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Radiation Exposure and Safety

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The Interventional Cardiology Training Manual

Abstract

Coronary angiography is a widely available diagnostic and therapeutic modality. Radiation exposure is set to increase as a result of greater complexity of coronary and structural cases now being undertaken. Therefore all cardiologists need to be aware of not only the risks of radiation but also strategies to minimize radiation exposure for both patients and catheter laboratory staff.

This chapter aims to provide a brief overview of basic radiation physics, highlight associated risks of radiation, and emphasize strategies to minimize radiation exposure.

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Bibliography

  • Abdelaal E, Plourde G, MacHaalany J, Arsenault J, Rimac G, Dery JP, et al. Effectiveness of low rate fluoroscopy at reducing operator and patient radiation dose during transradial coronary angiography and interventions. JACC Cardiovasc Interv. 2014;7(5):567–74.

    Article  Google Scholar 

  • Agarwal S, Parashar A, Bajaj NS, Khan I, Ahmad I, Heupler FA Jr, et al. Relationship of beam angulation and radiation exposure in the cardiac catheterization laboratory. JACC Cardiovasc Interv. 2014;7(5):558–66.

    Article  Google Scholar 

  • Authors on behalf of ICRP, Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, 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(1–2):1–322.

    Google Scholar 

  • Cantor WJ, Puley G, Natarajan MK, Dzavik V, Madan M, Fry A, et al. Radial versus femoral access for emergent percutaneous coronary intervention with adjunct glycoprotein IIb/IIIa inhibition in acute myocardial infarction—the RADIAL-AMI pilot randomized trial. Am Heart J. 2005;150(3):543–9.

    Article  CAS  Google Scholar 

  • Chase AJ, Fretz EB, Warburton WP, Klinke WP, Carere RG, Pi D, et al. Association of the arterial access site at angioplasty with transfusion and mortality: the M.O.R.T.A.L study (Mortality Benefit of Reduced Transfusion after percutaneous coronary intervention via the arm or leg). Heart. 2008;94(8):1019–25.

    Article  CAS  Google Scholar 

  • Delewi R, Hoebers LP, Ramunddal T, Henriques JP, Angeras O, Stewart J, et al. Clinical and procedural characteristics associated with higher radiation exposure during percutaneous coronary interventions and coronary angiography. Circ Cardiovasc Interv. 2013;6(5):501–6.

    Article  Google Scholar 

  • Hamada N, Fujimichi Y, Iwasaki T, Fujii N, Furuhashi M, Kubo E, et al. Emerging issues in radiogenic cataracts and cardiovascular disease. J Radiat Res. 2014;55(5):831–46.

    Article  Google Scholar 

  • Hart D, Hillier MC, Shrimpton PC. Doses to patients from radiographic and fluoroscopic x-ray imaging procedures in the UK – 2010 review. HPA-CRCE-034. 2012. http://www.hpa.org.uk/Publications/Radiation/CRCEScientificAndTechnicalReportSeries/HPACRCE034.

  • Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J. 2009;157(1):132–40.

    Article  Google Scholar 

  • Jolly SS, Cairns J, Niemela K, Steg PG, Natarajan MK, Cheema AN, et al. Effect of radial versus femoral access on radiation dose and the importance of procedural volume: a substudy of the multicenter randomized RIVAL trial. JACC Cardiovasc Interv. 2013;6(3):258–66.

    Article  Google Scholar 

  • Koenig TR, Wolff D, Mettler FA, Wagner LK. Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. AJR Am J Roentgenol. 2001a;177(1):3–11.

    Article  CAS  Google Scholar 

  • Koenig TR, Mettler FA, Wagner LK. Skin injuries from fluoroscopically guided procedures: part 2, review of 73 cases and recommendations for minimizing dose delivered to patient. AJR Am J Roentgenol. 2001b;177(1):13–20.

    Article  CAS  Google Scholar 

  • Kuipers G, Delewi R, Velders XL, Vis MM, van der Schaaf RJ, Koch KT, et al. Radiation exposure during percutaneous coronary interventions and coronary angiograms performed by the radial compared with the femoral route. JACC Cardiovasc Interv. 2012;5(7):752–7.

    Article  Google Scholar 

  • Kuon E. Radiation exposure in invasive cardiology. Heart. 2008;94(5):667–74.

    Article  Google Scholar 

  • Kuon E, Schmitt M, Dahm JB. Significant reduction of radiation exposure to operator and staff during cardiac interventions by analysis of radiation leakage and improved lead shielding. Am J Cardiol. 2002;89(1):44–9.

    Article  Google Scholar 

  • Kuon E, Birkel J, Schmitt M, Dahm JB. Radiation exposure benefit of a lead cap in invasive cardiology. Heart. 2003;89(10):1205–10.

    Article  CAS  Google Scholar 

  • Kuon E, Dahm JB, Empen K, Robinson DM, Reuter G, Wucherer M. Identification of less-irradiating tube angulations in invasive cardiology. J Am Coll Cardiol. 2004;44(7):1420–8.

    Article  Google Scholar 

  • Lange HW, von Boetticher H. Reduction of operator radiation dose by a pelvic lead shield during cardiac catheterization by radial access: comparison with femoral access. JACC Cardiovasc Interv. 2012;5(4):445–9.

    Article  Google Scholar 

  • Loomba RS, Rios R, Buelow M, Eagam M, Aggarwal S, Arora RR. 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;116(1):43–9.

    Article  Google Scholar 

  • Meinel FG, Nance JW Jr, Harris BS, De Cecco CN, Costello P, Schoepf UJ. Radiation risks from cardiovascular imaging tests. Circulation. 2014;130(5):442–5.

    Article  Google Scholar 

  • Musallam A, Volis I, Dadaev S, Abergel E, Soni A, Yalonetsky S, et al. A randomized study comparing the use of a pelvic lead shield during trans-radial interventions: threefold decrease in radiation to the operator but double exposure to the patient. Catheter Cardiovasc Interv. 2015;85(7):1164–70.

    Article  Google Scholar 

  • Olcay A, Guler E, Karaca IO, Omaygenc MO, Kizilirmak F, Olgun E, et al. Comparison of fluoro and cine coronary angiography: balancing acceptable outcomes with a reduction in radiation dose. J Invasive Cardiol. 2015;27(4):199–202.

    PubMed  Google Scholar 

  • Pancholy SB, Joshi P, Shah S, Rao SV, Bertrand OF, Patel TM. Effect of vascular access site choice on radiation exposure during coronary angiography: the REVERE Trial (Randomized Evaluation of Vascular Entry Site and Radiation Exposure). JACC Cardiovasc Interv. 2015;8(9):1189–96.

    Article  Google Scholar 

  • Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res. 2000;154(2):178–86.

    Article  CAS  Google Scholar 

  • Plourde G, Pancholy SB, Nolan J, Jolly S, Rao SV, Amhed I, 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;386(10009):2192–203.

    Article  Google Scholar 

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

    Article  Google Scholar 

  • Preston DL, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res. 2007;168(1):1–64.

    Article  CAS  Google Scholar 

  • Preston DL, Shimizu Y, Pierce DA, Suyama A, Mabuchi K. Studies of mortality of atomic bomb survivors. Report 13: solid cancer and noncancer disease mortality: 1950-1997. 2003. Radiat Res. 2012;178(2):AV146–72.

    Article  CAS  Google Scholar 

  • Reeves RR, Ang L, Bahadorani J, Naghi J, Dominguez A, Palakodeti V, et al. Invasive cardiologists are exposed to greater left sided cranial radiation: the BRAIN Study (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures). JACC Cardiovasc Interv. 2015;8(9):1197–206.

    Article  Google Scholar 

  • Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol. 2013;111(9):1368–72.

    Article  Google Scholar 

  • Tsapaki V, Kottou S, Vano E, Parviainen T, Padovani R, Dowling A, et al. Correlation of patient and staff doses in interventional cardiology. Radiat Prot Dosimetry. 2005;117(1–3):26–9.

    Article  CAS  Google Scholar 

  • Vano E, Gonzalez L. Accreditation in radiation protection for cardiologists and interventionalists. Radiat Prot Dosimetry. 2005;117(1–3):69–73.

    Article  CAS  Google Scholar 

  • Vano E, Ubeda C, Leyton F, Miranda P, Gonzalez L. Staff radiation doses in interventional cardiology: correlation with patient exposure. Pediatr Cardiol. 2009;30(4):409–13.

    Article  Google Scholar 

  • Yoshinaga S, Mabuchi K, Sigurdson AJ, Doody MM, Ron E. Cancer risks among radiologists and radiologic technologists: review of epidemiologic studies. Radiology. 2004;233(2):313–21.

    Article  Google Scholar 

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Correspondence to James Nolan .

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Sandhu, K., Bhatia, G., Nolan, J. (2018). Radiation Exposure and Safety. In: Myat, A., Clarke, S., Curzen, N., Windecker, S., Gurbel, P.A. (eds) The Interventional Cardiology Training Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-71635-0_7

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  • DOI: https://doi.org/10.1007/978-3-319-71635-0_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71633-6

  • Online ISBN: 978-3-319-71635-0

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