PMID- 29544609
OWN - NLM
STAT- MEDLINE
DCOM- 20190729
LR  - 20191210
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 71
IP  - 11
DP  - 2018 Mar 20
TI  - Radiation Exposure of Operators Performing Transesophageal Echocardiography 
      During Percutaneous Structural Cardiac Interventions.
PG  - 1246-1254
LID - S0735-1097(18)30201-8 [pii]
LID - 10.1016/j.jacc.2018.01.024 [doi]
AB  - 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 muSv (interquartile 
      range [IQR]: 0.95 to 4.76 muSv), similar to OP1 E: 1.91 muSv (IQR: 0.48 to 3.81 
      muSv) (p = 0.101), but significantly higher than secondary operator E: 0.48 muSv 
      (IQR: 0.00 to 1.91 muSv) (p < 0.001) and anesthetist E: 0.48 muSv (IQR: 0.00 to 
      1.43 muSv) (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 muSv [IQR: 0.95 to 4.76] to 0.48 muSv [IQR: 0.00 to 1.43 
      muSv] [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.
CI  - Crown Copyright (c) 2018. Published by Elsevier Inc. All rights reserved.
FAU - Crowhurst, James A
AU  - Crowhurst JA
AD  - Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia; University of Queensland, St. Lucia, Queensland, Australia. Electronic 
      address: Jimcrowhurst@hotmail.com.
FAU - Scalia, Gregory M
AU  - Scalia GM
AD  - Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia; University of Queensland, St. Lucia, Queensland, Australia.
FAU - Whitby, Mark
AU  - Whitby M
AD  - Biomedical Technical Services, The Prince Charles Hospital, Chermside, 
      Queensland, Australia.
FAU - Murdoch, Dale
AU  - Murdoch D
AD  - Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia; University of Queensland, St. Lucia, Queensland, Australia.
FAU - Robinson, Brendan J
AU  - Robinson BJ
AD  - Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia.
FAU - Turner, Arianwen
AU  - Turner A
AD  - Medical Imaging Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia.
FAU - Johnston, Liesie
AU  - Johnston L
AD  - Medical Imaging Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia.
FAU - Margale, Swaroop
AU  - Margale S
AD  - Department of Anaesthesia, The Prince Charles Hospital, Chermside, Queensland, 
      Australia.
FAU - Natani, Sarvesh
AU  - Natani S
AD  - Department of Anaesthesia, The Prince Charles Hospital, Chermside, Queensland, 
      Australia.
FAU - Clarke, Andrew
AU  - Clarke A
AD  - Department of Cardio-thoracic Surgery, The Prince Charles Hospital, Chermside, 
      Queensland, Australia.
FAU - Burstow, Darryl J
AU  - Burstow DJ
AD  - Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia; University of Queensland, St. Lucia, Queensland, Australia.
FAU - Raffel, Owen C
AU  - Raffel OC
AD  - Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia; University of Queensland, St. Lucia, Queensland, Australia.
FAU - Walters, Darren L
AU  - Walters DL
AD  - Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, 
      Australia; University of Queensland, St. Lucia, Queensland, Australia.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
CIN - J Am Coll Cardiol. 2018 Mar 20;71(11):1255-1258. PMID: 29544610
MH  - Australia
MH  - *Echocardiography, Transesophageal/adverse effects/methods
MH  - Female
MH  - Humans
MH  - Male
MH  - *Occupational Exposure/analysis/prevention & control
MH  - Outcome Assessment, Health Care
MH  - Percutaneous Coronary Intervention/*methods
MH  - Radiation Dosage
MH  - *Radiation Exposure/analysis/prevention & control
MH  - Radiation Protection/*methods
OTO - NOTNLM
OT  - echocardiography
OT  - exposure
OT  - intervention
OT  - radiation
OT  - reduction
EDAT- 2018/03/17 06:00
MHDA- 2019/07/30 06:00
CRDT- 2018/03/17 06:00
PHST- 2017/08/22 00:00 [received]
PHST- 2018/01/08 00:00 [revised]
PHST- 2018/01/11 00:00 [accepted]
PHST- 2018/03/17 06:00 [entrez]
PHST- 2018/03/17 06:00 [pubmed]
PHST- 2019/07/30 06:00 [medline]
AID - S0735-1097(18)30201-8 [pii]
AID - 10.1016/j.jacc.2018.01.024 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2018 Mar 20;71(11):1246-1254. doi: 10.1016/j.jacc.2018.01.024.