Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures

Europace

Volumn 16, Issue 7, 2014, Pages 946-964

  Heidbuchel, Hein ^a,l   Wittkampf, Fred H M ^b   Vano, Eliseo ^c   Ernst, Sabine ^d   Schilling, Richard ^e   Picano, Eugenio ^f   Mont, Lluis ^g   Jais, Pierre ^h   De Bono, Joseph ⁱ   Piorkowski, Christopher ^j   Saad, Eduardo ^k   Femenia, Francisco ^e  

^a UNIVERSITY HOSPITALS LEUVEN   (Belgium)

^b UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

^c UNIVERSIDAD COMPLUTENSE DE MADRID   (Spain)

^d ROYAL BROMPTON AND HAREFIELD NHS FOUNDATION TRUST   (United Kingdom)

^e BARTS HEALTH NHS TRUST   (United Kingdom)

^f INSTITUTE OF CLINICAL PHYSIOLOGY   (Italy)

^g UNIVERSITY OF BARCELONA   (Spain)

^h HAUT LÉVÊQUE HOSPITAL   (France)

ⁱ QUEEN ELIZABETH HOSPITAL   (United Kingdom)

^j DRESDEN UNIVERSITY OF TECHNOLOGY   (Germany)

^k HOSPITAL PRÓ CARDÍACO   (Brazil)

^l HOSPITAL ESPAÑOL DE MENDOZA   (Argentina)

more..

Author keywords

Exposure; Interventional electrophysiology; Radiation; Radioprotection; Risk

Indexed keywords

ANGIOGRAPHY; ARTICLE; BRAIN TUMOR; CANCER RISK; CARDIAC MAPPING SYSTEM; CARDIOLOGIST; COLLIMATOR; COMPUTER ASSISTED TOMOGRAPHY; FLUOROSCOPY; FLUOROSCOPY SYSTEM; GUIDE WIRE; HEART ELECTROPHYSIOLOGY; HIGH RISK POPULATION; HUMAN; IMPLANTABLE CARDIOVERTER DEFIBRILLATOR; IMPLANTATION; INTERVENTIONAL CARDIOVASCULAR PROCEDURE; IONIZING RADIATION; MEDICAL STAFF; OPERATOR; PACEMAKER; PRIORITY JOURNAL; RADIATION DOSE REDUCTION; RADIATION EXPOSURE; RISK REDUCTION; STEREOTACTIC DEVICE; WORKFLOW; X RAY SYSTEM; EQUIPMENT DESIGN; HEART CATHETERIZATION; HEART FUNCTION TEST; INTERVENTIONAL RADIOLOGY; OCCUPATIONAL EXPOSURE; OCCUPATIONAL HEALTH; PATIENT SAFETY; PRACTICE GUIDELINE; PROSTHESIS IMPLANTATION; RADIATION DOSE; RADIATION INJURIES; RADIATION MONITORING; RADIATION PROTECTION; RISK ASSESSMENT; RISK FACTOR; STANDARDS;

CARDIAC CATHETERIZATION; ELECTROPHYSIOLOGIC TECHNIQUES, CARDIAC; EQUIPMENT DESIGN; FLUOROSCOPY; HUMANS; OCCUPATIONAL EXPOSURE; OCCUPATIONAL HEALTH; PATIENT SAFETY; PROSTHESIS IMPLANTATION; RADIATION DOSAGE; RADIATION INJURIES; RADIATION MONITORING; RADIATION PROTECTION; RADIOGRAPHY, INTERVENTIONAL; RISK ASSESSMENT; RISK FACTORS; WORKFLOW;

EID: 84904024566     PISSN: 10995129     EISSN: 15322092     Source Type: Journal    
DOI: 10.1093/europace/eut409     Document Type: Article

References (87)

1. Roguin A, Goldstein J, Bar O. Brain tumours among interventional cardiologists: A cause for alarm?. Report of four new cases from two cities and a review of the literature. EuroIntervention 2012;7:1081-6
2. Einstein AJ, Knuuti J. Cardiac imaging: Does radiation matter?. Eur Heart J 2012;33: 573-8
3. Picano E, Vano E, RehaniMM, Cuocolo A, Mont L, Bodi V et al. The appropriate and justified use of medical radiation in cardiovascular imaging: A position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. Eur Heart J 2014;35:665-72
4. Picano E. Sustainability of medical imaging. BMJ 2004;328:578-80
5. Mettler FA Jr, Bhargavan M, Faulkner K, Gilley DB, Gray JE, Ibbott GS et al. Radiologic and nuclear medicine studies in the United States and worldwide: Frequency, radiation dose, and comparison with other radiation sources - 1950-2007. Radiology 2009;253:520-31
6. Peplow M. Chernobyl's legacy. Nature 2011;471:562-5
7. Picano E, Vano E. The radiation issue in cardiology: The time for action is now. Cardiovas Ultrasound 2011;9:35
8. Gerber TC, Carr JJ, Arai AE, Dixon RL, Ferrari VA, Gomes AS et al. Ionizing radiation in cardiac imaging: A science advisory from theAmerican Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation 2009;119:1056-65
9. Venneri L, Rossi F, Botto N, AndreassiMG, Salcone N, EmadAet al. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: Insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report. Am Heart J 2009;157:118-24
10. Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol 2013;111:1368-72
11. Buchanan GL, Chieffo A, Mehilli J, MikhailGW, Mauri F, Presbitero P et al. The occupational effects of interventional cardiology: Results from the WIN for Safety survey. EuroIntervention 2012;8:658-63
12. Marinskis G, Bongiorni MG, Dagres N, Lewalter T, Pison L, Blomstrom-Lundqvist C. Scientific Initiative Committee, European Heart Rhythm Association. X-ray exposure hazards for physicians performing ablation procedures and device implantation: Results of the EuropeanHeart RhythmAssociation survey. Europace 2013;15:444-6
13. Linet MS, Kim KP, Miller DL, Kleinerman RA, Simon SL, Berrington de Gonzalez A. Historical review of occupational exposures and cancer risks in medical radiation workers. Radiat Res 2010;174:793-808
14. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007;37:1-332
15. HirshfeldJWJr, Balter S, Brinker JA, Kern MJ, Klein LW, LindsayBDet al.ACCF/AHA/ HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: A report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Circulation 2005;111:511-32
16. Miller DL, Vano E, Bartal G, Balter S, Dixon R, Padovani R 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;33:230-9
17. Vano E, Gonzalez L, Fernandez JM, Alfonso F, Macaya C. Occupational radiation doses in interventional cardiology: A 15-year follow-up. Br J Radiol 2006;79:383-8
18. Kim C, Vasaiwala S, Haque F, Pratap K, Vidovich MI. Radiation safety among cardiology fellows. Am J Cardiol 2010;106:125-8
19. Andreassi MG, Foffa I, Manfredi S, Botto N, Cioppa A, Picano E. Genetic polymorphisms in XRCC1, OGG1, APE1 and XRCC3 DNA repair genes, ionizing radiation exposure and chromosomalDNA damage in interventional cardiologists. Mutat Res 2009;666:57-63
20. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2.Washington DC: The National Academies Press; 2006
21. Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ 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;41:1-322
22. Valentin J. Avoidance of radiation injuries from medical interventional procedures. Ann ICRP 2000;30:7-67
23. Medical electrical equipment - part 2-43: Particular requirements for the basic safety and essential performance of X-ray equipment for interventional procedures. Report IEC 60601-2-43. Geneva, Switzerland. 2010
24. Ingwersen M, Drabik A, Kulka U, Oestreicher U, Fricke S, Krankenberg H et al. Physicians' radiation exposure in the catheterization lab: Does the type of procedure matter?. JACC Cardiovasc Interv 2013;6:1095-102
25. Council Directive 97/43/Euratom of 30 June 1997 on health protection of individuals against the dangers of ionising radiation in relation to medical exposure, and repealing Directive 84/466/Euratom. Off J Eur Commun 1997;180:22-7
26. Chambers CE, Fetterly KA, Holzer R, Lin PJ, Blankenship JC, Balter S et al. Radiation safety program for the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2011;77:546-56
27. Stecker MS, Balter S, Towbin RB, Miller DL, Vano E, Bartal G et al. Guidelines for patient radiation dose management. J Vasc Interv Radiol 2009;20(7 Suppl):S263-73
28. Patient dosimetry for X rays used in medical imaging, ICRU Report 74. International Commission on Radiological Units and Measurements. Bethesda, MD. 2005
29. European Commission. European guidance on estimating population doses from medical X-ray procedures. Radiation Protection Report 154, 2008. http://ec. europa.eu/energy/nuclear/radiation-protection/doc/publication/154.zip
30. Karambatsakidou A, Sahlgren B, Hansson B, Lidegran M, Fransson A. Effective dose conversion factors in paediatric interventional cardiology. Br J Radiol 2009;82: 748-55
31. Damilakis J, Theocharopoulos N, Perisinakis K, Manios E, Dimitriou P, Vardas P et al. Conceptus radiation dose and risk from cardiac catheter ablation procedures. Circulation 2001;104:893-7
32. Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:3147-97
33. Theocharopoulos N, Damilakis J, Perisinakis K, Manios E, Vardas P, Gourtsoyiannis N. Occupational exposure in the electrophysiology laboratory: Quantifying and minimizing radiation burden. Br J Radiol 2006;79:644-51
34. Efstathopoulos EP, Katritsis DG, Kottou S, Kalivas N, Tzanalaridou E, Giazitzoglou E et al. Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: A comprehensive analysis. Europace 2006;8: 443-8
35. Hart D, Wall BF. Radiation exposure of the UK population from medical and dental X-ray examinations. Public Health England. Health Protection Agency (HPA). Chilton, Didcot, Oxfordshire OX11 0RQ, UK; 2002 (ISBN: 0-85951-468-4).
36. Perisinakis K, Damilakis J, Theocharopoulos N, Manios E, Vardas P, Gourtsoyiannis N. Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures. Circulation 2001;104:58-62
37. Lickfett L, Mahesh M, Vasamreddy C, Bradley D, Jayam V, Eldadah Z et al. Radiation exposure during catheter ablation of atrial fibrillation. Circulation 2004;110: 3003-10
38. Kovoor P, Ricciardello M, Collins L, Uther JB, Ross DL. Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia. Circulation 1998;98:1534-40
39. Perisinakis K, Theocharopoulos N, Damilakis J, Manios E, Vardas P, Gourtsoyiannis N. Fluoroscopically guided implantation of modern cardiac resynchronization devices: Radiation burden to the patient and associated risks. J Am Coll Cardiol 2005;46:2335-9
40. Butter C, Schau T, Meyhoefer J, Neumann K, Minden HH, Engelhardt J. Radiation exposure of patient and physician during implantation and upgrade of cardiac resynchronization devices. Pacing Clin Electrophysiol 2010;33:1003-12
41. Mettler FA Jr, HudaW, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: A catalog. Radiology 2008;248:254-63
42. Rogers DP, England F, Lozhkin K, Lowe MD, Lambiase PD, Chow AW. Improving safety in the electrophysiology laboratory using a simple radiation dose reduction strategy: A study of 1007 radiofrequency ablation procedures. Heart 2011;97: 366-70
43. Estner HL, Deisenhofer I, LuikA, Ndrepepa G, von Bary C, Zrenner B et al. Electrical isolation of pulmonary veins in patients with atrial fibrillation: Reduction of fluoroscopy exposure and procedure duration by the use of a non-fluoroscopic navigation system (NavX). Europace 2006;8:583-7
44. Macle L, Weerasooriya R, Jais P, Scavee C, Raybaud F, Choi KJ et al. Radiation exposure during radiofrequency catheter ablation for atrial fibrillation. Pacing Clin Electrophysiol 2003;26(Pt 2):288-91
45. McFadden SL, MooneyRB, Shepherd PH. X-ray dose and associated risks from radiofrequency catheter ablation procedures. Br J Radiol 2002;75:253-65
46. Davies AG, Cowen AR, Kengyelics SM, Moore J, Pepper C, Cowan C et al. X-ray dose reduction in fluoroscopically guided electrophysiology procedures. Pacing Clin Electrophysiol 2006;29:262-71
47. Tsalafoutas IA, Spanodimos SG, Maniatis PN, Fournarakis GM, Koulentianos ED, Tsigas DL. Radiation doses to patients and cardiologists from permanent cardiac pacemaker implantation procedures. Pacing Clin Electrophysiol. 2005;28:910-6
48. Tsapaki V, Christou A, Spanodimos S, Nikolaou N, Poulianitou A, Triantopoulou C et al. Evaluation of radiation dose during pacemaker implantations. Radiat Prot Dosimetry 2011;147:75-7
49. Duray GZ, Hohnloser SH, Israel CW. Coronary sinus side branches for cardiac resynchronization therapy: Prospective evaluation of availability, implant success, and procedural determinants. J Cardiovasc Electrophysiol 2008;19:489-94
50. Suzuki S, Furui S, Yamakawa T, Isshiki T, Watanabe A, Iino R et al. Radiation exposure to patients' skin during cardiac resynchronization therapy. Europace 2009;11: 1683-8
51. Goldstein JA, Gallagher MJ, O'NeillWW, RossMA, O'Neil BJ, Raff GL.Arandomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol 2007;49:863-71
52. Rubinshtein R, Halon DA, Gaspar T, Schliamser JE, Yaniv N, Ammar R et al. Usefulness of 64-slice multidetector computed tomography in diagnostic triage of patients with chest pain and negative or nondiagnostic exercise treadmill test result. Am J Cardiol 2007;99:925-9
53. Coles DR, Smail MA, Negus IS, Wilde P, Oberhoff M, Karsch KR et al. Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. J Am Coll Cardiol 2006;47:1840-5
54. Li JH, Haim M, Movassaghi B, Mendel JB, Chaudhry GM, Haffajee CI et al. Segmentation and registration of three-dimensional rotational angiogram on live fluoroscopy to guide atrial fibrillation ablation: A new online imaging tool. Heart Rhythm 2009;6: 231-7
55. Wagner M, Butler C, Rief M, Beling M, Durmus T, Huppertz A et al. Comparison of non-gated vs. electrocardiogram-gated 64-detector-rowcomputed tomography for integrated electroanatomic mapping in patients undergoing pulmonary vein isolation. Europace 2010;12:1090-7
56. Hausleiter J, Meyer T, Hadamitzky M, Huber E, Zankl M, Martinoff S et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice: Impact of different scanning protocols on effective dose estimates. Circulation 2006;113:1305-10
57. Kriatselis C, Tang M, Roser M, Fleck E, Gerds-Li H. A new approach for contrast-enhanced X-ray imaging of the left atrium and pulmonary veins for atrial fibrillation ablation: Rotational angiography during adenosine-induced asystole. Europace 2009;11:35-41
58. Wielandts JY, De Buck S, Ector J, Lagerche A, Willems R, Bosmans H et al. Threedimensional cardiac rotational angiography: Effective radiation dose and image quality implications. Europace 2010;12:194-201
59. Knecht S, Wright M, Akrivakis S, Nault I, Matsuo S, Chaudhry GM et al. Prospective randomized comparison between the conventional electroanatomical system and three-dimensional rotational angiography during catheter ablation for atrial fibrillation. Heart Rhythm 2010;7:459-65
60. Ector J, Dragusin O, Adriaenssens B, Huybrechts W, Willems R, Ector H et al. Obesity is a major determinant of radiation dose in patients undergoing pulmonary vein isolation for atrial fibrillation. J Am Coll Cardiol 2007;50:234-42
61. Fetterly KA, Mathew V, Lennon R, Bell MR, Holmes DR Jr, Rihal CS. Radiation dose reduction in the invasive cardiovascular laboratory: Implementing a culture and philosophy of radiation safety. JACC Cardiovasc Interv 2012;5:866-73
62. De Buck S, La Gerche A, Ector J, Wielandts JY, Koopman P, Garweg C et al. Asymmetric collimation can significantly reduce patient radiation dose during pulmonary vein isolation. Europace 2012;14:437-44
63. Ector J, De Buck S, HuybrechtsW, Nuyens D, Dymarkowski S, Bogaert J et al. Biplane three-dimensional augmented fluoroscopy as single navigation tool for ablation of atrial fibrillation: Accuracy and clinical value. Heart Rhythm 2008;5:957-64
64. Savage C, Seale IV TM, Shaw CJ, Bruner AP, Marichal D, Rees CR. Evaluation of a suspended personal radiation protection system vs. conventional apron and shields in clinical interventional procedures. Open Journal of Radiology 2013:143-51
65. Dragusin O, Weerasooriya R, Jais P, Hocini M, Ector J, Takahashi Y et al. Evaluation of a radiation protection cabin for invasive electrophysiological procedures. Eur Heart J 2007;28:183-9
66. Vano E, Kleiman NJ, Duran A, Rehani MM, Echeverri D, Cabrera M. Radiation cataract risk in interventional cardiology personnel. Radiat Res 2010;174:490-5
67. Ciraj-Bjelac O, Rehani MM, Sim KH, Liew HB, Vano E, Kleiman NJ. Risk for radiation-induced cataract for staff in interventional cardiology: Is there reason for concerñ. Catheter Cardiovasc Interv 2010;76:826-34
68. Rolf S, Sommer P, Gaspar T, John S, Arya A, Hindricks G et al. Ablation of atrial fibrillation using novel 4-dimensional catheter tracking within autoregistered left atrial angiograms. Circ Arrhythm Electrophysiol 2012;5:684-90
69. Rotter M, Takahashi Y, Sanders P, Haissaguerre M, Jais P, Hsu LF et al. Reduction of fluoroscopy exposure and procedure duration during ablation of atrial fibrillation using a novel anatomical navigation system. Eur Heart J 2005;26:1415-21
70. Kesek M, Wallenius N, Ronn F, Hoglund N, Jensen S. Reduction of fluoroscopy duration in radiofrequency ablation obtained by the use of a non-fluoroscopic catheter navigation system. Europace 2006;8:1027-30
71. Sporton SC, Earley MJ, NathanAW, Schilling RJ. Electroanatomic versus fluoroscopic mapping for catheter ablation procedures: A prospective randomized study. J Cardiovasc Electrophysiol 2004;15:310-5
72. Earley MJ, Showkathali R, Alzetani M, Kistler PM, Gupta D, Abrams DJ et al. Radiofrequency ablation of arrhythmias guided by non-fluoroscopic catheter location: A prospective randomized trial. Eur Heart J 2006;27:1223-9
73. Casella M, Pelargonio G, Dello Russo A, Riva S, Bartoletti S, Santangeli P et al. 'Nearzero' fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX mapping system: Personal experience and reviewof the literature. J Interv Card Electrophysiol 2011;31:109-18
74. Hindricks G, Willems S, Kautzner J, De Chillou C, Wiedemann M, Schepel S et al. Effect of electroanatomically guided versus conventional catheter ablation of typical atrial flutter on the fluoroscopy time and resource use: A prospective randomized multicenter study. J Cardiovasc Electrophysiol 2009;20:734-40
75. Casella M, Dello Russo A, Pelargonio G, BongiorniMG, Del Greco M, PiacentiMet 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;22:539-46
76. Ferguson JD, Helms A, Mangrum JM, Mahapatra S, Mason P, Bilchick K et al. Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol 2009;2:611-9
77. Nazarian S, Kolandaivelu A, Zviman MM, Meininger GR, Kato R, Susil RC et al. Feasibility of real-time magnetic resonance imaging for catheter guidance in electrophysiology studies. Circulation 2008;118:223-9
78. Zhang F, Yang B, Chen H, Ju W, Kojodjojo P, Cao K et al. Magnetic versus manual catheter navigation for mapping and ablation of right ventricular outflow tract ventricular arrhythmias: A randomized controlled study. Heart Rhythm2013;10:1178-83
79. Kistler PM, Rajappan K, Harris S, Earley MJ, Richmond L, Sporton SC et al. The impact of image integration on catheter ablation of atrial fibrillation using electroanatomic mapping: A prospective randomized study. Eur Heart J 2008;29: 3029-36
80. Kerst G, Weig HJ, Weretka S, Seizer P, Hofbeck M, Gawaz M et al. Contact forcecontrolled zero-fluoroscopy catheter ablation of right-sided and left atrial arrhythmia substrates. Heart Rhythm 2012;9:709-14
81. Richter S, Doring M, Gaspar T, John S, Rolf S, Sommer P et al. Cardiac resynchronization therapy device implantation using a new sensor-based navigation system: Results from the first human use study. Circ Arrhythm Electrophysiol 2013;6:917-23
82. Dekker LR, van der Voort PH, Simmers TA, Verbeek XA, BullensRW, VeerMVet 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; 10:1678-82
83. Soderman M, Holmin S, Andersson T, Palmgren C, Babic D, Hoornaert B. Image noise reduction algorithm for digital subtraction angiography: Clinical results. Radiology 2013;269:553-60
84. Picano E. Informed consent and communication of risk from radiological and nuclear medicine examinations: How to escape from a communication inferno. BMJ 2004; 329:849-51
85. Malone J, Guleria R, Craven C, Horton P, JarvinenH, Mayo J et al. Justification of diagnostic medical exposures, some practical issues: Report of an International Atomic Energy Agency Consultation. Br J Radiol 2011;85:523-38
86. Semelka RC, Armao DM, Elias J Jr, Picano E. The information imperative: Is it time for an informed consent process explaining the risks of medical radiatioñ. Radiology 2012;262:15-8
87. Terranova G, Ferro M, Carpeggiani C, Recchia V, Braga L, Semelka RC et al. Low quality and lack of clarity of current informed consent forms in cardiology: How to improve them. JACC Cardiovasc Imaging 2012;5:649-55