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Cardiology
Radiation Safety
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 106 slides
Overview
- Ionizing radiation in interventional cardiology
- Personnel at risk in the cath lab
- Scope of radiation safety practice
Radiation physics and dose metrics
- X-rays as the imaging source
- Sources of radiation exposure in the cath lab
- Primary radiation
- Scatter radiation
- Determinants of scatter magnitude
- Leakage radiation
- Classification of radiation sources
- Deterministic and stochastic effects
- Air kerma
- Effective dose
- Dose-area product
- Fluoroscopy time as a dose surrogate
- Key dose thresholds and reductions
Health impacts of occupational exposure
- Pattern of occupational exposure
- Radiation cataract: lens radiosensitivity
- Evidence for cataract risk in operators
- Chromosomal damage and carcinogenesis
- Brain malignancy and left-sided predilection
- Thyroid cancer risk
- Cancer incidence in radiologic technologists
- Endothelial dysfunction and lipid metabolism
- Fetal effects of radiation exposure
- Dose limits in pregnancy
- Radiation-induced skin injury in patients
- Risk factors for cutaneous injury
- Mitigation and follow-up of skin dose
Principles of minimising exposure
- The ALARA principle
- Operator knowledge requirements
- The three pillars of radiation protection
- Practical tips to minimise cath lab exposure
- Methods and technologies for radiation reduction in the cath lab
- Methods and technologies for radiation reduction in the cath lab (continued)
- Methods and technologies for radiation reduction in the cath lab (continued)
- Methods and technologies for radiation reduction in the cath lab (continued)
- Methods and technologies for radiation reduction in the cath lab (continued)
- Factors influencing scatter exposure
- The inverse square law
- Contrast tubing extensions and operator stance
- Radial access and operator dose
- Table height and detector position
- System positioning and radiation exposure
- Gantry angulation and dose
- Reducing fluoroscopy time
- Pulsed fluoroscopy
- Cineangiography and fluoro-save
- Magnification and collimation
- Personal protective equipment in the cath lab
- Lead apron designs
- Lead apron specification and attenuation
- Musculoskeletal burden of protective garments
- Lightweight apron materials
- Thyroid shields
- Leaded eyewear
- Ceiling-mounted shields
- Table-mounted lead skirts
Advanced shielding technologies
- Advanced shielding systems in current use
- RadPad shielding drape
- Sterile scatter-attenuating drape in use
- Efficacy of the scatter-attenuating drape
- Rampart Defender portable shield
- Mobile lead-free operator shield
- Efficacy of the portable barrier system
- EggNest shielding platform
- Table-integrated shielding platform
- Efficacy of the table-integrated platform
- Protego radiation system
- Radiaction shielding system
- C-arm mounted head-to-toe shielding device
- Zero-Gravity suspended protection system
- Ceiling-suspended full-body lead protection
- Efficacy of the suspended protection system
Technology, imaging and monitoring
- Robotic percutaneous coronary intervention
- Limitations of robotic adoption
- Next-generation angiography systems
- Artificial intelligence in angiography systems
- Coronary roadmap systems
- Intravascular imaging as a fluoroscopy substitute
- Echocardiographic guidance in structural intervention
- CT planning and AI plaque analysis
- The dosimeter
- Two-badge dosimetry
- Limitations of conventional dosimetry
- Real-time radiation monitoring systems
- Evidence for real-time monitoring
Summary and references
- Practical priorities in the cath lab
- Direction of travel in radiation protection
- References
- References (continued)
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- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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