RADIATION EXPOSURE IN DIFFERENT CARDIAC CATHETERIZATION PROCEDURES IN CATH LAB
Abstract
Background: Interventional procedures render cardiologolists and their team members to high doses of radiations. This study was conducted to assess the radiation exposure in various cardiac catheterization procedures. Methods: This descriptive cross sectional study was conducted at the catheterization laboratory of Lady Reading Hospital Peshawar from November 2008 to December 2009. Patients were categorized into four groups for procedures a. coronary angiography, b. percutaneous coronary intervention (PCI), c. permanent pacemakers (PPM) and d. percutaneous transvenous mitral commisurotomy (PTMC), two groups for operators (consultants and trainees), and three groups for various accesses (femoral, radial and sub-clavian). Results: A total of 99 patients undergoing cardiac catheterization were studied. Coronary angiography was performed in 52 (52.5%) patients, PCI in 32 (32.3%)), pacemakers in 6 (6.1%), and PTMC in 9 (9.1%) patients. Consultants did 72(72.7%) procedures and trainees did 27(27.3%) procedures. Through radial access, 22(22.2%) procedures were performed, 71(71.7%) through femoral, and 6 (6.1%) through sub-clavian. The mean radiation dose for coronary angiography was (4907.862±15231.6358 µGym2), PCI (10375.16±16083.4385 µGym2), pacemakers (1406.823±785.489 µGym2), and PTMC (1157.91±760.437 µGym2). The mean radiation dose for radial (6147.33±8480.37 µGym2), femoral (6512.58±16566.73 µGym2), and sub-clavian was (1406.82±785.48 µGym2). While for various operators consultants (7489.5±16925.55 µGym2), and trainees (2475.25±1178.86 µGym2). The mean time for radial (8.59±7.28 min), femoral (6.95±6.43 min) and sub-clavian was (8.24±4.81 min). The mean time for coronary angiography (4.56±5.32 min), PCI (11.44±6.92 min), PPM (8.24±4.81 min), and PTMC (8.28±5.01 min). Conclusions: Radiation dose varies substantially across different groups by different operators and different routes.
Keywords: Radiation exposure, Radiation dose, cardiac catheterization proceduresReferences
American Board of Internal Medicine. Interventional Board Requirements. Available at: http://abim.org/resources/eiblue.shtm.
Hirshfeld JW, Balter S, Brinker JA. ACCF/AHA/HRS/SCAI clinical competence statement on optimizing patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures. J Am Coll Cardiol 2004;44:2259-82.
European-Union. Guidelines for Education and Training in Radiation Protection for Medical Exposures. Brussels: 2000. Available at: http://europa.eu.int/comm./environment/radprot/ 116/rp-116-en.pdf
Shope TB. Radiation-induced skin injuries from fluoroscopy. Radiographics 1996;16:1195-9.
Park TH, Eichling JO, Schechtman KB, Bromberg BI, Smith JM, Lindsay BD. Risk of radiation induced skin injuries from arrhythmia ablation procedures. Pacing Clin Electrophysiol 1996;19:1363-9.
Dehen L, Vilmer C, Humiliere C, Corcos T, Pentousis D, Ollivaud L, et al. Chronic radiodermatitis following cardiac catheterization: a report of two cases and a brief review of the literature. Heart 1999;81:308-12.
Balter S, editor. Interventional Fluoroscopy, Physics, Technology, Safety. New York: John Wiley; 2001.
Hall EJ, Giaccia AJ, editors. Radiobiology for the Radiologist. 4thed. Philadelphia: Lippincott Williams and Wilkins; 1994.
Bushberg J, Seibert JA, Ledidholdt EM, Boone JM. The Essential physics of Medical Imaging. 2nd ed. Baltimore: Lippincott Williams and Wilkins; 2002.
Hershfeld JW Jr, Balter S, Brinker JA, Kern MJ, Klein LW, Lindsay BD, et 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.
Finestone S, Schesinger T, Amir H, Richter E, Milgrom C. Do physicians correctly estimate radiation risks from medical imaging? Arch Enrviron Health 2003;58:59-61.
Shiralkar S, Rennie A, Snow M, Galland RB, Lewis MH, Gower-Thomas K. Doctors knowledge of radiation exposure: questionnaire study. BMJ 2003;327:371-2.
Lee CI, Hairms AH, Monico EP, Brink JA, Forman HP. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 2004;231:393-8.
Correia MJ, Hellies A, Andreassi MG, Ghelarducci B, Picano E. Lack of radiological awareness in a tertiary care cardioilogical centre. Int J Cardiol 2005;103:307-11.
Andreassi MG. The biological effects of diagnostic cardiac imaging on professionally exposed physicians: the importance of being non-ionizing. Cardiovasc Ultrasound 2004;2:25-7
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.