James A Crowhurst1, Gregory M Scalia2, Mark Whitby3, Dale Murdoch2, Brendan J Robinson4, Arianwen Turner5, Liesie Johnston5, Swaroop Margale6, Sarvesh Natani6, Andrew Clarke7, Darryl J Burstow2, Owen C Raffel2, Darren L Walters2. 1. Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia. Electronic address: Jimcrowhurst@hotmail.com. 2. Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia. 3. Biomedical Technical Services, The Prince Charles Hospital, Chermside, Queensland, Australia. 4. Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia. 5. Medical Imaging Department, The Prince Charles Hospital, Chermside, Queensland, Australia. 6. Department of Anaesthesia, The Prince Charles Hospital, Chermside, Queensland, Australia. 7. Department of Cardio-thoracic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia.
Abstract
BACKGROUND: Transesophageal echocardiography operators (TEEOP) provide critical imaging support for percutaneous structural cardiac intervention procedures. They stand close to the patient and the associated scattered radiation. OBJECTIVES: This study sought to investigate TEEOP radiation dose during percutaneous structural cardiac intervention. METHODS: Key personnel (TEEOP, anesthetist, primary operator [OP1], and secondary operator) wore instantly downloadable personal dosimeters during procedures requiring TEE support. TEEOP effective dose (E) and E per unit Kerma area product (E/KAP) were calculated. E/KAP was compared with C-arm projections. Additional shielding for TEEOP was implemented, and doses were measured for a further 50 procedures. Multivariate linear regression was performed to investigate independent predictors of radiation dose reduction. RESULTS: In the initial 98 procedures, median TEEOP E was 2.62 μSv (interquartile range [IQR]: 0.95 to 4.76 μSv), similar to OP1 E: 1.91 μSv (IQR: 0.48 to 3.81 μSv) (p = 0.101), but significantly higher than secondary operator E: 0.48 μSv (IQR: 0.00 to 1.91 μSv) (p < 0.001) and anesthetist E: 0.48 μSv (IQR: 0.00 to 1.43 μSv) (p < 0.001). Procedures using predominantly right anterior oblique (RAO) and steep RAO projections were associated with high TEEOP E/KAP (p = 0.041). In a further 50 procedures, with additional TEEOP shielding, TEEOP E was reduced by 82% (2.62 μSv [IQR: 0.95 to 4.76] to 0.48 μSv [IQR: 0.00 to 1.43 μSv] [p < 0.001]). Multivariate regression demonstrated shielding, procedure type, and KAP as independent predictors of TEEOP dose. CONCLUSION: TEE operators are exposed to a radiation dose that is at least as high as that of OP1 during percutaneous cardiac intervention. Doses were higher with procedures using predominantly RAO projections. Radiation doses can be significantly reduced with the use of an additional ceiling-suspended lead shield. Crown
BACKGROUND: Transesophageal echocardiography operators (TEEOP) provide critical imaging support for percutaneous structural cardiac intervention procedures. They stand close to the patient and the associated scattered radiation. OBJECTIVES: This study sought to investigate TEEOP radiation dose during percutaneous structural cardiac intervention. METHODS: Key personnel (TEEOP, anesthetist, primary operator [OP1], and secondary operator) wore instantly downloadable personal dosimeters during procedures requiring TEE support. TEEOP effective dose (E) and E per unit Kerma area product (E/KAP) were calculated. E/KAP was compared with C-arm projections. Additional shielding for TEEOP was implemented, and doses were measured for a further 50 procedures. Multivariate linear regression was performed to investigate independent predictors of radiation dose reduction. RESULTS: In the initial 98 procedures, median TEEOP E was 2.62 μSv (interquartile range [IQR]: 0.95 to 4.76 μSv), similar to OP1 E: 1.91 μSv (IQR: 0.48 to 3.81 μSv) (p = 0.101), but significantly higher than secondary operator E: 0.48 μSv (IQR: 0.00 to 1.91 μSv) (p < 0.001) and anesthetist E: 0.48 μSv (IQR: 0.00 to 1.43 μSv) (p < 0.001). Procedures using predominantly right anterior oblique (RAO) and steep RAO projections were associated with high TEEOP E/KAP (p = 0.041). In a further 50 procedures, with additional TEEOP shielding, TEEOP E was reduced by 82% (2.62 μSv [IQR: 0.95 to 4.76] to 0.48 μSv [IQR: 0.00 to 1.43 μSv] [p < 0.001]). Multivariate regression demonstrated shielding, procedure type, and KAP as independent predictors of TEEOP dose. CONCLUSION: TEE operators are exposed to a radiation dose that is at least as high as that of OP1 during percutaneous cardiac intervention. Doses were higher with procedures using predominantly RAO projections. Radiation doses can be significantly reduced with the use of an additional ceiling-suspended lead shield. Crown
Authors: Rebecca T Hahn; Feroze Mahmood; Susheel Kodali; Roberto Lang; Mark Monaghan; Linda D Gillam; Madhav Swaminathan; Robert O Bonow; Ralph Stephan von Bardeleben; Jeroen J Bax; Paul Grayburn; William A Zoghbi; Partho P Sengupta; Y Chandrashekhar; Stephen H Little Journal: JACC Cardiovasc Imaging Date: 2019-12
Authors: David A McNamara; Rajus Chopra; Jeffrey M Decker; Michael W McNamara; Stacie M VanOosterhout; Duane C Berkompas; Musa I Dahu; Mohamad A Kenaan; Wassim I Jawad; William M Merhi; Jessica L Parker; Ryan D Madder Journal: JAMA Netw Open Date: 2022-07-01
Authors: James A Crowhurst; Mark Whitby; Nicholas Aroney; Rustem Dautov; Darren Walters; Owen Raffel Journal: Br J Radiol Date: 2020-06-23 Impact factor: 3.039