Fetal radiation exposure risk in the pregnant neurointerventionalist

2020 ◽  
Vol 12 (10) ◽  
pp. 1014-1017 ◽  
Author(s):  
Stephanie H Chen ◽  
Marie-Christine Brunet
Keyword(s):  
Radiation Exposure ◽  
Radiation Safety ◽  
Women Physicians ◽  
Fluoroscopy Time ◽  
Exposure Risk ◽  
Safety Practices ◽  
Lead Apron ◽  
Significant Difference ◽  
Fetal Dose ◽  
Exposure Measurements

BackgroundThe prevalence of women physicians is steadily rising, but the field of neurointervention remains one of the most male-dominated subspecialties in medicine. A fear of radiation exposure, particularly during pregnancy and childbearing years, may be responsible for deterring some of the best and brightest. This is the first study to examine the amount of maternal and fetal radiation exposure during a pregnant neurointerventional fellow’s training.MethodsWe retrospectively analyzed the radiation exposure of a neurointerventional fellow prior to and during pregnancy from February 2018 to May 2019 in 758 neurointerventional cases. The collar dosimeter was used to measure overall maternal exposure and an additional fetal dosimeter was worn under two lead apron skirts to estimate fetal radiation exposure.ResultsThere was not a significant difference between pre- and post-pregnancy overall maternal radiation exposure as measured by the collar dosimeter (151 mrem pre-pregnancy and 105 mrem during pregnancy, p=0.129). Mean fluoroscopy time and fluoroscopy emission per procedure also did not differ prior to and during pregnancy. Fetal radiation exposure measurements from both the Mirion Genesis Ultra TLD dosimeter as well as the Mirion Instadose dosimeters worn under double lead apron skirts were 0 mrem for all 6 months.ConclusionThese findings suggest that, when optimal radiation safety practices are implemented, the fetal dose of a pregnant neurointerventionalist is negligible. Further studies and education are necessary to encourage women to choose neurointervention and allow practicing women neurointerventionalists to maintain their productivity during their reproductive years.

scholarly journals Does a fluoro-assisted direct anterior approach for total hip arthroplasty pose an excessive risk of radiation exposure to the surgeon?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 6
Author(s):  
Yuta Jinnai ◽  
Tomonori Baba ◽  
Xu Zhuang ◽  
Hiroki Tanabe ◽  
Sammy Banno ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Proximal Femoral Fracture ◽  
Fluoroscopy Time ◽  
Exposure Level ◽  
Intraoperative Fluoroscopy ◽  
Significant Difference ◽  
The Mean

Introduction: Intraoperative fluoroscopy can be easily used because patients are placed in the supine position during total hip arthroplasty via direct anterior approach (DAA-THA) to reduce complications. However, the cumulative level of radiation exposure by intraoperative fluoroscopy increases as the annual number of cases increases, increasing the risk of influencing the health of both the patients and medical workers. The objective of the study was to compare the radiation exposure time of DAA-THA with osteosynthesis and to determine if the level of radiation exposure exceeded safety limits. Material and methods: DAA-THA was performed in 313 patients between January 2016 and July 2018 and 60 patients with proximal femoral fracture were treated with osteosynthesis. The intraoperative fluoroscopy time was retrospectively surveyed and compared between these two groups. A total of eight surgeons operated DAA-THA employing the same procedure using a traction table. A total of nine surgeons operated osteosynthesis and fluoroscopy was appropriately used during reduction and implant insertion. Results: The mean operative time of DAA-THA was 103.3 min and that of osteosynthesis was 83.3 min, showing a significant difference (p < 0.05). The mean intraoperative fluoroscopy time was 0.83 min (SD ± 0.68) in DAA-THA and 8.91 min (SD ± 8.34) in osteosynthesis showing a significant difference (p < 0.05). Conclusions: The intraoperative exposure level was significantly lower and the fluoroscopy time was significantly shorter in DAA-THA than in osteosynthesis for proximal femoral fracture. It was clarified that the annual cumulative radiation exposure level in DAA-THA does not exceed the tissue dose limit.

Knowledge And Awareness of Radiation Safety Among Orthopaedic Surgeon: A Survey Analysis

2021 ◽  
Author(s):  
Bushu Harna ◽  
Shivali Arya ◽  
Jaikaran Singh ◽  
Palash Gupta ◽  
Ajay Gupta
Keyword(s):  
Radiation Exposure ◽  
Potential Risk ◽  
Radiation Safety ◽  
Training Programme ◽  
Minimal Invasive ◽  
Survey Analysis ◽  
Lead Apron ◽  
Orthopaedic Surgeons ◽  
Protective Gear ◽  
Level Of Knowledge

Abstract Purpose: Orthopaedic surgeons are at potential risk to suffer from radiation exposure. The radiation exposure has increased due to minimal invasive and complex orthopaedic procedures. This study evaluates the level of knowledge of orthopaedic surgeons regarding radiation safety and prevention.Methods: A survey consisting of 17 questions was conducted among the 519 orthopaedic surgeons. The orthopaedic surgeons were contacted via mobile or email and the data was analysed.Results: Total of 542 responses were received and 23 were excluded due to incomplete responses. The result depicted, only 5% of the orthopaedic surgeons were aware of the ALARA/ALARP principles. Only 45% of the surgeons were right about the collimated image acquisition. None of the surgeon used dosimeter in the study. Most of the surgeons (40%) were not aware of the influence of C-Arm orientation on the scattered radiation. The protective gears were used by 75% of the orthopaedic surgeons and 5% used it occasionally. A lead apron is used by all the orthopaedic surgeons using the protective gear whereas only 15% used thyroid shield additionally. Only 5% of orthopaedic surgeons had some training in radiation safety and protection.Conclusion: The study demonstrates the level of knowledge regarding radiation safety and consequences among orthopaedic surgeons. The study depicts the need for proper and appropriate training required by the orthopaedic surgeons. Further extensive and elaborate studies are required to ascertain the radiation safety as a part of the training programme of the orthopaedic surgeons.

scholarly journals Transradial approach for diagnostic cerebral angiograms in the elderly: a comparative observational study

2020 ◽  
pp. neurintsurg-2020-016140
Author(s):  
Ahmad Sweid ◽  
Somnath Das ◽  
Joshua H Weinberg ◽  
Kareem E l Naamani ◽  
Julie Kim ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Elderly Patients ◽  
Radiation Exposure ◽  
The Elderly ◽  
Fluoroscopy Time ◽  
Access Site ◽  
Transradial Approach ◽  
Contrast Dose ◽  
Significant Difference ◽  
Procedure Duration

BackgroundThe transradial approach (TRA) reduces mortality, morbidity, access site complications, hospital cost, and length of stay while maximizing patient satisfaction. We aimed to assess the technical success and safety of TRA for elderly patients (aged ≥75 years).MethodsA retrospective chart review and comparative analysis was performed for elderly patients undergoing a diagnostic cerebral angiogram performed via TRA versus transfemoral approach (TFA). Also, a second comparative analysis was performed among the TRA cohort between elderly patients and their younger counterparts.ResultsComparative analysis in the elderly (TRA vs TFA) showed no significant differences for contrast dose per vessel (43.7 vs 34.6 mL, P=0.106), fluoroscopy time per vessel (5.7 vs 5.2 min, P=0.849), procedure duration (59.8 vs 65.2 min, P=0.057), conversion rate (5.8% vs 2.9%, P=0.650), and access site complications (2.3% vs 2.9%, P=1.00). Radiation exposure per vessel (18.9 vs 51.9 Gy cm2, P=0.001) was significantly lower in the elderly TRA group.The second comparison (TRA in elderly vs TRA in the young) showed no significant differences for contrast dose per vessel (43.7 vs 37.8 mL, P=0.185), radiation exposure per vessel (18.9 vs 16.5 Gy cm2, P=0.507), procedure duration (59.8 vs 58.3 min, P=0.788), access site complication (2.3% vs 1.7%, P=0.55), and conversation rate (5.8% vs 1.8%, P=0.092). A trend for prolonged fluoroscopy time per vessel (5.7 vs 4.7 min, P=0.050) was observed in the elderly TRA group.ConclusionsTRA is a technically feasible and safe option for diagnostic neurointerventional procedures in the elderly. Our small elderly cohort was not powered enough to show a significant difference in terms of access site complications between TRA and TFA.

scholarly journals The Impact of Experience on Fluoroscopy Time for Peripherally Inserted Central Venous Catheters in a Pediatric Population: A Retrospective Review

2020 ◽  
Vol 3 ◽  
Author(s):  
Isaac Schumacher ◽  
Paul Haste
Keyword(s):  
Radiation Exposure ◽  
Pediatric Population ◽  
Venous Catheter ◽  
Fluoroscopy Time ◽  
Medical Procedures ◽  
Central Venous ◽  
Interventional Radiologist ◽  
Reduce Radiation Exposure ◽  
Significant Difference ◽  
The Impact

Background:  It is established that radiation exposure carries a risk for children. The best approach is to use the As Low As Reasonably Achievable (ALARA) principle for medical procedures. Peripherally inserted central venous catheter (PICC) placements expose children to a variable amount of radiation. The purpose of this study was to try and determine if procedural experience plays a part in reducing radiation exposure during PICC placements.    Methods:  Pediatric PICC placements by a junior attending pediatric interventional radiologist (JrIR) were reviewed, analyzing for a primary end point of fluoroscopy time (FT). These values were also compared to those of trainees and of a senior pediatric interventional radiologist (SrIR) with 15+ years of experience. Statistical analysis included the Mann-Whitney U test. P values < .05 were considered significant.    Results:  FT for 685 trainee, 459 JrIR, and 425 SrIR PICC placements were analyzed. No statistically significant decreasing trend in FT was noted for either the JrIR or SrIR over the course of the study period. Trainees required significantly more FT than the JrIR (Trainees = .80 min, JrIR = .70 min, P = .004) or the SrIR (SrIR = .60 min, P < .001), but there was no significant difference between the JrIR and SrIR (P = .058). Furthermore, trainees supervised by non-pediatric IRs had even greater median FT (1.30 min). All of these differences were significantly greater in smaller patients (Age <1) and cases in which increased procedural difficulty was encountered.    Conclusion:  This study suggests that the experience of the proceduralist may reduce radiation exposure in PICC placements, but it does not seem to support linear improvement early in a primary operator’s career. The results raise the question as to why the differences exist and may support the use of FT as a metric for analyzing proficiency in IR procedures.  

scholarly journals Cutting Staff Radiation Exposure and Improving Freedom of Motion during CT Interventions: Comparison of a Novel Workflow Utilizing a Radiation Protection Cabin versus Two Conventional Workflows

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1099
Author(s):  
Peter Dankerl ◽  
Matthias Stefan May ◽  
Christian Canstein ◽  
Michael Uder ◽  
Marc Saake
Keyword(s):  
Remote Control ◽  
Radiation Exposure ◽  
Radiation Protection ◽  
Full Potential ◽  
Control Room ◽  
Lead Apron ◽  
Significant Difference ◽  
Tube Output ◽  
Examination Room ◽  
Personal Dosimeter

This study aimed to evaluate the radiation exposure to the radiologist and the procedure time of prospectively matched CT interventions implementing three different workflows—the radiologist—(I) leaving the CT room during scanning; (II) wearing a lead apron and staying in the CT room; (III) staying in the CT room in a prototype radiation protection cabin without lead apron while utilizing a wireless remote control and a tablet. We prospectively evaluated the radiologist’s radiation exposure utilizing an electronic personal dosimeter, the intervention time, and success in CT interventions matched to the three different workflows. We compared the interventional success, the patient’s dose of the interventional scans in each workflow (total mAs and total DLP), the radiologist’s personal dose (in µSV), and interventional time. To perform workflow III, a prototype of a radiation protection cabin, with 3 mm lead equivalent walls and a foot switch to operate the doors, was built in the CT examination room. Radiation exposure during the maximum tube output at 120 kV was measured by the local admission officials inside the cabin at the same level as in the technician’s control room (below 0.5 μSv/h and 1 mSv/y). Further, to utilize the full potential of this novel workflow, a sterile packed remote control (to move the CT table and to trigger the radiation) and a sterile packed tablet anchored on the CT table (to plan and navigate during the CT intervention) were operated by the radiologist. There were 18 interventions performed in workflow I, 16 in workflow II, and 27 in workflow III. There were no significant differences in the intervention time (workflow I: 23 min ± 12, workflow II: 20 min ± 8, and workflow III: 21 min ± 10, p = 0.71) and the patient’s dose (total DLP, p = 0.14). However, the personal dosimeter registered 0.17 ± 0.22 µSv for workflow II, while I and III both documented 0 µSv, displaying significant difference (p < 0.001). All workflows were performed completely and successfully in all cases. The new workflow has the potential to reduce interventional CT radiologists’ radiation dose to zero while relieving them from working in a lead apron all day.

scholarly journals Implementation of Radiation Safety Utilization of Fluoroscopy Baggage Scanner at Port

2019 ◽  
Vol 125 ◽  
pp. 04008
Author(s):  
Sri Mulyati ◽  
Rini Indrati ◽  
Rasyid ◽  
Siti Masrochah ◽  
Luthfi Rusyadi ◽  
...  
Keyword(s):  
Ionizing Radiation ◽  
Radiation Exposure ◽  
Research Method ◽  
Radiation Safety ◽  
International Standards ◽  
Lead Glass ◽  
Exposure Rate ◽  
Radiation Workers ◽  
Radiation Testing ◽  
Exposure Measurements

The effort to ensure radiation safety guarantees for officers and the general public on the use of fluoroscopy baggage scanner is used at the port passenger terminal due to using ionizing radiation. The aim to be achieved is to find out the management of the use of ionizing radiation and related radiation protection according to national and international standards. The research method in this study was an observational survey by observing, interviewing and documenting safety facilities and procedures by performing management for operating fluoroscopy baggage scanner devices at the Port. Based on the results of this study: no operational license for fluoroscopy baggage scanner, radiation workers operator didn’t certify, they don’t have personal monitoring dose, they get health monitoring but not well documented, radiation testing has not been carried out for radiation workers and passengers. Radiation exposure measurements using surveymeter detected both for passengers and radiation workers around the fluoroscopy baggage scanner device was declared safe because the radiation exposure rate detected was below 1 µSv/h (FDA), PP No. 33 of 2007, Perka Bapeten No. 7 of 2009 and Perka Bapeten No. 4 of 2013. But it can be optimized by lead glass or lead apron.

scholarly journals Extensive Use of 3D Nonfluoroscopic Mapping Systems for Reducing Radiation Exposure during Catheter Ablation Procedures: An Analysis of 10 Years of Activity

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Massimiliano Marini ◽  
Marta Martin ◽  
Daniele Ravanelli ◽  
Maurizio Del Greco ◽  
Silvia Quintarelli ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Imaging Modality ◽  
Disease Free Survival ◽  
Fluoroscopy Time ◽  
Free Survival ◽  
X Ray ◽  
Significant Difference ◽  
Disease Free ◽  
Mapping Systems

Purpose. 3D nonfluoroscopic mapping systems (NMSs) are generally used in the catheter ablation (CA) of complex ventricular and atrial arrhythmias. The aim of this study was to evaluate the efficacy, safety, and long-term effect of the extended, routine use of NMSs for CA. Methods. Our study involved 1028 patients who underwent CA procedures from 2007 to 2016. Initially, CA procedures were performed mainly with the aid of fluoroscopy. From October 2008, NMSs were used for all procedures. Results. The median fluoroscopy time of the overall CA procedures fell by 71%: from 29.2 min in 2007 to 8.4 min in 2016. Over the same period, total X-ray exposure decreased by 65%: from 58.18 Gy⁎cm2 to 20.19 Gy⁎cm2. This reduction was achieved without prolonging the total procedure time. In AF CA procedures, the median fluoroscopy time fell by 85%, with an 86% reduction in total X-ray exposure. In SVT CA procedures, the median fluoroscopy time fell by 93%, with a 92% reduction in total X-ray exposure. At the end of the follow-up period, the estimated probability of disease-free survival was 67.7% at 12 months for AF CA procedures and 97.2% at 3 months for SVT CA, without any statistically significant difference between years. Conclusions. Our study shows the feasibility of using NMSs as the main imaging modality to guide CA. The extended, routine use of NMSs dramatically reduces radiation exposure, with only slight fluctuations due to the process of acquiring experience on the part of untrained operators, without affecting disease-free survival.

scholarly journals Navigated iliac screw placement may reduce radiation and OR time in lumbopelvic fixation of unstable complex sacral fractures

2021 ◽  
Author(s):  
M. F. Hoffmann ◽  
E. Yilmaz ◽  
D. C. Norvel ◽  
T. A. Schildhauer
Keyword(s):  
Radiation Exposure ◽  
Operative Time ◽  
Pelvic Ring ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Lumbopelvic Fixation ◽  
Navigation Group ◽  
Iliac Screws ◽  
Iliac Screw

Abstract Purpose Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views. The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates. Methods Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated. Results Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures. Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm2; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing. Conclusion For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

scholarly journals A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

2021 ◽  
Author(s):  
Andrew G. Yun ◽  
Marilena Qutami ◽  
Kory B. Dylan Pasko
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Hip Arthroplasty ◽  
Fluoroscopy Time ◽  
Lesser Trochanter ◽  
Total Hip ◽  
Preoperative Templating ◽  
The Mean ◽  
Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

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