Use of a Dose-dependent Follow-up Protocol and Mechanisms to Reduce Patients and Staff Radiation Exposure in Congenital and Structural Interventions
Increasingly complex structural/congenital cardiac interventions require efforts at reducing patient/staff radiation exposure. Standard follow-up protocols are often inadequate in detecting all patients that may have sustained radiation burns.
Single-center retrospective chart review divided into four intervals. Phase 1 (07/07-06/08, 413 procedures (proc)): follow-up based on fluoroscopy time only; frame rate for digital acquisition (DA) 30 fps, and fluoroscopy (FL) 30 fps. Dose-based follow-up was used for phase 2-4. Phase 2 (07/08-08/09, 458 proc): DA: 30 fps, FL: 15 fps. Phase 3 (09/09-06/10, 350 proc): DA: 15-30 fps, FL: 15 fps, use of added radiation protection drape. Phase 4 (07/10-10/10, 89 proc): DA: 15-30 fps, FL: 15 fps, superior noise reduction filter (SNRF) with high-quality fluoro-record capabilities.
There was a significant reduction in the median cumulative air kerma between the four study periods (710 mGy vs. 566 mGy vs. 498 mGy vs. 241 mGy, P < 0.001), even though the overall fluoroscopy times remained very similar (25 min vs. 26 min vs. 26 min vs. 23 min, P = 0.957). There was a trend towards lower physician radiation exposure over the four study periods (137 mrem vs. 126 mrem vs. 108 mrem vs. 59 mrem, P = 0.15). Fifteen patients with radiation burns were identified during the study period. When changing to a dose-based follow-up protocol (phase 1 vs. phase 2), there was a significant increase in the incidence of detected radiation burns (0.5% vs. 2%, P = 0.04).
Dose-based follow-up protocols are superior in detecting radiation burns when compared to fluoroscopy time-based protocols. Frame rate reduction of fluoroscopy and cine acquisition and use of modified imaging equipment can achieve a significant reduction to patient/staff exposure.
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ABSTRACT: The increase in the frequency of interventional procedures and in the number of medical specialties using fluoroscopically guided procedures together with the reevaluation of radiation risks by the International Commission on Radiological Protection (ICRP) and their impact on safety regulations has promoted several international research programs, guidelines produced by professional and scientific societies, and many valuable research articles during the last few years. This review summarizes the most important new findings and brings readers up to date on the subject of radiation safety in interventional radiology. Several key points are highlighted in the sections on guidelines of scientific and professional societies, national and regional patient and staff dose surveys, interventional procedures in pediatrics, automatic patient dose registry and analysis, occupational and lens dose evaluation, lens injury surveys, and patient dose follow-up and hybrid rooms. As a conclusion, the most relevant aspects are summarized as follows: the ICRP recommendation on the use of diagnostic reference levels for interventional procedures and new radiation thresholds for some tissue reactions; a new occupational dose limit for the lens and changes in regulation; guidelines of several medical societies on radiation safety for interventional procedures; relevant international research programs on the topic; advances in radiology systems offering standardized patient dose reports and optimized imaging protocols; more interest and actions in radiological protection training; more interest in patient dose management for pediatric procedures; concern with lens and skin radiation injuries and actions to avoid them; better postprocedural care as part of the quality programs and better clinical follow-up of patients and automatic collection and processing of individual patient doses to help in the optimization and contribute to the tracking of patient procedures and doses.
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ABSTRACT: Transradial (TR) cardiac catheterisation is thought to be associated with an increased exposure to radiation compared with the traditional transfemoral (TF) access. This paper provides a review of current literature describing these reported associations. Although several studies have reported an increase in radiation exposure to both operator and patient with TR compared with TF access, others have reported findings suggesting no significant difference, even reporting decreased exposure with TR access. Ultimately, increased radiation exposure appears likely with TR access; however, in consideration of the many benefits associated with TR access, radiation exposure remains only one of many considerations when deciding between routes of access.
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