Interventional Cardiology Procedures Research Articles

Same-day discharge strategy in a heart rhythm management clinic - what about patients' reported experience?

Abstract Background and aims Same-day discharge (SDD) has been adopted for many interventional cardiology procedures, however data on patients’ experience are scarce. The aim of this study was to investigate patient-reported experience of a SDD strategy following electrophysiology procedures (EP) in a Heart Rhythm Management Department. Methods Consecutive patients undergoing EP procedures in our centre, who fulfilled pre-defined eligibility criteria for SDD, were asked to complete the study questionnaire, right before hospital discharge. Procedures suitable for SDD ranged from non-invasive (electric cardioversion, tilt test) to invasive ones (EP studies, device replacement, rhythm recorders implantation, ablation of supraventricular tachycardias including atrial fibrillation). The questionnaire aimed to assess patients’ experience before and during the procedure, their satisfaction with the quality of the provided information and their comprehension of the given instructions regarding the post-discharge period and their medication. Results The study questionnaire was completed by 501 patients. The majority of participants described SDD as a good or a quite good experience (n=440, 87,8%), while 94,6% of them (n=474) would not hesitate to undergo a second SDD procedure, if necessary. A direct interview with a healthcare team member was viewed as the preferred method of obtaining information on the procedure. At discharge, 1 out of 10 patients were still unsure of the instructions given by the healthcare team, including their anticoagulation treatment. Patient reported satisfaction rates did not differ between invasive and non-invasive procedures. However, after an invasive procedure, patients seemed to significantly have a better understanding of post-discharge instructions. Conclusion Patients reported a high level of satisfaction with SDD EP procedures. However, significant efforts need to be made in order to ensure their understanding of post-discharge instructions.Figure : Patients' reported experience

An audit of patient radiation doses during interventional cardiology procedures in Uttarakhand, India, and establishment of local diagnostic reference levels.

The objective of this study was to investigate patient radiation doses by a dose audit of three common interventional cardiology (IC) procedures: coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and CA-PTCA procedures performed in IC centres in the Uttarakhand state of India, for the establishment of local diagnostic reference levels (DRLs) and the estimation of average effective dose (Eav) for these procedures. For each procedure, the values of kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of cine images were recorded from 1233 CA, 458 PTCA and 736 CA-PTCA procedures performed over a 12-month period at 13 IC centres of the state. From the recorded dose data, 0.6%, 1.53% and 7.9% patients were identified to have exceeded the PKA trigger level of 500 Gy cm2 for possible skin injury for CA, PTCA and CA-PTCA procedures, respectively. The 3rd quartile of the distribution of the recorded PKA values for each type of procedure was calculated to estimate local DRL values. The estimated values of DRLs and Eav were 37, 153 and 224 Gy cm2, and 6.72, 23.97 and 34.79 mSv for CA, PTCA and CA-PTCA procedures, respectively. For about 77% of the surveyed centres, the recorded patient doses were in agreement with the international standards. The local DRLs proposed in this study may be used to achieve patient dose optimization during IC procedures and the obtained patient dose data may also be archived into national dose database for the establishment of national DRLs.

Cardiovascular screening of elderly athletes.

The permanently growing interest in amateur and professional sports activities among young, middle-aged and elderly athletes raises serious concerns about athletes' health, the safety of physical training, and the sports-related risk of sudden cardiac death and other cardiovascular complications during exercise. In recent years there has been an increasing number of cases of sudden cardiac death during physical effort. At present, life expectancy in the most developed countries grows rapidly and the number of people >65 years dramatically increases. Moreover, biological age of the population is lower. Subsequently, relevant increase in the number of elderly athletes involved in various types of sports activities has been reported in many countries. It was also demonstrated that physical activity has strong beneficial effect on cognitive functions, psychomotor performance and thus exercise capacity, which is very important for the elderly people in their everyday routine activities. Nonetheless, it should be remembered that participation in amateur and professional sports activities may be associated with risk of serious cardiovascular events in the elderly athletes often suffering from various civilization diseases. It is also reported that the number of elderly people after interventional cardiology procedures, open heart surgery and cancer treatment (chemotherapy, radiotherapy), who wish to participate in various sports activities, systematically grows. The authors of the paper conduct a literature review on cardiovascular risk assessment in the elderly athletes including the contemporary cardiology diagnostic methods and diagnostic schemes to prevent sudden cardiac death and other cardiovascular events during exercise. The controversies over efficacy of particular diagnostic tools to detect cardiovascular diseases in the elderly athletes and worldwide epidemiologic data concerning risk of sudden cardiac death during physical exercise have been also presented. Here, the authors have derived suggestions for establishment of comprehensive diagnostic schemes to prevent sudden cardiac death during sports activities.

Occupational radiation exposure in interventional cardiology: Assessing anesthesia staff 's skin dose with thermoluminescent dosimetry

This research was conducted to evaluate the occupational dose for the skin in terms of equivalent doses experienced by anesthesia staff during interventional cardiology procedures in Saudi Arabia. Over a five-year period (2019–2023), thermoluminescent dosimetry (TLD) data were gathered for 175 anesthesia staff members. The TLDs used in this study estimated the skin-dose equivalent at a depth of 0.07 mm, referred to as Hp(0.07). The cohort comprised predominantly technologists, who formed about 72.4% of the participants (with a gender distribution of 55% male and 45% female), while consultants made up the remaining 27.6% (70% male and 30% female). The study's findings on the annual mean Hp(0.07) for all staff from 2019 to 2023 indicated notable fluctuations in radiation exposure over the years. The annual mean Hp(0.07) values showed a range, with the peak at 0.85 mSv in 2020 and the lowest at 0.64 mSv in 2023. A significant increase in the annual mean Hp(0.07) was observed from 0.66 mSv in 2019 to 0.85 mSv in 2020, followed by a slight rise to 0.86 mSv in 2021, and then a decrease to 0.72 mSv in 2022 and further to 0.64 mSv in 2023. These variations were statistically significant (p < 0.001). The overall annual mean Hp(0.07) over the study period was 0.75 ± 0.43 mSv. In terms of gender differences, the overall annual mean Hp(0.07) for male technologists was 0.73 mSv, and for female technologists, it was slightly higher at 0.87 mSv. Among consultants, male consultants had an overall annual mean Hp(0.07) of 0.69 mSv, while female consultants had a lower average of 0.47 mSv. The overall annual mean Hp(0.07) for technologists was 0.8 mSv, significantly higher than that for consultants, which was 0.62 mSv (p-value = 0.015). The gender-based analysis revealed that males had an overall annual mean Hp(0.07) of 0.72 ± 0.38 mSv, while females had a 0.79 ± 0.48 mSv, with no significant statistical difference (p = 0.344). Despite these variations, the annual mean Hp(0.07) values remained below the occupational exposure limit of 500 mSv annually. However, since the relationship between exposure to low-dose ionizing radiation and cancer risk has not yet been fully determined, compliance with radiation safety protocols and personal doses should be periodically assessed in any radiological department to keep radiation exposure to staff ALARA.

Protocolo de seguimento de pacientes com reações de pele tardias devido a procedimentos cardiológicos intervencionistas: seguimento de pacientes com reações de pele devido à radiação

Interventional cardiology procedures can generate high doses of ionizing radiation and delayed skin reactions in patients undergoing complex procedures with a substantial radiation dose level. Since 2014, we have implemented, in the cath lab, the monitoring of patients undergoing procedures with a substantial radiation dose level, to identify these patients and provide patient care support. We present two case reports of such patients, who are undergoing dermatological treatment. The implemented protocol provided specialized treatment for the patients and awareness of radiation safety among health workers.

Differing radiation exposure in scrub technicians and rotating staff in Cardiac catheterization laboratory: occupation matters

BackgroundRadiation exposure is a significant hazard associated with invasive Cardiology, with most studies based on primary operator exposure. This prospective, observational study aimed to find out over lead radiation exposure as effective dose acquired by non-physician staff comprising scrub technicians and rotating staff in the cath laboratory. Effective dose (ED) measured per procedure via Raysafe i2®dosimeter badges worn by both rotating staff and scrub technicians over lead aprons along with dose area product (DAP), fluoroscopy time (FT) and procedure time (PT) in minutes was collected prospectively over forty-six invasive Cardiology procedures.ResultsThis study shows that rotating staff acquire higher ED in comparison with their scrub technician colleagues in diagnostic, interventional and electrophysiology cases. However, a statistically significant difference in radiation exposure of both staff groups was demonstrated in diagnostic and interventional Cardiology procedures, with p values of 0.04 and 0.01, respectively.ConclusionsThese findings highlight occupational role and mobility around fluoroscopic sources as major factors in radiation exposure, which should be addressed within current radiation protection practices.

Establishment of local diagnostic reference levels for radiation dose in paediatric interventional cardiology procedures in Brazil

Diagnostic and therapeutic interventional cardiology procedures are essential tools for evaluating congenital pathologies in paediatric patients. However, these procedures may expose patients to high levels of ionizing radiation. In this paper, we present the results of the radiation doses received by patients undergoing interventional cardiac procedures at a paediatric hospital in Brazil, aiming to establish local Diagnostic Reference Levels (DRL). The data were collected over a period of three years (2019–2022), and 148 procedures were analyzed, comprising 53% male (78) and 47% female (70) patients. These procedures included both diagnostic (59%) and therapeutic (41%) cardiac catheterization interventions. The average patient weight was 21.4 ± 1.7 kg (2.0–112.0 kg), with an average age of 5.3 ± 0.4 years (0.0–17.1 years). Comprehensive data for each procedure were extracted from Radiation Dose Structure Reports generated by the equipment. The results showed significant differences between diagnostic and therapeutic procedures, and the DRL values were estimated considering the age and weight of the patients. The DRL values correspond to the 3rd quartile of the dose distribution for each group. The following local DRL values were estimated, considering the patient's ages. For diagnostic procedures, the PKA defined according to the age groups <1, 1–5, 5–10, 10–15, and >15 years were respectively: 1.4, 2.8, 3.1, 4.3 and 12.0 Gy cm2. For therapeutic procedures, the DRL values for patients with the same ages were: 2.0, 3.7, 5.4, 7.4, and 30.9 Gy cm2. For the total procedures, the PKA values were 1.7, 3.2, 4.9, 6.6, and 24.5 Gy cm2, respectively. The suggested local DRL values for weight groups (<5, 5–15, 15–30, 30–50, and 50–80 kg) for PKA in diagnostic procedures were: 1.3, 2.2, 3.2, 4.1, and 7.9 Gy cm2, respectively. For therapeutic procedures, the PKA values were 1.1, 2.7, 5.4, 5.5, and 30.9 Gy cm2, respectively. For the total procedures, the PKA values were 1.25, 2.5, 4.6, 4.2, and 18.3 Gy cm2, respectively. For establishing PKA DRL, patient weight was found to be preferable over age, whereas for Ka,r, both approaches yielded nearly identical results.

Successful Retrieval of Retained Rotablator Burr in the Mid Left Anterior Descending Coronary Artery using a Retrograde Approach: A Case Report

AbstractWe present a rare complication of Rotablator (Boston Scientific) atherectomy during percutaneous coronary intervention in a 67-year-old patient with a history of coronary artery disease and prior coronary artery bypass graft (CABG) surgery. The fracture of the Rotablator drive shaft and retention of the Rotablator burr in the mid left anterior descending coronary artery posed significant challenges in patient management. This case demonstrates the successful extraction of the retained Rotablator burr using retrograde total occlusion recanalization and highlights the importance of understanding the potential complications and management strategies in complex interventional cardiology procedures.

An Approach to Establishing Diagnostic Reference Levels in Interventional Pediatric Cardiology from Different Regions of Brazil.

Diagnostic reference levels (DRLs) are a pivotal strategy to be implemented since pediatric interventional cardiology procedures are increasing. This work aimed to propose an initial set of Brazilian DRLs for pediatric interventional diagnostic and therapeutic (D&T) procedures. A retrospective study was carried out in four Brazilian states, distributed across the three regions of the country. Data were collected from pediatric patients undergoing cardiac interventional procedures (CIPs), including their age and anthropometric characteristics, and at least four parameters (number of images, exposure time, air kerma-area product-PKA, and cumulative air kerma). Data from 279 patients undergoing CIPs were gathered (147 diagnostic and 132 therapeutic procedures). There were no significant differences in exposure time and the number of images between the D&T procedures. A wide range of PKA was observed when the therapeutic procedures were compared to diagnostics for all age groups. There were significant differences between the D&T procedures, whether grouping data by patient weight or age. In terms of cumulative air kerma, it was noted that no value exceeded the level to trigger a monitoring process for patients. This study shows that it is possible to adopt them as the first proposal to establish national DRLs considering pediatric patient groups.

Three-dimensional simulation for interventional cardiology procedures: Face and content validity

Introduction and objectivesThree-dimensional (3D) model simulation provides the opportunity to manipulate real devices and learn intervention skills in a realistic, controlled, and safe environment. To ensure that simulators provide a realistic surrogate to real procedures they must undergo scientific validation. We aimed to evaluate the 3D-printed simulator SimulHeart® for face and content validity to demonstrate its value as a training tool in interventional cardiology (IC). MethodsHealth professionals were recruited from sixteen Portuguese IC units. All participants received a 30-minute theoretical introduction, 10-minute demonstration of each task and then performed the intervention on a 3D-printed simulator (SimulHeart®). Finally, a post-training questionnaire focusing on the appearance of the simulation, simulation content, and satisfaction/self-efficacy was administered. ResultsWe included 56 participants: 16 “experts” (general and interventional cardiologists), 26 “novices” (cardiology residents), and 14 nurses and allied professionals. On a five-point Likert scale, the overall mean score of face validity was 4.38±0.35 and the overall mean score of content validity was 4.69±0.32. There was no statistically significant difference in the scores provided by “experts” and “novices”. Participants reported a high level of satisfaction/self-efficacy with 60.7% considering it strongly improved their skills. The majority (82.1%) “agreed” or “strongly agreed” that after the simulation they felt confident to perform the procedure on a patient. ConclusionThe 3D-printed simulator (SimulHeart®) showed excellent face and content validity. 3D simulation may play an important role in future IC training programs. Further research is required to correlate simulator performance with clinical performance in real patients.

Assessment of dosimetric approaches in evaluating radiation exposure for interventional cardiologists in Sri Lanka.

Interventional cardiologists face significant radiation exposure during interventional cardiology procedures. Therefore, this study focuses on assessing radiation exposure among interventional cardiologists during their procedures. Specifically, it aims to determine the effectiveness of both single and double dosimeter methods in estimating annual occupational radiation doses. This research holds pioneering significance as it represents the very first study undertaken in Sri Lanka. Thirteen interventional cardiologists performed 486 interventional cardiology procedures over three months in three different healthcare institutes. Active Hp(10) dosimeters were placed to measure radiation exposure. Effective doses were calculated using single and double dosimetric algorithms. Annual occupational doses were assessed on an operator basis. Statistical analyses were conducted to assess algorithmic differences and dose variations using the Kruskal-Wallis test and linear regression. The highest annual occupational dose for each dosimetric algorithm received as 2.00 ± 0.24 mSv, 2.29 ± 0.48 mSv, 3.35 ± 0.71 mSv, and 2.64 ± 0.42 mSv, respectively, and remained below the recommended safety limit of 20 mSv/year. The Kruskal-Wallis test revealed no significant differences in the effective doses among double dosimetric algorithms, as well as between single and double dosimetric algorithms (p > 0.05). Linear regression showed strong correlations among various algorithms, demonstrating consistency. The findings of this study hold significant effects on interventional cardiology practice in Sri Lanka, enhancing radiation safety and monitoring.

The Fluoroless Future in Electrophysiology: A State-of-the-Art Review.

Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.

Prevention of contrast-associated acute kidney injury in an era of increasingly complex interventional procedures.

Radiological and interventional cardiology procedures are in continuous expansion, leading to an important increase in the incidence of contrast-associated acute kidney injury (CA-AKI). Although numerous methods of CA-AKI prevention have been studied, at present, there is no consensus on the definition of this entity or on its prevention. In this paper, we aim to provide a critical analysis of the existing data on the epidemiology, pathophysiology, and clinical significance of CA-AKI. Existing and emergent approaches for CA-AKI prevention are also discussed, with a focus on parenteral fluid administration and on the most recent clinical and experimental data. We also emphasize a number of questions that remain to be answered, and we identify hotspots for future research.

The Importance of Weight-Based Protocols and Reduction of Frame Rates in ASD Percutaneous Closure

Introduction: In the context of interventional and diagnostic cardiology procedures, there is a growing effort to minimize exposure to ionizing radiation. Most modern angiography machines allow selection of exposure parameters based on the patient's weight. Our experience has led us to question whether the use of weight-based protocols is the right approach for pediatric interventional cardiology exams. Aim and Materials: The purpose of this research is to investigate the efficacy of techniques aimed at reducing radiation exposure during ASD percutaneous closure in pediatric patients. Since 2020, in all patients we used predefined acquisition parameters with a low exposure level (CARD &lt;6Kg) and reduced pulsations to 4p/s. Therefore, from 2020 we used the lowest possible radiological pediatric protocol regardless of patient weight. We compared this group of patients (B) with an historical group of patients (A) with an ASD, in which a radiological protocol based only on patient’s weight was applied. Results: Group A included 92 patients with ostium secundum atrial septal defect. Group B included 114 patients with ostium secundum atrial septal defect. In this group, 22 patients received a Gore Cardioform ASD occluder device with the need of a biplane imaging. The two groups were comparable in terms of age (p=0.1) and weight (p=0.2). The absorbed dose in group A was significantly higher than in group B. Median total air kerma was 6.55 mGy(1.2-255,6 mGy) in group A and 5.25 mGy(0.4-140.5 mGy) in group B (p 0.001). Dose area product (DAP) was 130,2 μGym²(24.25-5774 μGym²) in group A and 67.1 μGym²(8.6-3107 μGym²) in group B(p 0.001). Conclusion: Our strategy resulted in a significant reduction in radiation exposure to the patients while maintaining good radioscopic resolution. This significance was maintained despite the use of new devices in 2021 in addition to Amplatzer (GORE-Occlutech).

Local Diagnostic Reference Levels for Pediatric Interventional Cardiology Procedures in Argentina.

The aim of this work was to propose a preliminary local diagnostic reference levels (DRL) for pediatric interventional cardiology (PIC) procedures in Argentina, for different ranges of age and weight. This work has been conducted in the framework of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency to ensuring that radiation exposures of pediatric patients are the minimum necessary during fluoroscopy-guided interventional procedures. The local DRL values presented in this paper by weight group and age group were 7.1 Gy·cm2 (<5 kg), 10.7 Gy·cm2 (5-15 kg), 18.0 Gy·cm2 (15-30 kg), 15.9 Gy·cm2 (30-50 kg), and 28.2 Gy·cm2 (50-80 kg) and 5.3 Gy·cm2 (<1), 11.2 Gy·cm2 (1 to 5<), 19.6 Gy·cm2 (5 to 10<), and 21.4 Gy·cm2 (10 to 16<), respectively. Our dose results are among the values found in other international studies; however, there is great potential for dose optimization.

Evaluating Occupational Radiation Exposure in Interventional Cardiology: An Investigation into Estimating Effective Dose

To safeguard the safety and well-being of interventional cardiology healthcare workers, monitoring their occupational radiation exposure is crucial. This study evaluates the radiation dose of interventional cardiologists using the Swiss Ordinance for personal dosimetry approach. Its primary aim is to estimate the radiation dose for each operator engaged in interventional cardiology procedures to protect from dangerous levels of radiation. Additionally, this study assesses the correlation between under-apron and over-apron dosimeters. Notably, no previous studies in Sri Lanka have specifically assessed radiation dose in this context, making this research vital in shedding light on radiation exposure in an interventional cardiology environment. Two cardiologists conducted a total of 108 interventional cardiology procedures, including coronary angiograms and percutaneous coronary interventions for a month at the cardiac catheterization laboratory of Sri Jayewardenepura General Hospital, Sri Lanka. Active dosimeters were utilized to measure dose values using a two-dosimeter approach where one dosimeter was positioned above the thyroid collar and the other beneath the lead apron on the left side of the waist. The effective doses (E) were determined using the Swiss Ordinance algorithm. Furthermore, this study also examined the relationship between under and over-apron dose values. The Swiss Ordinance algorithm estimated the mean annual E values for each cardiologist, resulting in 3.0397 mSv/year and 0.9697 mSv/year, respectively showing that the estimated annual occupational doses remained well below the annual dose limit (20 mSv/year). The accuracy of the algorithm in interventional ionising radiation scenarios was also highlighted. A strong positive correlation (R2 = 0.9500) was observed between over-apron and under-apron dose values. Applying the Swiss Ordinance for personal dosimetry and studying the link between over and under-apron dosimeters in interventional cardiology improve our grasp of radiation dosimetry. Emphasizing precise dose estimation for the safety of cardiologists, this study enhances the radiation safety practices in interventional cardiology.

RADIATION EXPOSURE IN INTERVENTIONAL CARDIOLOGY: STRATEGIES FOR REDUCTION AND PROTECTION

Occupational radiation exposure is a significant concern among healthcare professionals, particularly those in interventional radiology and cardiology procedures. This study aims to comprehensively investigate radiation exposure and its health effects among 200 healthcare professionals, including 100 physicians, 50 nurses, and 50 technicians, across five hospitals. The study employed a controlled, multi-center, observational design, with 100 participants in the experimental group exposed to enhanced radiation protection strategies, while 100 participants in the control group adhered to standard safety protocols. The interventions included additional lead barriers, radiation-absorbent pads, real-time dose monitoring systems, and continuous staff training on radiation safety. Exposure levels were measured using personal dosimeters at regular intervals before and after the interventions. Subgroup analysis was conducted based on professional roles and procedure types, categorized into simple and complex interventions. The results showed a statistically significant reduction in annual radiation exposure in the experimental group compared to the control group, with substantial effect sizes. Subgroup analysis revealed varying degrees of exposure reduction among different professional roles. Notably, complex interventions demonstrated the most substantial reductions in radiation exposure. Furthermore, an analysis of X-ray beam angles indicated a statistically significant increase in exposure at steep angles (≥30°). However, no significant interaction between the control and experimental groups was observed, suggesting that other variables may influence the relationship between steep angles and exposure. The findings of this study emphasize the effectiveness of enhanced protection strategies in reducing occupational radiation exposure among healthcare professionals. The nuanced effects observed across different professional roles and procedure types underscore the importance of tailored safety measures. These results contribute to the ongoing efforts to optimize radiation safety in medical settings and promote the well-being of healthcare professionals. Ethical considerations, adherence to international standards, and the potential implications for policy and guidelines further underscore the significance of this study's findings.

Physical Image Quality Metrics for the Characterization of X-ray Systems Used in Fluoroscopy-Guided Pediatric Cardiac Interventional Procedures: A Systematic Review.

Pediatric interventional cardiology procedures are essential in diagnosing and treating congenital heart disease in children; however, they raise concerns about potential radiation exposure. Managing radiation doses and assessing image quality in angiographs becomes imperative for safe and effective interventions. This systematic review aims to comprehensively analyze the current understanding of physical image quality metrics relevant for characterizing X-ray systems used in fluoroscopy-guided pediatric cardiac interventional procedures, considering the main factors reported in the literature that influence this outcome. A search in Scopus and Web of Science, using relevant keywords and inclusion/exclusion criteria, yielded 14 relevant articles published between 2000 and 2022. The physical image quality metrics reported were noise, signal-to-noise ratio, contrast, contrast-to-noise ratio, and high-contrast spatial resolution. Various factors influencing image quality were investigated, such as polymethyl methacrylate thickness (often used to simulate water equivalent tissue thickness), operation mode, anti-scatter grid presence, and tube voltage. Objective evaluations using these metrics ensured impartial assessments for main factors affecting image quality, improving the characterization of fluoroscopic X-ray systems, and aiding informed decision making to safeguard pediatric patients during procedures.

Radiation exposure during distal and traditional radial coronary angiography and percutaneous coronary intervention: a meta-analysis of randomized controlled trials.

Previous studies show that the distal transradial approach (dTRA) is safe and effective for coronary angiography and percutaneous coronary intervention. However, the effect of dTRA on radiation exposure in the catheterization laboratory has not been characterized. The authors analyzed the available literature to compare the radiation exposure associated with dTRA vs the traditional radial approach (TRA). A systematic review and meta-analysis of the scientific literature was conducted by using relevant terms to search the PubMed, Embase, and Cochrane Library databases from their inception until October 13, 2022, to identify randomized controlled trials (RCTs) comparing dTRA with TRA. The primary outcome was radiation exposure reported as fluoroscopy time, air kerma, or kerma-dose product. The standard mean difference (SMD) and its 95% confidence interval were used to summarize continuous variables. Random effect and meta-regression also were used for analyses. Among 484 studies identified, 7 were RCTs, with a total of 3427 patients (1712 dTRA, 1715 TRA). No difference was found between dTRA and TRA in radiation exposure quantified as fluoroscopy time (SMD -0.10 [-0.36, 0.15], P=.43) or air kerma (SMD -0.31 [-0.74, 0.13], P=.17). The overall estimate favored lower kerma-area product in the TRA (SMD 0.19 [0.08, 0.30], P=.0006). Meta-regression showed no correlation between fluoroscopy time and year of publication. Compared with TRA, dTRA was associated with significantly greater radiation exposure per the kerma-area product during interventional cardiology procedures, with no differences in fluoroscopy time and air kerma.

Assessment of patient and occupational exposure and radiation risk from cath-lab procedure

Due to the extended localized fluoroscopy, many radiographic exposures, and multiple procedures that might result in tissue reaction, patients and personnel received a significant radiation dose during interventional cardiology (IR) procedures. This study aims to calculate the radiation risk and assess patient and staff effective doses during IC procedures. Thirty-two patients underwent a Cath lab treatment in total. Ten Cath lab personnel, including six nurses, two cardiologists, and two X-ray technologists. Optical stimulating-luminescent dosimeters (OSL) (Al2O3:C) calibrated for this purpose were used to monitor both occupational and ambient doses. Using an automated OSL reader, these badges were scanned. The Air Kerma (mGy) and Kerma Area Products (KAP, mGy.cm2) have a mean and standard deviation (SD) of 371 ± 132 and 26052, respectively. The average personal dose equivalent (mSv) and its range for cardiologists, nurses and X ray technologists were 1.11 ± 0.21 (0.96–1.26), 0.84 ± 0.11 (0.68–1.16), and 0.68 ± 0.014 (0.12–0.13), respectively. The current study findings showed that the annual effective dose for cardiologists, nurses, and X-ray technologists was lesser than the yearly occupational dose limit of 20 mSv recommended by national and international guidelines. The patients’ doses are comparable with some previously published studies and below the tissue reaction limits.