Patient Body Mass Index and Physician Radiation Dose During Coronary Angiography.

BACKGROUND: Consistent with the increasing prevalence of obesity in the general population, obesity has become more prevalent among patients undergoing cardiac catheterization. This study evaluated the association between patient body mass index (BMI) and physician radiation dose during coronary angiography. METHODS AND RESULTS: Real-time radiation exposure data were collected during consecutive coronary angiography procedures. Patient radiation dose was estimated using dose area product. Physician radiation dose in each case was recorded by a dosimeter worn by the physician and is reported as the personal dose equivalent (Hp10). Patient BMI was categorized as <25.0, 25.0 to 29.9, 30.0 to 34.9, 35.0 to 39.9, and ≥40. Among 1119 coronary angiography procedures, significant increases in dose area product and physician radiation dose were observed across increasing patient BMI categories ( P<0.001). Compared with a BMI <25, a patient BMI ≥40 was associated with a 2.1-fold increase in patient radiation dose (dose area product, 91.8 [59.6-149.2] versus 44.5 [25.7-70.3] Gy×cm2; P<0.001) and a 7.0-fold increase in physician radiation dose (1.4 [0.2-7.1] versus 0.2 [0.0-2.9] µSv; P<0.001). By multiple regression analysis, patient BMI remained independently associated with physician radiation dose (dose increase, 5.2% per unit increase in BMI; 95% CI, 3.0%-7.5%; P<0.0001). CONCLUSIONS: Among coronary angiography procedures, increasing patient BMI was associated with a significant increase in physician radiation dose. Additional studies are needed to determine whether patient obesity might have adverse effects on physicians, in the form of increased radiation doses during coronary angiography.

Impact of patient obesity on radiation doses received by scrub technologists during coronary angiography.

BACKGROUND: The impact of patient obesity on scrub technologist radiation dose during coronary angiography has not been adequately studied. METHODS: Real-time radiation exposure data were prospectively collected during consecutive coronary angiography cases. Patient radiation dose was estimated by dose area product (DAP). Technologist radiation dose was recorded by a dosimeter as the personal dose equivalent (Hp (10)). Patients were categorized according to their body mass index (BMI): <25.0, lean; 25.0-29.9, overweight; ≥30.0, obese. The study had two phases: in Phase I (N = 351) standard radiation protection measures were used; and in Phase II (N = 268) standard radiation protection measures were combined with an accessory lead shield placed between the technologist and patient. RESULTS: In 619 consecutive coronary angiography procedures, significant increases in patient and technologist radiation doses were observed across increasing patient BMI categories (p < 0.001 for both). Compared to lean patients, patient obesity was associated with a 1.7-fold increase in DAP (73.0 [52.7, 127.5] mGy × cm2 vs 43.6 [25.1, 65.7] mGy × cm2, p < 0.001) and a 1.8-fold increase in technologist radiation dose (1.1 [0.3, 2.7] µSv vs 0.6 [0.1, 1.6] µSv, p < 0.001). Compared to Phase I, use of an accessory lead shield in Phase II was associated with a 62.5% reduction in technologist radiation dose when used in obese patients (p < 0.001). CONCLUSIONS: During coronary angiography procedures, patient obesity was associated with a significant increase in scrub technologist radiation dose. This increase in technologist radiation dose in obese patients may be mitigated by use of an accessory lead shield.

Radiation Exposure Among Scrub Technologists and Nurse Circulators During Cardiac Catheterization: The Impact of Accessory Lead Shields.

OBJECTIVES: This study was performed to determine if the use of an accessory lead shield is associated with a reduction in radiation exposure among staff members during cardiac catheterization. BACKGROUND: Accessory lead shields that protect physicians from scatter radiation are standard in many catheterization laboratories, yet similar shielding for staff members is not commonplace. METHODS: Real-time radiation exposure data were prospectively collected among nurses and technologists during 764 consecutive catheterizations. The study had 2 phases: in phase I (n = 401), standard radiation protection measures were used, and in phase II (n = 363), standard radiation protection measures were combined with an accessory lead shield placed between the staff member and patient. Radiation exposure was reported as the effective dose normalized to dose-area product (EDAP). RESULTS: Use of an accessory lead shield in phase II was associated with a 62.5% lower EDAP per case among technologists (phase I: 2.4 [4.3] µSv/[mGy × cm2] × 10-5; phase II: 0.9 [2.8] µSv/[mGy × cm2] × 10-5; p < 0.001) and a 63.6% lower EDAP per case among nurses (phase I: 1.1 [3.1] µSv/[mGy × cm2] × 10-5; phase II: 0.4 [1.8] µSv/[mGy × cm2] × 10-5; p < 0.001). By multivariate analysis, accessory shielding remained independently associated with a lower EDAP among both technologists (34.2% reduction; 95% confidence interval: 20.1% to 45.8%; p < 0.001) and nurses (36.4% reduction; 95% confidence interval: 19.7% to 49.6%; p < 0.001). CONCLUSIONS: The relatively simple approach of using accessory lead shields to protect staff members during cardiac catheterization was associated with a nearly two-thirds reduction in radiation exposure among nurses and technologists.

Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the patient: an early exploration into the feasibility of telestenting (the REMOTE-PCI study).

AIMS: The present study explores the feasibility of telestenting, wherein a physician operator performs stenting on a patient in a separate physical location using a combination of robotics and telecommunications. METHODS AND RESULTS: Patients undergoing robotic stenting were eligible for inclusion. All manipulations of guidewires, balloons, and stents were performed robotically by a physician operator located in an isolated separate room outside the procedure room housing the patient. Communication between the operating physician and laboratory personnel was via telecommunication devices providing real-time audio and video connectivity. Among 20 patients who consented to participate, technical success, defined as successful advancement and retraction of guidewires, balloons, and stents by the robotic system without conversion to manual operation, was achieved in 19 of 22 lesions (86.4%). Procedural success, defined as <30% residual stenosis upon completion of the procedure in the absence of death or repeat revascularisation prior to hospital discharge, was achieved in 19 of 20 patients (95.0%). There were no deaths or repeat revascularisations prior to hospital discharge. CONCLUSIONS: To the best of our knowledge, the present study is the first to explore the feasibility of telestenting. Additional studies are required to determine if future advancements in robotics will facilitate telestenting over greater geographic distances.