Impact of a disposable sterile radiation shield on operator radiation exposure during percutaneous coronary intervention of chronic total occlusions

Review of skin dose calculation software in interventional cardiology.

Objectives The aim of this study was to quantify the radiation dose reduction during coronary angiography and percutaneous coronary intervention (PCI) through removal of the anti-scatter grid (ASG), and to assess its impact on image quality in adult patients with a low body mass index (BMI). Methods A phantom with different thicknesses of acrylic was used with a Westmead Test Object to simulate patient sizes and assess image quality. 129 low BMI patients underwent coronary angiography or PCI with or without the ASG in situ. Radiation dose was compared between both patient groups. Results With the same imaging system and a comparable patient population, ASG removal was associated with a 47% reduction in total dose-area product (DAP) (p < 0.001). Peak skin dose was reduced by 54% (p < 0.001). Operator scatter was reduced to a similar degree and was significantly reduced through removal of the ASG. Using an image quality phantom it was demonstrated that image quality remained satisfactory. Conclusions Removal of the ASG is a simple and effective method to significantly reduce radiation dose in coronary angiography and PCI. This was achieved while maintaining adequate diagnostic image quality. Selective removal of the ASG is likely to improve the radiation safety of cardiac angiography and interventions.

Selective anti-scatter grid removal during coronary angiography and PCI: a simple and safe technique for radiation reduction

The trend towards more minimally invasive procedures in the past few decades has resulted in an exponential growth in fluoroscopy-guided catheter-based cardiology procedures. As these techniques are becoming more commonly used and developed, the adverse effects of radiation exposure to the patient, operator, and ancillary staff have been a subject of concern. Although occupational radiation dose limits are being monitored and seldom reached, exposure to chronic, low dose radiation has been shown to have harmful biological effects that are not readily apparent until years after. Given this, it is imperative that reducing radiation dose exposure in the cardiac catheterization laboratory remains a priority. Staff education and training, radiation dose monitoring, ensuring use of proper personal protective equipment, employment of shields, and various procedural techniques in minimizing radiation must always be diligently employed. Special care and consideration should be extended to pregnant women working in the cardiac catheterization laboratory. This review article presents a practical approach to radiation dose management and discusses best practice recommendations in the cardiac catheterization laboratory.

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Radiation protection in the cardiac catheterization laboratory

Radiation safety in the cardiac catheterization lab: A time series quality improvement initiative.

Aims The aim of this study was to evaluate whether a real-time (RT) colour pictorial radiation dose monitoring system reduces patient skin and total radiation dose during coronary angiography and intervention. Methods and results Patient demographics, procedural variables and radiation parameters were recorded before and after institution of the RT skin dose recording system. Peak skin dose as well as traditionally available measures of procedural radiation dose were compared. A total of 1,077 consecutive patients underwent coronary angiography, of whom 460 also had PCI. Institution of the RT skin dose recording system resulted in a 22% reduction in peak skin dose after accounting for confounding variables. Radiation dose reduction was most pronounced in those having PCI but was also seen over a range of subgroups including those with prior coronary artery bypass surgery, high BMI, and with radial arterial access. This was associated with a significant reduction in the number of patients placed at risk of skin damage. Similar reductions in parameters reflective of total radiation dose were also demonstrated after institution of RT radiation monitoring. Conclusions Institution of an RT skin dose recording reduced patient peak skin and total radiation dose during coronary angiography and intervention. Consideration should be given to widespread adoption of this technology.

Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography.

http://www.thelancet.com/article/S2666606522000748/pdf

The carbon footprint of hospital diagnostic imaging in Australia

The usage of ionising radiation in medical investigations and procedures continues to increase. Cardiologists are responsible for a disproportionately high amount of this radiation, and the performance of percutaneous coronary intervention for chronic total occlusions (CTO PCI) often requires particularly high radiation doses. Consequently, both patients and proceduralists are potentially being exposed to harmful doses of radiation. This review discusses the potential dangers of radiation exposure during CTO PCI, as well as techniques to minimise radiation dose to the patient and proceduralist. Specific attention is paid to recent innovations in real-time dose monitoring and X-ray system developments that afford considerable dose savings during routine PCI as well as CTO PCI.

Radiation Management in Coronary Angiography: Percutaneous Coronary Intervention for Chronic Total Occlusion at the Frontier.

Aim: Radiation reduction is essential. In cardiac electrophysiology imaging without the anti-scatter grid has been proven as a means of achieving further radiation reduction. We evaluate the application of this gridless imaging technique to deliver further reductions in radiation risk to both patients and personnel during coronary angiography(C/C) and percutaneous coronary interventions (PCI). Methods and Results: We compared 6 consecutive coronary angiograms and 4 consecutive PCIs with and without the antiscatter grid in our new Toshiba Infinix-I angiography suite (Toshiba Medical Systems, Japan) in patients with a Body Mass Index (BMI) under 30. We chose this number as we felt it was a threshold BMI above which image quality may be compromised. For all cases all radiation and clinical data were recorded. All procedures were performed without complication. An appreciable difference in image quality without the grid was noted only during fluoroscopy with movement. However during still fluoroscopy and cine acquisition there was no notable difference. One possible future approach may also be selected use of the gridless technique with re-introduction of the grid in larger patients or during aspects of the procedure where image quality is important. The most marked difference in radiation reduction was seen during PCI.

Glenn Ison

Papers

Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography.

The carbon footprint of hospital diagnostic imaging in Australia

Selective anti-scatter grid removal during coronary angiography and PCI: a simple and safe technique for radiation reduction

Radiation Management in Coronary Angiography: Percutaneous Coronary Intervention for Chronic Total Occlusion at the Frontier.

Removing the Antiscatter Grid: A simple way to lower radiation during both Angiography and PCI