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Radioprotective strategies for interventional echocardiographers during structural heart interventions.

MedStar author(s):

Citation: Catheterization & Cardiovascular Interventions. 93(2):356-361, 2019 02 01.PMID: 30196578Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Echocardiography | *Heart Diseases/th [Therapy] | *Occupational Exposure/pc [Prevention & Control] | *Radiation Dosage | *Radiation Exposure/pc [Prevention & Control] | *Radiation Protection/mt [Methods] | *Radiography, Interventional | *Ultrasonography, Interventional | Echocardiography/ae [Adverse Effects] | Heart Diseases/dg [Diagnostic Imaging] | Humans | Occupational Exposure/ae [Adverse Effects] | Occupational Health | Occupational Injuries/et [Etiology] | Occupational Injuries/pc [Prevention & Control] | Radiation Exposure/ae [Adverse Effects] | Radiation Injuries/et [Etiology] | Radiation Injuries/pc [Prevention & Control] | Radiography, Interventional/ae [Adverse Effects] | Radiologists | Risk Assessment | Risk Factors | Time Factors | Ultrasonography, Interventional/ae [Adverse Effects]Year: 2019 Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:

1522-1946

Name of journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & InterventionsAbstract: BACKGROUND: Structural heart interventions are expanding in complexity with increased reliance on IE. Recent reports have demonstrated concerning exposure and higher radiation to the IE.CONCLUSIONS: Radiation exposure during structural heart interventions is concerning. With dedicated shielding, IE received lower doses to the body and lens than IC. Further optimization of structural suite design and shielding is needed.Copyright (c) 2018 Wiley Periodicals, Inc.METHODS: We monitored 32 structural interventions - 19 transcatheter aortic valve replacements (TAVR), 6 transcatheter mitral valve repairs, 5 paravalvular leak closures, and 2 atrial septal defect closures. Seventeen utilized transesophageal echocardiography (TEE) while 15 used transthoracic echocardiography (TTE). Members of the IC and IE teams wore multiple dosimeters on different sites of the body to measure radiation dose to the total body, lens of the eye, and hand. During each case, IE utilized dedicated radiation shielding.OBJECTIVE: We investigated radioprotective strategies for the interventional echocardiographer (IE) during structural heart interventions in comparison with the interventional cardiologist (IC).RESULTS: Mean doses were higher for the primary IC than the primary IE: IC#1-99, 222, 378; IE#1-48, 52, 416 (body, lens, and hand doses in muSv). IE radioprotective strategies were able to reduce body and lens doses compared to IC during both TTE and TEE-guided procedures. Hand equivalent dose remained higher for the IE driven by exposure during TEE-guided procedures (IC#1 294 vs. IE#1 676 muSv). In a subgroup using radioprotective drapes during TTE-guided TAVR, IC dose was reduced without effect on the IE.All authors: Babaliaros VC, Clements SD, Condado JF, Corrigan FE 3rd, Hall MJ, Howell S, Iturbe JM, Kamioka N, Lerakis S, Thourani VHOriginally published: Catheterization & Cardiovascular Interventions. :e27843, 2018 Sep 09Fiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1002/ccd.27843

ORCID:

http://orcid.org/0000-0002-1815-8813 http://orcid.org/0000-0001-7222-6197 http://orcid.org/0000-0002-1815-8813 http://orcid.org/0000-0001-7222-6197
http://orcid.org/0000-0002-1815-8813 http://orcid.org/0000-0001-7222-6197 http://orcid.org/0000-0002-1815-8813 http://orcid.org/0000-0001-7222-6197

Date added to catalog: 2018-09-28

Holdings ( 1 )
Title notes ( 8 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30196578	Available		30196578

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

BACKGROUND: Structural heart interventions are expanding in complexity with increased reliance on IE. Recent reports have demonstrated concerning exposure and higher radiation to the IE.

CONCLUSIONS: Radiation exposure during structural heart interventions is concerning. With dedicated shielding, IE received lower doses to the body and lens than IC. Further optimization of structural suite design and shielding is needed.

METHODS: We monitored 32 structural interventions - 19 transcatheter aortic valve replacements (TAVR), 6 transcatheter mitral valve repairs, 5 paravalvular leak closures, and 2 atrial septal defect closures. Seventeen utilized transesophageal echocardiography (TEE) while 15 used transthoracic echocardiography (TTE). Members of the IC and IE teams wore multiple dosimeters on different sites of the body to measure radiation dose to the total body, lens of the eye, and hand. During each case, IE utilized dedicated radiation shielding.

OBJECTIVE: We investigated radioprotective strategies for the interventional echocardiographer (IE) during structural heart interventions in comparison with the interventional cardiologist (IC).

RESULTS: Mean doses were higher for the primary IC than the primary IE: IC#1-99, 222, 378; IE#1-48, 52, 416 (body, lens, and hand doses in muSv). IE radioprotective strategies were able to reduce body and lens doses compared to IC during both TTE and TEE-guided procedures. Hand equivalent dose remained higher for the IE driven by exposure during TEE-guided procedures (IC#1 294 vs. IE#1 676 muSv). In a subgroup using radioprotective drapes during TTE-guided TAVR, IC dose was reduced without effect on the IE.

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