Reduction of Radiation Risk to Cardiologists and Patients during Coronary Angiography: Effect of Exposure Angulation and Composite Shields
,
Abstract
Purpose: This study aimed to design an improved form of a composite shield with different materials and shapes and simultaneously reduce the radiation dose to both the patient and operator.
Materials and Methods: A female phantom study was performed with and without bismuth belt-shaped composite shields on the breast region at different beam projections used in coronary angiography. Dose measurements were conducted using GR-200 thermo-luminescence dosimeters, dose area product (DAP), and air kerma (AK) over regular and large breast locations, with and without using bismuth shields. An electronic personal dosimeter was used for operator dose assessment. Patients received doses between 2.27 mSv and 3.38 mSv, depending on the size and strength of beam projections.
Results: The use of the developed shields caused a dose reduction of 18%–25% of sensitive breast tissue due to breast size and shield type. During coronary angiography, the mean values of DAP and AK were 2.02 (1.24-2.80) mGy.m2 and 314.1 (202.8-500) mGy, respectively. The highest recorded dose was at the LAO/CRA and LAO/CAU beam projections for both the patient and operator. After applying a belt shield, the operator's radiation dose was decreased by approximately 32%. We found a statistically significant correlation between the radiation dose received by the operator and the patient's breast radiation exposure dose (p<0.001, r2=0.93).
Conclusion: The designed belt shield can be a potentially promising protective device for decreasing the radiation risk to the patient's breast and the operator during coronary angiography. However, further studies will be considered before the application of this shield in standard clinical practice.
1- Bagher Farhood, Behzad Raei, Reza Malekzadeh, Maryam Shirvani, Masoud Najafi, and Tohid Mortezazadeh, "A review of incidence and mortality of colorectal, lung, liver, thyroid, and bladder cancers in Iran and compared to other countries." Contemporary Oncology, Vol. 23 (No. 1), pp. 7-15, (2019).
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3- Galit Aviram et al., "Clinical value of 16‐slice multi‐detector CT compared to invasive coronary angiography." International journal of cardiovascular interventions, Vol. 7 (No. 1), pp. 21-28, (2005).
4- Ali Tarighatnia, Asghar Mesbahi, Amir Hossein Mohammad Alian, Evin Koleini, and Nader Nader, "An analysis of operating physician and patient radiation exposure during radial coronary angioplasties." Radiation protection dosimetry, Vol. 182 (No. 2), pp. 200-07, (2018).
5- Ali Tarighatnia et al., "Radiation exposure levels according to vascular access sites during PCI." Herz, Vol. 44 (No. 4), pp. 330-35, (2019).
6- Ali Tarighatnia, L Pourafkari, A Farajollahi, AH Mohammadalian, M Ghojazadeh, and ND Nader, "Operator radiation exposure during transradial coronary angiography." Tarighatnia A, Pourafkari L, Farajollahi A, Mohammadalian AH, Ghojazadeh M, Nader ND. Operator radiation exposure during transradial coronary angiography. Herz. 2018 Sep;43(6):535-42., Vol. 43 (No. 6), pp. 535-42, (2018).
7- Reza Fardid, Hadi Rezaei, Fatemeh Mirzadeh, Mohammad Amin Mosleh-Shirazi, and Sedigheh Sina, "Evaluation of Correlation between DAP (Dose-Area Product) Values and Cardiologist Dose during Coronary Angiography Using Monte Carlo Simulation." Iranian Journal of Medical Physics, Vol. 18 (No. 5), pp. 306-13, (2021).
8- Lucia Venneri et al., "Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report." American heart journal, Vol. 157 (No. 1), pp. 118-24, (2009).
9- Akbar Zeraatpishe et al., "Effects of Melissa officinalis L. on oxidative status and DNA damage in subjects exposed to long-term low-dose ionizing radiation." Toxicology industrial health, Vol. 27 (No. 3), pp. 205-12, (2011).
10- Ayse Basak Engin, Mehmet Ali Ergun, Erkan Yurtcu, Derya Kan, and Gonul Sahin, "Effect of ionizing radiation on the pteridine metabolic pathway and evaluation of its cytotoxicity in exposed hospital staff." Mutation Research/Genetic Toxicology Environmental Mutagenesis, Vol. 585 (No. 1-2), pp. 184-92, (2005).
11- Nicolas Marque et al., "Impact of an extension tube on operator radiation exposure during coronary procedures performed through the radial approach." Archives of cardiovascular diseases, Vol. 102 (No. 11), pp. 749-54, (2009).
12- Reza Malekzadeh, Vahid Sadeghi Zali, Okhtay Jahanbakhsh, Murat Okutan, and Asghar Mesbahi, "The preparation and characterization of silicon-based composites doped with BaSO4, WO3, and PbO nanoparticles for shielding applications in PET and nuclear medicine facilities." Nanomedicine Journal, Vol. 7 (No. 4), pp. 324-34, (2020).
13- John P Gonzales, Christopher Moran, and James E Silberzweig, "Reduction of operator radiation dose by an extended lower body shield." Journal of Vascular Interventional Radiology, Vol. 25 (No. 3), pp. 462-68. e1, (2014).
14- Alessio Arrivi et al., "Operators’ radiation exposure reduction during cardiac catheterization using a removable shield." Cardiovascular intervention therapeutics, Vol. 35 (No. 4), pp. 379-84, (2020).
15- Aida Khaleghi Fard, Amir Hossein Mohammad Alian, Leili Pourafkari, Morteza Ghojazadeh, Ali Tarighatnia, and Alireza Farajollahi, "Impact of pelvic and rad-board lead shields on operator and patient radiation dose in trans-radial coronary procedures." Radiation protection dosimetry, Vol. 187 (No. 1), pp. 108-14, (2019).
16- Parinaz Mehnati, Mohammad Yousefi Sooteh, Reza Malekzadeh, Baharak Divband, and Soheila Refahi, "Breast conservation from radiation damage by using nano bismuth shields in chest CT scan." Crescent Journal of Medical Biological Sciences, Vol. 6 (No. 1), pp. 46-50, (2018).
17- Parinaz Mehnati, Reza Malekzadeh, and Mohammad Yousefi Sooteh, "New Bismuth composite shield for radiation protection of breast during coronary CT angiography." Iranian Journal of Radiology, Vol. 16 (No. 3), (2019).
18- Andrew J Einstein et al., "Effect of bismuth breast shielding on radiation dose and image quality in coronary CT angiography." Journal of Nuclear Cardiology, Vol. 19 (No. 1), pp. 100-08, (2012).
19- CP Shortt, L Malone, J Thornton, P Brennan, and MJ Lee, "Radiation protection to the eye and thyroid during diagnostic cerebral angiography: a phantom study." Journal of Medical Imaging Radiation Oncology, Vol. 52 (No. 4), pp. 365-69, (2008).
20- Anees Musallam et al., "A randomized study comparing the use of a pelvic lead shield during trans‐radial interventions: Threefold decrease in radiation to the operator but double exposure to the patient." Catheterization Cardiovascular Interventions, Vol. 85 (No. 7), pp. 1164-70, (2015).
21- Ali Tarighatnia, Amirhossien Mohammadalian, Morteza Ghojazade, Leili Pourafkari, and Alireza Farajollahi, "Beam projections and radiation exposure in transradial and transfemoral approaches during coronary angiography." Anatolian Journal of Cardiology, Vol. 18 (No. 4), p. 298, (2017).
22- P Mehnati, M Ghavami, and H Heidari, "Reducing radiation doses in female breast and lung during CT examinations of thorax: A new technique in two scanners." Journal of biomedical physics engineering, Vol. 7 (No. 3), p. 217, (2017).
23- Parinaz Mehnati, Vida Sargazi, Zainab Yazdi Sotoodeh, Afshin Nejadjahantigh, and Masoome Farsizaban, "Introducing SRF in Bismuth-Silicon and Polyurethane shields for breast dose reduction during chest CT." Journal of Complementary Medicine Research, Vol. 11 (No. 5), pp. 195-95, (2021).
24- Parinaz Mehnati, Reza Malekzadeh, Baharak Divband, and Mohammad Yousefi Sooteh, "Assessment of the effect of nano-composite shield on radiation risk prevention to Breast during computed tomography." Iranian Journal of Radiology, Vol. 17 (No. 1), (2020).
25- Parinaz Mehnati, Reza Malekzadeh, and Mohammad Yousefi Sooteh, "Application of personal non-lead nano-composite shields for radiation protection in diagnostic radiology: A systematic review and meta-analysis." Nanomedicine Journal, Vol. 7 (No. 3), pp. 170-82, (2020).
26- Parinaz Mehnati, Reza Malekzadeh, Mohammad Yousefi Sooteh, and Soheila Refahi, "Assessment of the efficiency of new bismuth composite shields in radiation dose decline to breast during chest CT." The Egyptian Journal of Radiology Nuclear Medicine, Vol. 49 (No. 4), pp. 1187-89, (2018).
27- Parinaz Mehnati, Reza Malekzadeh, and Mohammad Yousefi Sooteh, "New Bismuth composite shield for radiation protection of breast during coronary CT angiography." Iranian Journal of Radiology, Vol. 16 (No. 3), (2019).
28- Elham Mansouri, Asghar Mesbahi, Reza Malekzadeh, and Ahmad Mansouri, "Shielding characteristics of nanocomposites for protection against X-and gamma rays in medical applications: effect of particle size, photon energy and nano-particle concentration." Radiation Environmental Biophysics, Vol. 59 (No. 4), pp. 583-600, (2020).
29- P Mehnati, A Jafarabadi, and L Danaee, "Assessment of Patient Dose with Special Look at Pediatrics during Cardiovascular Imaging." ournal of Biomedical Physics & Engineering, Vol. 10 (No. 1), p. 51, (2020).
30- Nogueira MS Leyton F, Gubolino LA, Pivetta MR, Ubeda C. , "Correlation between scatter radiation dose at height of operator's eye and dose to patient for different angiographic projections." Applied Radiation and Isotopes, Vol. 117pp. 100-5, (2016).
2- Gregory A Roth et al., "Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015." Journal of the American college of cardiology, Vol. 70 (No. 1), pp. 1-25, (2017).
3- Galit Aviram et al., "Clinical value of 16‐slice multi‐detector CT compared to invasive coronary angiography." International journal of cardiovascular interventions, Vol. 7 (No. 1), pp. 21-28, (2005).
4- Ali Tarighatnia, Asghar Mesbahi, Amir Hossein Mohammad Alian, Evin Koleini, and Nader Nader, "An analysis of operating physician and patient radiation exposure during radial coronary angioplasties." Radiation protection dosimetry, Vol. 182 (No. 2), pp. 200-07, (2018).
5- Ali Tarighatnia et al., "Radiation exposure levels according to vascular access sites during PCI." Herz, Vol. 44 (No. 4), pp. 330-35, (2019).
6- Ali Tarighatnia, L Pourafkari, A Farajollahi, AH Mohammadalian, M Ghojazadeh, and ND Nader, "Operator radiation exposure during transradial coronary angiography." Tarighatnia A, Pourafkari L, Farajollahi A, Mohammadalian AH, Ghojazadeh M, Nader ND. Operator radiation exposure during transradial coronary angiography. Herz. 2018 Sep;43(6):535-42., Vol. 43 (No. 6), pp. 535-42, (2018).
7- Reza Fardid, Hadi Rezaei, Fatemeh Mirzadeh, Mohammad Amin Mosleh-Shirazi, and Sedigheh Sina, "Evaluation of Correlation between DAP (Dose-Area Product) Values and Cardiologist Dose during Coronary Angiography Using Monte Carlo Simulation." Iranian Journal of Medical Physics, Vol. 18 (No. 5), pp. 306-13, (2021).
8- Lucia Venneri et al., "Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report." American heart journal, Vol. 157 (No. 1), pp. 118-24, (2009).
9- Akbar Zeraatpishe et al., "Effects of Melissa officinalis L. on oxidative status and DNA damage in subjects exposed to long-term low-dose ionizing radiation." Toxicology industrial health, Vol. 27 (No. 3), pp. 205-12, (2011).
10- Ayse Basak Engin, Mehmet Ali Ergun, Erkan Yurtcu, Derya Kan, and Gonul Sahin, "Effect of ionizing radiation on the pteridine metabolic pathway and evaluation of its cytotoxicity in exposed hospital staff." Mutation Research/Genetic Toxicology Environmental Mutagenesis, Vol. 585 (No. 1-2), pp. 184-92, (2005).
11- Nicolas Marque et al., "Impact of an extension tube on operator radiation exposure during coronary procedures performed through the radial approach." Archives of cardiovascular diseases, Vol. 102 (No. 11), pp. 749-54, (2009).
12- Reza Malekzadeh, Vahid Sadeghi Zali, Okhtay Jahanbakhsh, Murat Okutan, and Asghar Mesbahi, "The preparation and characterization of silicon-based composites doped with BaSO4, WO3, and PbO nanoparticles for shielding applications in PET and nuclear medicine facilities." Nanomedicine Journal, Vol. 7 (No. 4), pp. 324-34, (2020).
13- John P Gonzales, Christopher Moran, and James E Silberzweig, "Reduction of operator radiation dose by an extended lower body shield." Journal of Vascular Interventional Radiology, Vol. 25 (No. 3), pp. 462-68. e1, (2014).
14- Alessio Arrivi et al., "Operators’ radiation exposure reduction during cardiac catheterization using a removable shield." Cardiovascular intervention therapeutics, Vol. 35 (No. 4), pp. 379-84, (2020).
15- Aida Khaleghi Fard, Amir Hossein Mohammad Alian, Leili Pourafkari, Morteza Ghojazadeh, Ali Tarighatnia, and Alireza Farajollahi, "Impact of pelvic and rad-board lead shields on operator and patient radiation dose in trans-radial coronary procedures." Radiation protection dosimetry, Vol. 187 (No. 1), pp. 108-14, (2019).
16- Parinaz Mehnati, Mohammad Yousefi Sooteh, Reza Malekzadeh, Baharak Divband, and Soheila Refahi, "Breast conservation from radiation damage by using nano bismuth shields in chest CT scan." Crescent Journal of Medical Biological Sciences, Vol. 6 (No. 1), pp. 46-50, (2018).
17- Parinaz Mehnati, Reza Malekzadeh, and Mohammad Yousefi Sooteh, "New Bismuth composite shield for radiation protection of breast during coronary CT angiography." Iranian Journal of Radiology, Vol. 16 (No. 3), (2019).
18- Andrew J Einstein et al., "Effect of bismuth breast shielding on radiation dose and image quality in coronary CT angiography." Journal of Nuclear Cardiology, Vol. 19 (No. 1), pp. 100-08, (2012).
19- CP Shortt, L Malone, J Thornton, P Brennan, and MJ Lee, "Radiation protection to the eye and thyroid during diagnostic cerebral angiography: a phantom study." Journal of Medical Imaging Radiation Oncology, Vol. 52 (No. 4), pp. 365-69, (2008).
20- Anees Musallam et al., "A randomized study comparing the use of a pelvic lead shield during trans‐radial interventions: Threefold decrease in radiation to the operator but double exposure to the patient." Catheterization Cardiovascular Interventions, Vol. 85 (No. 7), pp. 1164-70, (2015).
21- Ali Tarighatnia, Amirhossien Mohammadalian, Morteza Ghojazade, Leili Pourafkari, and Alireza Farajollahi, "Beam projections and radiation exposure in transradial and transfemoral approaches during coronary angiography." Anatolian Journal of Cardiology, Vol. 18 (No. 4), p. 298, (2017).
22- P Mehnati, M Ghavami, and H Heidari, "Reducing radiation doses in female breast and lung during CT examinations of thorax: A new technique in two scanners." Journal of biomedical physics engineering, Vol. 7 (No. 3), p. 217, (2017).
23- Parinaz Mehnati, Vida Sargazi, Zainab Yazdi Sotoodeh, Afshin Nejadjahantigh, and Masoome Farsizaban, "Introducing SRF in Bismuth-Silicon and Polyurethane shields for breast dose reduction during chest CT." Journal of Complementary Medicine Research, Vol. 11 (No. 5), pp. 195-95, (2021).
24- Parinaz Mehnati, Reza Malekzadeh, Baharak Divband, and Mohammad Yousefi Sooteh, "Assessment of the effect of nano-composite shield on radiation risk prevention to Breast during computed tomography." Iranian Journal of Radiology, Vol. 17 (No. 1), (2020).
25- Parinaz Mehnati, Reza Malekzadeh, and Mohammad Yousefi Sooteh, "Application of personal non-lead nano-composite shields for radiation protection in diagnostic radiology: A systematic review and meta-analysis." Nanomedicine Journal, Vol. 7 (No. 3), pp. 170-82, (2020).
26- Parinaz Mehnati, Reza Malekzadeh, Mohammad Yousefi Sooteh, and Soheila Refahi, "Assessment of the efficiency of new bismuth composite shields in radiation dose decline to breast during chest CT." The Egyptian Journal of Radiology Nuclear Medicine, Vol. 49 (No. 4), pp. 1187-89, (2018).
27- Parinaz Mehnati, Reza Malekzadeh, and Mohammad Yousefi Sooteh, "New Bismuth composite shield for radiation protection of breast during coronary CT angiography." Iranian Journal of Radiology, Vol. 16 (No. 3), (2019).
28- Elham Mansouri, Asghar Mesbahi, Reza Malekzadeh, and Ahmad Mansouri, "Shielding characteristics of nanocomposites for protection against X-and gamma rays in medical applications: effect of particle size, photon energy and nano-particle concentration." Radiation Environmental Biophysics, Vol. 59 (No. 4), pp. 583-600, (2020).
29- P Mehnati, A Jafarabadi, and L Danaee, "Assessment of Patient Dose with Special Look at Pediatrics during Cardiovascular Imaging." ournal of Biomedical Physics & Engineering, Vol. 10 (No. 1), p. 51, (2020).
30- Nogueira MS Leyton F, Gubolino LA, Pivetta MR, Ubeda C. , "Correlation between scatter radiation dose at height of operator's eye and dose to patient for different angiographic projections." Applied Radiation and Isotopes, Vol. 117pp. 100-5, (2016).
| Files | ||
| Issue | Vol 11 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v11i1.14515 | |
| Keywords | ||
| Bismuth Composite Shield Breast Shield Coronary Angiography Radiation Protection Operator Dose | ||
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How to Cite
1.
Malekzadeh R, Tarighatnia A, Mehnati P, Nader N. Reduction of Radiation Risk to Cardiologists and Patients during Coronary Angiography: Effect of Exposure Angulation and Composite Shields. Frontiers Biomed Technol. 2022;11(1):84-93.
