Generic placeholder image

Current Radiopharmaceuticals

Editor-in-Chief

ISSN (Print): 1874-4710
ISSN (Online): 1874-4729

Review Article

An In-depth Analysis of the Adverse Effects of Ionizing Radiation Exposure on Cardiac Catheterization Staffs

Author(s): Maryam Alvandi, Roozbeh Narimani Javid, Zahra Shaghaghi*, Soghra Farzipour and Sahar Nosrati

Volume 17, Issue 3, 2024

Published on: 25 January, 2024

Page: [219 - 228] Pages: 10

DOI: 10.2174/0118744710283181231229112417

Price: $65

conference banner
Abstract

Diagnostic and interventional angiograms are instrumental in the multidisciplinary approach to CAD management, enabling accurate diagnosis and effective targeted treatments that significantly enhance patient care and cardiovascular outcomes. However, cath lab staff, including interventional cardiologists, is consistently exposed to ionizing radiation, which poses inherent health risks. Radiation exposure in the cath lab primarily results from the use of fluoroscopy and cineangiography during diagnostic and interventional procedures. Understanding these risks and implementing effective radiation protection measurements are imperative to ensure the well-being of healthcare professionals while delivering high-quality cardiac care. Prolonged and repeated exposure can lead to both deterministic and stochastic effects. Deterministic effects, such as skin erythema and tissue damage, are more likely to occur at high radiation doses. Interventional cardiologists and staff may experience these effects when safety measures are not rigorously followed. In fact, while ionizing radiation is essential in the practice of radiation cardiology ward, cath lab staff faces inherent risks from radiation exposure. Stochastic effects, on the other hand, are characterized by a probabilistic relationship between radiation exposure and the likelihood of harm. These effects include the increased risk of cancer, particularly for those with long-term exposure. Interventional cardiologists, due to their frequent presence in the cath lab, face a higher lifetime cumulative radiation dose, potentially elevating their cancer risk. Protective measures, including the use of lead aprons, thyroid shields, and radiation monitoring devices, play a crucial role in reducing radiation exposure for cath lab personnel. Adherence to strict dose optimization protocols, such as minimizing fluoroscopy time and maximizing distance from the radiation source, is also essential in mitigating these risks. Ongoing research and advancements in radiation safety technology are essential in further for minimizing the adverse effects of ionizing radiation in the cath lab.

Next »
Graphical Abstract

[1]
Vaduganathan, M.; Mensah, G.A.; Turco, J.V.; Fuster, V.; Roth, G.A. The global burden of cardiovascular diseases and risk. J. Am. Coll. Cardiol., 2022, 80(25), 2361-2371.
[http://dx.doi.org/10.1016/j.jacc.2022.11.005] [PMID: 36368511]
[2]
Bhatt, D.L. Percutaneous coronary intervention in 2018. JAMA, 2018, 319(20), 2127-2128.
[http://dx.doi.org/10.1001/jama.2018.5281] [PMID: 29800163]
[3]
Kim, K.P.; Miller, D.L.; Balter, S.; Kleinerman, R.A.; Linet, M.S.; Kwon, D.; Simon, S.L. Occupational radiation doses to operators performing cardiac catheterization procedures. Health Phys., 2008, 94(3), 211-227.
[http://dx.doi.org/10.1097/01.HP.0000290614.76386.35] [PMID: 18301095]
[4]
Moorthy, S. How safe are radiation doses in diagnostic radiology? a historical perspective and review of current evidence. Indian J. Radiol. Imaging, 2021, 31(3), 653-660.
[http://dx.doi.org/10.1055/s-0041-1735927] [PMID: 34790311]
[5]
Anselmino, M.; Marcantoni, L.; Agresta, A.; Chieffo, E.; Floris, R.; Racheli, M.; Zingarini, G.; De Ruvo, E. Interventional cardiology and X-ray exposure of the head: Overview of clinical evidence and practical implications. J. Cardiovasc. Med., 2022, 23(6), 353-358.
[http://dx.doi.org/10.2459/JCM.0000000000001262] [PMID: 34580253]
[6]
Gaita, F.; Guerra, P.G.; Battaglia, A.; Anselmino, M. The dream of near-zero X-rays ablation comes true. Eur. Heart J., 2016, 37(36), 2749-2755.
[http://dx.doi.org/10.1093/eurheartj/ehw223] [PMID: 27354053]
[7]
Andreassi, M.G.; Piccaluga, E.; Guagliumi, G.; Del Greco, M.; Gaita, F.; Picano, E. Occupational health risks in cardiac catheterization laboratory workers. Circ. Cardiovasc. Interv., 2016, 9(4), e003273.
[http://dx.doi.org/10.1161/CIRCINTERVENTIONS.115.003273] [PMID: 27072525]
[8]
Klein, L.W.; Miller, D.L.; Balter, S.; Laskey, W.; Haines, D.; Norbash, A.; Mauro, M.A.; Goldstein, J.A. Occupational health hazards in the interventional laboratory: Time for a safer environment. Catheter. Cardiovasc. Interv., 2009, 73(3), 432-438.
[http://dx.doi.org/10.1002/ccd.21801] [PMID: 19214981]
[9]
ICRP. Occupational radiological protection in interventional procedures. ICRP publication 139. Ann. ICRP, 2018, 47(2), 1-118.
[http://dx.doi.org/10.1177/0146645317750356] [PMID: 29532669]
[10]
Bitarafan, R.A.; Noohi, F.; Hashemi, H.; Haghjoo, M.; Miraftab, M.; Yaghoobi, N.; Rastgou, F.; Malek, H.; Faghihi, H.; Firouzabadi, H.; Asgari, S.; Rezvan, F.; Khosravi, H.; Soroush, S.; Khabazkhoob, M. Ionizing radiation-induced cataract in interventional cardiology staff. Res. Cardiovasc. Med., 2015, 4(1), e25148.
[PMID: 25789258]
[11]
Bushong, S. Radiologic Science for Technologists: Physics, Biology, and Protection, 11th Ed; American Medical Association, 1980.
[12]
Singh, A.; Singh, H. Time-scale and nature of radiation-biological damage: Approaches to radiation protection and post-irradiation therapy. Prog. Biophys. Mol. Biol., 1982, 39(2), 69-107.
[http://dx.doi.org/10.1016/0079-6107(83)90014-7] [PMID: 7048420]
[13]
Shaghaghi, Z.; Alvandi, M.; Farzipour, S.; Dehbanpour, M.R.; Nosrati, S. A review of effects of atorvastatin in cancer therapy. Med. Oncol., 2022, 40(1), 27.
[http://dx.doi.org/10.1007/s12032-022-01892-9] [PMID: 36459301]
[14]
Amundson, S.A.; Do, K.T.; Fornace, A.J., Jr Induction of stress genes by low doses of gamma rays. Radiat. Res., 1999, 152(3), 225-231.
[http://dx.doi.org/10.2307/3580321] [PMID: 10453082]
[15]
Mezentsev, A.; Amundson, S.A. Global gene expression responses to low- or high-dose radiation in a human three-dimensional tissue model. Radiat. Res., 2011, 175(6), 677-688.
[http://dx.doi.org/10.1667/RR2483.1] [PMID: 21486161]
[16]
Lowe, S.W.; Schmitt, E.M.; Smith, S.W.; Osborne, B.A.; Jacks, T. p53 is required for radiation-induced apoptosis in mouse thymocytes. Nature, 1993, 362(6423), 847-849.
[http://dx.doi.org/10.1038/362847a0] [PMID: 8479522]
[17]
Patt, H.M. Factors in the radiosensitivity of mammaliam cells. Ann. N. Y. Acad. Sci., 1955, 59(4), 649-664.
[http://dx.doi.org/10.1111/j.1749-6632.1955.tb45976.x] [PMID: 14362308]
[18]
Gudkov, A.V.; Komarova, E.A. The role of p53 in determining sensitivity to radiotherapy. Nat. Rev. Cancer, 2003, 3(2), 117-129.
[http://dx.doi.org/10.1038/nrc992] [PMID: 12563311]
[19]
Midgley, C.A.; Owens, B.; Briscoe, C.V.; Thomas, D.B.; Lane, D.P.; Hall, P.A. Coupling between gamma irradiation, p53 induction and the apoptotic response depends upon cell type in vivo. J. Cell Sci., 1995, 108(5), 1843-1848.
[http://dx.doi.org/10.1242/jcs.108.5.1843] [PMID: 7657708]
[20]
Bouvard, V.; Zaitchouk, T.; Vacher, M.; Duthu, A.; Canivet, M.; Choisy-Rossi, C.; Nieruchalski, M.; May, E. Tissue and cell-specific expression of the p53-target genes: Bax, fas, mdm2 and waf1/p21, before and following ionising irradiation in mice. Oncogene, 2000, 19(5), 649-660.
[http://dx.doi.org/10.1038/sj.onc.1203366] [PMID: 10698510]
[21]
Komarova, E.A.; Chernov, M.V.; Franks, R.; Wang, K.; Armin, G.; Zelnick, C.R.; Chin, D.M.; Bacus, S.S.; Stark, G.R.; Gudkov, A.V. Transgenic mice with p53-responsive lacZ: P53activity varies dramatically during normal development and determines radiation and drug sensitivity in vivo. EMBO J., 1997, 16(6), 1391-1400.
[http://dx.doi.org/10.1093/emboj/16.6.1391] [PMID: 9135154]
[22]
Stewart-Ornstein, J.; Iwamoto, Y.; Miller, M.A.; Prytyskach, M.A.; Ferretti, S.; Holzer, P.; Kallen, J.; Furet, P.; Jambhekar, A.; Forrester, W.C.; Weissleder, R.; Lahav, G. p53 dynamics vary between tissues and are linked with radiation sensitivity. Nat. Commun., 2021, 12(1), 898.
[http://dx.doi.org/10.1038/s41467-021-21145-z] [PMID: 33563973]
[23]
Babini, G.; Baiocco, G.; Barbieri, S.; Morini, J.; Sangsuwan, T.; Haghdoost, S.; Yentrapalli, R.; Azimzadeh, O.; Rombouts, C.; Aerts, A.; Quintens, R.; Ebrahimian, T.; Benotmane, M.A.; Ramadan, R.; Baatout, S.; Tapio, S.; Harms-Ringdahl, M.; Ottolenghi, A. A systems radiation biology approach to unravel the role of chronic low-dose-rate gamma-irradiation in inducing premature senescence in endothelial cells. PLoS One, 2022, 17(3), e0265281.
[http://dx.doi.org/10.1371/journal.pone.0265281] [PMID: 35286349]
[24]
Rombouts, C.; Aerts, A.; Quintens, R.; Baselet, B.; El-Saghire, H.; Harms-Ringdahl, M.; Haghdoost, S.; Janssen, A.; Michaux, A.; Yentrapalli, R.; Benotmane, M.A.; Van Oostveldt, P.; Baatout, S. Transcriptomic profiling suggests a role for IGFBP5 in premature senescence of endothelial cells after chronic low dose rate irradiation. Int. J. Radiat. Biol., 2014, 90(7), 560-574.
[http://dx.doi.org/10.3109/09553002.2014.905724] [PMID: 24646080]
[25]
Shaghaghi, Z.; Alvandi, M.; Nosrati, S.; Hadei, S.K. Potential utility of peptides against damage induced by ionizing radiation. Future Oncol., 2021, 17(10), 1219-1235.
[http://dx.doi.org/10.2217/fon-2020-0577] [PMID: 33593084]
[26]
Chong, M.J.; Murray, M.R.; Gosink, E.C.; Russell, H.R.C.; Srinivasan, A.; Kapsetaki, M.; Korsmeyer, S.J.; McKinnon, P.J. Atm and Bax cooperate in ionizing radiation-induced apoptosis in the central nervous system. Proc. Natl. Acad. Sci. USA, 2000, 97(2), 889-894.
[http://dx.doi.org/10.1073/pnas.97.2.889] [PMID: 10639175]
[27]
Monje, M.L.; Mizumatsu, S.; Fike, J.R.; Palmer, T.D. Irradiation induces neural precursor-cell dysfunction. Nat. Med., 2002, 8(9), 955-962.
[http://dx.doi.org/10.1038/nm749] [PMID: 12161748]
[28]
Ohizumi, Y.; Tamai, Y.; Imamiya, S.; Akiba, T. Complications following re-irradiation for head and neck cancer. Am. J. Otolaryngol., 2002, 23(4), 215-221.
[http://dx.doi.org/10.1053/ajot.2002.124540] [PMID: 12105786]
[29]
Yazdi, A.H.; Ghadimi Farah, A.; Alvandi, M.; Shaghaghi, Z. Survey on ionizing radiation including gamma-ray exposure among the medical staff working in the non-intensive ward of farshchian cardiovascular hospital in Hamadan, Iran. Avicenna Journal of Clinical Medicine., 2022, 29(3), 156-160.
[30]
The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann. ICRP, 2007, 37(2-4), 1-332.
[PMID: 18082557]
[31]
López, P.O.; Dauer, L.T.; Loose, R.; Martin, C.J.; Miller, D.L.; Vañó, E.; Doruff, M.; Padovani, R.; Massera, G.; Yoder, C. ICRP Publication 139: Occupational radiological protection in interventional procedures. Ann. ICRP, 2018, 47(2), 1-118.
[http://dx.doi.org/10.1177/0146645317750356] [PMID: 29532669]
[32]
Part, N. Radiation protection and safety of radiation sources International Basic Safety Standards; IAEA, 2011.
[33]
Stahl, C.M.; Meisinger, Q.C.; Andre, M.P.; Kinney, T.B.; Newton, I.G. Radiation risk to the fluoroscopy operator and staff. AJR Am. J. Roentgenol., 2016, 207(4), 737-744.
[http://dx.doi.org/10.2214/AJR.16.16555] [PMID: 28829623]
[34]
Sanchez, R.; Vano, E.; Fernandez, J.M.; Gallego, J.J. Staff radiation doses in a real-time display inside the angiography room. Cardiovasc. Intervent. Radiol., 2010, 33(6), 1210-1214.
[http://dx.doi.org/10.1007/s00270-010-9945-4] [PMID: 20694467]
[35]
Meisinger, Q.C.; Stahl, C.M.; Andre, M.P.; Kinney, T.B.; Newton, I.G. Radiation protection for the fluoroscopy operator and staff. AJR Am. J. Roentgenol., 2016, 207(4), 745-754.
[http://dx.doi.org/10.2214/AJR.16.16556] [PMID: 27440524]
[36]
Klein, B.E.; Klein, R.; Linton, K.L.; Franke, T. Diagnostic x-ray exposure and lens opacities: The Beaver Dam Eye Study. Am. J. Public Health, 1993, 83(4), 588-590.
[http://dx.doi.org/10.2105/AJPH.83.4.588] [PMID: 8460743]
[37]
Lian, Y.; Xiao, J.; Ji, X.; Guan, S.; Ge, H.; Li, F.; Ning, L.; Liu, J. Protracted low-dose radiation exposure and cataract in a cohort of Chinese industry radiographers. Occup. Environ. Med., 2015, 72(9), 640-647.
[http://dx.doi.org/10.1136/oemed-2014-102772] [PMID: 26163545]
[38]
ICoR P. Recommendations of the international commission on radiological protection. Ann. ICRP, 1990, 21, 1.
[39]
Ciraj-Bjelac, O.; Rehani, M.M.; Sim, K.H.; Liew, H.B.; Vano, E.; Kleiman, N.J. Risk for radiation-induced cataract for staff in interventional cardiology: Is there reason for concern? Catheter. Cardiovasc. Interv., 2010, 76(6), 826-834.
[http://dx.doi.org/10.1002/ccd.22670] [PMID: 20549683]
[40]
Kanzawa, T.; Iwado, E.; Aoki, H.; Iwamaru, A.; Hollingsworth, E.F.; Sawaya, R.; Kondo, S.; Kondo, Y. Ionizing radiation induces apoptosis and inhibits neuronal differentiation in rat neural stem cells via the c-Jun NH2-terminal kinase (JNK) pathway. Oncogene, 2006, 25(26), 3638-3648.
[http://dx.doi.org/10.1038/sj.onc.1209414] [PMID: 16491125]
[41]
Kim, K.P.; Miller, D.L. Minimising radiation exposure to physicians performing fluoroscopically guided cardiac catheterisation procedures: A review. Radiat. Prot. Dosimetry, 2009, 133(4), 227-233.
[http://dx.doi.org/10.1093/rpd/ncp052] [PMID: 19329511]
[42]
Jacob, S.; Boveda, S.; Bar, O.; Brézin, A.; Maccia, C.; Laurier, D.; Bernier, M.O. Interventional cardiologists and risk of radiation-induced cataract: Results of a French multicenter observational study. Int. J. Cardiol., 2013, 167(5), 1843-1847.
[http://dx.doi.org/10.1016/j.ijcard.2012.04.124] [PMID: 22608271]
[43]
Vañó, E.; González, L.; Beneytez, F.; Moreno, F. Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories. Br. J. Radiol., 1998, 71(847), 728-733.
[http://dx.doi.org/10.1259/bjr.71.847.9771383] [PMID: 9771383]
[44]
McQuestion, M. Evidence-based skin care management in radiation therapy: Clinical update. Semin. Oncol. Nurs., 2011, 27(2), e1-e17.
[http://dx.doi.org/10.1016/j.soncn.2011.02.009] [PMID: 21514477]
[45]
Hymes, S.R.; Strom, E.A.; Fife, C. Radiation dermatitis: Clinical presentation, pathophysiology, and treatment 2006. J. Am. Acad. Dermatol., 2006, 54(1), 28-46.
[http://dx.doi.org/10.1016/j.jaad.2005.08.054] [PMID: 16384753]
[46]
Valentin, J. Abstract: Avoidance of radiation injuries from medical interventional procedures, ICRP Publication 85. Ann. ICRP, 2000, 30(2), 7-67.
[http://dx.doi.org/10.1016/S0146-6453(01)00004-5] [PMID: 11459599]
[47]
Vlietstra, R.; Wagner, L.K.; Koenig, T.; Mettler, F. Radiation burns as a severe complication of fluoroscopically guided cardiological interventions. J. Interv. Cardiol., 2004, 17(3), 131-142.
[http://dx.doi.org/10.1111/j.1540-8183.2004.09885.x] [PMID: 15209575]
[48]
Wagner, L.K.; Mulhern, O.R. Radiation-attenuating surgical gloves: Effects of scatter and secondary electron production. Radiology, 1996, 200(1), 45-48.
[http://dx.doi.org/10.1148/radiology.200.1.8657942] [PMID: 8657942]
[49]
Balter, S. Interventional fluoroscopy: physics, technology, safety; Wiley-Liss, 2001.
[50]
Rehani, M.M.; Ortiz-Lopez, P. Radiation effects in fluoroscopically guided cardiac interventions—keeping them under control. Int. J. Cardiol., 2006, 109(2), 147-151.
[http://dx.doi.org/10.1016/j.ijcard.2005.06.015] [PMID: 16033701]
[51]
Boos, C.J.; Anderson, R.A.; Lip, G.Y.H. Is atrial fibrillation an inflammatory disorder? Eur. Heart J., 2006, 27(2), 136-149.
[http://dx.doi.org/10.1093/eurheartj/ehi645] [PMID: 16278230]
[52]
Vonderlin, N.; Siebermair, J.; Kaya, E.; Köhler, M.; Rassaf, T.; Wakili, R. Critical inflammatory mechanisms underlying arrhythmias. Herz, 2019, 44(2), 121-129.
[http://dx.doi.org/10.1007/s00059-019-4788-5] [PMID: 30729269]
[53]
Little, M.P. Cancer and non-cancer effects in Japanese atomic bomb survivors. J. Radiol. Prot., 2009, 29(2A), A43-A59.
[http://dx.doi.org/10.1088/0952-4746/29/2A/S04] [PMID: 19454804]
[54]
Little, MP.; Kleinerman, RA.; Stovall, M.; Smith, SA.; Mabuchi, K. Analysis of dose response for circulatory disease after radiotherapy for benign disease. Int J Radiat Oncol Biol Phys, 2012, 84(5), 1101-1109.
[http://dx.doi.org/10.1016/j.ijrobp.2012.01.053]
[55]
Metz-Flamant, C.; Bonaventure, A.; Milliat, F.; Tirmarche, M.; Laurier, D.; Bernier, M.O. [Low doses of ionizing radiation and risk of cardiovascular disease: A review of epidemiological studies]. Rev. Epidemiol. Sante Publique, 2009, 57(5), 347-359.
[http://dx.doi.org/10.1016/j.respe.2009.04.009] [PMID: 19664891]
[56]
Basavaraju, S.R.; Easterly, C.E. Pathophysiological effects of radiation on atherosclerosis development and progression, and the incidence of cardiovascular complications. Med. Phys., 2002, 29(10), 2391-2403.
[http://dx.doi.org/10.1118/1.1509442] [PMID: 12408314]
[57]
Ehrhart, E.J.; Segarini, P.; Tsang, M.L.S.; Carroll, A.G.; Barcellos-Hoff, M.H. Latent transforming growth factor β1 activation in situ: quantitative and functional evidence after low‐dose γ‐irradiation. FASEB J., 1997, 11(12), 991-1002.
[http://dx.doi.org/10.1096/fasebj.11.12.9337152] [PMID: 9337152]
[58]
Picano, E.; Vano, E.; Domenici, L.; Bottai, M.; Thierry-Chef, I. Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer, 2012, 12(1), 157.
[http://dx.doi.org/10.1186/1471-2407-12-157] [PMID: 22540409]
[59]
The olfactory system and its disorders. In: Doty, R.L., Ed.; Seminars in neurology; Thieme Medical Publishers, 2009.
[60]
Rodgers, C.C. Dental X-ray exposure and Alzheimer’s disease: A hypothetical etiological association. Med. Hypotheses, 2011, 77(1), 29-34.
[http://dx.doi.org/10.1016/j.mehy.2011.03.016] [PMID: 21458164]
[61]
Andreassi, M.G.; Cioppa, A.; Botto, N.; Joksic, G.; Manfredi, S.; Federici, C.; Ostojic, M.; Rubino, P.; Picano, E. Somatic DNA damage in interventional cardiologists: A case‐control study. FASEB J., 2005, 19(8), 998-999.
[http://dx.doi.org/10.1096/fj.04-3287fje] [PMID: 15802491]
[62]
Russo, G.L.; Tedesco, I.; Russo, M.; Cioppa, A.; Andreassi, M.G.; Picano, E. Cellular adaptive response to chronic radiation exposure in interventional cardiologists. Eur. Heart J., 2012, 33(3), 408-414.
[http://dx.doi.org/10.1093/eurheartj/ehr263] [PMID: 21862464]
[63]
Díaz, D.; Recio, J.S.; Baltanás, F.C.; Gómez, C.; Weruaga, E.; Alonso, J.R. Long-lasting changes in the anatomy of the olfactory bulb after ionizing irradiation and bone marrow transplantation. Neuroscience, 2011, 173, 190-205.
[http://dx.doi.org/10.1016/j.neuroscience.2010.10.082] [PMID: 21056092]
[64]
Drew, M.R.; Denny, C.A.; Hen, R. Arrest of adult hippocampal neurogenesis in mice impairs single- but not multiple-trial contextual fear conditioning. Behav. Neurosci., 2010, 124(4), 446-454.
[http://dx.doi.org/10.1037/a0020081] [PMID: 20695644]
[65]
Raber, J.; Rola, R.; LeFevour, A.; Morhardt, D.; Curley, J.; Mizumatsu, S.; VandenBerg, S.R.; Fike, J.R. Radiation-induced cognitive impairments are associated with changes in indicators of hippocampal neurogenesis. Radiat. Res., 2004, 162(1), 39-47.
[http://dx.doi.org/10.1667/RR3206] [PMID: 15222778]
[66]
Silasi, G.; Diaz-Heijtz, R.; Besplug, J.; Rodriguez-Juarez, R.; Titov, V.; Kolb, B.; Kovalchuk, O. Selective brain responses to acute and chronic low-dose X-ray irradiation in males and females. Biochem. Biophys. Res. Commun., 2004, 325(4), 1223-1235.
[http://dx.doi.org/10.1016/j.bbrc.2004.10.166] [PMID: 15555557]
[67]
Linet, M.S.; Kim, K.P.; Miller, D.L.; Kleinerman, R.A.; Simon, S.L.; de Gonzalez, A.B. Historical review of occupational exposures and cancer risks in medical radiation workers. Radiat. Res., 2010, 174(6b), 793-808.
[http://dx.doi.org/10.1667/RR2014.1] [PMID: 21128805]
[68]
Matanoski, G.M.; Seltser, R.; Sartwell, P.; Diamond, E.L.; Elliott, E.A. The current mortality rates of radiologists and other physician specialists: Deaths from all causes and from cancer. Am. J. Epidemiol., 1975, 101(3), 188-198.
[http://dx.doi.org/10.1093/oxfordjournals.aje.a112086] [PMID: 1115058]
[69]
Ho, T.L.; Shieh, S.H.; Lin, C.L.; Shen, W.C.; Kao, C.H. Risk of cancer among cardiologists who frequently perform percutaneous coronary interventions: A population‐based study. Eur. J. Clin. Invest., 2016, 46(6), 527-534.
[http://dx.doi.org/10.1111/eci.12628] [PMID: 27018993]
[70]
Mancuso, M.; Pasquali, E.; Leonardi, S.; Tanori, M.; Rebessi, S.; Di Majo, V.; Pazzaglia, S.; Toni, M.P.; Pimpinella, M.; Covelli, V.; Saran, A. Oncogenic bystander radiation effects in Patched heterozygous mouse cerebellum. Proc. Natl. Acad. Sci., 2008, 105(34), 12445-12450.
[http://dx.doi.org/10.1073/pnas.0804186105] [PMID: 18711141]
[71]
Pflugbeil, S.; Pflugbeil, C.; Schmitz-Feuerhake, I. Risk estimates for meningiomas and other late effects after diagnostic X-ray exposure of the skull. Radiat. Prot. Dosimetry, 2011, 147(1-2), 305-309.
[http://dx.doi.org/10.1093/rpd/ncr344] [PMID: 21831864]
[72]
Matanoski, G.M.; Seltser, R.; Sartwell, P.; Diamond, E.L.; Elliott, E.A. The current mortality rates of radiologists and other physician specialists: Specific causes of death. Am. J. Epidemiol., 1975, 101(3), 199-210.
[http://dx.doi.org/10.1093/oxfordjournals.aje.a112087] [PMID: 1115059]
[73]
Hardell, L.; Mild, K.H.; Påhlson, A.; Hallquist, A. Ionizing radiation, cellular telephones and the risk for brain tumours. Eur. J. Cancer Prev., 2001, 10(6), 523-529.
[http://dx.doi.org/10.1097/00008469-200112000-00007] [PMID: 11916351]
[74]
Carozza, S.E.; Wrensch, M.; Miike, R.; Newman, B.; Olshan, A.F.; Savitz, D.A.; Yost, M.; Lee, M. Occupation and adult gliomas. Am. J. Epidemiol., 2000, 152(9), 838-846.
[http://dx.doi.org/10.1093/aje/152.9.838] [PMID: 11085395]
[75]
Roguin, A.; Goldstein, J.; Bar, O.; Goldstein, J.A. Brain and neck tumors among physicians performing interventional procedures. Am. J. Cardiol., 2013, 111(9), 1368-1372.
[http://dx.doi.org/10.1016/j.amjcard.2012.12.060] [PMID: 23419190]
[76]
Eagan, J.T., Jr; Jones, C.T.; Roubin, G.S. Interventional cardiologists: Beware and be aware: An updated report of radiation‐induced cutaneous cancers. Catheter. Cardiovasc. Interv., 2018, 91(3), 475-477.
[http://dx.doi.org/10.1002/ccd.27258] [PMID: 29044964]
[77]
Klein, L.W.; Miller, D.L.; Balter, S.; Laskey, W.; Haines, D.; Norbash, A.; Mauro, M.A.; Goldstein, J.A. Occupational health hazards in the interventional laboratory: Time for a safer environment. Radiology, 2009, 250(2), 538-544.
[http://dx.doi.org/10.1148/radiol.2502082558] [PMID: 19188321]
[78]
Hasan, F.; Bonatti, J. Robotically assisted percutaneous coronary intervention: benefits to the patient and the cardiologist; Taylor & Francis, 2015, pp. 1165-1168.
[79]
Khalil, T.M. Ergonomics in back pain: a guide to prevention and rehabilitation; Van Nostrand Reinhold Company, 1993.
[80]
Goldstein, J.A.; Balter, S.; Cowley, M.; Hodgson, J.; Klein, L.W. Occupational hazards of interventional cardiologists: Prevalence of orthopedic health problems in contemporary practice. Catheter. Cardiovasc. Interv., 2004, 63(4), 407-411.
[http://dx.doi.org/10.1002/ccd.20201] [PMID: 15558765]
[81]
Ross, A.M.; Segal, J.; Borenstein, D.; Jenkins, E.; Cho, S. Prevalence of spinal disc disease among interventional cardiologists. Am. J. Cardiol., 1997, 79(1), 68-70.
[http://dx.doi.org/10.1016/S0002-9149(96)00678-9] [PMID: 9024739]
[82]
Jagger, J.; Berguer, R.; Phillips, E.K.; Parker, G.; Gomaa, A.E. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation. J. Am. Coll. Surg., 2010, 210(4), 496-502.
[http://dx.doi.org/10.1016/j.jamcollsurg.2009.12.018] [PMID: 20347743]
[83]
Hansen, M.E.; Miller, G.L., III; Redman, H.C.; McIntire, D.D. Needle-stick injuries and blood contacts during invasive radiologic procedures: frequency and risk factors. AJR Am. J. Roentgenol., 1993, 160(5), 1119-1122.
[http://dx.doi.org/10.2214/ajr.160.5.8470590] [PMID: 8470590]
[84]
Leena, R.V.; Shyamkumar, N.K. Glove perforations during interventional radiological procedures. Cardiovasc. Intervent. Radiol., 2010, 33(2), 375-378.
[http://dx.doi.org/10.1007/s00270-009-9719-z] [PMID: 19795166]
[85]
Tso, D.K.; Athreya, S. Reducing blood-borne exposure in interventional radiology: What the IR should know. Cardiovasc. Intervent. Radiol., 2013, 36(4), 913-916.
[http://dx.doi.org/10.1007/s00270-013-0580-8] [PMID: 23435743]
[86]
Velázquez, M.; Pombo, M.; Unzué, L.; Bastante, T.; Mejía, E.; Albarrán, A. Radiation exposure to the pregnant interventional cardiologist. Does it really pose a risk to the fetus? Rev. Esp. Cardiol., 2017, 70(7), 606-608.
[http://dx.doi.org/10.1016/j.rec.2016.11.037] [PMID: 28214247]
[87]
Bottollier-Depois, J.F.; Chau, Q.; Bouisset, P.; Kerlau, G.; Plawinski, L.; Lebaron-Jacobs, L. Assessing exposure to cosmic radiation during long-haul flights. Radiat. Res., 2000, 153(5), 526-532.
[http://dx.doi.org/10.1667/0033-7587(2000)153[0526:AETCRD]2.0.CO;2] [PMID: 10790273]
[88]
Jankowski, C.B. Radiation and pregnancy. Putting the risks in proportion. Am. J. Nurs., 1986, 86(3), 260-265.
[http://dx.doi.org/10.2307/3425457] [PMID: 3513577]
[89]
Best, P.J.M.; Skelding, K.A.; Mehran, R.; Chieffo, A.; Kunadian, V.; Madan, M.; Mikhail, G.W.; Mauri, F.; Takahashi, S.; Honye, J.; Hernández-Antolín, R.; Weiner, B.H. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. Catheter. Cardiovasc. Interv., 2011, 77(2), 232-241.
[http://dx.doi.org/10.1002/ccd.22877] [PMID: 21061249]
[90]
Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet. Gynecol., 2017, 130(4), e210-e216.
[http://dx.doi.org/10.1097/AOG.0000000000002355] [PMID: 28937575]
[91]
McCollough, C.H.; Schueler, B.A.; Atwell, T.D.; Braun, N.N.; Regner, D.M.; Brown, D.L.; LeRoy, A.J. Radiation exposure and pregnancy: When should we be concerned? Radiographics, 2007, 27(4), 909-917.
[http://dx.doi.org/10.1148/rg.274065149] [PMID: 17620458]
[92]
Wagner, L.K.; Hayman, L.A. Pregnancy and women radiologists. Radiology, 1982, 145(2), 559-562.
[http://dx.doi.org/10.1148/radiology.145.2.7134471] [PMID: 7134471]
[93]
Patel, S.J.; Reede, D.L.; Katz, D.S.; Subramaniam, R.; Amorosa, J.K. Imaging the pregnant patient for nonobstetric conditions: Algorithms and radiation dose considerations. Radiographics, 2007, 27(6), 1705-1722.
[http://dx.doi.org/10.1148/rg.276075002] [PMID: 18025513]
[94]
Ratnapalan, S.; Bentur, Y.; Koren, G. "Doctor, will that x-ray harm my unborn child?" CMAJ, 2008, 179(12), 1293-1296.
[http://dx.doi.org/10.1503/cmaj.080247] [PMID: 19047611]
[95]
Chandra, V.; Dorsey, C.; Reed, A.B.; Shaw, P.; Banghart, D.; Zhou, W. Monitoring of fetal radiation exposure during pregnancy. J. Vasc. Surg., 2013, 58(3), 710-714.
[http://dx.doi.org/10.1016/j.jvs.2013.01.052] [PMID: 23591191]
[96]
Kuon, E.; Dahm, J.B.; Empen, K.; Robinson, D.M.; Reuter, G.; Wucherer, M. Identification of less-irradiating tube angulations in invasive cardiology. J. Am. Coll. Cardiol., 2004, 44(7), 1420-1428.
[http://dx.doi.org/10.1016/j.jacc.2004.06.057] [PMID: 15464322]
[97]
Pancholy, S.B.; Payne, M.; Pancholy, P.S.; Patel, G.A.; Patel, S.; Shah, S.C.; Kaul, P.; Pancholy, S.A.; Patel, T.M. Association between distance from the radiation source and radiation exposure: A phantom-based study. Catheter. Cardiovasc. Interv., 2021, 97(6), E810-E816.
[http://dx.doi.org/10.1002/ccd.29223] [PMID: 32881383]
[98]
Sciahbasi, A.; Rigattieri, S.; Sarandrea, A.; Cera, M.; Di Russo, C.; Fedele, S.; Patrizi, R.; Romano, S.; Pugliese, F.R.; Penco, M.; Pancholy, S.B. Determinants of operator radiation exposure during percutaneous coronary procedures. Am. Heart J., 2017, 187, 10-18.
[http://dx.doi.org/10.1016/j.ahj.2017.02.012] [PMID: 28454793]
[99]
Abdelaal, E.; Plourde, G.; MacHaalany, J.; Arsenault, J.; Rimac, G.; Déry, J.P.; Barbeau, G.; Larose, E.; De Larochellière, R.; Nguyen, C.M.; Allende, R.; Ribeiro, H.; Costerousse, O.; Mongrain, R.; Bertrand, O.F. Effectiveness of low rate fluoroscopy at reducing operator and patient radiation dose during transradial coronary angiography and interventions. JACC Cardiovasc. Interv., 2014, 7(5), 567-574.
[http://dx.doi.org/10.1016/j.jcin.2014.02.005] [PMID: 24746649]
[100]
Christopoulos, G.; Makke, L.; Christakopoulos, G.; Kotsia, A.; Rangan, B.V.; Roesle, M.; Haagen, D.; Kumbhani, D.J.; Chambers, C.E.; Kapadia, S.; Mahmud, E.; Banerjee, S.; Brilakis, E.S. Optimizing radiation safety in the cardiac catheterization laboratory. Catheter. Cardiovasc. Interv., 2016, 87(2), 291-301.
[http://dx.doi.org/10.1002/ccd.25959] [PMID: 26526181]
[101]
Plourde, G.; Pancholy, S.B.; Nolan, J.; Jolly, S.; Rao, S.V.; Amhed, I.; Bangalore, S.; Patel, T.; Dahm, J.B.; Bertrand, O.F. Radiation exposure in relation to the arterial access site used for diagnostic coronary angiography and percutaneous coronary intervention: A systematic review and meta-analysis. Lancet, 2015, 386(10009), 2192-2203.
[http://dx.doi.org/10.1016/S0140-6736(15)00305-0] [PMID: 26411986]
[102]
Liu, H.; Jin, Z.; Jing, L. Comparison of radiation dose to operator between transradial and transfemoral coronary angiography with optimised radiation protection: A phantom study. Radiat. Prot. Dosimetry, 2014, 158(4), 412-420.
[http://dx.doi.org/10.1093/rpd/nct261] [PMID: 24162374]
[103]
Correia, M.J.; Hellies, A.; Andreassi, M.G.; Ghelarducci, B.; Picano, E. Lack of radiological awareness among physicians working in a tertiary-care cardiological centre. Int. J. Cardiol., 2005, 103(3), 307-311.
[http://dx.doi.org/10.1016/j.ijcard.2004.08.070] [PMID: 16098394]
[104]
Kim, C.; Vasaiwala, S.; Haque, F.; Pratap, K.; Vidovich, M.I. Radiation safety among cardiology fellows. Am. J. Cardiol., 2010, 106(1), 125-128.
[http://dx.doi.org/10.1016/j.amjcard.2010.02.026] [PMID: 20609659]
[105]
Watson, R.M. Editorial comment: Radiation exposure: Clueless in the cath lab, or sayonara ALARA. Cathet. Cardiovasc. Diagn., 1997, 42(2), 126-127.
[http://dx.doi.org/10.1002/(SICI)1097-0304(199710)42:2<126:AID-CCD5>3.0.CO;2-F] [PMID: 9328691]
[106]
Vano, E. Radiation exposure to cardiologists: how it could be reduced; BMJ Publishing Group Ltd, 2003, pp. 1123-1124.
[107]
Rajaraman, P.; Doody, M.M.; Yu, C.L.; Preston, D.L.; Miller, J.S.; Sigurdson, A.J.; Freedman, D.M.; Alexander, B.H.; Little, M.P.; Miller, D.L.; Linet, M.S. Incidence and mortality risks for circulatory diseases in US radiologic technologists who worked with fluoroscopically guided interventional procedures, 1994–2008. Occup. Environ. Med., 2016, 73(1), 21-27.
[http://dx.doi.org/10.1136/oemed-2015-102888] [PMID: 26350678]
[108]
Doll, R.; Wakeford, R. Risk of childhood cancer from fetal irradiation. Br. J. Radiol., 1997, 70(830), 130-139.
[http://dx.doi.org/10.1259/bjr.70.830.9135438] [PMID: 9135438]
[109]
Wrixon, A.D. New ICRP recommendations. J. Radiol. Prot., 2008, 28(2), 161-168.
[http://dx.doi.org/10.1088/0952-4746/28/2/R02] [PMID: 18495983]
[110]
Dauer, L.T.; Miller, D.L.; Schueler, B.; Silberzweig, J.; Balter, S.; Bartal, G.; Chambers, C.; Collins, J.D.; Damilakis, J.; Dixon, R.G.; Victoria Marx, M.; Stecker, M.S.; Vañó, E.; Venkatesan, A.M.; Nikolic, B. Occupational radiation protection of pregnant or potentially pregnant workers in IR: A joint guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J. Vasc. Interv. Radiol., 2015, 26(2), 171-181.
[http://dx.doi.org/10.1016/j.jvir.2014.11.026] [PMID: 25645407]
[111]
Gomes, M.; Matias, A.; Macedo, F. Risks to the fetus from diagnostic imaging during pregnancy: Review and proposal of a clinical protocol. Pediatr. Radiol., 2015, 45(13), 1916-1929.
[http://dx.doi.org/10.1007/s00247-015-3403-z] [PMID: 26271622]
[112]
Pleis, J.R.; Coles, R. Summary Health Statistics for US Adults: National Health Interview Survey: Department of Health and Human Services; Centers for Disease Control and, 2009.
[113]
Valentin, J. The 2007 recommendations of the international commission on radiological protection; Elsevier Oxford, 2007.
[114]
Merriam, G.R., Jr; Focht, E.F. A clinical and experimental study of the effect of single and divided doses of radiation on cataract production. Trans. Am. Ophthalmol. Soc., 1962, 60, 35-52.
[PMID: 13935039]
[115]
Faroux, L.; Blanpain, T.; Fernandez, A.; Nazeyrollas, P.; Tassan-Mangina, S.; Heroguelle, V.; Tourneux, C.; Metz, D. Impact of the table height and the operator’s height on the level of radiation delivered to interventional cardiologists. Radiat. Prot. Dosimetry, 2019, 187(1), 21-27.
[http://dx.doi.org/10.1093/rpd/ncz131] [PMID: 31111934]
[116]
d’Othée, B.J.; Lin, P.J.P. The influence of angiography table shields and height on patient and angiographer irradiation during interventional radiology procedures. Cardiovasc. Intervent. Radiol., 2007, 30(3), 448-454.
[http://dx.doi.org/10.1007/s00270-006-0063-2] [PMID: 17278031]
[117]
Kidoń, J.; Polaczek-Grelik, K.; Żurek, P.; Wojakowski, W.; Ochala A Exposure of the eye lens and brain for interventional cardiology staff. Adv. Interv. Cardiol., 2021, 17(3), 298-304.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy