-Induced Cataracts: Investigation of Radiation Exposure to the Eye Lens During Endourologic Procedures. J Endourol. 2018 Oct;32(10):897–903.

CATEGORIES:

Abstract

The aim of the study was to analyze real radiation exposure to the eye lens of the urologist during various interventions, during which the patient is in the lithotomy position. The correlation between DAP and the apron dose of the urologist was in average 0.07lSv per 1lGym2. The more experienced urologists yielded a mean DAP of 166lGym2 for stage I and 415lGym2 for stage II procedures. The interventionist was exposed with 10lSv in mean outside the lead apron collar. The mean dose value of the eye lenses per intervention was ascertained to 20lSv (mean DAP: 233lGym2).

143]

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.

Abstract

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.

144]

Hassan AE, Amelot S. Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site Experience. Interventional Neurology. 2017 Oct;6(3-4):105-116.

CATEGORIES:

Abstract

We evaluated patient exposure to radiation during common neurointerventions performed with a recent flat-panel detector angiographic system and compared our results with those of recently published studies.The DAP (Gy × cm2), fontal and lateral CAK (Gy), FT (min), and total number of DSA frames were as follows: 43 (33–60), 0.26 (0.19–0.33), 0.09 (0.07–0.13), 5.6 (4.2–7.5), and 245 (193–314) for diagnostic cerebral angiographies, and 66 (41–110), 0.46 (0.25–0.80), 0.18 (0.10–0.30), 18.3 (9.1–30.2), and 281 (184–427) for interventions.

145]

Hayes J, Smith I, O’Connell H, Stafford W. Radiation Exposure Optimisation During AF Ablations Utilising the Cryoballoon Ablation System. Heart Lung Circ. 2019 Dec;28(12):1819-1826.

CATEGORIES:

Abstract

Radiation risk minimisation during cardiac catheterisation, particularly atrial fibrillation (AF) ablation procedures, requires a multifaceted approach involving both technique and technology. Consecutive patients undergoing AF ablation were collected in a single-centre registry. Radiation and procedural data for index AF ablation procedures using four ablation techniques were compared: RF ablation with and without the anti-scatter grid (RF Grid and RF Gridless), and cryoballoon ablation utilising first and second-generation Medtronic Arctic Front Cryoballoons (Cryo; Arctic Front, Medtronic, Minneapolis, MN, USA), with and without 3D imaging during fluoroscopy (Cryo 3D and Cryo).

146]

Heilmaier C, Kara L, Zuber N, et al. Combined Use of a Patient Dose Monitoring System and a Real-Time Occupational Dose Monitoring System for Fluoroscopically Guided Interventions. J Vasc Interv Radiol. 2016 Apr;27(4):584-92.

CATEGORIES:

Abstract

To determine the effect on patient radiation exposure of the combined use of a patient dose monitoring system and real-time occupational dose monitoring during fluoroscopically guided interventions (FGIs). Patient radiation exposure, in terms of the kerma area product (KAP; Gy ∙ cm(2)), was measured in period 1 with a patient dose monitoring system, and a real-time occupational dose monitoring system was additionally applied in period 2. Mean/median KAP in 19 different types of FGIs was analyzed in both periods for two experienced interventional radiologists combined as well as individually.

147]

Hein S, Schoenthaler M, Wilhelm K, et al. Ultralow Radiation Exposure During Flexible Ureteroscopy in Patients With Nephrolithiasis-How Far Can We Go? Urology. 2017 Oct;108:34-39.

CATEGORIES:

Abstract

To evaluate the feasibility and clinical performance of a novel surgeon technique and protocol targeting ultralow fluoroscopy usage in retrograde intrarenal surgery (RIRS). All RIRS procedures between 2009 and 2015 for 10- to 20-mm renal calculi performed by the same 2 experienced urologists were eligible. All procedures were performed using a highly standardized step-by-step RIRS technique. This technique was modified by the ultralow radiation exposure RIRS protocol; herein, as much as possible of the standardized steps were performed without radiation control targeting ultralow fluoroscopy usage. Primary end points were fluoroscopy time and dose area product.

148]

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.

Abstract

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.

149]

Hernández-Girón I, Mourik JE, Overvelde ML, et al. MULTICENTRE COMPARISON OF IMAGE QUALITY FOR LOW-CONTRAST OBJECTS AND MICROCATHETER TIPS IN X-RAY-GUIDED TREATMENT OF ARTERIOVENOUS MALFORMATION IN THE BRAIN. Radiat Prot Dosimetry. 2016 Jun;169(1-4):325-30.

CATEGORIES:

Abstract

The treatment of brain arteriovenous malformations (AVMs) can be performed as a minimally invasive X-ray-guided procedure using a microcatheter for navigation to reach the target site. The performance of the interventional vascular surgery devices used for AVM was compared in four hospitals. The relation between image quality and the entrance surface air kerma (ESAK) was assessed for the default protocols for digital subtraction angiography (DSA) and fluoroscopy. A custom phantom, built with PMMA and aluminium plates was used to mimic the attenuation properties of the patient head. Image quality was assessed using low-contrast objects and catheters embedded in two phantoms. Differences were found in the ESAK values, especially for the fluoroscopy, whereas for DSA, the ESAK values were similar. The differences in image quality can be related to acquisition parameters, such as kV and filtration, and post-processing. The proposed method can be used to optimise the existing AVM protocols.

150]

Hertault A, et al. Impact of Hybrid Rooms with Image Fusion on Radiation Exposure during Endovascular Aortic Repair. Eur J Vasc Endovasc Surg. 2014 Oct;48(4):382–390.

Abstract

To evaluate exposure to radiation during endovascular aneurysm repair (EVAR) performed with intraoperative guidance by preoperative computed tomographic angiogram fusion. When compared with a previous cohort, there was a significant reduction in DAP during BIF, FEN, and BR procedures, and a significant reduction of iodinated contrast volume during FEN and BR procedures. There was also a significant reduction in DAP during BIF procedures when compared with the literature (p < .01). DAP measurement on radiochromic films was strongly correlated with indirect DAP values (r2 = .93).

151]

Heye S, Maleux G, Oyen RH, et al. Occupational Radiation Dose:Percutaneous Interventional Procedures on Hemodialysis Arteriovenous Fistulas and Grafts. Radiology. 2012 Jul;264(1):278–284.

CATEGORIES:

Abstract

To evaluate operator radiation exposure during percutaneous interventions on hemodialysis arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). Mean operator radiation doses for the left hand, right hand, eye lens, left leg, and right leg were 0.28, 0.28, 0.03, 0.11, and 0.12 mSv, respectively. Radiation exposure to the hands was significantly higher compared with that to the legs (P < .0001). Eye lens radiation dose was significantly higher for procedures with the flat-panel detector system (P = .002).

152]

Hill KD, Carboni MP, Doyle TP, et al. Variability in Radiation Dose and Image Quality: A Comparison Across Fluoroscopy-system Vendors and Generations of Equipment. Circulation. 2016 Nov 11;134(suppl_1):A12670.

CATEGORIES:

Abstract

To evaluate differences in radiation dose and image quality across institutions, fluoroscope vendors and generations of fluoroscopes for pediatric cardiac catheterization. There is currently little understanding of variability in the dose-image quality relationship across institutions, fluoroscope vendor and/or generation of equipment. We evaluated latest generation fluoroscopes from Phillips, Siemens, GE, and Toshiba, and an older generation Phillips fluoroscope (release date 2003) at three different institutions. Radiation dose was measured using an anthropomorphic dose-assessment phantom with effective dose in mSv estimated from Monte Carlo simulations. Image quality phantom images were scored on a 12-point scale by three blinded reviewers.

153]

Hinrichs JB, Renne J, Hoeper MM, et al. Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance. Eur Radiol. 2016 Nov;26(11):4064-4071.

CATEGORIES:

Abstract

To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA). Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT.

154]

Hiremath G, Meadows J, Moore P. How Slow Can We Go? 4 Frames Per Second (fps) Versus 7.5 fps Fluoroscopy for Atrial Septal Defects (ASDs) Device Closure. Pediatr Cardiol. 2015 Jun;36(5):1057-61.

CATEGORIES:

Abstract

Radiation exposure remains a significant concern for ASD device closure. In an effort to reduce radiation exposure, the default fluoroscopy frame rate in our Siemens biplane pediatric catheterization laboratory was reduced to 4 fps in November 2013 from an earlier 7.5 fps fluoro rate. This study aims to evaluate the components contributing to total radiation exposure and compare the procedural success and radiation exposure during ASD device closure using 4 versus 7.5 fps fluoroscopy rates. T

155]

Hirshfeld JW, Ferrari VA, Bengel FM, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 2: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection. Catheter Cardiovasc Interv. 2018 Aug 1;92(2):222-246.

Abstract

This document covers equipment operation for the 3 cardiovascular procedure classes that employ ionizing radiation: x‐ray fluoroscopy, x‐ray CT, and radionuclide scintigraphy. For the 3 modalities, it includes discussions of radiation delivery and strategies to minimize dose both to patients and to occupationally exposed medical personnel. In addition, it covers issues of quality assurance, radiation monitoring, and tracking. The document’s purpose is to provide a comprehensive information source about ionizing radiation use in cardiovascular procedures.

156]

Hoffmann R, Langenbrink L, Reimann D, et al. Image noise reduction technology allows significant reduction of radiation dosage in cardiac device implantation procedures. Pacing Clin Electrophysiol. 2017 Dec;40(12):1374-1379.

CATEGORIES:

Abstract

Novel x-ray systems with real-time image noise reduction technology (INRT) to reduce radiation dose during fluoroscopy and cine acquisition have become available. This study evaluated the reduction of radiation dose in device implantation with INRT. Radiation dose data from 132 consecutive new device implantation procedures (102 pacemaker [PM] or implantable cardioverter defibrillator [ICD] and 30 cardiac resynchronization therapy [CRT] devices) performed between January 2015 and December 2015 on an angiography system with INRT (Allura ClarityIQ) were collected. For comparison, radiation dose data from 147 consecutive device implantation procedures (121 PM/ICDs and 26 CRT devices) performed between June 2013 and September 2014 on a C-arm system with continuous and pulsed fluoroscopy option (4 frames/second) were evaluated. Total dose area product (DAP), fluoroscopy DAP, and cine DAP were evaluated.

157]

Hsi RS, Harper JD. Fluoroless ureteroscopy: zero-dose fluoroscopy during ureteroscopic treatment of urinary-tract calculi. J Endourol. 2013 Apr;27(4):432-7.

CATEGORIES:

Abstract

Fluoroscopy usage during endoscopic procedures exposes the patient and operating room staff to ionizing radiation. Pooled mean fluoroscopy usage time during ureteroscopy reported from recent literature is 144 seconds per case. The purpose of this study was to evaluate radiation exposure using a minimal-use fluoroscopy protocol during ureteroscopic treatment of urinary-tract calculi and determine patient and perioperative factors associated with increased fluoroscopy time.

158]

Huang AL, Mughai N, Tabas F, et al. Pulmonary Vein Isolation for Atrial Fibrillation Can Be Achieved With Low Radiation Exposure. Heart Lung Circ. 2018 Jul;27(7):812–818.

Abstract

This study aims to determine the significance of radiation exposure from Pulmonary Vein Isolation (PVI). Entrance skin dose was similar between PVI and flutter ablation groups but significantly higher in the diagnostic angiography group, with median and IQR for PVI vs. flutter ablation vs. diagnostic angiography, 100.4 (52.8–179.9) vs. 73.2 (37.0–142.1) vs. 393.5 (276.1–555.6) mGy (p < 0.0001). Dose area product in PVI (1831.2 and 887.7–3460.8 cGycm2) was higher than flutter ablation (1077.8 and 452.9–2410.2 cGycm2, p < 0.05) but lower than the diagnostic angiography group (3446.8 and 2341.9–5283.1 cGycm2, p < 0.0001). The fluoroscopy time and entrance skin dose for PVI decreased over time, likely due to increased operator experience.

159]

Huang PS, et al. Evaluation of Radiation Exposure on Physicians During Angioplasty for Hemodialysis Access Dysfunction. Acta Cardiol Sin. 2019 Jan;35(1):27-31.

Abstract

In this study, we investigated the precise radiation dose at the patients’ back and at the non-targeted organs of the operators. The results indicated that there was a significantly higher radiation dose in the central lesion group than in the upper arm and forearm groups. Conversely, there were no specific differences in total procedure time and fluoroscopy time among groups. The radiation exposure doses in the operators showed that regardless of the site, including lens, hands and gonads of the operators, the radiation dose was significantly higher in the central lesion group.

160]

Hwang J, Lee SY, Chon MK, et aql. Radiation Exposure in Coronary Angiography: A Comparison of Cineangiography and Fluorography. Korean Circ J. 2015 Nov;45(6):451-456.

Abstract

In this study, there was an evaluation of whether fluorography resulted in decreased radiation exposure, as compared with cineangiography. The total AK and DAP were significantly lower in the fluorography group (159.3±64.9 mGy and 1337.9±629.6 µGy · m2, respectively) than in the cineangiography group (326.9±107.5 mGy and 2341.1±849.9 µGy · m2, respectively; p=0.000 for both).

161]

Ihn YK, Kim BS, Byun JS, et al. Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study. Neurointervention. 2016 Sep;11(2):78-85.

Abstract

To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL). Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were assessed for both diagnostic and therapeutic procedures. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm2 for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm2 for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively.

162]

Illuminati G, Pacilè MA, Ceccanei G, et al. Peroperative Intravascular Ultrasound for Endovascular Aneurysm Repair versus Peroperative Angiography: A Pilot Study in Fit Patients with Favorable Anatomy. Ann Vasc Surg. 2019 Nov 11. pii: S0890-5096(19)30975-6. doi:10.1016/j.avsg.2019.11.013. [Epub ahead of print]

CATEGORIES:

Abstract

In 2011, national diagnostic reference levels (DRLs) were proposed for pain management fluoroscopic procedures in Belgium. The primary goal of this work is to compare the dose area product values (DAP) recorded at the Saint-Luc University Hospital to these DRLs. From 2012 to 2015, 7664 interventional pain management procedures (4740 epidural, 2097 medial branch and 807 transforaminal infiltrations) were performed. Uni/multivariable analyses were done regarding the influence of different factors. The fluoroscopy duration and the DAP are lower to the DRLs (p < 0.001). From 7644 procedures' DAP, 1431 (18.7%) were higher than the DRLs: 1397 epidural (29.5%), 16 medial branch (0.8%) and 18 transforaminal infiltrations (2.2%) (p < 0.001 between procedures).

163]

Ingwersen M, Drabik A, Kulka U, et al. Physicians Radiation Exposure in the Catheterization Lab. JACC Cardiov Interv. Oct 2013;6(10):1095–1102.

Abstract

This study sought to evaluate differences in radiation exposure of the operator depending on the type of catheterization lab procedure. The type of procedure, the patient’s body mass index, and the fluoroscopy time were independently associated with the operator’s radiation exposure. Per procedure, the operators were exposed to a mean effective dose (E) of 2.2 ± 5.9 μSv. Compared with coronary angiography, E was 2.3-fold higher in pelvic procedures (95% confidence interval [CI]: 1.7 to 3.0, p < 0.001), 1.7-fold higher in upper limb procedures (95% CI: 1.3 to 2.1, p < 0.001), and 1.4-fold higher in below-the-knee procedures (95% CI: 1.1 to 2.0, p = 0.023). The mean eye dose was 19.1 ± 37.6 μSv. Eye doses were significantly higher in peripheral procedures than in coronary angiography procedures. The mean hand dose was 99.6 ± 196.0 μSv. Hand doses were significantly higher in pelvic than in coronary angiography, upper limb, and below-the-knee procedures.

164]

Iqtidar AF, Jeon C, Rothman R, et al. Reduction in operator radiation exposure during transradial catheterization and intervention using a simple lead drape. Am Heart J. 2013 Mar;165(3):293-8.

CATEGORIES:

Abstract

Transradial access for cardiac catheterization and intervention is a recognized method for reducing complications and improving patient comfort. However, there are concerns over possible increased operator radiation exposure. We tested the hypothesis that a simple lead drape would reduce operator exposure in transradial procedures.

165]

Isoardi P, D’Ercole L, Vavallari M, et al. Patient Dose in Angiographic Interventional Procedures: A Multicentre Study in Italy. Physica Medica. 2019 Aug;64:273–292.

Abstract

This work reports the early experience of managing dose data from patients under going angiography in a multicentre study. The duration and dose values of fluoroscopic exposure for each procedure is strongly dependent on individual clinical circumstances including the complexity of the procedure; the observed distribution of patient doses was very wide, even for a specified protocol.The median values of the parameters were compared with the diagnostic reference levels (DRL) proposed for some procedures in Italy (ISTISAN) or internationally. This work proposes local DRL values for three procedures.

166]

Iwachow P, Miechowicz I, Kałmucki P, et al. Evaluation of radiological risk during coronary angioplasty procedures: comparison of transradial and transfemoral approaches. Int J Cardiovasc Imaging. 2017 Sep;33(9):1297-1303.

CATEGORIES:

Abstract

Increasing operator experience and newer available interventional cardiology devices require reassessment of radiological risk related to percutaneous coronary interventions (PCI). We aimed at comparison of radiological risk and procedural data of PCIs performed by radial (RA) and femoral (FA) approach in real life patients. Detailed retrospective analysis of 1500 consecutive PCIs with the use of radial or femoral access was performed.

167]

Jacob S, Michel M, Brezin AP, et al. Ionizing Radiation as a Risk Factor for Cataract: What about Low-Dose Effects? J Clinic Experiment Opthalmol. 2011;S:1.

CATEGORIES:

Abstract

In this article, we present an overview of the physiopathology of radiation-induced cataracts and a review of the main epidemiological results which have led to question the possible implication of lower doses of ionizing radiation exposure in the early development of cataracts resulting in the decreased ICRP dose threshold.

168]

Jiang Y, Wang HR, Wang PF, Xu SG. The Surgical Approach Visualization and Navigation (SAVN) System reduces radiation dosage and surgical trauma due to accurate intraoperative guidance. Injury. 2019 Apr;50(4):859-863.

CATEGORIES:

Abstract

The intraoperative fluoroscopy has been widely used in modern neuro-spinal surgery due to the overwhelming trend toward minimal-access surgery. However, both patients and surgical personnel were under ionizing-radiation exposure during fluoroscopy usage. Since the fluoroscopy constitutes the vast majority of radiation exposure for both surgeons and patients, the development and improvement of new interventional possibilities are of great importance and interests.

169]

Joncyzk M, Gebaur B, Rotzinger R, et al. Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience. In Vivo. Jan-Feb 2018;32(1):179-184.

CATEGORIES:

Abstract

To evaluate the combination of access site and level of experience on fluoroscopy times (FT) and dose area products (DAP) during implantation of port catheters in a large patient population. Senior radiologists required less FT/DAP (0.24 s/57.3 μGy m2 versus 0.43 s/68.2 μGy m2, respectively; p<0.001). Right jugular vein access required the least FT/DAP (0.25 s/56.15 μGy m2) and right-sided implantation lower FT/DAP (right: 0.26 s/56.4 μGy m2, left: 0.40 s/85.10 μGy m2, p<0.001).

170]

Jonczyk M, Gebauer B, Schnapauff D, et al. Peripherally inserted central catheters: dependency of radiation exposure from puncture site and level of training. Acta Radiol. 2018 Jun;59(6):688-693.

CATEGORIES:

Abstract

Background Several interventional procedures show a dependency on fluoroscopy times (FT) and level of training. Furthermore, FT and dose area products (DAP) vary depending on access site and target vessel for chest port implantations, but not for other thoracic interventions such as percutaneous coronary interventions. Purpose To evaluate the influence of the combination of venous access site and level of training on FTs and DAPs during peripherally inserted central catheters (PICC) implantations in a large cohort of patients.

171]

Jone PN, Zablah JE, Burkett DA, et al. Three-Dimensional Echocardiographic Guidance of Right Heart Catheterization Decreases Radiation Exposure in Atrial Septal Defect Closures. J Am Soc Echocardiogr. 2018 Sep;31(9):1044-1049.

Abstract

The aim of this study was to evaluate the feasibility of 3D TEE guidance of RHC in ASD closures and radiation reduction compared with historical control subjects. There was a 54% reduction in total fluoroscopy time and a 78% radiation reduction demonstrated with 3D TEE guidance of patients with ASDs compared with control subjects. Although there were no statistically significant differences in the RHC time compared with control subjects, the fluoroscopy time (mean, 0.06 ± 0.23 min) for RHC guidance using 3D TEE imaging was almost zero. There was decreased RHC time as we progressed through the learning curve of performing 3D TEE guidance of RHC (r = −0.63, P < .01). There were no statistically significant differences in total procedural time.

172]

Jones MA, Cocker M, Khiani R, et al. The benefits of using a bismuth-containing, radiation-absorbing drape in cardiac resynchronization implant procedures. Pacing Clin Electrophysiol. 2014 Jul;37(7):828-33.

CATEGORIES:

Abstract

Radiation exposure is a major concern in cardiac device implantation, especially cardiac resynchronization therapy (CRT) procedures. The RadPad (Worldwide Innovations & Technologies, Inc., Kansas City, MO, USA), a radiation-attenuating adhesive drape, has been shown to be beneficial in several clinical settings involving fluoroscopy, but less is known about the actual benefits in CRT procedures.

173]

Jones T, Brennan PC, Mello-Thoms C, Ryan. Contemporary Australian Dose Area Product Levels In The Fluoroscopic Investigation Of Paediatric Congenital Heart Disease. Radiat Protect Dosimetry. 2016 Apr 15;173(4): 374–379.

Abstract

This study examines radiation dose levels delivered to children from birth to 15 yof age in the investigation of congenital heart disease (CHD) at a major Sydneychildren’s hospital. The aims are to compare values with those derived from similar studies, to provideatemplatefor moreconsistentdosereporting, to establish local and national diagnostic reference levels and to contribute to the worldwide paediatric dosimetry database.

174]

Jungen, Christiane et al. “Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure.” PloS one vol. 10,10 e0140386. 14 Oct. 2015, doi:10.1371/journal.pone.0140386. Accessed May 21 2020.

Abstract

To investigate whether percutaneous left atrial appendage (LAA) closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE) and fluoroscopy imaging results in decreased radiation exposure. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm2; p = 0.01). Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53).

175]

Jurado-Román A, Sánchez-Pérez I, Lozano Ruíz-Poveda F, et al. Effectiveness of the implementation of a simple radiation reduction protocol in the catheterization laboratory. Cardiovasc Revasc Med. 2016 Jul-Aug;17(5):328-32.

CATEGORIES:

Abstract

A reduction in radiation doses at the catheterization laboratory, maintaining the quality of procedures is essential. Our objective was to analyze the results of a simple radiation reduction protocol at a high-volume interventional cardiology unit. We analyzed 1160 consecutive procedures: 580 performed before the implementation of the protocol and 580 after it. The protocol consisted in: the reduction of the number of ventriculographies and aortographies, the optimization of the collimation and the geometry of the X ray tube-patient-receptor, the use of low dose-rate fluoroscopy and the reduction of the number of cine sequences using the software “last fluoroscopy hold”.

176]

Kahn EN, Gemmete JJ, Chaudhary N, et al. Radiation Dose Reduction during Neurointerventional Procedures by Modification of Default Settings on Biplane Angiography Equipment. J NeuroInterv Surg. 2016 Aug;8(8):819–823.

Abstract

We sought to assess the effect during neurointerventional procedures of varying default rates of radiation dose in fluoroscopy (F) and image acquisition (IA) modes, and frame rates during cine acquisition (CINE) on total X-ray dose, acquisition exposures, fluoroscopy time, and complications.

177]

Kalef-Ezra JA, Karavasilis S, Kouvelos G, et al. Endovascular abdominal aortic aneurysm repair: Methods of radiological risk reduction. J Cardiovasc Surg (Torino). 2011 Dec;52(6):769-78.

Abstract

The aim of this study was to quantify the radiological risks to patients and operating team, and to develop strategies to assess and reduce them. The probability for radiation induced biological effects due to the repair itself and the preoperative and life-long surveillance, as carried out, was about 2.4 10-3. The peak skin dose of repairs was linearly correlated with the DAP and did not exceed 1.2 Gy. The collective effective dose of the staff that carried out repairs using the mobile unit was 5.5 and 8 μSv per repair using an angiographic and a surgical table, respectively. The use of the high-power fluroscopic unit resulted in a many fold higher radiation burden to both patient and personne

178]

Kalem M, Basarir K, Kocaoglu H, et al. The Effect of C-Arm Mobility and Field of Vision on Radiation Exposure in the Treatment of Proximal Femoral Fractures: A Randomized Clinical Trial. BioMed Res Int. 2018 Mar 27;2018:6768272.

CATEGORIES:

Abstract

To examine the effect of fluoroscopy devices with different sizes of image intensifier and C-arm maneuverability on operating time, fluoroscopy time, radiation dose and reduction, and fixation quality at intertrochanteric femoral fractures.

179]

Kaljevic J, Ciraj-Bjelac O, Stankovic J, et al. OCCUPATIONAL DOSE ASSESSMENT IN INTERVENTIONAL CARDIOLOGY IN SERBIA. Radiat Prot Dosimetry. 2016 Sep;170(1-4):279-83.

CATEGORIES:

Abstract

A double-dosimetry method was applied for the estimation of whole-body dose, using thermoluminescent dosemeters, calibrated in terms of the personal dose equivalent Hp(10). Besides the double-dosimetry method, eye dose was also estimated by means of measuring ambient dose equivalent, H*(10), and doses per procedure were reported. Doses were assessed for 13 physicians, 6 nurses and 10 radiographers, for 2 consequent years. The maximum annual effective dose assessed was 4.3, 2.1 and 1.3 mSv for physicians, nurses and radiographers, respectively. The maximum doses recorded by the dosemeter worn at the collar level (over the apron) were 16.8, 11.9 and 4.5 mSv, respectively. This value was used for the eye lens dose assessment. Estimated doses are in accordance with or higher than annual dose limits for the occupational exposure.

180]

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.

Abstract

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).

181]

Kaplan SL, Magill D, Felice MA, et al. Intussusception reduction: Effect of air vs. liquid enema on radiation dose. Pediatr Radiol. 2017 Oct;47(11):1471-1476.

CATEGORIES:

Abstract

We test the hypothesis that air enema reduction of ileocolic intussusception results in lower radiation dose than liquid contrast enema independent of fluoroscopy time. We describe a role for automatic exposure control in this dose difference. We retrospectively evaluated air and liquid intussusception reductions performed on a single digital fluoroscopic unit during a 26-month period. We compared patient age, weight, gender, exam time of day and year, performing radiologist(s), radiographic image acquisitions, grid and magnification use, fluoroscopy time and dose area product.

182]

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.

Abstract

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.

183]

Kastrati M, Langenbrink L, Piatkowski M, et al. Reducing Radiation Dose in Coronary Angiography and Angioplasty Using Image Noise Reduction Technology. Am J Cardiol. 2016 Aug 1;118(3):353-356.

Abstract

This study sought to quantitatively evaluate the reduction of radiation dose in coronary angiography and angioplasty with the use of image noise reduction technology in a routine clinical setting. The dose area product was reduced from 3195 ± 2359 to 983 ± 972 cGycm2 (65%, p <0.001) in coronary angiograms and from 7123 ± 4551 to 2431 ± 1788 cGycm2 (69%, p <0.001) in coronary interventions using the new noise reduction technology. Image quality was graded as similar between the evaluated systems (4.0 ± 0.7 vs 4.2 ± 0.6, not significant).

184]

Katsurada M, Izumo T, Nagai Y, et al. The Dose and Risk Factors for Radiation Exposure to Medical Staff during Endobronchial Ultrasonography with a Guide Sheath for Peripheral Pulmonary Lesions under X-ray Fluoroscopy. Jpn J Clin Oncol. 2014 Mar;44(3):257–262.

Abstract

A corollary to the increasing number of transbronchial biopsies for peripheral pulmonary nodules is the increased chances of radiation exposure during fluoroscopy. Our aim was to determine the dose and risk factors of radiation exposure to medical staff. The median radiation exposure dose to operator physicians was 12 μSv/exam (range 1–99), while that of the other medical staff was lower. In a multivariate analysis, body mass index and the location of the radial ultrasound probe had significantly higher odds ratios.

185]

Kelly R, McMahon A, Hegarty D. Ionizing Radiation Dose Exposure to the Ocular Region of Pain Physicians During C-arm Guided Pain Interventions. Pain Physician. 2018 Sep;21(5):E523-E532.

CATEGORIES:

Abstract

The objectives of this study are to quantify the typical IR exposure in the ocular region of PP and to compare it to recommended international guidelines. The estimated annual lens dose experienced by pain physicians performing fluoroscopy-guided procedures is less than the recommended international guidelines. A significant linear relationship between screening time and IR exposure was estimated (rs = 0.93, P < 0.01)

186]

Ketterly KA, Schueler B, Grams, et al. Head and Neck Radiation Dose and Radiation Safety for Interventional Physicians. JACC Cardiovasc Interv. 2017 Mar 13;10(5):520-528.

Abstract

The first aim of this study was to assess the magnitude of radiation dose to tissues of the head and neck of physicians performing x-ray-guided interventional procedures. The second aim was to assess protection of tissues of the head offered by select wearable radiation safety devices.

187]

Khelassi-Toutaoui N, Toutaoui A, Merad A, et al. Assessment of radiation protection of patients and staff in interventional procedures in four Algerian hospitals. Radiat Prot Dosimetry. 2016 Jan;168(1):55-60.

CATEGORIES:

Abstract

This study was aimed to assess patient dosimetry in interventional cardiology (IC) and radiology (IR) and radiation safety of the medical operating staff. For this purpose, four major Algerian hospitals were investigated. The data collected cover radiation protection tools assigned to the operating staff and measured radiation doses to some selected patient populations. The analysis revealed that lead aprons are systematically worn by the staff but not lead eye glasses, and only a single personal monitoring badge is assigned to the operating staff. Measured doses to patients exhibited large variations in the maximum skin dose (MSD) and in the dose area product (DAP).

188]

Kherad B, Jerichow T, Blaschke F, et al. Efficacy of RADPAD protective drape during coronary angiography. Herz. 2018 Jun;43(4):310-314.

CATEGORIES:

Abstract

Chronic exposure to low-dose radiation confers a risk for skin damage, eye lens opacities or cataracts, and malignant diseases to staff in the catheter laboratory. The RADPAD is a sterile surgical drape that reduces the effect of scatter radiation on the operator. We sought to assess the efficacy of RADPAD shields in reducing radiation dose experienced by operators during routine diagnostic coronary angiography.

189]

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.

Abstract

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.

190]

Kirkwood M, Chamseddin K, Arbique GM, et al. Patient And Operating Room Staff Radiation Dose During Fenestrated/Branched Endovascular Aneurysm Repair Using Premanufactured Devices. J Vasc Surg. 2018 Nov;68(5):1281-1286.

CATEGORIES:

Abstract

Introduction: Fenestrated endovascular aneurysm repair (FEVAR) is the highest radiation dose procedure performed by vascular surgeons. We sought to characterize the radiation dose to patients and staff during FEVAR procedures with different premanufactured devices.

191]

Kirkwood ML, Arbique GM, Guild JB, et al. Radiation Brain Dose To Vascular Surgeons During Fluoroscopically Guided Interventions Is Not Effectively Reduced By Wearing Lead Equivalent Surgical Caps. J Vasc Surg. 2018 Aug;68(2):567-571.

Abstract

We sought to determine the efficacy of the RADPAD (Worldwide Innovations & Technologies, Lenexa, Kan) No Brainer surgical cap (0.06 mm lead equivalent at 90 kVp) in reducing radiation dose to the surgeon’s and trainee’s head during FGIs and to a phantom to determine relative brain dose reductions. This was a prospective, single-center study that included 29 endovascular aortic aneurysm procedures. The average procedure reference air kerma was 2.6 Gy. The hat attenuation at the temporal position for the attending physician and fellow was 60% ± 20% and 33% ± 36%, respectively.

192]

Kirkwood ML, Arbique GM, Guild JB, et al. Surgeon Education Decreases Radiation Dose In Complex Endovascular Procedures And Improves Patient Safety. J Vasc Surg. 2013 Sep;58(3):715-721.

Abstract

The purpose of this study was to determine whether surgeon education on radiation dose control can lead to lower reference air kerma (RAK) and peak skin dose (PSD) levels in high-dose procedures.

193]

Kirkwood ML, Guild JB, Arbique GM, et al. New Image-Processing And Noise-Reduction Software Reduces Radiation Dose During Complex Endovascular Procedures. J Vasc Surg. 2016 Nov;64(4):1357-1365.

CATEGORIES:

Abstract

This study determined whether the surgeon and patient radiation dose during complex endovascular procedures (CEPs) is decreased after the implementation of this new operating system. The analysis included 234 CEPs; 95 performed without Clarity and 139 with Clarity. Practice patterns of operators during procedures with and without Clarity were not significantly different. For all cases, procedure radiation dose to the patient and the primary and assistant operators were significantly decreased in the Clarity group by 60% compared with the non-Clarity group. By procedure type, fluorography dose rates decreased from 44% for fenestrated endovascular repair and up to 70% with lower extremity interventions. Fluoroscopy dose rates also significantly decreased, from about 37% to 47%, depending on procedure type.

194]

Kirkwood ML, Guild JB, Arbique GM, et al. Surgeon Radiation Dose During Complex Endovascular Procedures. J Vasc Surg. 2015 Aug;62(2):457-463.

Abstract

Surgeon radiation dose during complex fluoroscopically guided interventions (FGIs) has not been well studied. We sought to characterize radiation exposure to surgeons during FGIs based on procedure type, operator position, level of operator training, upper vs lower body exposure, and addition of protective shielding. The mean operator effective dose for FEVARs was higher than for other case types (P < .03), 20 μSv at position A and 9 μSv at position B. For all case types, position A (9.0 μSv) and position D (20 μSv) received statistically higher effective doses than position B (4 μSv) or position C (0.4 μSv) (P < .001). However, the mean operator effective dose for position D was not statistically different from that for position A. The addition of the lead skirt significantly decreased the lower body dose (33 ± 3.4 μSv to 6.3 ± 3.3 μSv) but not the upper body dose (6.5 ± 3.3 μSv to 5.7 ± 2.2 μSv). Neither ceiling-mounted shielding nor level of fellow training affected operator dose.

195]

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.

Abstract

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.

196]

Kleemann T, Brachmann J, Lewalter T, et al. Development of radiation exposure in patients undergoing pulmonary vein isolation in Germany between 2007 and 2014: great potential to minimize radiation dosage. Clin Res Cardiol. 2016 Oct;105(10):858-64.

CATEGORIES:

Abstract

The aim of this study was to analyze the radiation usage in patients undergoing pulmonary vein isolation (PVI) in Germany and to evaluate the possibility to reduce radiation dose. A total of 6617 patients with atrial fibrillation (AF) from the German ablation registry and the FREEZEplus registry (control group), who underwent first PVI between 2007 and 2014, were analyzed. In the second step, the effect of optimized conventional fluoroscopy and optimized 3D mapping use was evaluated in 526 consecutive patients with AF who underwent first PVI at the Klinikum Ludwigshafen (optimized group) between 2007 and 2014.

197]

Klein LW, Maroney J. Optimizing Operator Protection By Proper Radiation Shield Positioning In The Interventional Cardiology Suite. JACC Cardiovasc Interv. 2011 Oct;4(10):1140-1141.

CATEGORIES:

Abstract

Interventional cardiologists are keenly aware of the “as low as reasonably achievable” principle governing patient radiation exposure in the interventional laboratory. Shielding of the operator from exposure to the scatter radiation must be optimized. The most advantageous shield positioning can have a greater than 4-fold relative reduction in scatter radiation exposure; thus, it should be done even when inconvenient. Learning to coordinate multiple shields should be among the fundamental principles taught in every interventional cardiology training program.

198]

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.

Abstract

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.

199]

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.

Abstract

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).

200]

Klepanec A, Salat D, Harsany J, et al. Neurointerventionalist and Patient Radiation Doses in Endovascular Treatment of Acute Ischemic Stroke. Cardiovasc Intervent Radiol. 2020 Apr;43(4):604-612.

CATEGORIES:

Abstract

From October 2017 to January 2019, we prospectively collected patient radiation data and neurointerventionalist data from real-time dosimetry from all consecutive thrombectomies. Multivariate analysis was performed to analyze patient total dose area product (DAP) and neurointerventionalist dose variability in terms of clinical characteristics and the technical parameters of thrombectomies. Local dose reference levels (RL) were derived as the 75th percentile of the patient dose distributions.

201]

Knecht S, Sticherling C, Reichlin T, et al. Effective Reduction Of Fluoroscopy Duration By Using An Advanced Electroanatomic-Mapping System And A Standardized Procedural Protocol For Ablation Of Atrial Fibrillation: ‘The Unleaded Study’. Europace. 2015 Nov;17(11): 1694-1699.

Abstract

The aim of this study was to determine whether fluoroscopy-free mapping and ablation using a standardized procedural protocol is feasible in patients undergoing pulmonary vein isolation (PVI). The main outcome measures were the feasibility of fluoroscopy-free mapping and ablation, total fluoroscopy time, total dose area product (DAP), and procedure time.

202]

Koca S, Pac FA, Eris D, et al. Electroanatomic mapping-guided pediatric catheter ablation with limited/zero fluoroscopy. Anatol J of Cardiol. 2018 Sep;20(3):159-164.

Abstract

The use of fluoroscopy in pediatric catheter ablation has decreased because of mapping systems. In this study, we present the efficiency and reliability of the electroanatomic mapping system in nonfluoroscopic pediatric catheter ablation.

203]

Kohlbrenner R, Lehrman ED, Taylor AG, et al. Operator Dose Reduction during Transjugular Liver Biopsy Using a Radiation-Attenuating Drape: A Prospective, Randomized Study. J Vasc Interv Radiol. 2018 Sep;29(9):1248-1253.

CATEGORIES:

Abstract

To assess the effectiveness of disposable radiation-absorbing surgical drapes on operator radiation dose during transjugular liver biopsy (TJLB). This dual-arm prospective, randomized study was conducted between May 2017 and January 2018 at a single institution. TJLB procedures (N = 62; patient age range, 19-80 y) were assigned at a 1:1 ratio to the use of radiation-absorbing surgical drapes or standard surgical draping.

204]

Konieczny MR, Krauspe R. Navigation Versus Fluoroscopy in Multilevel MIS Pedicle Screw Insertion: Separate Analysis of Exposure to Radiation of the Surgeon and of the Patients. Clin Spine Surg. 2019 Jun;32(5):E258-E265.

CATEGORIES:

Abstract

To analyze exposure to radiation of the surgeon and-separately-of patients in minimally invasive surgery (MIS) of multilevel posterior stabilization by percutaneous pedicle screw insertion guided by navigation (PIN) versus percutaneous pedicle screw insertion guided by fluoroscopy (PIF).

205]

Korir GK, Ochieng BO, Wambani JS, et al. Radiation exposure in interventional procedures. Radiat Prot Dosimetry. 2012 Dec;152(4):339-44.

CATEGORIES:

Abstract

The aim of this study was to estimate radiation doses patients and staff are exposed to during interventional procedures (IPs), compare them with the international diagnostic reference levels and to develop initial National Diagnostic Reference Levels. The IP survey was undertaken as the initial task of which, retrospective data were collected from the only four Kenyan hospitals carrying out interventional radiology and cardiology procedures at the time of the study. Real-time measurement of radiation dose to patients and staff during these procedures was done. To the patients, kerma-area product (KAP) and fluoroscopy time measurements were done using an in-built KAP meter, while peak skin dose (PSD) was measured using slow Extended Dose Range (EDR2(®)) radiographic films. The staff occupational doses were measured using individual thermoluminescence dosemeters.

206]

Kosaka H, Monzen H, Matsumoto K, et al. Reduction of Operator Hand Exposure in Interventional Radiology With a Novel Finger Sack Using Tungsten-containing Rubber. Health Phys. 2019 May;116(5):625-630.

CATEGORIES:

Abstract

The purpose of this study was to evaluate the x-ray shielding ability of a novel tungsten-particle-containing rubber-based finger sack for use in interventional radiology. Shielding rates for the air kerma (mGy m) were measured using a semiconductor dosimeter with and without the finger sack and commercial lead gloves, at a 20 cm distance from the field of view. A C-arm digital angiography system was used with x-ray tube voltages of 60, 80, 100, and 120 kVp. In addition, the 70 μm dose equivalent to the operator’s finger was measured using fluorescent glass dosimeters with and without the finger sack during interventional radiology examinations.

207]

Kostakou PM, Damaskos DS, Dagre AG, et al. A safety radiation marker in the cardiac catheterization lab. Acta Cardiol. 2016 Apr;71(2):145-50.

CATEGORIES:

Abstract

The purpose of this study was to calculate the radiation exposure in association with the radiation absorbed by interventional cardiologists, in order to estimate a safety radiation marker in the catheterization laboratory.

208]

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.

Abstract

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.

209]

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 … Continue reading 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.

Abstract

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.

210]

Kuon E, Empen K, Weitmann K, et al. Long-Term Efficacy Of A Mini-Course In Radiation-Reducing Techniques In Invasive Cardiology. Rofo. 2013 Aug;185(8):720-725.

Abstract

To validate the long-term efficacy of a 90-min. educational mini-course in less-irradiating cardiac interventional techniques. The median patient DAP for periods I, II and III was 31.4, 15.8 and 8.5 Gy × cm2, respectively. The long-term effect was related to shorter median fluoroscopy times (180, 172, and 120 s), shorter (57, 52, and 45) and fewer (12, 12, and 10) radiographic runs, consistent collimation and restriction to an adequate image quality. Both radiographic DAP/frame (28.7, 17.0, and 18.4 mGy × cm2) and fluoroscopic DAP/second (45.7, 24.2, and 10.0 mGy × cm2) decreased significantly.

211]

Kuon E, Felix SB, Weitmann K, et al. ECG-gated coronary angiography enables submillisievert imaging in invasive cardiology. Herz. 2015 May;40 Suppl 3:247-53.

CATEGORIES:

Abstract

We investigated the feasibility of prospective electrocardiogram (ECG)-gated coronary angiography (CA)-a novel technique in invasive cardiology-with respect to possible reduction in irradiation effects. Instead of universally fix-rated radiographic acquisition within 7.5-15 frames/s, one single frame/heartbeat was triggered toward the diastolic moment immediately before atrial contraction (77 % of ECG-RR interval) most likely to provide motion-free and hence optimized resolution of the coronary tree. For 200 patients (body mass index 27.8 kg/m(2), age 67.5 years, male 55 %, 68 bpm) undergoing ECG-gated CA, we measured various median (interquartile range) parameters for radiation exposure.

212]

Kuon E, Weitmann K, Hoffmann W, et al. Efficacy Of A Minicourse In Radiation-Reducing Techniques In Invasive Cardiology. JACC Cardiovasc Interv. 2014 Apr;7(4):382-390.

Abstract

Our goal was to validate an educational 90-min minicourse in lower-irradiating cardiac invasive techniques. A total of 154 cardiologists attended the minicourse and achieved significant (p < 0.001) decrease in patients' median overall DAP (–48.4%), from baseline 26.5 to 13.7 Gy × cm2. They reduced fluoroscopy times (–20.8%), radiographic runs (–9.1%), frames/run (–18.6%) and frames (–29.6%), and both radiographic DAP/frame (–27.4%) and fluoroscopic DAP/s (–39.3%), which indicate improved collimation, reduced-irradiation angulations, or adequate image quality.

213]

Kuon E, Weitmann K, Hoffmann W, et al. Multicenter long-term validation of a minicourse in radiation-reducing techniques in the catheterization laboratory. Am J Cardiol. 2015 Feb 1;115(3):367-73.

CATEGORIES:

Abstract

We aimed to investigate, in a multicenter field study, the long-term efficacy of an educational 90-minute workshop in cardiac invasive techniques with reduced irradiation. Before and at a median period of 2.5 months and 2.0 years after the minicourse (periods I, II, and III, respectively) at 5 German cardiac centers, 18 interventionalists documented various radiation parameters for 10 coronary angiographies.

214]

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.

Abstract

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 %).

215]

Kwartowitz DM, Mefleh FN, Baker GH. Toward computer-assisted image-guided congenital heart defect repair: an initial phantom analysis. Int J Comput Assist Radiol Surg. 2017 Oct;12(10):1839-1844.

CATEGORIES:

Abstract

Cardiac catheterizations rely heavily on fluoroscopic imaging exposing both patient and clinician to ionizing radiation. An image-guided surgery system capable of facilitating cardiac catheterizations was developed and tested to evaluate dose reduction.

216]

Lalys F, Favre K, Villena A, et al. A Hybrid Image Fusion System For Endovascular Interventions Of Peripheral Artery Disease. Int J Comput Assist Radiol Surg. 2018 Jul;13(7): 997-1007.

CATEGORIES:

Abstract

This paper presents a novel hybrid image fusion system for endovascular intervention of PAD. We present two different roadmapping methods from intra- and pre-interventional imaging that can be used either simultaneously or independently, constituting the navigation system

217]

Larsen TR, Saini A, Moore J, et al. Fluoroscopy reduction during device implantation by using three-dimensional navigation. A single-center experience. J Cardiovasc Electrophysiol. 2019;30:2027-2033.

CATEGORIES:

Abstract

The use of nonfluoroscopic three-dimensional electroanatomic mapping (3DM) systems reduces radiation exposure during ablation procedures. In this study, we sought to determine the value of 3DM during routine device implant procedures. Seventy nonselected patients underwent implantation of a single chamber, dual chamber, or biventricular device guided by Ensite (Abbott Laboratories) to limit fluoroscopy use and compared with 70 consecutive patients, who underwent matching procedures with standard fluoroscopy use (FL) in the period immediately preceding the use of 3DM.

218]

Lee JH, Kim J, Kim M, et al. Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation: A comparison of 2 versus 4 frame rate. Medicine (Baltimore). 2017 Jun;96(24):e7200.

Abstract

We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF. The 4-FPS group showed higher median DAP (599.9 cGy cm2; interquartile range [IR], 371.4–1337.5 cGy cm2 vs. 392.0 cGy cm2; IR, 289.7–591.4 cGy cm2; P < .01), longer median fluoroscopic time (24.4 min; IR, 17.5–34.9 min vs. 15.1 min; IR, 10.7–20.1 min; P < .01), and higher median ED (1.1 mSv; IR, 0.7–2.5 mSv vs. 0.7 mSv; IR, 0.6–1.1 mSv; P < .01) compared with the 2-FPS group.

219]

Lee K, Lee KM, Park MS, et al. Measurements of surgeons’ exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy. Spine (Phila Pa 1976). 2012 Jun 15;37(14):1240-4.

CATEGORIES:

Abstract

This study was performed to measure the equivalent scattered radiation dose delivered to susceptible organs while simulating orthopaedic surgery using conventional and mini C-arm fluoroscopy. In addition, shielding effects on the thyroid, thymus, and gonad, and the direct exposure delivered to the patient’s hands were also compared. A conventional and mini C-arms were installed in an operating room, and a hand and an operator phantom were used to simulate a patient’s hand and a surgeon. Photoluminescence dosimeters were used to measure the equivalent dose by scattered radiation arriving at the thyroid, thymus, and gonad on a whole-body phantom in the position of the surgeon.

220]

Lee YS, Lee HK, Cho JH, Kim HG. Analysis of radiation risk to patients from intra-operative use of the mobile X-ray system (C-arm). J Res Med Sci. 2015 Jan;20(1):7-12.

Abstract

The aim of this study was to investigate clinical applications of mobile C-arms and consequent radiation risk, to increase medical attention on radiation protection, and to provide basic data for safe radiation use in the operating room. Orthopedic surgery was the most frequent with 165 cases (44.1%). The highest DAP value and effective dose were found in liver transplant among surgical specialty fields. The highest DAP value and effective dose were observed in intra-operative mesenteric portography among types of surgery.

221]

Lee, B., Kim, M., Eum, D. et al. The radiation environment of anaesthesiologists in the endoscopic retrograde cholangiopancreatography room. Sci Rep. 2019 Jun 24;9(1): 9124.

CATEGORIES:

Abstract

Therefore, we aimed to investigate the radiation environment generated by fluoroscopic endoscopic retrograde cholangiopancreatography (ERCP) and the radiation exposure of anaesthesiologists.

222]

Lehrmann H, Jadidi AS, Minners J, et al. Important Reduction Of The Radiation Dose For Pulmonary Vein Isolation Using A Multimodal Approach. Europace. 2018 Feb 1;20(2): 279-287.

Abstract

The aim of our study was to reduce radiation exposure during these procedures to a critical amount without compromising patient safety.

223]

Leon S. Assessment Of Volumetric Absorbed Dose For Mobile Fluoroscopic 3D Image Acquisition. J Appl Clin Med Phys. 2017 Jul;18(4):230-236.

CATEGORIES:

Abstract

The purpose of this work was to explore the impact of these factors (c-arm unit making 3D resconstruction images) on the volumetric dose calculation and to provide practical recommendations for clinical physicists assessing dose from these units using commonly available equipment.

224]

Leyton F, Nogueira MS, Gubolino LA, et al. Correlation Between Scatter Radiation Dose At Height Of Operator’s Eye And Dose To Patient For Different Angiographic Projections. Appl Radiat Isot. 2016 Nov;117:100-105.

CATEGORIES:

Abstract

The aim of this paper is to report scattered radiation doses at the height of the operator’s eye in an interventional cardiology facility without considering radiation protection devices and to correlate these values with different angiographic projections and operational modes.

225]

Lim PCY,Toh JJH, Loh JKSY, et al. Remote Magnetic Catheter Navigation Versus Conventional Ablation In Atrial Fibrillation Ablation: Fluoroscopy Reduction. J Arrhythm. 2017 Jun;33(3):167-171.

Abstract

The primary objective of this study was to compare fluoroscopy and total procedural times between RMN and conventional manual (MAN) ablation of atrial fibrillation. Fluoroscopy time was significantly shorter in the RMN group than the MAN group (53.5±30.1 vs 68.1±27.6 min, respectively; p<0.01); however, the total procedural time was longer in the RMN group (280.2±74.4 min vs 213.1±64.75, respectively; p>0.001). Further subgroup analysis of the most recent 50 ablations each from the RMN and MAN groups, to attenuate the RMN learning curve effect, showed an even greater difference in fluoroscopy time (RMN vs MAN: 53.5±30.1 vs 68.1±27.6 min), though a consistently longer procedure time with RMN (249.5±65.5 vs 186.3±65.6 min, respectively). The acute procedural success rate was comparable between the groups (98.6% vs 95.6%, respectively; p=0.07).

226]

Lim YH, Lee Y, Shin J, et al. Comparisons of Clinical and Procedural Outcomes Between Transradial and Transfemoral Approaches in Percutaneous Coronary Intervention (from the Korean Transradial Intervention Prospective Registry). Am J Cardiol. 2016 Apr 15;117(8):1272-81.

CATEGORIES:

Abstract

As few studies have reported the impact of transradial interventions (TRIs) versus transfemoral interventions (TFIs) on percutaneous coronary interventions using real-world registry data, we compared the clinical and procedural outcomes between TRIs and TFIs in the Korean Transradial Intervention Prospective Registry. Patients undergoing percutaneous coronary interventions were consecutively registered from February 2014 to July 2014 in this multicenter registry. Composite events were evaluated for all-cause deaths, nonfatal myocardial infarctions, and repeat revascularizations within 30 days. Nonlesion complications included access site complications and bleeding events.

227]

Lin PJP, Schueler BA, Balter S, et al. Accuracy And Calibration Of Integrated Radiation Output Indicators In Diagnostic Radiology: A Report Of The AAPM Imaging Physics Committee Task Group 190. Med Phys. 2015 Dec;42(12):6815-29.

CATEGORIES:

Abstract

The charge of TG 190 (Accuracy and Calibration of Integrated Radiation Output Indicators in Diagnostic Radiology) has also been realigned to investigate the “Accuracy and Calibration of Integrated Radiation Output Indicators” which is reflected in the title of the task group, to include situations where the KAP may be acquired with or without the presence of a physical “meter.” To accomplish this goal, validation test protocols were developed to compare the displayed radiation output value to an external measurement. These test protocols were applied to a number of clinical systems to collect information on the accuracy of dose display values in the field.

228]

Liu H, Jin Z, Jing L. Comparison Of Radiation Dose To Operator Between Transradial And Transfemoral Coronary Angiography With Optimised Radiation Protection: A Phantom Study. Radiat Prot Dosimetry. 2013 Mar;158(4) 412-420.

CATEGORIES:

Abstract

This study used an anthropomorphic phantom to simulate transradial and transfemoral coronary angiography with optimised radiation protection conditions. Compared with the femoral route, the radial route was associated with a dose decrease of 15 % at the operator’s chest level with optimised radiation shielding. However, radiation exposure to the operator’s hand remained significantly higher when applying radial access even with collective protective equipment used (bya factor of 2).

229]

Liu X, Palmer J. Outcomes of 200 consecutive, fluoroless atrial fibrillation ablations using a new technique. Pacing Clin Electrophysiol. 2018 Nov;41(11):1404-1411.

CATEGORIES:

Abstract

A technique was developed to eliminate radiation exposure for routine atrial fibrillation (AF) ablation, to simplify the procedure and to achieve cost effectiveness. We here report the outcomes of this approach. Two hundred consecutive AF ablations (55% paroxysmal) were performed by a single operator. Pulmonary vein isolation (PVI) was achieved by antral ablation without left atrial anatomic mapping, guided by contact force sensing and intracardiac echocardiogram (ICE). All ablations were performed using three ipsilateral 8 French catheters (ICE, Lasso, and ablation).

230]

Lo N, Gutierrez JA, Swaminathan RV. Robotic-Assisted Percutaneous Coronary Intervention. Curr Treat Options Cardiovasc Med. 2018 Feb;20(2):14.

Abstract

The goal of this review is to describe the benefits and limitations of robotic-assisted percutaneous coronary intervention (PCI), the most important and recent clinical data, and the future applications as robotic technology continues to develop.

231]

Lo TS, Ratib K, Chong AY, et al. Impact of access site selection and operator expertise on radiation exposure; a controlled prospective study. Am Heart J. 2012 Oct;164(4):455-61.

CATEGORIES:

Abstract

Published data relating to arterial access site selection and radiation exposure during coronary procedures suggest radial access may lead to increased radiation exposure, but this is based on poorly controlled studies. We sought to measure radiation exposure to patients and operators during elective coronary angiography (CA) according to access site, with other procedure related variables controlled for. We also investigated the specific effect of operator expertise in relation to radiation exposure.

232]

Loomba RS, Rios R, Buelow M, et al. Comparison Of Contrast Volume, Radiation Dose, Fluoroscopy Time, And Procedure Time In Previously Published Studies Of Rotational Versus Conventional Coronary Angiography. Am J Cardiol. 2015

Abstract

This study compares procedural characteristics of conventional coronary angiography and rotational coronary angiography.

233]

Maccagni D, Benincasa S, Bellini B, et al. Noise reduction technology reduces radiation dose in chronic total occlusions percutaneous coronary intervention: a propensity score-matched analysis. Int J Cardiovasc Imaging. 2018 Aug;34(8):1185-1192.

CATEGORIES:

Abstract

Chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is associated with high radiation dose. Our study aim was to evaluate the impact of the implementation of a noise reduction technology (NRT) on patient radiation dose during CTO PCI. A total of 187 CTO PCIs performed between February 2016 and May 2017 were analyzed according to the angiographic systems utilized: Standard (n = 60) versus NRT (n = 127). Propensity score matching (PSM) was performed to control for differences in baseline characteristics. Primary endpoints were Cumulative Air Kerma at Interventional Reference Point (AK at IRP), which correlates with patient’s tissue reactions; and Kerma Area Product (KAP), a surrogate measure of patient’s risk of stochastic radiation effects.

234]

Maccagni D, Candilio L, Latib A, et al. Implementation of a Low Frame-Rate Protocol and Noise-Reduction Technology to Minimize Radiation Dose in Transcatheter Aortic Valve Replacement. J Invasive Cardiol. 2018 May;30(5):169-175.

CATEGORIES:

Abstract

Limiting radiation exposure is necessary in radiological procedures. This study evaluates the impact of a radiological low frame-rate protocol in a standard angiographic system and the implementation of a noise-reduction technology (NRT) on patient radiation exposure during transcatheter aortic valve replacement (TAVR).

235]

Maccagni D, Godino C, Latib A, et al. Analysis of a Low Dose Protocol to Reduce Patient Radiation Exposure During Percutaneous Coronary Interventions. Am J Cardiol. 2017 Jan 15;119(2):203-209.

CATEGORIES:

Abstract

The purpose of this study was to evaluate the effectiveness and impact of a radiological low dose protocol (LDP) in terms of reduction in patient radiation exposure during percutaneous coronary interventions (PCIs). From November 2014 to October 2015, 906 consecutive patients who underwent PCI were evaluated. Of these, 571 patients (63%) were treated with the standard dose protocol (SDP) of 15 frames per second for cine acquisition and standard settings for fluoroscopy, and 335 patients (37%) with the LDP of 7.5 frames per second for cine acquisition and low-dose settings for fluoroscopy.

236]

Maccia C, Malchair F, Gobert I, et al. Assessment of Local Dose Reference Values for Recanalization of Chronic Total Occlusions and Other Occlusions in a High-Volume Catheterization Center. Am J Cardiol. 2015 Oct 15;116(8):1179-84.

CATEGORIES:

Abstract

The increasing number and complexity of these procedures have led to a higher number of patients at risk for tissue reactions like skin injuries. Monitoring of their dose indicators is essential in recognizing these patients. The aim of this work was to determine local diagnostic reference levels (DRLs) for recanalization of chronic total occlusion (CTO) and other occlusions procedures. All data from patients who underwent cardiac procedures were reviewed and classified according to their complexity. Dose indicators such as fluoroscopy time (FT), dose area product (DAP), and air kerma at patient entrance reference point (AKr) were recorded. Correlations with patient’s body mass index, operators, procedure strategy, and complexity were studied.

237]

Machado R, Ferreira VMD, Loureiro L, et al. Radiation Exposure In Endovascular Infra-Renal Aortic Aneurysm Repair And Factors That Influence It. Braz J Cardiovasc Surg. Nov-Dec 2016;31(6):415-421.

Abstract

The endovascular repair of aortic abdominal aneurysms exposes the patients and surgical team to ionizing radiation with risk of direct tissue damage and induction of gene mutation. This study aims to describe our standard of radiation exposure in endovascular aortic aneurysm repair and the factors that influence it.

238]

Madder RD, VanOosterhout S, Jacoby ME, et al. Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the patient: an early exploration into the feasibility of telestenting (the REMOTE-PCI study). EuroIntervention. 2017 Jan 20;12(13):1569-1576.

CATEGORIES:

Abstract

The present study explores the feasibility of telestenting, wherein a physician operator performs stenting on a patient in a separate physical location using a combination of robotics and telecommunications. In addition to assessing the feasibility of performing telestenting in a room separate from the interventional laboratory, REMOTE-PCI compares secondary endpoints, including air kerma, to a propensity-matched control group.

239]

Madder RD, VanOosterhout S, Mulder A, et al. Impact of Robotics and a Suspended Lead Suit on Physician Radiation Exposure during Percutaneous Coronary Intervention. Cardiovasc Revasc Med. Apr-May 2017;18(3):190-196.

CATEGORIES:

Abstract

Reports of left-sided brain malignancies among interventional cardiologists have heightened concerns regarding physician radiation exposure. This study evaluated the impact of a suspended lead suit and robotic system on physician radiation exposure during percutaneous coronary intervention (PCI).

240]

Mahesh M, Morin RL. Radiation Exposure And Patient Dose In Cardiology. J Am Coll Radiol. 2017 Dec;14(12):1581-1582.

CATEGORIES:

Abstract

Q: How have radiation exposure and patient dose changed in cardiology over the past decade? A: The short answer is that both have decreased.

241]

Mahmud E, Naghi J, Ang L, et al. Demonstration of the Safety and Feasibility of Robotically Assisted Percutaneous Coronary Intervention in Complex Coronary Lesions: Results of the CORA-PCI Study (Complex Robotically Assisted Percutaneous Coronary Intervention). JACC Cardiovasc Interv. 2017 Jul 10;10(13):1320-1327.

CATEGORIES:

Abstract

The aims of this study were to evaluate the feasibility and technical success of robotically assisted percutaneous coronary intervention (R-PCI) for the treatment of coronary artery disease (CAD) in clinical practice, especially in complex lesions, and to determine the safety and clinical success of R-PCI compared with manual percutaneous coronary intervention (M-PCI).

242]

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.

Abstract

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.

243]

Maino P, Presilla S, Colli Franzone PA, et al. Radiation Dose Exposure for Lumbar Transforaminal Epidural Steroid Injections and Facet Joint Blocks Under CT vs. Fluoroscopic Guidance. Pain Pract. 2018 Jul;18(6):798-804.

CATEGORIES:

Abstract

Transforaminal epidural steroid injections (TFESIs) and facet joint blocks can be performed under fluoroscopy or computed tomography (CT) guidance. The purpose of this retrospective cohort study was to compare patient radiation dose for lumbar TFESIs and facet joint blocks under CT guidance vs. fluoroscopic guidance.

244]

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

Abstract

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.

245]

Mangiarotti M, D’Ercole L, Quaretti P, et al. EVALUATION OF AN ACTIVE PERSONAL DOSIMETRY SYSTEM IN INTERVENTIONAL RADIOLOGY AND NEURORADIOLOGY: PRELIMINARY RESULTS. Radiat Prot Dosimetry. 2016 Dec;172(4):483-487.

CATEGORIES:

Abstract

Active personal dosimeters (APD) supply real-time data on radiation dose rates and equivalent doses, enabling reduction of operator exposure to radiation in diagnostic and surgical procedures. Data from the use of the Raysafe i2 APD system in an angiography room are reported. Preliminary characterisation of the APD system was first carried out in terms of angular dependence and of Hp(10) response during the simulation of five typical surgical protocols. Reference measurements, simultaneously obtained from TLDs, were used to obtain a correction factor. APD data for patients and for primary and secondary operators were then recorded over 52 surgical procedures. The correlation between kerma air product (KAP) and reference point air kerma (Kar) and operator dose as a function of position with respect to the source of radiation is reported. The data indicate that the APD system could help operators to optimise behaviours and use of room protection to effectively minimise radiation dose.

246]

Manu S, Suntharos P, Boyle GJ, et al. Radiation Reduction in the Pediatric Catheterization Laboratory Using a Novel Imaging System. J Invasive Cardiol. 2018 Jan;30(1):28-33.

CATEGORIES:

Abstract

Radiation dose was compared between two modern imaging systems with different x-ray tube technology (Megalix vs Gigalix) and detector type (amorphous vs crystalline silicon) at the same institution. Further reduction in radiation dose than currently reported may be achievable with advances in x-ray tube and detector technology.

247]

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.

Abstract

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.

248]

Marazziti D, Tomaiuolo F, Dell’Osso, et al. Neuropsychological testing in interventional cardiology staff after long-term exposure to ionizing radiation. J Int Neuropsychol Soc. 2015 Oct;21(9):670-6.

CATEGORIES:

Abstract

This study aimed at comparing neuropsychological test scores in 83 cardiologists and nurses (exposed group, EG) working in the cardiac catheterization laboratory, and 83 control participants (non exposed group, nEG), to explore possible cognitive impairments. The neuropsychological assessment was carried out by means of a battery called “Esame Neuropsicologico Breve.” EG participants showed significantly lower scores on the delayed recall, visual short-term memory, and semantic lexical access ability than the nEG ones. No dose response could be detected. EG participants showed lower memory and verbal fluency performances, as compared with nEG.

249]

Marazzitti D, Baroni S, Catena-Dell’Osso M, et al. Cognitive, psychological and psychiatric effects of ionizing radiation exposure. Curr Med Chem. 2012;19:1864-9.

Abstract

Radiation exposure leads to an increased risk for cancer and, possibly, additional ill-defined non-cancer risk, including atherosclerotic, cardiovascular, cerebro-vascular and neurodegenerative effects. Studies of brain irradiation in animals and humans provide evidence of apoptosis, neuro-inflammation, loss of oligo-dendrocytes precursors and myelin sheaths, and irreversible damage to the neural stem compartment with long-term impairment of adult neurogenesis. With the present paper we aim to present a comprehensive review on brain effects of radiation exposure, with a special focus on its impact on cognitive processes and psychological functions, as well as on their possible role in the pathophysiology of different psychiatric disorders.

250]

Marini M, Martin M, Ravanelli D, et al. Extensive Use Of 3D Nonfluoroscopic Mapping Systems For Reducing Radiation Exposure During Catheter Ablation Procedures: An Analysis Of 10 Years Of Activity. Biomed Res Intl. 2019 Mar 10;2019:1-10.

Abstract

The aim of this study was to evaluate the efficacy, safety, and long-term effect of the extended, routine use of nonfluoroscopic mapping systems (NMSs) for CA.

251]

Martin CJ. Radiation shielding for diagnostic radiology. Radiat Prot Dosimetry. 2015 Jul;165(1-4):376-81.

CATEGORIES:

Abstract

Scattered radiation makes up the majority of the stray radiation field around an X-ray unit. The scatter is linked to the amount of radiation incident on the patient. It can be estimated from quantities used to assess patient dose such as the kerma-area product, and factors have been established linking this to levels of scattered radiation for radiography and fluoroscopy. In radiography shielding against primary radiation is also needed, but in other modalities this is negligible, as the beam is intercepted by the image receptor. In the same way scatter from CT can be quantified in terms of dose-length product, but because of higher radiation levels, exposure to tertiary scatter from ceilings needs to be considered. Transmission requirements are determined from comparisons between calculated radiation levels and agreed dose criteria, taking into account the occupancy of adjacent areas. Thicknesses of shielding material required can then be calculated from simple equations.

252]

Masterson M, Cournane S, McWilliams N, et al. Relative response of dosimeters to variations in scattered X-ray energy spectra encountered in interventional radiology. Phys Med. 2019;67:141-147.

CATEGORIES:

Abstract

The new lower eye lens dose limit is of relevance in interventional radiology, where higher dose procedures result in increased scattered radiation to staff. The eye lens dose may be monitored using the directional dose equivalent at 3 mm depth, Hp(3), or through Hp(10) or Hp(0.07) measurements and using conversion factors. However, there are a considerable range of factors which contribute to measurement uncertainties, one of which is the incident photon energy. This study investigated the energy spectra of scattered radiation in interventional radiology, and the dosimetry accuracy of dosimeter types, evaluating their energy dependence.

253]

Maurel B, Hertault A, Salomon du Mont L, et al. A Multicenter Survey of Endovascular Theatre Equipment and Radiation Exposure in France during Iliac Procedures. Ann Vasc Surg. 2017 Apr;40:50-56.

CATEGORIES:

Abstract

The aim of this study is to evaluate radiation exposure, endovascular theatre equipment, and practices in France during iliac angioplasty. A prospective observational study was performed among vascular surgeons who attended a half day of radiation safety training in 2012 and 2015 and had to collect data on 3 patients undergoing iliac procedure. In 2012, 330 surgeons performed 899 procedures, compared with 114 surgeons and 338 procedures in 2015. Due to exclusions, 653 and 306 procedures were analyzed in 2012 and 2015, respectively. Endovascular environment, practices, anatomical characteristics, and radiation parameters were collected, analyzed, and compared generally and between the 2 groups.

254]

Maurel, Blandine et al. “A Prospective Observational Trial Of Fusion Imaging In Infrarenal Aneurysms”. Journal Of Vascular Surgery, vol 68, no. 6, 2018, pp. 1706-1713.e1. Elsevier BV, doi:10.1016/j.jvs.2018.04.015. Accessed 27 May 2020.

CATEGORIES:

Abstract

The aim of this study is to determine if radiation dose reduction would occur with the addition of fusion imaging in infrarenal repair in all imaging environments.

255]

Mayekar EM, Bayrak A, Shah S, Mejia A. Radiation Exposure to the Orthopaedic Surgeon and Efficacy of a Novel Radiation Attenuation Product. J Surg Orthop Adv. 2017 WINTER;26(4):246-249.

CATEGORIES:

Abstract

The purpose of this study was to examine the intraoperative radiation dosage to different body parts and to determine the effectiveness of a new lightweight radiation-attenuating fabric (XPF) versus lead, the current standard. For 51 cases involving fluoroscopy, one attending orthopaedic surgeon wore a set of three dosimeters at various locations. Per each set of three, one dosimeter was shielded with a swatch of XPF, one was placed underneath the lead apron, and one was left exposed.

256]

McArthur BA, Schueler BA, Howe BM, et al. Radiation Exposure during Fluoroscopic Guided Direct Anterior Approach for Total Hip Arthroplasty. J Arthroplasty. 2015 Sep;30(9):1565-8.

CATEGORIES:

Abstract

Fluoroscopic guidance is commonly utilized during direct anterior total hip arthroplasty (DA THA). The purpose of this study was to measure patient and surgeon exposure utilizing this technique. Fifty-one consecutive patients who underwent primary DA THA by a single surgeon were prospectively studied. Fluoroscopic guidance was utilized according to an established protocol. Dose-area product (DAP) (Gy-cm(2)) and fluoroscopy time were recorded for each case.

257]

McArthur N, Conlan DP, Crawford JR. Radiation exposure during scoliosis surgery: a prospective study. Spine J. 2015 Mar 2;15(3 Suppl):S33-6.

Abstract

To assess the radiation exposure in patients and surgeons during scoliosis surgery and estimate the increased cancer risk of both groups. Over a 6-month period, we conducted a prospective study to monitor the intraoperative radiation dose received by both patients and surgeons during scoliosis cases.

258]

McCauley MD, Patel N, Greenberg SJ, et al. Fluoroscopy-free Atrial Transseptal Puncture. Eur J Arrhythm Electrophysiol. Winter 2016;2(2): 57-61.

Abstract

Here, we describe a feasibility study of a zero-fluoroscopy transseptal puncture (ZFTSP) technique utilising electroanatomical mapping (EAM) and intracardiac echo (ICE) in a small case series of patients undergoing ablation for atrial fibrillation (AF). We then compare this technique to other established ZFTSP techniques for paroxysmal AF ablation.

259]

McNally MM, Scali ST, Feezor RJ, et al. Three-Dimensional Fusion Computed Tomography Decreases Radiation Exposure, Procedure Time, And Contrast Use During Fenestrated Endovascular Aortic Repair. J Vasc Surg. 2015 Feb;61(2):309-316.

CATEGORIES:

Abstract

The purpose of this analysis was to determine the effect of using intraoperative 3D fusion CT on the performance of fenestrated endovascular aortic repair (FEVAR). A total of 72 patients (41 before vs 31 after 3D fusion CT implementation) underwent FEVAR from September 2012 through March 2014. For two-vessel fenestrated endografts, there was a significant decrease in radiation exposure (3400 ± 1900 vs 1380 ± 520 mGy; P = .001), fluoroscopy time (63 ± 29 vs 41 ± 11 minutes; P = .02), and contrast usage (69 ± 16 vs 26 ± 8 mL; P = .0002) with intraoperative 3D fusion CT. Similarly, for combined three-vessel and four-vessel FEVAR, significantly decreased radiation exposure (5400 ± 2225 vs 2700 ± 1400 mGy; P < .0001), fluoroscopy time (89 ± 36 vs 64 ± 21 minutes; P = .02), contrast usage (90 ± 25 vs 39 ± 17 mL; P < .0001), and procedure time (330 ± 100 vs 230 ± 50 minutes; P = .002) was noted.

260]

McNeice AH, Brooks M, Hanratty CG, et al. A retrospective study of radiation dose measurements comparing different cath lab X-ray systems in a sample population of patients undergoing percutaneous coronary intervention for chronic total occlusions. Catheter Cardiovasc Interv. 2018 Sep 1;92(3):E254-E261.

CATEGORIES:

Abstract

A retrospective study was performed to investigate if the generation of X-ray system used was an independent factor for radiation dose in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The authors suspected progressive reductions in radiation doses for CTO PCI as newer X-ray systems were introduced into clinical practice.

261]

Merriam GR Jr, Worgul BV. Experimental radiation cataract–its clinical relevance. Bull N Y Acad Med. 1983 May59(4):372-92. 372-92.

CATEGORIES:

Abstract

Radiation cataract, a type of complicated cataract, has proved a useful model for studying the mechanisms involved in the development of senile opacities. The initial insult is to the lens epithelium with subsequent disorganization of the meridional rows and the appearance of the abnormal nucleated fibers (Wedl cells) posteriorly. Experimental studies involved in the formation of our present understanding of cataract development are detailed. Much remains to be done but it would appear that the opacification process is primarily the result of basic changes in the epithelial cells.

262]

Metaxas VI, Messaris GA, Gatzounis GD, et al. DO THE BMI AND SURGEON INFLUENCE THE PATIENT DOSE IN FLUOROSCOPICALLY GUIDED LUMBAR DISCECTOMY AND FUSION?☆. Radiat Prot Dosimetry. 2019 Dec 31;185(4):472-482.

CATEGORIES:

Abstract

A survey was conducted to evaluate the role of the surgeon and the patients’ body size, on patient radiation dose in fluoroscopically guided lumbar discectomy and fusion (LDF) procedures.

263]

Miller C, Kendrick D, Shevitz A, et al. Evaluating Strategies For Reducing Scattered Radiation In Fixed-Imaging Hybrid Operating Suites. J Vasc Surg. 2018 Apr;67(4):1227-1233.

Abstract

The purpose of this study was to evaluate the efficacy of two methods in reducing scattered radiation exposure.

264]

Miller D, Klein LW, Balter S, et al. Occupational Health Hazards in the Interventional Lab: Progress Report of the Multi-specialty Occupational Hazard Group, Journal of Vascular Interventional Radiology. 2010;21:1338-1341.

Abstract

The Multispecialty Occupational Health Group (MSOHG), formed in 2005, is an informal coalition of societies representing professionals who work in, or are concerned with, interventional fluoroscopy. The group’s long-term goals are to improve occupational health and operator and staff safety in the interventional laboratory while maintaining quality patient care and optimal use of the laboratory. MSOHG has conducted a dialogue with equipment manufacturers and has developed a list of specific objectives for research and development. The group has also represented the member societies in educating regulators, in educating interventionalists, and in fostering and collaborating on research into occupational health issues affecting interventionalists. Not least of the group’s accomplishments, as a result of their collaboration in MSOHG, the group’s members have developed a mutual respect that can serve as a basis for joint efforts in the future among interventionalists of different medical specialties.

265]

Miller DL, Hilohi CM, Spelic DC. Patient radiation doses in interventional cardiology in the U.S.: advisory data sets and possible initial values for U.S. reference levels. Med Phys. 2012 Oct;39(10):6276-86.

CATEGORIES:

Abstract

To determine patient radiation doses from interventional cardiology procedures in the U.S and to suggest possible initial values for U.S. benchmarks for patient radiation dose from selected interventional cardiology procedures [fluoroscopically guided diagnostic cardiac catheterization and percutaneous coronary intervention (PCI)].

266]

Miller DL, Vañó E, Bartal G, et al. Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cardiovasc Intervent Radiol. 2010 Apr;33(2):230–239.

Abstract

This guideline is intended to offer a basic review of the medical physics relevant to occupational radiation safety and to provide advice and guidance to interventional radiologists who perform procedures with the guidance of ionizing radiation and their staff. In this document, the emphasis is radiation protection during fluoroscopically guided procedures.

267]

Miller DL. Review Of Kerma-Area Product Effective Dose And Dose Conversion Coefficients For Non-Cardiac Interventional Fluoroscopy Procedures. Med Phys. 2020 Mar;47(3):975-982.

Abstract

To provide current data on average air kerma-area product (PKA) and effective dose (E) for noncardiac interventional fluoroscopy procedures and suggested values of dose coefficients (DCE) for conversion of PKA to estimates of effective dose.

268]

Miller TR, Jindal G, Krejza J, Gandhi D. Impact Of Endovascular Technique On Fluoroscopy Usage: Stent-Assisted Coiling Versus Flow Diversion For Paraclinoid Internal Carotid Artery Aneurysms. Neuroradiol J. 2014 Dec;27(6):725-731.

Abstract

The purpose of this study was to evaluate the impact of endovascular technique–flow diversion versus stent-assisted coiling (SAC) on fluoroscopy time in patients treated for wide-neck paraclinoid ICA aneurysms. Flow diversion was associated with a significant reduction in fluoroscopy time (52.0 minutes versus 77.4 minutes), and demonstrated a strong trend towards shorter total procedure time (172 minutes versus 202 minutes). Average patient radiation exposure as measured by DAP was lower in the flow diversion group, 13225 mGy(x)cm(2) versus 15124 mGy(x)cm(2), although this finding was not statistically significant. There was no significant difference in contrast usage between the two groups, 152 ml and 159 (flow diversion and SAC respectively). The rate of complete aneurysm occlusion was higher in the flow diversion group (80% versus 60%).

269]

Miraglia R, Gerasia R, Maruzzelli L, et al. Radiation Doses To Operators Performing Transjugular Intrahepatic Portosystemic Shunt Using A Flat-Panel Detector-Based System And Ultrasound Guidance For Portal Vein Targeting. Eur Radiol. 2017 May;27(5): 1783-1786.

Abstract

The aim of this study was to prospectively evaluate effective dose (E) of operators performing transjugular intrahepatic portosystemic shunts (TIPS) in a single centre. Mean E for the primary operator was 1.40 μSv (SD 2.68, median 0.42, range 0.12 – 12.18), for the assistant operator was 1.29μSv(SD 1.79, median0.40, range 0.10 – 4.89), for the anaesthesia nurse was 0.21 μSv (SD 0.67, median 0.10, range 0.03 – 3.99), for the radiographer was 0.42 μSv (SD0.71,median0.25, range 0.03–2.67). Mean patient DAP was 59.31 GyCm2 (SD 56.91, median 31.58, range 7.66 – 281.40); mean FT was 10.20 min (SD 7.40, median 10.40, range 3.8 – 31.8).

270]

Miraglia R, Maruzzelli L, Cortis K, et al. Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation. Cardiovasc Intervent Radiol. 2016 Feb;39(2):210-7.

CATEGORIES:

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) creation is considered as being one of the most complex procedures in abdominal interventional radiology. Our aim was twofold: quantification of TIPS-related patient radiation exposure in our center and identification of factors leading to reduced radiation exposure.

271]

Miwa Y, Ueda A, Komeda M, et al. Reducing radiation exposure during atrial fibrillation ablation using lectures to promote awareness. Open Heart 2019;6:e000982.

Abstract

Recently, concern has increased regarding the hazards of radiation exposure in patients and laboratory staff. Since the numbers of complex catheter ablations (CA) performed, duration of procedure times, and need for multiple sessions have increased, radiation exposure during each session needs to be minimised. Our study aimed to assess the impact of awareness on radiation exposure during CA for atrial fibrillation (AF).

272]

Mohapatra A, Greenberg RK, Mastracci TM, et al. Radiation Exposure To Operating Room Personnel And Patients During Endovascular Procedures. J Vasc Surg. 2013 Sep;58(3):702-709.

Abstract

To characterize radiation exposure to patients and operating room personnel during fluoroscopic procedures. The dosimeter on the anesthesia equipment received 143 μSv (38-247) more radiation per case than the average operator, and the scrub nurse and RT received 106 μSv (66-146) and 100 μSv (55-145) less, respectively.

273]

Monzen H, et al. A Novel Radiation Protection Device Based On Tungsten Functional Paper For Application In Interventional Radiology. J Appl Clin Med Phys. 2017 May;18(3):215-220.

Abstract

Tungsten functional paper (TFP ), which contains 80% tungsten by weight, has radiation‐shielding properties. We investigated the use of TFP for the protection of operators during interventional or therapeutic angiography.

274]

Moriña D, Grellier J, Carnicer A, et al. InterCardioRisk: a novel online tool for estimating doses of ionising radiation to occupationally-exposed medical staff and their associated health risks. J Radiol Prot. 2016 Sep;36(3):561-578.

Abstract

Those working in interventional cardiology and related medical procedures are potentially subject to considerable exposure to x-rays. Two types of tissue of particular concern that may receive considerable doses during such procedures are the lens of the eye and the brain. Ocular radiation exposure results in lens changes that, with time, may progress to partial or total lens opacification (cataracts). We present InterCardioRisk, a tool featuring an easy-to-use web interface that provides a general estimation of both cumulated absorbed doses experienced by medical staff exposed in the interventional cardiology setting and their estimated associated health risks.

275]

Morita S, Endo K, Suzaki S, et al. Reduction of Radiation Exposure Using Dynamic Trace Digital Angiography and Spot Fluoroscopy During Adrenal Venous Sampling. Cardiovasc Intervent Radiol. 2017 May;40(5):697-703.

CATEGORIES:

Abstract

To compare radiation exposure of adrenal venous sampling (AVS) using dynamic trace digital angiography (DTDA) and spot fluoroscopy with that using conventional methods.

276]

Morris PP, Geer CP, Singh J, et al. Radiation dose reduction during neuroendovascular procedures. J Neurointerv Surg. 2018 May;10(5):481-486.

CATEGORIES:

Abstract

To describe the impact of steps towards reduction of procedural doses of radiation during neuroendovascular procedures. Phantom exposures under controlled circumstances were performed using a Rando-Alderson adult-sized head phantom. Customized imaging protocols were devised for pediatric and adult imaging and implemented in clinical use. Outcome data for estimated skin doses (ESD) and dose-area product (DAP) following pediatric and adult diagnostic and interventional procedures over 4.5 years were analyzed retrospectively.

277]

Muniraj T, Asianian HR, Laine L, et al. Patient radiation dose reduction using an X-ray imaging noise reduction technology for cardiac angiography and intervention. Am J Gastroenterol. 2015 May;10(5):690-6.

CATEGORIES:

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with radiation exposure to the endoscopist and staff that may be significant in high-volume centers. We investigated whether a radiation-attenuating drape over the fluoroscopy image intensifier reduces radiation exposure during ERCP.

278]

National Council on Radiation Protection (NCRP) Report No. 168. Radiation dose management for fluoroscopically guided interventional procedures. July 2010.

CATEGORIES:

Abstract

279]

National Council on Radiation Protection and Measurements. CC 1: Radiation Protection Guidance For The United States. NCR. Bethesda, MD. June 2, 2015.

Abstract

New knowledge has been obtained on radiation effects at doses lower than apparent in 1993. A review of recent radiation epidemiologic studies by NCRP Scientific Committee SC 1-25 will address dose-response models in general, including threshold models, and their applicability to radiation protection guidance. The results of the SC 1-25 effort will be reflected in the Council Committee 1 (CC 1) report.

280]

National Research Council. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII – Phase 2 (2006).

CATEGORIES:

Abstract

281]

O’Connor U, Walsh C, Gallagher A, et al. Occupational Radiation Dose To Eyes From Interventional Radiology Procedures In Light Of The New Eye Lens Dose Limit From The International Commission On Radiological Protection. Br J Radiol. 2015 May;88(1049):20140627.

CATEGORIES:

Abstract

We aimed to obtain a reliable estimate of eye dose to IR operators. Based on their typical workloads, two of the four interventional radiologists would exceed the new ICRP dose limit with annual estimated doses of 31 and 45mSv to their left eye. These results are for an “unprotected” eye, and for IR staff who routinely wear lead glasses, the dose beneath the glasses is likely to be significantly lower. Staff eye dose normalized to patient kerma–area product and eye dose per procedure have been included in the analysis.

282]

O’Connor U, Gallagher A, Malone L, O’Reilly G. Occupational Radiation Dose To Eyes From Endoscopic Retrograde Cholangiopancreatography Procedures In Light Of The Revised Eye Lens Dose Limit From The International Commission On Radiological Protection. Br J Radiol. 2013 Feb;86(1022): 20120289.

CATEGORIES:

Abstract

The aim of this study was to measure occupational eye doses obtained from ERCP procedures. The mean equivalent dose to the lens of the eye of a gastroenterologist is 0.01 mSv per ERCP procedure with an undercouch X-ray tube and 0.09 mSv per ERCP procedure with an overcouch X-ray tube. Staff eye dose normalised to patient kerma area product is also presented.

283]

Ockert S, Heinrich M, Kaufmann T, et al. Endovascular Aortic Sealing With Nellix Reduces Intraoperative Radiation Dose When Compared To Endovascular Aortic Repair. J Vasc Surg. 2018 Apr;67(4):1068-1073.

CATEGORIES:

Abstract

To analyze radiation exposure during endovascular aortic sealing (EVAS) in comparison with standard endovascular aortic repair (EVAR) in clinical practice. The effective dose was significantly reduced in the EVAS group (3.72 mSv) compared with the group treated with standard EVAR (6.8 mSv; P ≤ .001). The cumulative air kerma was also lowered in EVAS (67.65 mGy vs 139 mGy in EVAR; P ≤ .001). FT for the entire group was 13 minutes and was shorter (P < .001) for EVAS (9 minutes) in comparison with EVAR (19 minutes). The dose area product for the entire cohort was 16.95 Gy.cm2 and was lower during EVAS (12.4 Gy.cm2) than during EVAR (22.6 Gy.cm2; P < .001).

284]

Oliveira da Silva MW, Canevaro LV, Hunt J, Rodrigues BBD. COMPARING MEASURED AND CALCULATED DOSES IN INTERVENTIONAL CARDIOLOGY PROCEDURES. Radiat Prot Dosimetry. 2017 Nov 1;176(4):439-443.

CATEGORIES:

Abstract

In this paper, detailed irradiation scenarios were simulated mathematically and the resulting dose estimates were compared with real measurements made previously under very similar irradiation conditions and geometries. The real measurements and the calculated doses were carried out using or simulating an interventional cardiology system with a flat monoplane detector installed in a dedicated room with an Alderson phantom placed on the procedure table.

285]

Ordiales JM, Nogales JM, Sanchez-Casaneuva R, et al. Reduction Of Occupational Radiation Dose In Staff At The Cardiac Catheterisation Laboratory By Protective Material Placed On The Patient. Radiat Protect Dosimetry. 2015 Jul;165(1-4):272-275.

CATEGORIES:

Abstract

In this work, the effectiveness of a shielding drape above the patient in different geometric shapes for a standard procedure in interventional cardiology was evaluated. The average dose rates for the experiment were within the range of 11–153 mSv h21 for the dosemeter positions evaluated.

286]

Ordiales JM, Nogales JM, Vano E, et al. Occupational dose reduction in cardiac catheterisation laboratory: a randomised trial using a shield drape placed on the patient. Radiat Prot Dosimetry. 2017 Apr 25;174(2):255-261.

CATEGORIES:

Abstract

The aim of this study was to evaluate the occupational radiation dose in interventional cardiology by using a shielding drape on the patient. A random study with and without the protective material was conducted.

287]

Ordiales JM, Vano E, Nogales JM, et al. Optimisation of imaging protocols in interventional cardiology: impact on patient doses. J Radiol Prot. 2017 Sep;37(3):684-696.

CATEGORIES:

Abstract

The purpose of this work is to evaluate the impact of the imaging protocol as part of the optimisation of patient doses in interventional cardiology. This paper reports the results of an initial study to refine the existing fluoroscopy and cine settings, evaluates a new imaging protocol by measuring the image quality and phantom entrance air kerma values, and tests the clinical implementation of the new protocol in terms of the reduction in patient doses and the impact on clinical images. The initial study developed a new fluoroscopy mode using 7.5 frames s-1 (instead of the previous 15 frames s-1) with a similar dose/frame and a reduction of approximately 26% in dose/frame for the existing standard cine mode.

288]

Osei B, Xu L, Johnston A, et al. Retrospective study of patients radiation dose during cardiac catheterization procedures. Br J Radiol. 2019 Jul;92(1099):20181021.

CATEGORIES:

Abstract

This study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory.

289]

Osherov AB, Bruoha S, Farkash AL, et al. Reduction In Operator Radiation Exposure During Transradial Coronary Procedures Using A Simple Lead Rectangle. Heliyon. 2017 Feb 24;3(2):e00254.

Abstract

We evaluated the efficacy of a lead-attenuator in reducing radiation exposure during transradial PCI. In the attenuator group patients were relatively older with a higher prevalence of peripheral vascular disease (67.9 vs 58.7 p = 0.0292 and 12% vs 7.6% p < 0.001 respectively). Despite similar average fluoroscopy times and average examination doses, the total radiation exposure to the operator, at the thyroid level, was significantly lower when the lead-attenuator was utilized (20.2% p < 0.0001) as compared to the control group. Amongst the 26 patients assigned to the lead-attenuator, there was a significant reduction in measured radiation of 94.5% (p < 0.0001), above as compared to underneath the lead attenuator.

290]

Oude VB, Molenaar M, Reinhart Dorman HG, et al. Use of three-dimensional computed tomography overlay for real-time cryoballoon ablation in atrial fibrillation reduces radiation dose and contrast dye. Neth Heart J. 2017 Jun;25(6):388–393.

Abstract

To evaluate the benefits of 3D CT overlay during cryoballoon ablation, we studied the use of 3D CT overlay versus contrast pulmonary venography in a randomised fashion in patients with paroxysmal atrial fibrillation undergoing cryoballoon PV isolation. Patients in the contrast pulmonary venography group received significantly more contrast agent (77.1 ± 21.2 cc vs 40.1 ± 17.6 cc, p < 0.001) and radiation (43.0 ± 21.9 Gy.cm2 vs 28.41 ± 11.7 Gy.cm2, p = 0.04) than subjects in the 3D CT overlay group. There was no difference in total procedure time, fluoroscopy time and the amount of cryoapplications between the two groups.

291]

Overtchouk P, Sudre A, Delhaye C, et al. Advanced image processing with fusion and calcification enhancement in transcatheter aortic valve implantation: impact on radiation exposure. Interact Cardiovasc Thorac Surg. 2018 Oct 1;27(4):512–519.

Abstract

We aimed at investigating if per-operative advanced image processing can reduce patient and operator irradiation use during TAVI. The dose–area product was reduced in the test group: mean reduction of −27.5 Gy × cm2. Furthermore, effective dose [mean reduction −6.5 (95% CI: 5.9–7.2) mSv, P < 0.001] and air kerma [mean reduction −167.5 (95% CI 163.4–177.3) mGy, P < 0.001] were lower in the test group. Fluoroscopy time, contrast volume and clinical outcomes were similar.

292]

Ozpelit ME, Ercan E, Ozpelit E, et al. OPERATOR DEPENDENCY OF THE RADIATION EXPOSURE IN CARDIAC INTERVENTIONS: FEASIBILITY OF ULTRA LOW DOSE LEVELS. Radiat Prot Dosimetry. 2017 Apr 15;173(4):383-388.

CATEGORIES:

Abstract

Mean radiation exposure in invasive cardiology varies greatly between different centres and interventionists. The International Commission on Radiological Protection and the EURATOM Council stipulate that, despite reference values, ‘All medical exposure for radiodiagnostic purposes shall be kept as low as reasonably achievable’ (ALARA). The purpose of this study is to establish the effects of the routine application of ALARA principles and to determine operator and procedure impact on radiation exposure in interventional cardiology.

293]

Pancholy SB, Joshi P, Shah S, et al. Effect Of Vascular Access Site Choice On Radiation Exposure During Coronary Angiography. JACC Cardiovasc Interv. 2015 Aug 17;8(9):1189-1196.

CATEGORIES:

Abstract

This study sought to perform a randomized noninferiority trial of radiation exposure during cardiac catheterization comparing femoral access (FA) with left radial access (LRA) and right radial access (RRA). Median operator exposure was higher in the LRA group (3 mrem [IQR: 2 to 5 mrem], p = 0.001 vs. FA, and p = 0.0001 vs. RRA) compared with the FA (2 mrem [IQR: 2 to 4 mrem] and RRA groups (3 mrem [IQR: 2 to 5 mrem]).

294]

Panetta CJ, Galbraith E, Yanavitski M, et al. Reduced radiation exposure in the cardiac catheterization laboratory with a novel vertical radiation shield. Catheter Cardiovasc Interv. 2020 Jan;95(1):7-12.

CATEGORIES:

Abstract

Investigation of novel vertical radiation shield (VRS) in reducing operator radiation exposure. A mannequin simulating an operator was placed near a computational phantom, simulating a patient. Measurement of dose equivalent and Air Kerma located the angle with the highest radiation, followed by a common magnification (8 in.) and comparison of horizontal radiation absorbing pads (HRAP) with or without VRS with two different: CCL, phantoms, and dosimeters.

295]

Pantos I, Koukorava C, Nirgianaki E, et al. Radiation Exposure Of The Operator During Cardiac Catheter Ablation Procedures. Radiat Protect Dosimetry. 2012 Jul150;150(3):306-311.

Abstract

The purpose of the present study was to determine the occupational radiation exposure per procedure in order to assess the radiation exposure during catheter ablation for various types of cardiac arrhythmias in a modern electrophysiology laboratory equipped with an FD angiographic unit and electroanatomic navigation. The ranges of fluoroscopy time and air kerma area product values associated with cardiac ablation procedures were wide (6.3–48.3 min and 1.7–80.3 Gy cm2, respectively). The measured median radiation doses per procedure for each monitored position were 23.6 and 21.3 mSv to the left and right wrists, respectively, 25.3 and 30.4 mSv to the left and right legs, respectively. The doses to the eyes were below the minimum detectable dose of 9 mSv. The estimated median effective dose was 22.5 mSv. Considering the actual workload of the operator, the calculated annual doses to the hands, legs and eyes, as well as the annual effective dose, were all below the corresponding limits.

296]

Panuccio G, Greenberg RK, Wunderle K, et al. Comparison Of Indirect Radiation Dose Estimates With Directly Measured Radiation Dose For Patients And Operators During Complex Endovascular Procedures. J Vasc Surg. 2011 Apr;53(4):885-894.e1.

CATEGORIES:

Abstract

We embarked on this study in an attempt to accurately determine the amount of radiation exposure given to patients undergoing complex endovascular aortic repair. eTAAA repair was performed in 54 patients over 5 months, of which 47 had the repair limited to the thoracoabdominal segment. Clinical follow-up was complete in 98% of the patients. No patients had evidence of radiation-induced skin injury. CAK exceeded 15 Gy in 3 patients (the Joint Commission on Accreditation of Healthcare Organizations [JCAHO] threshold for sentinel events); however, the direct measurements were well below 15 Gy in all patients. PSD was measured by quantifying the exposure of the radiochromatic film. PSD correlated weakly with FT but better with CAK and KAP (r = 0.55, 0.80, and 0.76, respectively). The following formula provides the best estimate of actual PSD = 0.677 + 0.257 CAK. The average effective dose was 119.68 mSv (for type II or III eTAAA) and 76.46 mSv (type IV eTAAA). The operator effective dose averaged 0.17 mSv/case and correlated best with the KAP (r = 0.82, P < .0001).

297]

Patel C, Grossman M, Shabanova V, Asnes J. Reducing Radiation Exposure in Cardiac Catheterizations for Congenital Heart Disease. Pediatr Cardiol. 2019 Mar;40(3):638-649.

CATEGORIES:

Abstract

Ionizing radiation exposure is a necessary risk entailed during congenital cardiac catheterizations. The congenital catheterization lab at Yale New Haven Children’s Hospital employed quality improvement strategies to minimize radiation exposure in this vulnerable population. In two phases, we implemented six interventions, which included adding and utilizing lower fluoroscopy and digital angiography (DA) doses, increasing staff and physician radiation awareness, focusing on tighter collimation, and changing the default fluoroscopy and DA doses to lower settings. Post-intervention data were collected prospectively for all procedures in the congenital catheterization lab and compared to pre-intervention radiation data collected retrospectively.

298]

Patet C, Ryckx N, Arroyo D, et al. Efficacy of the SEPARPROCATH® radiation drape to reduce radiation exposure during cardiac catheterization: A pilot comparative study. Catheter Cardiovasc Interv. 2019 Sep 1;94(3):387-391.

CATEGORIES:

Abstract

We sought to compare the radiation exposure (RE) of the cardiac catheterization room staff using SEPARPROCATH®, a novel radio-protective drape versus standard shielding equipment. This was a two-step prospective, randomized pilot trial: first, in experimental conditions using a phantom model, and second, during cardiac catheterization.

299]

Paul J, Jacobi V, Farhang M, et al. Radiation Dose And Image Quality Of X-Ray Volume Imaging Systems: Cone-Beam Computed Tomography, Digital Subtraction Angiography And Digital Fluoroscopy. Eur Radiol. 2013 Jun;23(6):1582-1593.

Abstract

Radiation dose and image quality estimation of three X-ray volume imaging (XVI) systems. Mean DAP and SED were lower in recent XVI than its previous counterparts in CBCT, DSA and DF. HU of all measured locations was non-significant between the groups except the hepatic artery. Noise showed significant difference among groups (P<0.05). Regarding CNR and SNR, the recent XVI showed a higher and significant difference compared to its previous versions. Qualitatively, CBCT showed significance between versions unlike the DSA and DF which showed non-significance

300]

Paul J, Mbalisike EC, Vogl TJ. Radiation Dose To Procedural Personnel And Patients From An X-Ray Volume Imaging System. Eur Radiol. 2013 Dec;23(12):3262-3270.

Abstract

Radiation dose and image quality estimation of three X-ray volume imaging (XVI) systems. Mean DAP and SED were lower in recent XVI than its previous counterparts in CBCT, DSA and DF. HU of all measured locations was non-significant between the groups except the hepatic artery. Noise showed significant difference among groups (P<0.05). Regarding CNR and SNR, the recent XVI showed a higher and significant difference compared to its previous versions. Qualitatively, CBCT showed significance between versions unlike the DSA and DF which showed non-significance

301]

Pavlicek W, Sensakovic WF, Zhou Y, et al. Sample Content Of Kinesthetic Educational Training: Reducing Scattered X‐Ray Exposures To Interventional Physician Operators Of Fluoroscopy. J Appl Clin Med Phys. 2020 Jul;21(7):196-208.

Abstract

Here, we share one example of a kinesthetic (live, hands‐on simulation) educational program in use at our facility for some time (~10 years). In this example, the format and content specifically target methods of reducing physician operator exposures from scattered x rays. A kinesthetic format identifies and promotes the adoption of exposure‐reducing behaviors. Key kinesthetic elements of this type of training include: physician hands‐on measurements of radiation levels at locations specific to their standing positions (e.g., primary arterial access points) in the room using handheld exposure rate meters, measurement of exposure rate reduction to physicians provided by using personal protective equipment, that is, wearable aprons, hanging lead drapes, and pull‐down shields. Physician choice of procedure‐specific tableside selectable controls affecting exposure rate from optional fluoroscopy, Cine or digital subtraction angiography (DSA), along with comparative measured contribution to physician exposure is demonstrated. The inverse square exposure rate reduction to physicians when stepping back from the table during DSA is a key observation.

302]

Pavlović N, Reichlin T, Kuhne M, et al. Fluoroscopy-Free Recrossing Of The Interatrial Septum During Left Atrial Ablation Procedures. J Interv Card Electrophysiol. 2014 Dec;41(3):261-266.

Abstract

The purpose of this is to evaluate the safety and feasibility of recrossing the interatrial septum in case of inadvertent loss of or need for repeated left atrial access using a simple electroanatomical landmark without the use of fluoroscopy. Using the described technique, EP fellows and experienced operators could recross the interatrial septum without fluoroscopy in all patients.

303]

Peach G, Sinha S, Black SA, et al. Operator-Controlled Imaging Significantly Reduces Radiation Exposure During EVAR. Eur J Vasc Endovasc Surg. 2012 Oct;44(4):395-398.

Abstract

The aim of this study was to assess whether changing from radiographer-controlled imaging to a system of operator-controlled imaging (OCI) would influence radiation exposure, screening time or contrast dose during EVAR. Median DAP was significantly lower after installation of OCI (4.9 mGy m2; range 1.25–13.3) than it had been before installation (6.9 mGy m2; range 1.91–95.0) (p = 0.005). Median screening times before and after installation of OCI were 20.0 min and 16.2 min respectively (p = 0.027) and median contrast volumes before and after the change to OCI were 100 ml and 90 ml respectively (p = 0.21).

304]

Perry BC, Monroe EJ, McKay T, et al. Pediatric Percutaneous Osteoid Osteoma Ablation: Cone-Beam CT with Fluoroscopic Overlay Versus Conventional CT Guidance. Cardiovasc Intervent Radiol. 2017 Oct;40(10):1593-1599.

CATEGORIES:

Abstract

To compare technical success, clinical success, complications, radiation dose, and total room utilization time for osteoid osteoma thermal (radiofrequency or microwave) ablation using cone-beam computed tomography (CBCT) with two-axis fluoroscopic navigational overlay versus conventional computed tomography (CT) guidance.

305]

Peyrol M, Sbragia P, Quatre A, et al. Reduction of procedure duration and radiation exposure with a dedicated inner lumen mapping catheter during pulmonary vein cryoablation. Pacing Clin Electrophysiol. 2013 Jan;36(1):24-30.

CATEGORIES:

Abstract

The Achieve catheter (AC; Medtronic-CryoCath, Pointe-Claire, Canada) is a circular mapping catheter introduced through the lumen of the cryoballoon (CB) catheter which is safe and effective to both navigate the CB to the pulmonary veins (PV) and allow PV potential recording during PV cryoablation. The aim of this study was to evaluate the impact of the use of the AC on procedural outcomes.

306]

Picano E, Andreassi MG, Piccaluga E, et al. OCCUPATIONAL RISKS OF CHRONIC LOW DOSE RADIATION EXPOSURE IN CARDIAC CATHETERISATION LABORATORY: THE ITALIAN HEALTHY CATH LAB STUDY. EMJ Int Cardiol. 2013:1,50-58.

Abstract

This paper describes the rationale of the ongoing Healthy Cath Lab (HCL) Study, designed by interventional cardiologists, for interventional cardiologists. The Italian HCL project is a case-control study that will include a cohort of 500 highly exposed subjects (interventional cardiologists, nurses, and technicians working in the cath lab >3 years) and a ‘best match’ control group of 500 unexposed subjects. All aspects of in-room personnel radiation exposure (e.g. standard safety precautions, workload), as well the health status of each participant, will be investigated by using a web survey.

307]

Picano E, Vano E, Domenici L, et al. Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer. 2012 Apr 27;12:157.

CATEGORIES:

Abstract

According to a fundamental law of radiobiology (“Law of Bergonié and Tribondeau”, 1906), the brain is a paradigm of a highly differentiated organ with low mitotic activity, and is thus radio-resistant. This assumption has been challenged by recent evidence discussed in the present review.

308]

Pillarisetti J, Kanmanthareddy A, Reddy YM, et al. MediGuide-impact on catheter ablation techniques and workflow. J Interv Card Electrophysiol. 2014 Sep;40(3):221-7.

CATEGORIES:

Abstract

Since the introduction of percutaneous intervention in modern medical science, specifically cardiovascular medicine fluoroscopy has remained the gold standard for navigation inside the cardiac structures. As the complexity of the procedures continue to increase with advances in interventional electrophysiology, the procedural times and fluoroscopy times have proportionately increased and the risks of radiation exposure both to the patients as well as the operator continue to rise. 3D electroanatomic mapping systems have to some extent complemented fluoroscopic imaging in improving catheter navigation and forming a solid platform for exploring the electroanatomic details of the target substrate. MediGuide is one such innovative technology that exploits the geo-positioning system principles.

309]

Plank F, Stowasser B, Till D, et al. Reduction of fluoroscopy dose for cardiac electrophysiology procedures: A feasibility and safety study. Eur J Radiol. 2019 Jan;110:105-111.

Abstract

Exposure to high doses of radiation during cardiac interventional procedures is associated with increased rates of cataract and cancer in patients and staff members. Thus, reduction of radiation is recommended by international medical societies. The aim of this study was to evaluate, if the lowest reasonable fluoroscopic acquisition setting for electrophysiological procedures using a novel X-ray detector operated at a minimum detector entrance dose per fluoroscopy pulse is feasible and safe.

310]

Plastaras C, Appasamy M, Sayeed Y, et al. Flouroscopy procedure and equipment changes to reduce staff radiation expsoure in the interventional spine suite. Pain Physician. Nov-Dec 2013;16(6):E731-E738.

Abstract

The goal of this study was to quantify effective dose rates to staff before and after interventions. A total of 685 interventional procedures were performed in the pre-intervention period and 385 in the post-intervention period. The median cumulative mrem (interquartile range) for all staff combined in the pre-intervention period was 71 (28,75) and post-intervention period was 1 (0,3). The median mrem per procedure was significantly higher in the pre-intervention group 0.46 (0.36, 0.54) compared to post-intervention 0.01 (0.0.03); P < 0.01. The percentage reduction in overall effective dose per procedure to all staff was 97.3%.

311]

Plourde G, Pancholy SB, Nolan J, et al. Radiation Exposure In Relation To The Arterial Access Site Used For Diagnostic Coronary Angiography And Percutaneous Coronary Intervention: A Systematic Review And Meta-Analysis. Lancet. 2015 Nov 28;386(10009):2192-2203.

Abstract

Our aim was therefore to compare radiation exposure between transradial access and transfemoral access for diagnostic coronary angiograms and percutaneous coronary interventions (PCI). Our primary analyses showed that transradial access was associated with a small but signifi cant increase in fl uoroscopy time for diagnostic coronary angiograms and PCI compared with transfemoral access. Transradial access was also associated with higher kerma-area product for diagnostic coronary angiograms and signifi cantly higher kerma-area product for PCI. Mean operator radiation doses for PCI with basic protection were 107 μSv (SD 110) with transradial access and 74 μSv (68) with transfemoral access; with supplementary protection, the doses decreased to 21 μSv (17) with transradial access and 46 μSv (9) with transfemoral.

312]

Ploux S, Jesel L, Eschalier R, et al. Performance of a radiation protection cabin during extraction of cardiac devices. Can J Cardiol. 2014 Dec;30(12):1602-6.

CATEGORIES:

Abstract

Pacemaker implants are associated with a high cumulative exposure of the operators to radiation. Standard radiation protection with lead aprons is incomplete and the cause of spine disorders. A radiation protection cabin offers complete protection by surrounding the operator, without requiring a lead apron.

313]

Politi L, Biondi-Zoccai G, Nocetti L, et al. Reduction of scatter radiation during transradial percutaneous coronary angiography: a randomized trial using a lead-free radiation shield. Catheter Cardiovasc Interv. 2012 Jan 1;79(1):97-102.

CATEGORIES:

Abstract

Occupational radiation exposure is a growing problem due to the increasing number and complexity of interventional procedures performed. Radial artery access has reduced the number of complications at the price of longer procedure duration. Radpad® scatter protection is a sterile, disposable bismuth-barium radiation shield drape that should be able to decrease the dose of operator radiation during diagnostic and interventional procedures. Such radiation shield has never been tested in a randomized study in humans.

314]

Pontone G, Andreini D, Petulla M, et al. Left Atrium And Pulmonary Vein Imaging Using Sub-Millisiviert Cardiac Computed Tomography: Impact On Radiofrequency Catheter Ablation Cumulative Radiation Exposure And Outcome In Atrial Fibrillation Patients. Int J Cardiol. 2017 Feb 1;228:805-811.

Abstract

Aim of this study was comparing RFCA procedural characteristics, AF recurrence and radiation exposure between patients in whom RFCA was guided by CCT image integration with MBIR versusa CCT standard protocol.

315]

Pourdjabbar A, Ang L, Behnamfar O, et al. Robotics in percutaneous cardiovascular interventions. Expert Rev Cardiovasc Ther. 2017 Nov;15(11):825-833.

CATEGORIES:

Abstract

The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy.

316]

Prenner SB, Wayne DB, Sweis RN, et al. Simulation-based education leads to decreased use of fluoroscopy in diagnostic coronary angiography. Catheter Cardiovasc Interv. 2018 May 1;91(6):1054-1059.

CATEGORIES:

Abstract

The aim of this study is to determine whether simulation-based education (SBE) translates into reduced procedure time, radiation, and contrast use in actual clinical care. Reports of SBE in interventional cardiology are limited and there is little understanding of the potential downstream clinical impact of these interventions.

317]

Quan C, Lee SS. Pattern and degree of radiation exposure during endovascular surgery performed using a mobile C-arm or in a hybrid room. Ann Surg Treat Res. 2019 Mar;96(3):131-137.

CATEGORIES:

Abstract

A prospective study was conducted to compare radiation exposure to different parts of an endovascular surgeon’s body when using a mobile C-arm with that in a hybrid room.F201. The procedures performed, fluoroscopy time, and dose-area product were not significantly different between groups. The dose-area product per second in the hybrid room group appeared greater than in the C-arm group (4.5 µGym2/sec vs. 3.1 µGym2/sec). In the C-arm group, the peak skin dose on the right neck (1.77 mSv) and shoulder (1.48 mSv) appeared higher than those on their left side (0.32 mSv, 0.53 mSv, respectively) and the counterparts of the hybrid room group (0.88 mSv, 0.20 mSv, respectively).

318]

Racadio J, Nachabe R, Carelsen B, et al. Effect of real-time radiation dose feedback on pediatric interventional radiology staff radiation exposure. J Vasc Interv Radiol. 2014 Jan;25(1):119-26.

CATEGORIES:

Abstract

To measure and compare individual staff radiation dose levels during interventional radiologic (IR) procedures with and without real-time feedback to evaluate whether it has any impact on staff radiation dose.

319]

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.

Abstract

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.

320]

Rashid MS, Aziz S, Haydar S, et al. Intra-operative fluoroscopic radiation exposure in orthopaedic trauma theatre. Eur J Orthop Surg Traumatol. 2018 Jan;28(1):9–14.

Abstract

This study aimed to report appropriate intra-operative fluoroscopy use in orthopaedic trauma and compare the effect of surgery type and surgeon grade on radiation exposure. Median DAP for dynamic hip screws for extracapsular femoral neck fractures was 668 mGy/cm2 (ST 36 s), 1040 mGy/cm2 (ST 49 s) for short proximal femoral nail, 1720 mGy/cm2 (ST 2 m 36 s) for long femoral nail for diaphyseal fractures, 25 mGy/cm2 (ST 25 s) for manipulation and Kirschner wire fixation in distal radius fractures, and 27 mGy/cm2 (ST 23 s) for volar locking plate fixation in distal radius fractures. These represented the five commonest procedures performed in the trauma operating room in our hospital. Experienced surgeons utilized less radiation in the operating room than junior surgeons (DAP 90.55 vs. 366.5 mGy/cm2, p = 0.001) and took fewer fluoroscopic images (49 vs. 66, p = 0.008) overall.

321]

Rathmann N, et al. Radiation Exposure Of The Interventional Radiologist During Percutaneous Biopsy Using A Multiaxis Interventional C-Arm CT System With 3D Laser Guidance: A Phantom Study. Br J Radiol. 2015;88(1055):20150151.

CATEGORIES:

Abstract

Evaluation of absolute radiation exposure values for interventional radiologists (IRs) using a multiaxis interventional flat-panel C-arm cone beam CT (CBCT) system with three-dimensional laser guidance for biopsy in a triple-modality, abdominal phantom. Mean radiation values of all TLDs were 190 µSv for CBCT (eye lens: 180 µS, umbilicus: 230 µSv, ankle: 150 µSv) without a significant difference (p > 0.005) between in- and out-of-plane biopsies. In terms of radiation exposure of the phantom, the mean DAP was not statistically significantly different (p > 0.05) for in- and out-of-plane biopsies. Fluoroscopy showed a mean DAP of 7 or 6 μGym2, respectively. C-arm CT showed a mean DAP of 5150 or 5130 μGym2, respectively.

322]

Ratnayaka K, Kanter JP, Faranesh AZ, et al. Radiation-free CMR diagnostic heart catheterization in children. J Cardiovasc Magn Reson. 2017 Sep 6;19(1):65.

Abstract

We intend to perform complete radiation-free diagnostic right heart catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety.

323]

Reents T, Jilek C, Schuster P, et al. Multicenter, randomized comparison between magnetically navigated and manually guided radiofrequency ablation of atrioventricular nodal reentrant tachycardia (the MagMa-AVNRT-trial). Clin Res Cardiol. 2017 Dec;106(12):947-952.

CATEGORIES:

Abstract

Remote magnetic navigation (RMN) is attributed to diminish radiation exposure for both patient and operator performing catheter ablation for different arrhythmia substrates. The purpose of this prospective, randomized study was to compare RMN with manually guided catheter ablation for AV nodal reentrant tachycardia (AVNRT) regarding fluoroscopy time/dosage, acute and long-term efficacy as well as safety.

324]

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.

Abstract

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.

325]

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.

Abstract

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.

326]

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 … Continue reading 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.

Abstract

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.

327]

Reißberg S, Ludeke L, Fritsch M. Comparison Of Radiation Exposure Of The Surgeon In Minimally Invasive Treatment Of Osteoporotic Vertebral Fractures – Radiofrequency Kyphoplasty Versus Balloon Kyphoplasty With Cement Delivery Systems (CDS). Röfo. 2020 Jan;192(1):59-64.

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Abstract

The aim of the present study was to compare the radiation exposure of the surgeon when using two different kyphoplasty systems for the minimally invasive treatment of osteoporotic vertebral body fractures. The measured surface doses for the lenses were four times higher in balloon kyphoplasty. For the left wrist, the values for balloon kyphoplasty were about 8 times higher.

328]

Reissmann B, Maurer T, Wohlmuth P, et al. Significant Reduction Of Radiation Exposure In Cryoballoon-Based Pulmonary Vein Isolation. Europace. 2018 Apr 1;20(4):608-613.

Abstract

The objective of this study is to evaluate a modified fluoroscopy protocol aiming at reduction of radiation exposure in CB ablation. A total of 475 PVs were identified and successfully isolated. Median dose area product and fluoroscopy time were significantly shorter in Group 2 as compared to Group 1 [389 (285; 550) cGycm2 vs. 2168 (1355; 3490) cGycm2 (P < 0.0001) and 10 (8; 12) min vs. 14 (11; 19) min (P < 0.0001)].

329]

Renaud L. A 5-y follow-up of the radiation exposure to in-room personnel during cardiac catheterization. Health Phys. 1992;62:10-5.

Abstract

This study documents the radiation doses received by all in-room personnel of three cardiac catheterization laboratories where more than 15,000 cardiac procedures have been performed over a 5-y period. It is shown that all in-room personnel was exposed to a body dose equivalent well below any regulatory limits. However, some workers may have exceeded the occupational 150 mSv y-1 recommended limit for the lens of the eye. The physicians-in-training and the staff physicians are the two groups more likely to reach this limit. It is also demonstrated that a low correlation exists between the annual number of procedures and the annual head dose equivalent of a physician, but more variation is likely to originate from his/her working attitude and techniques. The mean dose equivalent at the collar level of the physicians is estimated to be 0.04 +/- 0.02 mSv per procedure.

330]

This study documents the radiation doses received by all in-room personnel of three cardiac catheterization laboratories where more than 15,000 cardiac procedures have been performed over a 5-y period. It is shown that all in-room personnel was exposed to a body dose equivalent well below any regulatory limits. However, some workers may have exceeded the … Continue reading Renaud L. A 5-y follow-up of the radiation exposure to in-room personnel during cardiac catheterization. Health Phys. 1992;62:10-5.

Abstract

This study documents the radiation doses received by all in-room personnel of three cardiac catheterization laboratories where more than 15,000 cardiac procedures have been performed over a 5-y period. It is shown that all in-room personnel was exposed to a body dose equivalent well below any regulatory limits. However, some workers may have exceeded the occupational 150 mSv y-1 recommended limit for the lens of the eye. The physicians-in-training and the staff physicians are the two groups more likely to reach this limit. It is also demonstrated that a low correlation exists between the annual number of procedures and the annual head dose equivalent of a physician, but more variation is likely to originate from his/her working attitude and techniques. The mean dose equivalent at the collar level of the physicians is estimated to be 0.04 +/- 0.02 mSv per procedure.

331]

Roccatagliata L, Presilla S, Pravatà E, Cianfoni A. Radiation dose to the operator during fluoroscopically guided spine procedures. Neuroradiology. 2017 Sep;59(9):885-892.

CATEGORIES:

Abstract

Fluoroscopy is widely used to guide diagnostic and therapeutic spine procedures. The purpose of this study was to quantify radiation incident on the operator (operator Air Kerma) during a wide range of fluoroscopy-guided spine procedures and its correlation with the amount of radiation incident on the patient (Kerma Area Product-KAP).

332]

Rodríguez-González E, Castanedo-Álvarez M, León-Aliz E, et al. Right lateral versus left lateral view for forearm coronary angiography. An operator radiation exposure and image quality study. J Radiol Prot. 2017 Jun 26;37(2):450-458.

CATEGORIES:

Abstract

The aim of this study was to analyze the operator radiation exposure (ORE) and the image quality in a coronary angiography (CA) of the standard left lateral view (LLV) and compare it with an alternative right lateral view (RLV).

333]

Rogers DPS, England F, Lozhkin K, et al. Improving safety in the electrophysiology laboratory using a simple radiation dose reduction strategy: a study of 1007 radiofrequency ablation procedures. Heart. 2011;97(5):366-370.

Abstract

To assess the effects of radiation dose reduction manoeuvres (DRM) during radiofrequency ablation (RFA) procedures. Over a 39-month period, 1007 ablation procedures were performed (631 simple, 376 complex). Radiation dose was significantly reduced after DRM for both simple (20.4±26.9 Gycm2 vs 8.0±10.3 Gycm2, p<0.00001) and complex ablations (63.3±50.1 Gycm2 vs 32.8±31.7 Gycm2, p<0.00001) with no difference in screening times. The mean lifetime risk of fatal cancer attributable to radiation exposure per million procedures was reduced from 182 to 68 for simple ablations and from 440 to 155 for complex ablations.

334]

Rogits B, Jungnickel K, Lowenthal D, et al. Prospective Evaluation Of The Radiologist’s Hand Dose In CT-Guided Interventions. Röfo. 2013 Nov;185(11):1081-1088.

Abstract

Assessment of radiologist’s hand dose in CT-guided interventions and determination of influencing factors. 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 – 240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 – 140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 – 3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other.

335]

Roguin A, et al. Brain And Neck Tumors Among Physicians Performing Interventional Procedures. Am J Cardiol. 2013 May 1;111(9):1368-72.

Abstract

The aim of the present report was to increase the awareness and request the creation of a large-scale registry. The present report documented brain and neck tumors occurring in 31 physicians: 23 interventional cardiologists, 2 electrophysiologists, and 6 interventional radiologists. All physicians had worked for prolonged periods (latency period 12 to 32 years, mean 23.5 – 5.9) in active interventional practice with exposure to ionizing radiation in the catheterization laboratory. The tumors included 17 cases (55%) of glioblastoma multiforme (GBM), 2 astrocytomas (7%), and 5 meningiomas (16%). In 26 of 31 cases, data were available regarding the side of the brain involved. The malignancy was left sided in 22 (85%), midline in 1, and right sided in 3 operators.

336]

Rola R, Otsuka S, Obenaus A, et al. Indicators Of Hippocampal Neurogenesis Are Altered By56fe-Particle Irradiation In A Dose-Dependent Manner. Radiat Res. 2004 Oct;162(4):442-446.

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Abstract

The health risks to astronauts exposed to high-LET radiation include possible cognitive deficits. The pathogenesis of radiation-induced cognitive injury is unknown but may involve loss of neural precursor cells from the subgranular zone (SGZ) of the hippocampal dentate gyrus. To address this hypothesis, adult female C57BL/6 mice received whole-body irradiation with a 1 GeV/nucleon iron-particle beam in a single fraction of 0, 1, 2 and 3 Gy. The present data provide the first evidence that high-LET radiation has deleterious effects on cells associated with hippocampal neurogenesis.

337]

Rolf S, Schoene K, Kircher S, et al. Catheter ablation of atrial fibrillation with nonfluoroscopic catheter visualization-a prospective randomized comparison. J Interv Card Electrophysiol. 2019 Jan;54(1):35-42.

CATEGORIES:

Abstract

The application of a novel platform for nonfluoroscopic catheter sensor tracking within pre-recorded x-ray loops in the context of catheter ablation of atrial fibrillation (AF) demonstrated significant potential for reduction of fluoroscopy. We sought to provide the first prospective randomized comparison of fluoroscopy needs, procedure times, and complications in AF catheter ablation with or without additional use of nonfluoroscopic catheter visualization (NFCV).

338]

Rolls AE, Rosen S, Constantinou J, et al. Introduction Of A Team Based Approach To Radiation Dose Reduction In The Enhancement Of The Overall Radiation Safety Profile Of FEVAR. Eur J Vasc Endovasc Surg. 2016 Oct;52(4):451-457.

CATEGORIES:

Abstract

The aim of this study is to evaluate the radiation dose effect of introducing a team-based approach to complex aortic repair. Change in operative approach resulted in a significant reduction in PT for the Modern group compared with the Historic group. There were reductions in skin dose for the Modern group compared with the Historic group, and DAP for Historic. There were no significant differences in FT, and pre- and post-operative eGFR between the two groups. Weight and height were distributed equally across both groups. Structured dose reports including the changes in frame rate were not available for analysis.

339]

Ron E, Brenner A. Non-malignant thyroid diseases after a wide range of radiation exposures. Radiat Res. 2010 Dec;174(6):877-88.

CATEGORIES:

Abstract

The aim of this review is to evaluate the effects of high and low dose radiation on benign structural and functional diseases of the thyroid. Following a wide range of doses of ionizing radiation, an increased risk of thyroid adenomas and nodules was observed in a variety of populations and settings. The dose response appeared to be linear at low to moderate doses, but in one study there was some suggestion of a reduction in risk above 5 Gy. The elevated risk for benign tumors continues for decades following exposure. In general, associations for these outcomes were fairly weak and significant radiation effects were most often observed following high doses, particularly for hypothyroidism.

340]

Roukema GR, De Jong L, Van Rijckevorsel VAJIM, et al. Radiation exposure during direct versus indirect image acquisition during fluoroscopy-controlled internal fixation of a hip fracture: Results of a randomized controlled trial. Injury. 2019;50:2263-2267.

CATEGORIES:

Abstract

Intra-operative image acquisition can be obtained indirectly (via verbal request to a technician) or directly (executed at the tableside, by a surgeon stepping on a foot pedal). Direct image acquisition could reduce the exposure time and thus the risk of radiation damage. The aim of this randomized controlled trial was to compare direct surgeon-controlled fluoroscopy with indirect technician-operated fluoroscopy during internal fixation of a hip fracture.

341]

Rubesch-Kütemeyer V, Fischbach T, Guckel D, et al. Long-term development of radiation exposure, fluoroscopy time and contrast media use in daily routine in cryoballoon ablations after implementation of intracardiac echocardiography and other radioprotective measures: experiences from a large single-centre cohort. J Interv Card Electrophysiol. 2019 Jun 5. doi: 10.1007/s10840-019-00564-5. [Epub ahead of print]

CATEGORIES:

Abstract

The concern of higher radiation exposure during cryoballoon ablation (CBA) compared with radiofrequency ablation for atrial fibrillation (AF) was raised before. Previously, we compared CBA plus intracardiac echocardiography (ICE) to our former standard approach without ICE. A substantial reduction of radiation exposure without compromising safety or outcome was observed. We now investigate if at all and possibly to which amount radiation reduction can be achieved with growing experience

342]

Rubesch-Kütemeyer V, Molatta S, Vogt J, et al. Reduction Of Radiation Exposure In Cryoballoon Ablation Procedures: A Single-Centre Study Applying Intracardiac Echocardiography And Other Radioprotective Measures. Europace. 2017 Jun 1;19(6):947-953.

Abstract

We aimed to demonstrate that radiation exposure can be markedly reduced by intracardiac echocardiography (ICE) and optimized settings of the X-ray system. Dose area product was significantly lower (1555 ± 1219 vs. 4935 ± 2094 cGycm2, P < 0.001), total freezing time was significantly shortened (1855 ± 399 vs. 2121 ± 756 s, P = 0.031), and contrast media use was significantly reduced (66 ± 25 vs. 109 ± 27 mL, P < 0.001). At the same time, total procedure duration and complication rates did not differ significantly between both groups.

343]

Ruffino MA, Fronda M, Discalzi A, et al. Radiation dose during endovascular aneurysm repair (EVAR): upgrade of an angiographic system from standard to Eco mode. Radiol Med. 2018 Dec;123(12):966-972.

CATEGORIES:

Abstract

To evaluate the radiation dose reduction during endovascular aneurysm repair (EVAR) after the reconfiguration of a Philips AlluraXper FD20 X-ray system. Between 2013 and 2015, we implemented a low-dose protocol (Eco dose) increasing the filtration with 1 mm of Al and 0.1 of Cu on both fluoroscopy and fluorography and halving the frames per second in fluoroscopy. The switch was complemented by hybrid operating room staff education and training in radiation protection. We compared two samples of 50 patients treated before the switch (normal dose) with 50 patients treated after the switch (Eco dose).

344]

Sabat S, Slonimsky E. Radiation Reduction in Low Dose Pulsed Fluoroscopy versus Standard Dose Continuous Fluoroscopy during Fluoroscopically-Guided Lumbar Punctures: A Prospective Controlled Study. J Clin Imaging Sci. 2018 Mar 9;8:9.

Abstract

The purpose of this study was to evaluate radiation dose reduction in fluoroscopically guided lumbar punctures (FGLP) using “pulsed fluoroscopy in a low dose mode” compared with the commonly used “continuous fluoroscopy in a standard dose mode” while maintaining the technical success. Average entrance surface dose of the study group was significantly lower (3.81 mGy [range: 0.21–11.14, [±2.8 SD]]) compared with the control group (22.45 mGy [range: 1.23–73.44, [±19.41 [SD]]). The average DAP of the study group (10 mGy·cm2 [range: 1–41, [±9.8 SD]]) was also significantly lower than the control group (65 mGy·cm2 [range: 5–199, [±53 SD]]).

345]

Sadamatsu K, Nakano Y. The Effect Of Low Frame Rate Fluoroscopy On The X-Ray Dose During Coronary Intervention. Intern Med. 2016;55(15):1943-6.

CATEGORIES:

Abstract

The aim of this study was to investigate whether the use of low frame rate fluoroscopy at 7.5 frames per second during coronary intervention could reduce radiation exposure in Japanese patients. Although there were no differences in the contrast volume or fluoroscopy time, the total air kerma at the interventional reference point, which is used to monitor the patient’s radiation dose, was significantly lower in the LR group than in the OR group (701.4±427.9 vs. 936.8±623.9 mGy, p=0.02).

346]

Sadek MM, Ramirez FD, Nery PB, et al. Completely nonfluoroscopic catheter ablation of left atrial arrhythmias and ventricular tachycardia. J Cardiovasc Electrophysiol. 2019 Jan;30(1):78-88.

CATEGORIES:

Abstract

Fluoroscopy use during catheter ablation procedures increases the cumulative lifetime radiation exposure of patients and operators, potentially leading to a higher risk of cancer and radiation-related injuries. Nonfluoroscopic ablation (NFA) has been described for supraventricular tachycardia, typical atrial flutter, paroxysmal atrial fibrillation (AF), and outflow-tract ventricular tachycardia (VT). Complete transition to NFA of more complex arrhythmias, including persistent AF, left atrial (LA) flutter, and structural VT, has not been previously described. We describe the transition to completely NFA of complex arrhythmias, including LA flutter and structural VT. The techniques, challenges, limitations, and results are described.

347]

Sailer AM, Paulis L, Vergoossen L, et al. Optimizing Staff Dose in Fluoroscopy-Guided Interventions by Comparing Clinical Data with Phantom Experiments. J Vasc Interv Radiol. 2019 May;30(5):701-708.e1.

CATEGORIES:

Abstract

Comprehensive phantom experiments were performed in an angiography suite to evaluate the effects of several parameters on operator dose, such as patient body part, radiation shielding, x-ray tube angulation, and acquisition type. Phantom data were compared with operator dose data from clinical procedures (n = 281), which were prospectively acquired with the use of electronic real-time personal dosimeters (PDMs) combined with an automatic dose-tracking system (DoseWise Portal; Philips, Best, The Netherlands). A reference PDM was installed on the C-arm to measure scattered radiation. Operator exposure was calculated relative to this scatter dose.

348]

Sailer AM, Schurink GW, Bol ME, et al. Occupational Radiation Exposure During Endovascular Aortic Repair. Cardiovasc Intervent Radiol. 2015 Aug;38(4):827-32.

CATEGORIES:

Abstract

Occupational radiation exposure was prospectively evaluated during 22 infra-renal aortic repair procedures (EVAR), 11 thoracic aortic repair procedures (TEVAR), and 11 fenestrated or branched aortic repair procedures (FEVAR). Real-time over-lead dosimeters attached to the left breast pocket measured personal doses for the first operators (FO) and second operators (SO), radiology technicians (RT), scrub nurses (SN), anesthesiologists (AN), and non-sterile nurses (NSN). Besides protective apron and thyroid collar, no additional radiation shielding was used. Procedural dose area product (DAP), iodinated contrast volume, fluoroscopy time, patient’s body weight, and C-arm angulation were documented.

349]

Sailer AM, Vergoossen L, Paulis L, et al. Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring. Cardiovasc Intervent Radiol. 2017;40:1756–1762.

Abstract

Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04–0.50) µSv/Gy cm2 versus (phase 2) 0.08 (0.02–0.24) µSv/Gy cm2, p = 0.002].

350]

Sandblom, V et al. “Evaluation Of The Impact Of A System For Real-Time Visualisation Of Occupational Radiation Dose Rate During Fluoroscopically Guided Procedures”. Journal Of Radiological Protection, vol 33, no. 3, 2013, pp. 693-702.

CATEGORIES:

Abstract

The aim of the present study was to evaluate the impact of a system for real-time visualisation of radiation dose rate on optimisation of occupational radiological protection in fluoroscopically guided procedures. The median radiation dose (Hp(10)) per procedure decreased from 68 to 28 µSv (p = 0.003) for this cardiologist and from 4.3 to 2.5 µSv (p=0.001)for the assisting nurses.The results of the present study indicate that a system for real-time visualisation of radiation dose rate may have a positive impact on optimisation of occupational radiological protection.

351]

Santoro A, Di Clemente F, Baiocchi C, et al. From near-zero to zero fluoroscopy catheter ablation procedures. J Cardiovasc Electrophysiol. 2019;30:2397-2404.

CATEGORIES:

Abstract

The use of electroanatomical mapping (EAM) systems can reduce radiation exposure (RX) and it can also completely eliminate the use of RX. Radiation exposure related to conventional radiofrequency ablation procedures can have a stochastic and deterministic effect on health. The main aim of this study was to evaluate the safety and feasibility of an entirely nonfluoroscopic approach to catheter ablation (CA) using EAM CARTO3.

352]

Santos WS, Belinato W, Perini AP, et al. Occupational Exposures During Abdominal Fluoroscopically Guided Interventional Procedures For Different Patient Sizes — A Monte Carlo Approach. Phys Med. 2018 Jan;45:35-43.

CATEGORIES:

Abstract

In this study we evaluated the occupational exposures during an abdominal fluoroscopically guided interventional radiology procedure. The results showed that increasing the BMI of the patient, adjusted for each patient protocol, the CC values for medical radiation workers decrease. It is important to note that these results were obtained with fixed exposure parameters.

353]

Sarti G, Busca F, Carpano L, et al. DOSE MEASUREMENTS TO THE LENS IN NUCLEAR MEDICINE AND IN FLUOROSCOPY-GUIDED INTERVENTIONAL PROCEDURES: ANALYSIS OF THE RESULTS AND ASSESSMENT OF THE EFFECTIVENESS OF PROTECTIVE EYEWEAR ANTI-X. Radiat Prot Dosimetry. 2016 Sep;170(1-4):181-6.

Abstract

The new limit of 20 mSv to the lens raises the need for further assessment of the equivalent dose to the lens for nuclear medicine and interventional radiology operators. (a) A measurement campaign was performed in nuclear medicine, (b) a routine monitoring was organised in interventional procedures and (c) the effectiveness of protective eyewear was assessed. In nuclear medicine, for photon fields, the adequacy of Hp(0.07) of dosemeter worn on the trunk is confirmed; with (90)Y, the annual values of Hp(3) measured in therapeutic session are <5 mSv. In interventional procedures, routine monitoring of the dose to the lens must be maintained where the values of Hp(0.07) dosemeter worn on the trunk are higher than one-third of the new limits. The measures carried out have shown that the attenuation factor mean of the protective glasses is equal to ∼4 (range 1.7-11.4).

354]

Saukko E, et al. THE ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVELS IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A PRACTICAL TOOL FOR THE OPTIMISATION AND FOR QUALITY ASSURANCE MANAGEMENT. Radiat Prot Dosimetry. 2016, Apr 15;173(4):338-344.

CATEGORIES:

Abstract

The aim of this study was to describe the current level of patient radiation doses in endoscopic retrograde cholangiopancreatography (ERCP) collected from a single centre, as well as to establish and review local diagnostic reference levels (DRLs) in ERCP. The mean dose area product (DAP) was 2.05Gycm2, fluoroscopy time (FT) 1.7 min and the number of images was 3.The proposed local DRLs for ERCP were 3.00 Gy cm2 and 3.0 min. Local DRLs were reviewed in a sample of 25 patients 5 yafter they had been established.

355]

Schaefers JF, Wunderle K, Usai MV, et al. Radiation Doses For Endovascular Aortic Repairs Performed On Mobile And Fixed C-Arm Fluoroscopes And Procedure Phase-Specific Radiation Distribution. J Vasc Surg. 2018 Dec;68(6):1889-1896.

CATEGORIES:

Abstract

The objective of this study was to analyze radiation risk to patients during endovascular aneurysm repair (EVAR) using mobile C-arm (MA) or fixed C-arm (FA) fluoroscopes and to describe the dose distribution during the different phases of the procedure. Per-phase analysis demonstrated that identification of the proximal landing zone and main body deployment required the most radiation, accounting for 24% of the total radiation dose. Overall, 47.6% of the exposure was due to digital subtraction angiography.

356]

Schernthaner RE, Duran R, Chapiro J, et al. A new angiographic imaging platform reduces radiation exposure for patients with liver cancer treated with transarterial chemoembolization. Eur Radiol. 2015;25:3255–3262.

Abstract

To quantify the reduction of radiation liver cancer patients are exposed to during transarterial chemoembolization (TACE), while maintaining diagnostic image quality, using a new C-arm imaging platform. Both cohorts showed no significant differences with regard to patient characteristics and tumour burden. The new system resulted in a statistically significant reduction of cumulative DAP of 66 % compared to the old platform (median 132.9 vs. 395.8 Gy cm2). Individually, DAP of DF, DSA and CBCT decreased by 52 %, 79 % and 15 % (p<0.01,p<0.01, p=0.51), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms.

357]

Schernthaner RE, Haroun RR, Nguyen S, et al. Characteristics of a New X-Ray Imaging System for Interventional Procedures: Improved Image Quality and Reduced Radiation Dose. Cardiovasc Intervent Radiol. 2018;41:502–508.

CATEGORIES:

Abstract

To compare image quality and radiation exposure between a new angiographic imaging system and the preceding generation system during uterine artery embolization (UAE). There was no significant difference between the patients treated on the new (n = 36) and the old system (n = 18) regarding age (p = 0.10), BMI (p = 0.18), DF time (p = 0.35) and DSA time (p = 0.17). The new system significantly reduced the cumulative AK and DAP by 64 and 72%, respectively (median 0.58 Gy and 145.9 Gy*cm2 vs. 1.62 Gy and 526.8 Gy*cm2, p < 0.01 for both). Specifically, DAP for DF and DSA decreased by 59% (75.3 vs. 181.9 Gy*cm2, p < 0.01) and 78% (67.6 vs. 312.2 Gy*cm2, p < 0.01), respectively. The new system achieved a significant decrease in DF image noise (p < 0.01) and a significantly better DSA image quality (p < 0.01).

358]

Schneider R, Lauschke J, Schneider D, et al. Reduction Of Radiation Exposure During Ablation Of Atrial Fibrillation. Herz. 2015;40(6):883-891.

Abstract

The aim of our study was to describe a method to reduce DAP by simple means during ablation of AFib. The study comprised 206 patients, who were assigned to the SG (n = 101, 49 %) or to the redDAP group (n = 105, 51 %). Mean FT was significantly reduced from 29.9 ± 11.3 min (SG) to 13.3 ± 8.3 min (redDAP group); mean DAP was reduced by approximately 90 % from 8,690 ± 5,727 to 837 ± 647 cGycm2. The groups did not differ significantly in body mass index (28.8 ± 4.1 vs. 29.0 ± 5.0). PVI could be achieved in 98 of 101 patients (97 %) from the SG group and in all patients (100 %) from the redDAP group. Procedure time was significantly longer in the redDAP group (160.9 ± 35.7 vs. 138.1 ± 34.3 min).

359]

Sciahbasi A, Frigoli E, Sarandrea A, et al. Radiation Exposure And Vascular Access In Acute Coronary Syndromes The RAD-Matrix Trial. J Am Coll Cardiol. 2017 May 23;69(20):2530-2537.

Abstract

This study sought to determine whether radial access increases radiation exposure. Among 18 operators, performing 777 procedures in 767 patients, the noninferiority primary endpoint was not achieved. Operator equivalent dose at the thorax (77 μSv) was significantly higher with radial than femoral access (41 μSv; p = 0.02). After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ for right radial (84 μSv) compared to left radial access (52 μSv; p = 0.15). In the overall MATRIX population, fluoroscopy time and DAP were higher with radial compared to femoral access.

360]

Sciahbasi A, Piccaluga E, Saranrea A, et al. Operator Pelvic Radiation Exposure During Percutaneous Coronary Procedures. J Invasive Cardiol. 2018 Feb;30(2):71-74.

CATEGORIES:

Abstract

During percutaneous coronary procedures, the operator’s pelvic region is close to the x-ray source and is probably exposed to more radiation than the operator’s thorax. The RADIANT study (NCT01974453) is a prospective, single-center, observational study evaluating operator radiation exposure during percutaneous coronary procedures using electronic dosimeters placed at thorax level. In the last period of the study enrollment, a single operator was also equipped with an adjunctive electronic dedicated dosimeter to evaluate pelvic radiation exposure.

361]

Sciahbasi A, Rigattieri S, Sarandrea A, et al. Determinants of operator radiation exposure uring percutaneous coronary procedures. Am Heart J. 2017 May;187:10-18.

CATEGORIES:

Abstract

Radiation exposure is an important issue for interventional cardiologists that is often underevaluated. Our aim was to evaluate determinants of operator radiation exposure during percutaneous coronary procedures. The RADIANT (NCT01974453) is a prospective, single-center observational study involving 4 expert operators and 2 fellows performing percutaneous coronary procedures. The operator radiation dose was evaluated using dedicated electronic dosimeters in 2,028 procedures: 1,897 transradial access (TRA; 1,120 right and 777 left TRA) and 131 transfemoral access (TFA).

362]

Sciahbasi A, Rigattieri S, Sarandrea A, et al. Operator radiation exposure during right or left transradial coronary angiography: A phantom study. Cardiovasc Revasc Med. 2015 Oct-Nov;16(7):386-90.

CATEGORIES:

Abstract

Previous studies showed a possible lower radiation dose absorbed by operators comparing LRA and RRA for percutaneous coronary procedures. The reasons of this lower radiation dose are not well known. The aim of this study was to evaluate the radiation dose absorbed by operators comparing left with right radial access (LRA and RRA respectively) during a simulated diagnostic coronary angiography using a phantom.

363]

Sciahbasi A, Romagnoli E, Trani C, et al. Operator Radiation Exposure During Percutaneous Coronary Procedures Through The Left Or Right Radial Approach: the TALENT dosimetric substudy. Circ Cardiovasc Interv. 2011 Jun;4(3):226-231.

Abstract

The aim of the present study was to evaluate radiation dose absorbed by operators during coronary procedures through the RRA and LRA. From February to December 2009, 390 patients were randomly assigned to the RRA (185 patients; age, 66±11 years) or the LRA (185 patients; age, 66±11 years). There were no significant differences in fluoroscopy time (for RRA, 369 seconds; interquartile range, 134 to 857 seconds; for LRA, 362 seconds; interquartile range, 142 to 885 seconds; P=0.58) between the 2 groups. There were no significant differences in monthly radiation dose at the thorax (0.85±0.46 mSv for RRA and 1.12±0.78 mSv for LRA, P=0.33), at the thyroid (0.36±0.2 mSv for RRA and 0.34±0.3 mSv for LRA, P=0.87), and at the shoulder (0.73±0.44 mSv for RRA and 0.94±0.42 mSv for LRA, P=0.27). The dose at the wrist was significantly higher for the RRA (2.44±1.12 mSv) compared with the LRA (1±0.8 mSv, P=0.002). In both radial approaches, the thoracic radiation dose under the lead apron was undetectable.

364]

Sciahbasi A, Sarandrea A, Rigattieri S, et al. Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures. Circ Cardiovasc Interv. 2019 Feb;12(2):e007586.

CATEGORIES:

Abstract

Different tools and devices are effective to reduce operator radiation exposure at thorax level during percutaneous coronary procedures, but the operator radiation dose received at pelvic region still remains high. Our aim was to evaluate the efficacy of under-the-table adjunctive shields to reduce operator radiation exposure during percutaneous coronary procedures Methods and Results: The EXTRA-RAD study (Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures) is a prospective, single-center, randomized study.

365]

Sciahbasi A, Sarandrea A, Rigattieri S, et al. Staff radiation dose during percutaneous coronary procedures: Role of adjunctive protective drapes. Cardiovasc Revasc Med. 2018 Oct;19(7 Pt A):755-758.

CATEGORIES:

Abstract

The use of adjunctive protective drapes placed on the patient protects the operating physician from scatter radiation during percutaneous coronary procedures (PCP). No data are available on the effect of these drapes for staff members’ radio-protection. The RADIANT study (NCT01974453) is a prospective, observational study evaluating operator radiation exposure during PCP using electronic dosimeter. In a sub-group of procedures all the staff members (II operator, nurse circulator and technologist) were also equipped with a dedicated electronic dosimeter.

366]

See J, Amora JL, Lee S, et al. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure. Singapore Med J. 2016 Jul;57(7):390-5.

Abstract

This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time. Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001).

367]

Seiffert M, Ojeda F, Müllerleile K, et al. Reducing radiation exposure during invasive coronary angiography and percutaneous coronary interventions implementing a simple four-step protocol. Clin Res Cardiol. 2015 Jun;104(6):500-6.

CATEGORIES:

Abstract

With an increasing number of complex and repeated percutaneous coronary interventions (PCI), radiation-induced hazards for patients and operators remain an important issue in fluoroscopy-guided procedures. Our objective was to evaluate radiation exposure during coronary angiographic procedures and assess the efficacy of a four-step program to reduce radiation exposure during coronary angiography (CAG) and PCI.

368]

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.

CATEGORIES:

Abstract

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.

369]

Shah A, Nassri M, Kay J, et al. Intraoperative radiation exposure in hip arthroscopy: a systematic review. Hip Int. 2019 Nov 25:1120700019887362.

CATEGORIES:

Abstract

Fluoroscopy is used in hip arthroscopy (HA) for portal placement, instrument localisation, and guidance in bony resection. The recent increase in arthroscopic hip procedures may place patients and surgeons at risk for increased radiation exposure and radiation-induced complications. The purpose of the current systematic review was to assess intraoperative radiation exposure in HA.

370]

Shah B, Bangalore S, Feit F, et al. Radiation Exposure During Coronary Angiography Via Transradial Or Transfemoral Approaches When Performed By Experienced Operators. Am Heart J. 2013 Mar;165(3):286-292.

Abstract

Studies demonstrate an increase in radiation exposure with transradial approach (TRA) when compared with transfemoral approach (TFA) for coronary angiography. Given the learning curve associated with TRA, it is not known if this increased radiation exposure to patients is seen when procedures are performed by experienced operators.We retrospectively evaluated 1,696 patients who underwent coronary angiography with or without percutaneous coronary intervention (PCI) by experienced operators at a tertiary center from October 2010 to June 2011.

371]

Shah B, Burdowski J, Guo Y, et al. Effect Of Left Versus Right Radial Artery Approach For Coronary Angiography On Radiation Parameters In Patients With Predictors Of Transradial Access Failure. Am J Cardiol. 2016 Aug 15;118(4):477-481.

CATEGORIES:

Abstract

The aim of this study was to determine the effects of left versus right TRA on radiation parameters in patients with predictors of TRA failure. In an intention-to-treat analysis, DAP (34.1 Gy*cm2 [24.9–45.6] vs 41.9 Gy*cm2 [27.3–58.0], p=0.08), fluoroscopy time (3.7 min [2.4–6.3] vs 5.6 min [3.1–8.7], p=0.07), and operator radiation exposure (516 uR [275–967] vs. 730 uR [503–1165], p=0.06) were not significantly different between left and right TRA, but total dose (411 mGy [310–592] vs 537 mGy [368–780], p=0.03) was significantly lower with left versus right TRA. Radiation parameters were lowest in the TFA cohort (DAP 24.5 Gy*cm2 [15.7–33.2], p<0.001; fluoroscopy time 2.3 min [1.5–3.7], p<0.001; operator radiation exposure 387 uR [264–557]; total dose 345 mGy [250–468], p=0.001).

372]

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.

Abstract

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).

373]

Shah RM, Patel D, Abbate A, et al. Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis. Catheter Cardiovasc Interv. 2016 Dec;88(7):1027-1033.

CATEGORIES:

Abstract

Coronary angiography and angioplasty via transradial approach is shown to be associated with significant reduction in access site complications. Due to a lack of sufficient data, the use of the right or left radial approach is still operator-dependent. We performed a meta-analysis of prospective randomized studies to compare right versus left radial artery approach for coronary procedures.

374]

Shalganov T, Stoyanov M, Kunev B. The non-fluoroscopic navigation reduces significantly not only the fluoroscopic exposure during catheter ablation of the cavotricuspid isthmus but the total radiofrequency time as well. Acta Cardiol. 2017 Apr;72(2):167-171.

CATEGORIES:

Abstract

The non-fluoroscopic navigation (NFN) is known to reduce the fluoroscopic time during catheter ablation of various arrhythmias. We aimed to study the impact of NFN over several procedural parameters during radiofrequency (RF) catheter ablation of the cavo-tricuspid isthmus (CTI) in patients with CTI-dependent atrial flutter.

375]

Sharma D, Ramsewak A, Manoharan G, et al. Efficacy of RADPAD® protection drape in reducing radiation exposure to the primary operator during Transcatheter Aortic Valve Implantation (TAVI). Minerva Cardioangiol. 2016 Feb;64(1):41-6.

CATEGORIES:

Abstract

The efficacy of RADPAD® (a sterile, lead-free drape) has been demonstrated to reduce the scatter radiation to the primary operator during fluoroscopic procedures. However, the use of the RADPAD® during TAVI procedures has not been studied. Transcatheter aortic valve implantation (TAVI) is now an established treatment for patients with symptomatic severe aortic stenosis who are deemed inoperable or at high risk for conventional surgical aortic valve replacement (AVR). Consequently the radiation exposure to the patient and the interventional team from this procedure has become a matter of interest and importance. Methods to reduce radiation exposure to the interventional team during this procedure should be actively investigated. In this single center prospective study, we determined the radiation dose during this procedure and the efficacy of RADPAD® in reducing the radiation dose to the primary operator.

376]

Sharma PS, Huang HF, Trohman RG, et al. Low Fluoroscopy Permanent His Bundle Pacing Using Electroanatomic Mapping. Circ Arrhythm Electrophysiol. 2019 Feb;12(2):3006967.

Abstract

The aim of this study was to assess the feasibility and safety of performing low fluoroscopy PHBP using 3-dimensional electroanatomic mapping and comparing outcomes with conventional fluoroscopy guided PHBP implants. PHBP was successful in 9 of 10 patients (90%) in group 1 and 100% successful in the group 2 patients. The mean His lead fluoroscopy time was significantly lower in group 1 (0.2±0.2 minutes) compared with 8±7 minutes in group 2 (P=0.002) as was the total fluoroscopy time (0.8±0.3 versus 13±8 minutes, P=0.003) and the dose area product (96±83 versus 1531±923 microGy/m2, P=0.003). The HB capture threshold was lower in group 1 (0.7±0.4 at 1 ms) compared with patients in group 2 (1.15±0.7 at 1 ms) P=0.04.

377]

Shorrock D, Christopoulos G, Wosik J, et al. Impact of a Disposable Sterile Radiation Shield on Operator Radiation Exposure During Percutaneous Coronary Intervention of Chronic Total Occlusions. J Invasive Cardiol. 2015 Jul;27(7):313-6.

CATEGORIES:

Abstract

Daily radiation exposure over many years can adversely impact the health of medical professionals. Operator radiation exposure was recorded for 124 percutaneous coronary interventions (PCIs) performed at our institution between August 2011 and May 2013: 69 were chronic total occlusion (CTO)-PCIs and 55 were non-CTO PCIs. A disposable radiation protection sterile drape (Radpad; Worldwide Innovations & Technologies, Inc) was used in all CTO-PCI cases vs none of the non-CTO PCI cases. Operator radiation exposure was compared between CTO and non-CTO PCIs.

378]

Sigterman TA, Bolt LJ, Snoeijs MG, et al. Radiation Exposure during Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease. Ann Vasc Surg. 2016 May;33:167-72.

CATEGORIES:

Abstract

Endovascular interventions often are the preferred treatment in peripheral arterial disease for both intermittent claudication and chronic critical limb ischemia. Ever more advanced and anatomically complex procedures are being performed, which may increase the radiation exposure of patients and medical staff. We sought to determine the radiation exposure sustained in contemporary interventional radiology practice. A single-center observational cohort study of patients undergoing endovascular interventions for symptomatic peripheral arterial disease between January 1st, 2011 and July 31st, 2013 was performed. R

379]

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

Abstract

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)

380]

Simson N, Stonier T, Suleyman N, et al. Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study. BJU Int. 2020;125:292-298.

CATEGORIES:

Abstract

To define reference levels for intraoperative radiation during stent insertion, ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL); to identify variation in radiation exposure between individual hospitals across the UK, between low- and high-volume PCNL centres, and between grade of lead surgeon.

381]

Singh G, Campos E, Kavinsky CJ, et al. Comparative Analysis of Radial Versus Femoral Diagnostic Cardiac Catheterization Procedures in a Cardiology Training Program. J Invasive Cardiol. 2016 Jun;28(6):254-7.

CATEGORIES:

Abstract

This study was conducted to evaluate the differences in the procedural variables between transradial and transfemoral access for coronary angiography, with cardiology fellows as the primary operators. This was a retrospective study of 163 radial and 180 femoral access diagnostic cardiac catheterization procedures, and involved cardiology fellowship trainees as primary operators.

382]

Skripochnik E, Loh SA. Fluoroscopy time is not accurate as a surrogate for radiation exposure. Vascular. 2017 Oct;25(5):466-471.

CATEGORIES:

Abstract

The Food and Drug Administration and the Vascular Quality Initiative still utilize fluoroscopy time as a surrogate marker for procedural radiation exposure. This study demonstrates that fluoroscopy time does not accurately represent radiation exposure and that dose area product and air kerma are more appropriate measures.

383]

Slattery MM, Goh GS, Power S, et al. Comparison of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery puncture techniques. Cardiovasc Intervent Radiol. 2015 Jun;38(3):579-82.

CATEGORIES:

Abstract

To prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques. Hundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture.

384]

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

Abstract

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.

385]

Smilowitz NR, Moses JW, Sosa FA, et al. Robotic-Enhanced PCI Compared to the Traditional Manual Approach. J Invasive Cardiol. 2014 Jul;26(7):318-21.

CATEGORIES:

Abstract

Remote-controlled robotic-enhanced percutaneous coronary intervention (PCI) was developed to improve procedural outcomes, reduce operator radiation exposure, and improve ergonomics. Critics questioned whether protection of the operator might result in increased radiation exposure to the patient and increase contrast media use. We studied this in a single-center comparison of robotic-enhanced versus traditional PCIs. A total of 40 patients who enrolled in the PRECISE study and had PCI with the CorPath 200 robotic system (Corindus Vascular Robotics) were compared to 80 consecutive patients who underwent conventional PCI.

386]

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.

Abstract

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).

387]

Sommer P, Bertagnolli L, Kircher S, et al. Safety profile of near-zero fluoroscopy atrial fibrillation ablation with non-fluoroscopic catheter visualization: experience from 1000 consecutive procedures. Europace. 2018;20(12):1952–1958.

Abstract

We aimed to evaluate the impact of this NFCV technology on atrial fibrillation (AF) catheter ablation in terms of reduction in procedural and radiation time as well as safety aspects. In a cohort of 1000 patients (62.9 ± 11 years; 72% men; left ventricular ejection fraction 57%; and left atrial diameter 43.2 mm), the median procedure time was 120 min, median fluoroscopy time was 0.90 min, and the median fluoroscopy dose of was 345.1 cGy · cm2. Stratification of the first (Group 1) and the last 250 (Group 2) cases showed significant improvement in the median procedure time (140–110 min) and reduction in the median fluoroscopy time (6–0.5 min) and the median dose (2263–151.9 cGy · cm2). The overall complication rate was 2.0%.

388]

Sommer P, Richter S, Hindricks G, Rolf S. Non-fluoroscopic catheter visualization using MediGuide™ technology: experience from the first 600 procedures. J Interv Card Electrophysiol. 2014 Sep;40(3):209-14.

CATEGORIES:

Abstract

A novel cardiovascular navigation system known as MediGuide™ (MG) which allows non-fluoroscopic catheter tracking over a background of pre-recorded cine loops was recently introduced. This system allows significant reduction of fluoroscopy exposure which is one of the potentially harmful aspects of today’s electrophysiological procedures such as ablations or device implantations. We provide a summary of recently published studies related to this new technological platform and describe our experience from the first 600 MG procedures at our institution.

389]

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.

CATEGORIES:

Abstract

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.

390]

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.

CATEGORIES:

Abstract

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.

391]

Spira D, Kirchner S, Blumenstock G, et al. Therapeutic angiographic procedures: differences in dose area product between analog image intensifier and digital flat panel detector. Acta Radiol. 2016 May;57(5):587-94.

CATEGORIES:

Abstract

Radiation exposure remains an unceasing concern in angiographic procedures. Modern angiography machines such as analog image intensifiers (AII) or the new flat panel detectors (FPD) aim at a further dose reduction. To present dose area products (DAP) in a broad spectrum of therapeutic angiographic procedures, comparing an AII to an FPD angiography system.

392]

Stangenberg L, Shuja F, Carelsen B, et al. A Novel Tool For Three-Dimensional Roadmapping Reduces Radiation Exposure And Contrast Agent Dose In Complex Endovascular Interventions. J Vasc Surg. 2015 Aug;62(2):448-455.

CATEGORIES:

Abstract

We hypothesized that use of a novel image fusion software, VesselNavigator (Philips Healthcare, Best, The Netherlands), facilitates precise and expeditious procedures and therefore reduces radiation exposure and contrast agent dose.

393]

Stangenberg L, Shuja F, van der Bom IMJ, et al. Modern Fixed Imaging Systems Reduce Radiation Exposure To Patients And Providers. Vasc Endovasc Surg. 2018 Jan;52(1):52-58.

Abstract

The present study explores another approach to reduce radiation exposure. Advanced imaging technology, which includes both hardware and software modifications aimed at noise reduction, can reduce the patient entrance dose and subsequently scatter radiation without compromising image quality.11 In this study, we evaluate 1 such technology (Philips ClarityIQ; Philips Healthcare, Best, the Netherlands) before and after an upgrade of the fixed cardiovascular imaging system at our institution and compared its effect on radiation exposure during EVAR or superficial femoral artery (SFA) interventions for patients and providers.

394]

Stec S, Śledź J, Mazij M, et al. Feasibility of implementation of a “simplified, No-X-Ray, no-lead apron, two-catheter approach” for ablation of supraventricular arrhythmias in children and adults. J Cardiovasc Electrophysiol. 2014 Aug;25(8):866-874.

Abstract

Although the “near-zero-X-Ray” or “No-X-Ray” catheter ablation (CA) approach has been reported for treatment of various arrhythmias, few prospective studies have strictly used “No-X-Ray,” simplified 2-catheter approaches for CA in patients with supraventricular tachycardia (SVT). We assessed the feasibility of a minimally invasive, nonfluoroscopic (MINI) CA approach in such patients.

395]

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.

Abstract

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.

396]

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.

CATEGORIES:

Abstract

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.

397]

Sullivan PM, Harrison D, Badran S, et al. Reduction in Radiation Dose in a Pediatric Cardiac Catheterization Lab Using the Philips AlluraClarity X-ray System. Pediatr Cardiol. 2017 Dec;38(8):1583-1591.

CATEGORIES:

Abstract

The objective of this study was to compare radiation doses and imaging quality using Philips AlluraClarity (Philips Healthcare, Best, The Netherlands) X-ray system and an older generation reference system. AlluraClarity is a new generation fluoroscopy system designed to reduce radiation without compromising image quality, but reports of its use in pediatric patients are limited. Dose area products (DAP, mGy cm2) and DAP/kg were compared in patients catheterized using Allura Xper and AlluraClarity systems over a year of use for each. Randomly selected studies from each system were assessed for image quality.

398]

Sun Z, AbAziz A, Yusof AKM. Radiation-Induced Noncancer Risks In Interventional Cardiology: Optimisation Of Procedures And Staff And Patient Dose Reduction. Biomed Res Int. 2013;2013:976962.

Abstract

Concerns about ionizing radiation during interventional cardiology have been increased in recent years as a result of rapid growth in interventional procedure volumes and the high radiation doses associated with some procedures. Noncancer radiation risks to cardiologists and medical staff in terms of radiation-induced cataracts and skin injuries for patients appear clear potential consequences of interventional cardiology procedures, while radiation-induced potential risk of developing cardiovascular effects remains less clear. This paper provides an overview of the evidence-based reviews of concerns about noncancer risks of radiation exposure in interventional cardiology. Strategies commonly undertaken to reduce radiation doses to both medical staff and patients during interventional cardiology procedures are discussed; optimisation of interventional cardiology procedures is highlighted.

399]

Suzuki A, Matsubara K, Sasa Y. MEASUREMENT OF RADIATION DOSES TO THE EYE LENS DURING ORTHOPEDIC SURGERY USING AN C-ARM X-RAY SYSTEM. Radiat Prot Dosimetry. 2018 Apr 1;179(2):189-195.

CATEGORIES:

Abstract

The present study aimed to determine doses delivered to the eye lenses of surgeons while using the inverted-C-arm technique and the protective effect of leaded spectacles during orthopedic surgery. The kerma in air was measured at five positions on leaded glasses positioned near the eye lens and on the neck using small optically stimulated luminescence (OSL) dosemeters. The lens equivalent dose was also measured at the neck using an OSL dosemeter. The maximum equivalent dose to the eye lens and the maximum kerma were 0.8 mSv/month and 0.66 mGy/month, respectively. The leaded glasses reduced the exposure by ~60%. Even if the surgeons are exposed to the maximum dose of X-ray radiation for 5 years, the equivalent doses to the eye lens will not exceed the present limit recommended by the ICRP.

400]

Tacher V, Petit A, Derbel H, et al. Three-dimensional Image Fusion Guidance for Transjugular Intrahepatic Portosystemic Shunt Placement. Cardiovasc Intervent Radiol. 2017 Nov;40(11):1732-1739.

CATEGORIES:

Abstract

To assess the safety, feasibility and effectiveness of image fusion guidance with pre-procedural portal phase computed tomography with intraprocedural fluoroscopy for transjugular intrahepatic portosystemic shunt (TIPS) placement.

401]

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.

CATEGORIES:

Abstract

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. Considerin