Author + information
- Received August 22, 2017
- Revision received January 8, 2018
- Accepted January 11, 2018
- Published online March 12, 2018.
- James A. Crowhurst, BSc (Hons)a,b,∗ ( )(, )
- Gregory M. Scalia, MBBS, MMedScia,b,
- Mark Whitby, MSc, PhDc,
- Dale Murdoch, MBBSa,b,
- Brendan J. Robinson, BappScia,
- Arianwen Turner, BappScid,
- Liesie Johnston, BappScid,
- Swaroop Margale, MBBSe,
- Sarvesh Natani, MBBS, MDe,
- Andrew Clarke, MBBSf,
- Darryl J. Burstow, MBBSa,b,
- Owen C. Raffel, MBa,b and
- Darren L. Walters, MBBS, MPhila,b
- aCardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
- bUniversity of Queensland, St. Lucia, Queensland, Australia
- cBiomedical Technical Services, The Prince Charles Hospital, Chermside, Queensland, Australia
- dMedical Imaging Department, The Prince Charles Hospital, Chermside, Queensland, Australia
- eDepartment of Anaesthesia, The Prince Charles Hospital, Chermside, Queensland, Australia
- fDepartment of Cardio-thoracic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
- ↵∗Address for correspondence:
Mr. James Crowhurst, Cardiac Investigations Unit, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia.
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 μSv (interquartile range [IQR]: 0.95 to 4.76 μSv), similar to OP1 E: 1.91 μSv (IQR: 0.48 to 3.81 μSv) (p = 0.101), but significantly higher than secondary operator E: 0.48 μSv (IQR: 0.00 to 1.91 μSv) (p < 0.001) and anesthetist E: 0.48 μSv (IQR: 0.00 to 1.43 μSv) (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 μSv [IQR: 0.95 to 4.76] to 0.48 μSv [IQR: 0.00 to 1.43 μSv] [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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 22, 2017.
- Revision received January 8, 2018.
- Accepted January 11, 2018.
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