Feature | Cath Lab | June 02, 2015| Michael Ragosta, M.D., University of Virginia Health System

Helping Interventional Cardiologists Reduce Exposure to Ionizing Radiation

Implementing cath lab safety programs and equipment to reduce X-ray radiation

The University of Virginia Health System (UVA) installed a Corindus Corpath robotoic PCI system to help reduce the amount of radiation operators are exposed with table side during procedures.

The University of Virginia Health System (UVA) installed a Corindus Corpath robotoic PCI system to help reduce the amount of radiation operators are exposed with table side during procedures.

Long-term exposure to ionizing radiation is a primary occupational concern for today's interventional cardiologists. To address these concerns, many interventional cardiologists are enlisting the support of their hospital administrators to create workplace environments that reduce exposure to ionizing radiation. 

As the medical director for interventional cardiology at the University of Virginia Health System (UVA), I am proud to say that our organization is taking proactive steps to improve workplace safety for our team of interventional cardiologists and the staff working in our cardiac catheterization laboratories. 

In 2014, UVA launched its "Be Safe" initiative, which is designed to make the health system the safest place in healthcare for patients and employees alike. The initiative focuses on training UVA team members to identify issues that improve safety, workflow and outcomes by increasing protection of operators in the cath lab, where risks from harmful radiation exposure and traditional protection methods continue to be a major concern.

To support the Be Safe initiative, UVA has invested in staff education and equipment purchases to create a culture that empowers all front-line staff to call out issues that affect safety, workflow and outcomes. These efforts help address many of the factors that contribute to health issues resulting from long-term exposure to ionizing radiation. 

The Long-Term Impact of Radiation Exposure

In recent years, the interventional cardiology profession has paid much closer attention to the long-term health impact of exposure to ionizing radiation that is prevalent in cath labs. This focused attention is well founded, as the radiation exposure rates found in interventional cardiologists are two to 10 times higher than those experienced by other medical specialties, due to the physician's proximity to the radiation source in the cath lab.[1] 

In addition, there is mounting evidence linking interventional cardiologists to a series of long-term health effects, including:

   • Left-sided brain tumors [2] 

   • Skin cancer [3]

   • Posterior subcapsular lens changes (a precursor to cataracts)[4]

   • Thyroid disease [5] 

   • Neuro-degenerative disease [6] 

 

Plus, more generalized adverse health effects, such as cardiovascular disease and diminishment of reproductive capacity, also may be linked to general chronic, low-dose radiation exposure.[7]

 

Equipment Investments

Part of our efforts to improve safety includes adding equipment to reduce radiation exposure. These include implementing imaging equipment that uses lower levels of radiation while in operation, and the addition of shields and drapes that reduce scatter radiation during procedures. 

Additionally, UVA has installed CorPath robotic-assisted systems (Corindus Vascular Robotics) in two of its cath labs. The system has demonstrated a reduction in radiation exposure to the primary operator by more than 95 percent in clinical trials.[8]  The CorPath system allows physicians to perform percutaneous coronary intervention (PCI) procedures from the comfort of a radiation-shielded cockpit that includes angiography and hemodynamics monitors. Physicians using the system are able to take measurements, with sub-millimeter accuracy, of relevant anatomy and well as advance or retract guide wires and/or balloon stent catheters with precise movements as small as a millimeter. 

Our team of interventional cardiologists at UVA has used the robotic-assisted systems in more than 100 PCI procedures to-date, and is now exploring robotic PCI in an expanded set of highly complex cases to reduce operator radiation exposure. 

 

Quantifying Reductions in Radiation Exposure

We are confident that our efforts at UVA are going in the right direction to improve workplace safety for our interventional cardiologists. To quantify the results of our efforts, I initiated a study in January 2015 that is evaluating the ionizing radiation exposure levels of interventional cardiologists using the CorPath system during various points of PCI procedures. Findings of the study will be published at a future date. 

My hope is that the research can be used to help other interventional cardiologists — and the administrators at their organizations — have additional data to develop strategies that improve workplace safety. 

 

Read the article, "5 Technologies to Reduce Cath Lab Radiation Exposure."

 

Editor’s note: Michael Ragosta, M.D., is the medical director for interventional cardiology at the University of Virginia Health System. He also is a professor of medicine/cardiology at the University of Virginia. Ragosta has been principal investigator or co-principal investigator on 10 clinical trials involving myocardial viability, coronary collateral circulation, coronary flow reserve, fractional flow reserve and myocardial contrast echocardiography. He has shared his research and experience through more than 40 invited lectures or visiting professorships and by authoring or co-authoring more than 120 peer-reviewed journal publications

 

References:

 
 
 
 
 
 
 
 

Related Content

Feature | Cath Lab | September 14, 2021 | By Aaron Detate and Lars Thording
In the electrophysiology (EP) lab, hundreds
An example of the Medis QCA angiography imaging derived fractional flow reserve (FFR) assessment. This technology removes the need for pressure wires and adenosine used in traditional FFR assessments of the coronary arteries.

An example of the Medis QCA angiography imaging derived fractional flow reserve (FFR) assessment. This technology removes the need for pressure wires and adenosine used in traditional FFR assessments of the coronary arteries.

News | Cath Lab | July 22, 2021
July 22, 2021 — Medis Medical Imaging is partnering with CORRIB Core Lab and Sinomed in randomized clinical trial of
ast End Medical announced it received U.S. Food and Drug Administration (FDA) clearance for the company's SafeCross Transseptal Radiofrequency (RF) Puncture and Steerable Balloon Introducer System. The 3-in-1 system, which includes a steerable introducer sheath with an ultra-visible positioning balloon and radiofrequency (RF) puncture dilator, aims to provide a predictable and safe solution for electrophysiology (EP) and structural heart interventions requiring left atrial access.
News | Cath Lab | July 14, 2021
July 13, 2021 — East End Medical announced it received U.S.
There is a trend in interventional cardiology that is now being called “renalism,” where patients with poor renal function are being excluded from interventional procedures because they are automatically considered too high risk. However, some hospitals are also creating cardio-renal care teams so these patients can be cared for by a team of experts rather than interventional cardiologists going it alone. #SCAI21 #SCAI2021 Creating a card0-renal program.

There is a trend in interventional cardiology that is now being called “renalism,” where patients with poor renal function are being excluded from interventional procedures because they are automatically considered too high risk. However, some hospitals are also creating cardio-renal care teams so these patients can be cared for by a team of experts rather than interventional cardiologists going it alone.

Feature | Cath Lab | May 14, 2021 | By Dave Fornell, Editor
There is a trend in interventional cardiology that is now being called “renalism,” where patients with poor renal fun
Abbott recently announced its new interventional imaging platform powered by Ultreon 1.0 Software, has gained European CE marked. This first-of-its-kind imaging software merges optical coherence tomography (OCT) intravascular imaging with the power of artificial intelligence (AI) for enhanced visualization. The new Ultreon Software can automatically detect the severity of calcium-based blockages and measure vessel diameter to enhance the precision of physicians’ decision-making during coronary stenting proc

Abbott recently announced its new interventional imaging platform powered by Ultreon 1.0 Software, has gained European CE marked. This first-of-its-kind imaging software merges optical coherence tomography (OCT) intravascular imaging with the power of artificial intelligence (AI) for enhanced visualization. The new Ultreon Software can automatically detect the severity of calcium-based blockages and measure vessel diameter to enhance the precision of physicians’ decision-making during coronary stenting procedures.

News | Cath Lab | May 12, 2021
May 12, 2021 — Abbott recently announced its new interventional imaging platform powered by Ultreon 1.0 Software, has
SCAI 2021 late-breaking presentations included the data on the Medtronic Harmony transcatheter pulmonary valve, cutting radial access hemostasis time by 50 percent, improving cardiogenic shock survival to 71 percent, and data showing very high mortality in COVID patients who suffer a STEMI heart attack. #SCAI21 #SCAI2021

SCAI 2021 late-breaking presentations included the data on the Medtronic Harmony transcatheter pulmonary valve, cutting radial access hemostasis time by 50 percent, improving cardiogenic shock survival to 71 percent, and data showing very high mortality in COVID patients who suffer a STEMI.

Feature | Cath Lab | May 06, 2021 | By Dave Fornell, Editor
April 29, 2021 — Here is the list of late-breaking study presentations and links to articles about each of them from
Most Stable Ischemic Heart Disease Patients Did Not Meet ISCHEMIA Trial Enrollment Criteria, raising questions about its application in real-world practice. #SCAI2021 Getty Images

Getty Images

News | Cath Lab | May 03, 2021
May 3, 2021 – Results from a new study find a broad range of patients who typically undergo revascularization for sta
New study demonstrates depression, HIV, mental health, obesity, alcohol and drug abuse are risk factors on most common type of heart disease in young black patients. Photo by Dave Fornell
News | Cath Lab | April 29, 2021
April 29, 2021 – A retrospective analysis of risk factors for coronary artery disease (CAD) in young African American
There are far fewer patients coming to hospitals with heart attacks during the COVID-19 pandemic as compared to averages prior to the pandemic. This has raised concerns that delayed treatment will cause an uptick in cardiac deaths and heart failure. Photo from Getty Images 

There are far fewer patients coming to hospitals with heart attacks during the COVID-19 pandemic as compared to averages prior to the pandemic. This has raised concerns that delayed treatment will cause an uptick in cardiac deaths and heart failure. Photo from Getty Images 

News | Cath Lab | April 28, 2021
April 28, 2021 – Results from a retrospective observational study, presented today at...