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Tag: Scatter-radiation

radiation-protection-products
RADPAD® Radiation Products Protect Healthcare Providers and Patients

RADPAD® Radiation Products Protect Healthcare Providers and Patients

Posted on March 18, 2019 by in Uncategorized with no comments

RADPAD® Absorbs Scatter Radiation

RADPAD® Radiation Protection Shields are used by physicians and cath lab personnel during fluoro-guided procedures to protect them from the harmful effects of ionizing x-radiation. Placed on the patient in front of the operator, RADPAD® works by absorbing scatter radiation coming from the patient and creating a “shade zone” for the cath lab team to work in during interventional procedures. All RADPAD® Radiation Protection Products are non-lead and PVC-free products. They are procedure specific and designed for single use.

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Physician Protection

Sterile, disposable RADPAD® Radiation Protection Products are placed directly on the patient to protect the operator and cath lab personnel during fluoro-guided procedures from harmful scatter radiation. They are backed by 30 clinical studies and proven in thousands of hospitals on a daily basis worldwide

RADPAD® 5000 series products are comprised of several procedure-specific radiation protection shields designed to provide maximum protection to the operator and cath lab personnel during fluoro-guided procedures

RADPAD® 7000 series are comprised of several procedures specific sterile drape + RADPAD® Radiation Protection Shields, designed to protect operators and cath lab personnel during fluoro-guided procedures

RADPAD® 9000 series of Personal Protection Products are comprised of products worn by the operator and cath lab personnel to for additional protection during fluoro or CT guided procedures. These products include:

  • RADPAD® No Brainer®  is an attenuation material-lined scrub cap worn by the cath lab personnel to protect their brain from scatter radiation during fluoro-guided procedures
  • RADPAD® Thyroid Shield w/ Cover is a RADPAD® thyroid shield worn by the cath lab personnel to protect thyroid glands during fluoro-guided procedures
  • RADPAD® Radiation Protection Sleeve is a full arm-length cover worn the operator during CT guided procedures

Additional Products

RADPAD® Table Skirts w/ Anchor are table skirts that anchor to the table in the cath lab to block scatter radiation coming from below the table

 

Patient Protection

RADPAD® Specialty Shields: Shields of various shapes and sizes used to protect the patient during fluoro guided, interventional radiology, electrophysiology, and cardiac cath examinations

RADPAD® Patient Protection Pads: Pads used underneath the lower or upper body during fluoro-guided procedures

RADPAD® Body Guard Sets: Wraps fitted for adults, children, and infants used to protect the brain, thyroid, upper and lower body during CT examinations

 

Testimony of Clinical Need for Radiation Protection

“72 million CT scans are performed annually in the United States, which is about one scan for every four people in the country…which could account for roughly 29,000 future cancer cases each year!”¹

“In 2013, a scientific consensus was reached that even just one CT scan in childhood is linked to the risk of developing future cancers.”²

“Even 15 or more years after the first exposure to ionizing radiation from CT scan, cancer risks remain elevated by 24%.”³

Sterile, disposable RADPAD® Radiation Protection Products are placed directly on the patient to protect the operator and cath lab personnel during fluoro-guided procedures from harmful scatter radiation. They are backed by 30 clinical studies and proven in thousands of hospitals on a daily basis worldwide.


Contact Us or send inquiries to info@radpad.com for a free No Brainer™ surgical cap sample.

 

The original article appeared on https://www.medalliancegroup.com/product/radpad/.
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RADPAD® Safety News:  Radiation Exposure in Cath Lab Depends on Shield Placement

RADPAD® Safety News: Radiation Exposure in Cath Lab Depends on Shield Placement

Posted on February 19, 2018 by in Safety with no comments

MedPage Today and the American Heart Association collaborated on an insightful article explaining the importance of shield placement in the reduction of scatter radiation exposure:

 

MEDPAGE TODAY ®

Cardiology

Radiation Exposure in Cath Lab Depends on Shield Placement

by Chris Kaiser

Cardiology Editor, MedPage Today October 17, 2011

 

This article is a collaboration between MedPage Today® and:

Screen Shot 2018-02-19 at 2.07.31 PMlife is why

Interventional cardiologists are at greatest risk of scatter radiation exposure compared with other personnel in the cath lab, but their risk can be significantly reduced with the optimal placement of radiation shielding, researchers found.

A ceiling-mounted upper body shield protected best from scatter radiation when it was positioned tight to the patient’s body and just toward the head from the femoral access point, reported Kenneth A. Fetterly, PhD, from the Mayo Clinic in Rochester, Minn., and colleagues.

However, a difference of 5 cm away from the patient’s body and 20 cm closer to the x­ ray tube resulted in a fourfold reduction in protection, according to the study in Oct. 25 Journal of the American College of Cardiology: Cardiovascular Interventions.

“That the most advantageous shield positioning can have a greater than fourfold relative reduction in scatter radiation exposure, supports its use even when inconvenient, and suggests that learning to coordinate multiple shields should be among the fundamental principles taught in every interventional cardiology training program,” wrote Lloyd W. Klein, MD, and Justin Maroney, MD, from Advocate Illinois Masonic Medical Center in Chicago, in an accompanying editorial.

Klein and Maroney noted that the design of the interventional suite has remained stagnant over the past few decades even as innovations in techniques and devices have soared. And because optimal placement of shielding “continues to be operator­ dependent,” it requires a deliberate effort on the part of cath lab personnel to place shield s.

To determine how best to protect against scatter radiation, which occurs when the primary x-ray beam interacts with patient tissue and changes direction, investigators tested four different shielding models individually and in com binat ion:

 

  • A ceiling-mounted upper body shield

 

  • A table side rail-mounted lower body shield

 

  • An accessory vertical shield that mounts as an upper extension of the lower body shield

 

  • A disposable radiation-absorbing pad

 

Researchers used anthropomorphic phantoms through which they directed the x-ray beam in a straight posterior-anterior posit ion.

They measured the scatter radiation from three common physician positions corresponding to standard right femoral art ery, right jugular vein, and left anterior thoracic access point s.

Results showed that maximum protection was provided at the femoral artery access position compared with the other two access points.

When the ceiling-mounted upper body shield was moved away from the patient’s body by 5 cm, and moved more cephalad from the femoral access point by 20 cm, the protective benefit to the middle and upper body went from greater than 80% to less than 20%.

The accessory vertical extension to the lower body shield provided between 25% and 90% additional protection at heights in the range of 100 cm to 150 cm. The disposable pad also provided extra upper body protection, in the range of 55% to 70%.

Researchers found that the combined use of the table apron with vertical extension and the upper body shield resulted in “at least 80% protection at all elevations and 90% protection for elevations below 150 cm” at the femoral access point.

Regarding protection from the right jugular vein and left anterior thoracic access points, testing showed that the lower body shield provided better than 90% reduction in scatter exposure, but no upper body protection, while the disposable pad provided lower body protection and only modest upper body protection (between 40% to 70%).

The upper body shield also interfered with the x-ray receptor and patient access when the right jugular vein access point was used, and it interfered with patient access from the anterior thoracic access point. Patient interference was common with the vertical extension as well.

“A major finding of this work is that the upper body protection provided by the ceiling­ mounted upper body shield is highly dependent on precise positioning,” researchers wrote.

“Note that conventional wisdom is that shields should be placed close to the source of radiation to maximize the size of the protective ‘radiation shadow’ of the shield. Properly positioning the upper body shield requires the opposite mindset,” Fetterly and colleagues said.

Klein and Maroney echoed this sentiment, saying the shield should be used “as one would use an umbrella in wind-driven rain: the closer to the operator’s body the more eff ect ive.”

Limitations of the study included the use of only the posterior-anterior projections, and the lack of an analysis of radiation scatter when involved with the treatment of abdominal and peripheral vessels.

 

The study authors and the editorialists reported relationships relevant to the contents of the study or editorial.

 Reviewed by Zalman S. Agus, MD Em er itus Professor

University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN , BC-ADM, CDE, Nurse Planner 

Primary Source

JACC: Cardiovascular Interventions

Source Reference: Fetterly, KA et al “Effective use of radiation shields to minimize operator dose during invasive cardiology procedures” J Am Coll Cardiol Intv 2011; 4: 1133-1139.

Secondary Source

JACC: Cardiovascular Interventions

Source Reference : Klein LW, et al “Optimizing operator protection by proper radiation shield positioning in the interventional cardiology suite” J Am Coll Cardiol Intv 2011;4:1140-1141.


CONTACT US

Send inquiries to info@radpad.com for a free No Brainer™ sample. The No Brainer™ blocks up to 95% of radiation exposure to the brain. Lightweight, adjustable protection for all O.R. suite and fluoro lab personnel during interventional procedures.

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730 or 1-877-7RADPAD (1-877-772-3723)
Fax: 913-648-0131
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Scatter Radiation is Unavoidable, Physician Protection is Not

Scatter Radiation is Unavoidable, Physician Protection is Not

Posted on November 27, 2017 by in Products, Safety with no comments

Protecting Hospital Staff During Fluoro-Guided Procedures

Radiation Therapy is a powerful tool in medicine, especially when used to treat cancer. Radiation works by killing and slowing the growth of cancer cells – but it can also damage healthy cells in the process, which can increase the risk of developing cancer in the future.

In 2017, approximately 80,000 new cases of brain tumors are expected to be diagnosed, with roughly 26,000 of those being malignant cases.^1 This depicts brain and other central nervous system cancer as the 10th leading cause of death in both men and women, and an estimated 16,700 individuals are expected to die from primary brain cancer this year. ^2

 

RADPAD® Radiation protection Products

While healthcare providers are diligent in their efforts to keep patients safe from scatter radiation, it is also important for providers to consider their safety when performing these procedures. Scatter radiation is secondary radiation that deflects from an object, most commonly the patient, during procedures, and can affect the healthcare provider’s brain in the process.

RADPAD® from Worldwide Innovations & Technologies is a full line of radiation protection products that are dedicated to protecting hospital staff during fluoro-guided procedures.

The No Brainer

The No Brainer®

The RADPAD® No Brainer® is an attenuation material-lined scrub cap worn by cath lab personnel that protects the brain from scatter radiation during fluoro-guided procedures.

 

x-ray-protection-thyroid-collar

Thyroid Collar

 

The RADPAD® is also available as a thyroid shield and a full-length protection sleeve to cover the neck and arms of the physician during these procedures.

 

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Table Skirt with Anchor

The RADPAD® Table Skirt anchors to the table in the cath lab to block scatter radiation that flows from below the table, and the RADPAD® Specialty Shields create a shade zone where the physician can work from.

To learn more about how you can protect yourself and your patients with the RADPAD®, contact us:

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730 or 1-877-7RADPAD (1-877-772-3723)
Fax: 913-648-0131

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1 http://www.abta.org/about-us/news/brain-tumor-statistics/?referrer=https://www.google.com/

2 http://www.cancer.net/cancer-types/brain-tumor/statistics

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RADPAD Presents: Cardiovascular Procedure Volume Growth Report

RADPAD Presents: Cardiovascular Procedure Volume Growth Report

Posted on September 19, 2017 by in Uncategorized with no comments

Here we present an article from MedMarket Diligence that provides information about the growth of cardiovascular procedure volume worldwide.

Based on their report described below, the volume of procedures is predicted to grow by an average of 3.7% per year from 2016 – 2022. The volume of corresponding surgeries and transcatheter interventions is forecast to expand to more than 18.73 million.

 

Cardiovascular procedure volume growth (interventional and surgical)

Cardiovascular surgical and interventional procedures are performed to treat conditions causing inadequate blood flow and supply of oxygen and nutrients to organs and tissues of the body. These conditions include the obstruction or deformation of arterial and venous pathways, distortion in the electrical conducting and pacing activity of the heart, and impaired pumping function of the heart muscle, or some combination of circulatory, cardiac rhythm, and myocardial disorders. Specifically, these procedures are:

  • Coronary artery bypass graft (CABG) surgery;
  • Coronary angioplasty and stenting;
  • Lower extremity arterial bypass surgery;
  • Percutaneous transluminal angioplasty (PTA) with and without bare metal and drug-eluting stenting;
  • Peripheral drug-coated balloon angioplasty;
  • Peripheral atherectomy;
  • Surgical and endovascular aortic aneurysm repair;
  • Vena cava filter placement
  • Endovenous ablation;
  • Mechanical venous thrombectomy;
  • Venous angioplasty and stenting;
  • Carotid endarterectomy;
  • Carotid artery stenting;
  • Cerebral thrombectomy;
  • Cerebral aneurysm and AVM surgical clipping;
  • Cerebral aneurysm and AVM coiling & flow diversion;
  • Left Atrial Appendage closure;
  • Heart valve repair and replacement surgery;
  • Transcatheter valve repair and replacement;
  • Congenital heart defect repair;
  • Percutaneous and surgical placement of temporary and permanent mechanical cardiac support devices;
  • Pacemaker implantation;
  • Implantable cardioverter defibrillator placement;
  • Cardiac resynchronization therapy device placement;
  • Standard SVT & VT ablation; and
  • Transcatheter AFib ablation

For 2016 to 2022, the total worldwide volume of these cardiovascular procedures is forecast to expand on average by 3.7% per year to over 18.73 million corresponding surgeries and transcatheter interventions in the year 2022. The largest absolute gains can be expected in peripheral arterial interventions (thanks to explosive expansion in utilization of drug-coated balloons in all market geographies), followed by coronary revascularization (supported by continued strong growth in Chinese and Indian PCI utilization) and endovascular venous interventions (driven by grossly underserved patient caseloads within the same Chinese and Indian market geography).

Venous indications are also expected to register the fastest (5.1%) relative procedural growth, followed by peripheral revascularization (with 4.0% average annual advances) and aortic aneurysm repair (projected to show a 3.6% average annual expansion).

Source: MedMarket Diligence, LLC; “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022,” (Report #C500).

Geographically, Asian-Pacific (APAC) market geography accounts for slightly larger share of the global CVD procedure volume than the U.S. (29.5% vs 29,3% of the total), followed by the largest Western European states (with 23.9%) and ROW geographies (with 17.3%). Because of the faster growth in all covered categories of CVD procedures, the share of APAC can be expected to increase to 33.5% of the total by the year 2022, mostly at the expense of the U.S. and Western Europe.

However, in relative per capita terms, covered APAC territories (e.g., China and India) are continuing to lag far behind developed Western states in utilization rates of therapeutic CVD interventions with roughly 1.57 procedures per million of population performed in 2015 for APAC region versus about 13.4 and 12.3 CVD interventions done per million of population in the U.S. and largest Western European countries.

Source: MedMarket Diligence, LLC; “Global Dynamics of Surgical and Interventional Cardiovascular Procedures, 2015-2022,” (Report #C500).


Global Cardiovascular Procedures report #C500 details the current and projected surgical and interventional therapeutic procedures commonly used in the management of acute and chronic conditions affecting myocardium and vascular system.

Read the original article:

http://blog.mediligence.com/2017/02/13/cardiovascular-procedure-volume-growth-interventional-and-surgical/


CONTACT US

Send inquiries to info@radpad.com for a free No Brainer™ sample. The No Brainer™ blocks up to 95% of radiation exposure to the brain. Lightweight, adjustable protection for all O.R. suite and fluoro lab personnel during interventional procedures.

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730 or 1-877-7RADPAD (1-877-772-3723)
Fax: 913-648-0131
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RADPAD Safety News: Low Doses of Radiation Could Harm Cardiovascular Health

Posted on August 31, 2017 by in Safety with no comments

It is known that populations exposed to ionizing radiation in medical or environmental settings have symptoms suggesting an increased risk of cardiovascular disease. However, this research study suggests that low exposure to doses of around 0.5 Gy (the equivalent of repeated CT scans) is associated with a significantly increased risk of cardiovascular damage, up to decades after exposure. This raises questions about the nature of long-term alterations in the heart’s vascular system caused by such doses.”

For more about this study read the article below, originally published by Diagnostic and Interventional Cardiology:


NEWS | RADIATION DOSE MANAGEMENT | JULY 17, 2017

Low Doses of Radiation Could Harm Cardiovascular Health

New study suggests dose of 0.5 Gy associated with significantly increased risk of cardiovascular damage as long as decades after exposure. 

Low Doses of Radiation Could Harm Cardiovascular Health

July 17, 2017 — Ionizing radiation, such as X-rays, has a harmful effect on the cardiovascular system even at doses equivalent to recurrent computed tomography (CT) imaging, a new study published in the International Journal of Radiation Biology suggests.

It is known that populations exposed to ionizing radiation in medical or environmental settings have symptoms suggesting an increased risk of cardiovascular disease. However, this research study suggests that low exposure to doses of around 0.5 Gy (the equivalent of repeated CT scans) is associated with a significantly increased risk of cardiovascular damage, up to decades after exposure. This raises questions about the nature of long-term alterations in the heart’s vascular system caused by such doses.

Soile Tapio, M.D., and Omid Azimzadeh, M.D., of Helmholtz Zentrum München, German Research Center for Environmental Health, and colleagues studied how human coronary artery endothelial cells respond to a relatively low radiation dose of 0.5 Gy and found several permanent alterations in the cells that had the potential to adversely affect their essential functions.

Endothelial cells, which form the inner layer of blood vessels, were found to produce reduced amounts of nitric oxide, an essential molecule in several physiological processes including vascular contraction. Previously, high-dose radiation (16 Gy) has been shown to persistently reduce levels of nitric oxide in the serum of mice, but this is the first study to indicate impaired nitric oxide signaling at much lower doses.

Cells damaged by low-dose radiation also produced increased amounts of reactive oxygen species (ROS), which are formed as a natural byproduct of normal oxygen metabolism and play an important role in cell signaling. Increased ROS can damage DNA and proteins.

In addition, exposed cardiac endothelial cells were found to have reduced capacity to degrade oxidized proteins and to be aging prematurely. Such harmful changes did not occur immediately (that is, within a day) but first began in the longer term (one to two weeks). As these cells do not divide rapidly in the body, this observed time in the cell culture would correspond to several years in the living organism.

All these molecular changes are indicative of long-term premature dysfunction and suggest a mechanistic explanation to the epidemiological data showing increased risk of cardiovascular disease after low-dose radiation exposure, the authors concluded.

 


CONTACT US

Send inquiries to info@radpad.com for a free No Brainer™ sample. The No Brainer™ blocks up to 95% of radiation exposure to the brain. Lightweight, adjustable protection for all O.R. suite and fluoro lab personnel during interventional procedures.

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730 or 1-877-7RADPAD (1-877-772-3723)
Fax: 913-648-0131
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RADPAD Interventional Cardiology News: the EARLY TAVR Trial

RADPAD Interventional Cardiology News: the EARLY TAVR Trial

Posted on July 21, 2017 by in Procedures with no comments

The following article from Diagnostic and Interventional Cardiology  offers interesting news about the EARLY TAVR trial, and insights from Philippe Genereux, M.D., interventional cardiologist and the trial’s lead investigator.

The EARLY TAVR trial’s purpose is to assess any health benefit from replacing the aortic valve through a minimally invasive, catheter-based procedure prior to patients showing symptoms, as opposed to the standard of care of observing patients until symptoms develop.

 

FEATURE | HEART VALVE TECHNOLOGY | JULY 14, 2017

First Patient in World Enrolled in Study Evaluating TAVR for Asymptomatic Severe Aortic Stenosis

Morristown Medical Center randomizes first patient in the EARLY TAVR trial, which may change treatment paradigm to save heart function, prevent deterioration

Edwards Sapien 3 TAVR valve will be implanted in asymptomatic aortic stenosis patients in the EARLY TAVR Trial

July 14, 2017 — Morristown Medical Center, part of Atlantic Health System, has randomized the first patient in the world to the EARLY TAVR (Evaluation of Transcatheter Aortic Valve Replacement Compared to SurveilLance for Patients With AsYmptomatic Severe Aortic Stenosis) trial.

Philippe Genereux, M.D., an interventional cardiologist and co-director of the Structural Heart Program at the Gagnon Cardiovascular Institute at Morristown Medical Center, serves as the trial’s principal (lead) investigator. The study is a U.S. Food and Drug Administration approved inventigational device exemption (IDE) trial.

Traditionally, patients with severe aortic stenosis (AS)—a narrowing of the aortic valve in the heart that keeps it from opening fully—who do not yet have symptoms (asymptomatic), are regularly followed and monitored by their cardiologist, and treatment is not initiated until they become symptomatic. However, many elderly patients with asymptomatic severe AS can develop irreversible heart damage or even die while waiting for symptoms to appear. The EARLY TAVR trial will evaluate whether there is benefit from replacing the aortic valve via a minimally invasive, catheter-based procedure (called a transcatheter aortic valve replacement) before patients develop symptoms (shortness of breath, dizziness, fainting, or angina) as compared to the standard of care of watching the patient until symptoms develop.

“The EARLY TAVR trial is an incredibly important trial for the more than 2.5 million people who suffer from aortic stenosis because it may provide an answer to the frequent dilemma cardiologists face about how they should treat severe aortic stenosis, even though patients have no symptoms,” Genereux explained. “The progression of aortic stenosis is unpredictable, and there may be a price to pay for waiting to treat—the goal of early intervention with valve replacement is to preserve the heart’s function, prevent further heart deterioration, and in some case, death.”

“As a nationally recognized leader in cardiology and cardiovascular surgery, Atlantic Health System is committed to both prolonging and improving the quality of life for patients with heart disease,” said Linda D. Gillam, M.D., MPH, The Dorothy and Lloyd Huck Chair of Cardiovascular Medicine at Morristown Medical Center/Atlantic Health System. “Our participation in clinical trials, like EARLY TAVR, not only ensures our patients have access to new treatments before they are approved or available to the general public, but helps our clinicians remain on the cutting edge of medicine with access to the latest medications, devices, and technology.”

 

About the EARLY TAVR Trial

Evaluation of Transcatheter Aortic Valve Replacement Compared to SurveilLance for Patients With AsYmptomatic Severe Aortic Stenosis (EARLY TAVR) is a randomized, controlled, multi-center clinical trial study. Patients aged 65 and older diagnosed with asymptomatic, severe aortic stenosis will be randomized to receive a transcatheter aortic valve replacement (TAVR) with the Edwards Sapien 3 heart valve, or standard of care clinical surveillance. The study will enroll 1,000 patients in 65 cardiovascular centers.

Patients will be randomized (TAVR or surveillance) based on their ability to perform a treadmill stress test, as well as other factors. Those patients with a positive treadmill stress test or who do not meet other factors for randomization may be followed in a registry for data collection on subsequent treatment and mortality, as applicable.

The EARLY TAVR trial is sponsored by Edwards Lifesciences. According to Edwards Lifesciences, global transcatheter heart valve therapy (THVT) sales rose 29 percent to $432 million in the past year. In the United States, sales grew by 38 percent. Edwards said cardiac surgeons and interventional cardiologists are now implanting the company’s Sapien 3 TAVR devices at more than 500 hospitals in the U.S.

For more information: www.atlantichealth.org/valveresearch

CONTACT US

Send inquiries to info@radpad.com for a free No Brainer™ sample. The No Brainer™ blocks up to 95% of radiation exposure to the brain. Lightweight, adjustable protection for all O.R. suite and fluoro lab personnel during interventional procedures.

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730 or 1-877-7RADPAD (1-877-772-3723)
Fax: 913-648-0131
Unknown

 

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RADPAD® Attends SIR 2017 Annual Scientific Meeting in Washington DC

RADPAD® Attends SIR 2017 Annual Scientific Meeting in Washington DC

Posted on March 24, 2017 by in Uncategorized with no comments

The Society of Interventional Radiology

SIR is a national organization of physicians, scientists and allied health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapeutic interventions.

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RADPAD at SIR 2017 

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Goals of the SIR 2017 Annual Scientific Meeting

It is SIR’s goal to promote the high-quality practice of interventional radiology through this and other educational programs. Meeting attendees will receive the latest information in basic and clinical research; experience techniques and technologies utilized by interventional radiologists around the world; see the latest equipment used in IR; and discuss social, political and economic issues important to the IR community.

 

SIR 2017 ANNUAL SCIENTIFIC MEETING OBJECTIVES

At the end of this meeting the learner should be able to:

1. Demonstrate the high-quality practice of interventional radiology in a team environment

2. Illustrate the latest information regarding basic and clinical research in diseases, including techniques and technologies integral to the practice of interventional radiology

3. Evaluate the latest equipment developed for interventional radiology procedures

4. Discuss societal, political and economic issues of importance to the interventional radiology community

 

WORLDWIDE INNOVATIONS & TECHNOLOGIES, INC. (WIT)
14740 W 101st Terrace
Lenexa, KS 66215
Phone: 913-648-3730
or 1-877-7RADPAD (1-877-772-3723)Fax: 913-648-0131

Email: info@radpad.com

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RADPAD CLI Perspectives: Alternative Access for CTOs in CLI

RADPAD CLI Perspectives: Alternative Access for CTOs in CLI

Posted on September 12, 2016 by in Procedures with no comments

Last year, Cath Lab Digest published an interview covering alternative access for chronic total occlusions in critical limb ischemia. J.A. Mustapha, MD, interviewed Andrej Schmidt, MD, Department of Angiology, Leipzig Heart Center, Leipzig, Germany. 

Read the full article below or click the link for the original publicaiton:

http://www.cathlabdigest.com/article/CLI-PERSPECTIVES-Alternative-Access-CTOs-CLI

 


CLI PERSPECTIVES: Alternative Access for CTOs in CLI

Author(s):

CLI Perspectives is headed by section editor J.A. Mustapha, MD, 

Metro Health Hospital, Wyoming, Michigan. 

 

Topics:
Access
Critical limb ischemia
Chronic total occlusions (CTO)
Issue Number:
Volume 23 – Issue 2 – February, 2015

 

 

 

J. Mustapha: What is your preferred access method for crossing complex superficial femoral artery (SFA) CTOs, with the exception of ostial SFA disease?

A. Schmidt: Most SFA CTO crossing is performed via ipsilateral antegrade approach.

 

 

J. Mustapha: Why do you prefer an ipsilateral antegrade approach?

A. Schmidt: For multiple beneficial reasons, including shortening the distance from the access site to the CTO, enhancement of pushability, and much better wire and catheter torque.

 

J. Mustapha: Do you ever perform a contralateral access approach for SFA CTOs?

 

A. Schmidt: Yes, mostly in patients who are not good candidates for antegrade access such as obese patients, those with proximal disease, ostial SFA disease, or CTOs. Mostly, I prefer antegrade access for SFA CTOs.

 

J. Mustapha: Many of us have seen you perform live cases and have witnessed your excellent techniques in retrograde popliteal and SFA access in complex CTO crossing. Why do you access these segments?

A. Schmidt: We access distal to the CTO cap of the SFA or popliteal CTO only when we fail to cross from antegrade approach first. The reason we access close to the CTO is similar to the reasoning of the antegrade access, close to the CTO cap, which in turns helps with retrograde pushability and torqueability.

J. Mustapha: What advice would you give practitioners who would like to perform similar retrograde access in the SFA/popliteal?

A. Schmidt: Proceed with caution, as this should only be attempted after an antegrade approach fails.  Be sure to have a balloon across the occluded target lesion and the guidewire across the distal access before taking the access catheter out, so that in case a problem (dissection, occlusion) occurs at the distal entrance, balloon angioplasty can be done to fix it. Hemostasis is principally done by external compression.

 

 

J. Mustapha: What is the average time of your balloon inflation?

A. Schmidt: The time depends on the size of the access catheter or the sheath used. Most of the time, we use the smallest catheter possible, .018-inch to .035-inch.  Therefore, we perform a three-minute balloon inflation followed by an angiogram.

 

J. Mustapha: Is this the same for a stick in a stent vs no stent?

A. Schmidt: Yes.

 

J. Mustapha: Do you worry about harming the stent after getting access in it?

A. Schmidt: No. So far, in our experience, we have not had any issues with stents in these situations. Keep in mind, we only get an access in the stent in extreme cases and place the smallest catheter possible.

J. Mustapha: Moving to retrograde tibial access, which access method do you use to enter the artery, angiogram-guided or ultrasound-guided?

A. Schmidt: We use angiogram-guided access.

 

J. Mustapha: Which is your preferred tibial artery for retrograde access and which part of the artery do you like to enter?

A. Schmidt: My preferred artery is the anterior tibial artery and I prefer to enter it proximally.

 

J. Mustapha: Why proximal versus distal?

A. Schmidt: Proximally, because the vessel diameter is larger and accommodates a 4 French sheath if needed.

 

J. Mustapha: How do you get the access?

A. Schmidt: First we position the foot supine and support it with a rolled-up towel, then perform an angiogram in left oblique 30° view, and enter the needle thru the skin into the artery. If no blood returns, we perform an oblique view with repeat angiogram which helps show the tip of the needle and artery.

 

J. Mustapha: How do you obtain hemostasis after the proximal tibial access?

A. Schmidt: Most of the time, we use an external blood pressure cuff.  Occasionally, we use an intra-arterial balloon.

 

J. Mustapha: If needed, what are your tips and tricks for getting distal tibial access?

A. Schmidt: Starting with the dorsalis pedis access, foot positioning is important. First we position the foot supine and support it with a rolled-up towel, then the C-arm is positioned at about 15° ipsilateral and 10° cranial. We then use the quick access needle holder, followed with an angiogram. Also, we can puncture and perform contrast injection simultaneously, as needed.

 

J. Mustapha: Do you recommend road mapping for tibial access?

A. Schmidt: No, side movements of the artery due to puncture needles are not noticed, which may lead to accidental venous access and failed attempts. Also, I don’t recommend coming in from a lateral approach.

 

J. Mustapha: How do you know your needle is in line with the artery?

A. Schmidt: After angiogram is done, make the needle form one line with the artery (Figure 1A-B).

 

J. Mustapha: What do you do in the setting of no blood return?

A. Schmidt: Obtain oblique orthogonal views at 55-65°, load the guidewire into the needle, and perform contrast injection via the proximal sheath and pull back very slowly. Keep testing if the guidewire makes it through. Another method is to pull back slowly and inject contrast from the needle holder until you see contrast in the artery, then advance the guidewire (Figure 2A-G).

 

J. Mustapha: Any tips on how to get peroneal access?

A. Schmidt: Start with an anterior approach. Place the C-arm at ipsilateral LAO 30° (Figure 3A), perform antegrade angiogram, and position the needle in line with the artery.  If no success, then move the C-arm to right anterior oblique (RAO) 70° (Figure 3B) and repeat angiogram. Redirect the needle toward the artery, puncturing the peroneal artery through the membrana interossea.

 

J. Mustapha: Which puncture site is safer?

A. Schmidt: The distal tibial access approach is safer, as it is not associated with compartment syndrome.

 

J. Mustapha: What needles to you use for proximal and distal tibial access?

A. Schmidt: For proximal anterior tibial, posterior tibial, and peroneal access, we use a 7cm, 21g needle. For distal tibials, we use a 4cm, 21g needle.

 

J. Mustapha: Please advise what NOT to do in infrapopliteal retrograde access.

A. Schmidt: One should not access communication arteries, especially those off of the peroneal artery, as shown in Figure 4.

 

J. Mustapha: How do you minimize radiation exposure?

A. Schmidt: My angiographical approach to retrograde pedal and tibial puncture is quick and precise, minimizing radiation exposure. I attribute this to experience and the right equipment (Figure 5A). I wear a ring dosimeter (Figure 5B) to measure my exposure.

Disclosure: Dr. Mustapha reports he is a consultant to Bard Peripheral Vascular, Covidien, Cordis, CSI, Spectranetics, and Boston Scientific. Dr. Schmidt reports occasional consulting for Bard and Medtronic.

Dr. Andrej Schmidt and Dr. J.A. Mustapha can be contacted at jihad.mustapha@metrogr.org

 

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Mounting Evidence That Cath Lab Work Has Radiation-Related Health Effects

Mounting Evidence That Cath Lab Work Has Radiation-Related Health Effects

Posted on September 2, 2016 by in Safety with no comments

A research study was conducted in which 466 scatter radiation exposed hospital staff members were evaluated based on work-related and lifestyle information, current medications and health status. These staff members included interventional cardiologists, electrophysiologists, nurses and technicians, half of which had been working for over ten years. The results of this study concluded almost 3% of the interventional cardiology staff had a history with cancer, compared to less than 1% of unexposed comparison group. Along with that, 8% of lab workers experienced skin lesions, 30% had orthopedic illness and 5% had cataracts. These issues have all been associated with scatter radiation exposure.

McKeown, LA. “Survey Adds to Mounting Evidence That Cath Lab Work Has Radiation-Related Health Effects.”tctmd: Cardiovascular Research Foundation, 13 Apr. 2016. Web. 26 May 2016

See the original article here: http://www.tctmd.com/show.aspx?id=134783

Read the full text below:

 

Survey Adds To Mounting Evidence That Cath Lab Work Has Radiation-Related Health Effects

By L.A. McKeown
Wednesday, April 13, 2016

 

Interventional cardiologists and other personnel who work in environments with fluoroscopy-guided procedures appear to have more health problems than their colleagues in the same field who are not exposed to radiation, a survey suggests. The health problems range from eye, skin, and orthopedic problems to mental health issues, and cancers.

Another View. Survey Adds To Mounting Evidence That Cath Lab Work Has Radiation-Related Health Effects

Researchers led by Maria Grazia Andreassi, MSc, PhD (CNR Institute of Clinical Physiology, Pisa, Italy), say “every effort should be made to raise the radiation awareness in the professional communities of interventional cardiologists and cardiac electrophysiologists, promoting justification of the examination, optimization of the dose, and maximal protection of the radiation workers.”

They surveyed 466 physicians and other staff members with an average of 10 years of experience working in interventional cardiology or electrophysiology laboratories as well as 280 individuals working in the cardiology field but having no exposure, including physicians, researchers, nurses, and administrative staff. All completed a questionnaire about their present and past medical history, medication use, duration of work, and frequency of cigarette and alcohol use. An occupational radiological risk score, which combined length of employment, individual caseload, and proximity to the radiation source, was formulated for each participant.

Physical, Psychological Differences Evident

Reporting their results online April 12, 2016, ahead of publication in Circulation: Cardiovascular Interventions, Andreassi and colleagues found that not only were potential radiation-related health issues such as skin lesions, orthopedic problems (back, neck, knee), cataracts, and cancers more prevalent in radiation-exposed vs unexposed workers, they were also more common among physicians vs technicians and nurses, and among those with longer vs shorter work histories. Across every disease category, those with 16 or more years of working in an environment with fluoroscopy-guided procedures had the highest event rates.

The prevalence of anxiety/depression was also increased among the radiation-exposed group—at a rate 6 times higher than unexposed colleagues, while the rate of thyroid disease was doubled. Radiation-exposed workers also had greater rates of hypertension and hypercholesterolemia, but not of cardiovascular events.

Rates of health problems in the radiation-exposed versus unexposed groups were confirmed in multiple logistic regression analysis.

Table. Survey Adds To Mounting Evidence That Cath Lab Work Has Radiation-Related Health Effects

“Unfortunately, cardiologists pay little heed to monthly or cumulative reports of radiation exposure. And recent studies confirm that simple, effective protection measures—such as a lead curtain, protection glasses and thyroid collars—are not used by the majority of exposed cardiologists,” Andreassi said in a press release.

Exposure-Related Associations Abound

Among the health problems reported in the survey and previously described in the literature, radiation-induced cancer is “the most alarming and serious” of the long-term occupational risks for interventional cardiologists, the study authors write. Concerns of brain cancer on the left side of the head, which is known to be more exposed to radiation and least protected by standard shielding, have been apparent in the literature as far back as 1998, they note.

“Although the evidence supporting an increase in radiation-induced cancer among interventional cardiologists remains inconclusive, molecular studies showed that interventional cardiologists have a two-fold increase of chromosomal damage (surrogate biomarkers of cancer risk) in circulating lymphocytes than clinical cardiologists,” Andreassi and colleagues write. Recently, findings from the International Nuclear Workers cohort showed strong evidence of positive associations between protracted low-dose radiation exposure and leukemia.

Interestingly, Andreassi and colleagues point out that radiation-related increases in hypertension and elevated serum cholesterol concentrations have also been seen in atomic-bomb survivors, more than half of whom were exposed to an average dose of < 50 mSv. In the press release, Andreassi notes that experienced, busy interventional cardiologists and electrophysiologists typically are exposed to about 5 mSv yearly. In a study published last year, her group also found that cath lab workers showed early signs of vascular aging and subclinical atherosclerosis. They suggest that chronic low-dose rate radiation “triggers changes in the endothelial cell biology that induce the onset of premature senescence, and these alterations may in part be responsible for the increased risk of chronic low-dose radiation–associated cardiovascular disease.”

As for the higher incidence of anxiety and depression in the radiation workers, Andreassi and colleagues hypothesize that this may be related to “high stress and psychological strain,” or a direct effect of radiation exposure to the head of the operator, resulting in “hippocampal neurogenesis and neuronal plasticity, with possible negative effects on mood stability and psychiatric morbidity.”

Stress a Likelier Culprit

Commenting for TCTMD, Stephen Balter, PhD, of Columbia University Medical Center (New York, NY), said the biggest flaw with the study is that everything was assumed to stem from radiation.

“It’s a high-stress job and I’m not surprised that there are health risks associated with doing the job, but these things are unlikely to be associated with radiation per se,” Balter said. “I think people trying to do the best they can are stressed out, and that’s reflected in their mental state and in their chemistry.”

Other than cataracts, which have a long, documented history in operators and others routinely exposed to occupational radiation, the other health issues such as cancers have not been substantiated in the literature as related to exposure, he added.

“The message is you have to be careful, but there’s no reason for panic,” Balter commented, adding that enforcing the wearing of radiation protection glasses and other gear among cath lab workers remains a challenge.

Profit Over People

Even though the current study is limited, there is “more than enough information for us to conclude that the interventional catheterization laboratory is not a healthy workplace,” observe Lloyd W. Klein, MD and Mugurel Bazavan, MD (Rush Medical College, Chicago, IL), in an accompanying editorial.

Despite the known risks to operators, the technology used in cath labs has outpaced safety-related changes in cath lab design and personnel protection, they say, primarily due to a profit mentality on the part of administrators that values talented, young, and inexpensive workers who can be readily replaced.

“Certainly, investing money in an innovative cath laboratory design to protect its workers is hardly cost-effective when nurturing a long career is not the goal of management,” Klein and Bazavan write. “We call on industry and hospital administration to provide responsible stewardship, and for physician societies and interventional leaders to advocate visibly and set new priorities, so that those of us who choose to help patients live a longer and healthier life can ourselves enjoy a long and healthy career, one that allows us to use all the magnificent and cherished skills we have dedicated years to master.”


Sources:

  • Andreassi MG, Piccaluga E, Guagliumi G, et al. Occupational health risks in cardiac catheterization laboratory workers. Circ Cardiovasc Interv. 2016;Epub ahead of print.
  • Klein LW, Bazavan M. The economic imperatives underlying the occupational health hazards of the cardiac catheterization laboratory. Circ Cardiovasc Interv. 2016;Epub ahead of print.

Disclosures:

  • Andreassi, Klein, and Bazavan report no relevant conflicts of interest.
  • Balter reports serving on the speakers’ bureau for Mavig, a manufacturer of radiation-protection supplies.

 

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14740 W 101st Terrace
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Phone: 913-648-3730
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BRAIN Study Confirms Higher Radiation Dose to Cardiologists’ Left Side

BRAIN Study Confirms Higher Radiation Dose to Cardiologists’ Left Side

Posted on July 29, 2016 by in Safety, Uncategorized with no comments

BRAIN Study Confirms Higher Radiation Dose to Cardiologists’ Left Side:

This study was conducted by Ethisham Mahmud, MD, of University of California, San Diego, along with 7cardiology fellows and 4 physicians as they performed diagnostic and interventional cardiovascular procedures to show the attenuation of radiation by using a lead-free cap. Dr. Mahmud discusses the significant amount of exposure the left time of the cranium receives compared to the right during these procedures. Dr. Mahmud says that we need to do a lot more to further understand the equipment being used and the dangers of radiation in the lab. He notes that lead-free caps are a great way to reduce scatter radiation.

Contact us for a No Brainer surgical cap sample

 

Read the full article below or see the original piece here:

http://www.tctmd.com/show.aspx?id=130244

 

BRAIN Study Confirms Higher Radiation Dose to Cardiologists’ Left Side

Key Points:

  • Single-center study looks at whether protective cap can limit radiation exposure during interventional procedures
  • Exposure consistently greater on left side of head; secondary operators receive more radiation than primary

By Yael L. Maxwell
Tuesday, August 18, 2015

Radiation exposure to the cranium is higher on the left than on the right side for cardiologists doing invasive procedures, though this difference can be attenuated by wearing a nonlead-based cap in the cath lab, according to a study published in the August 17, 2015, issue of JACC: Cardiovascular Interventions.

Implications: BRAIN Study Confirms Higher Radiation Dose to Cardiologists’ Left Side

For the BRAIN (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures) study, Ehtisham Mahmud, MD, of the University of California, San Diego (La Jolla, CA), and colleagues assessed 7 cardiology fellows and 4 attending physicians (mean age 38.4 years; all men) at their institution as they performed diagnostic and interventional cardiovascular procedures (mean 66.2 cases per operator; mean fluoroscopy time 14.9 minutes).

Each participant wore a lightweight XPF attenuating cap (BLOXR; Salt Lake City, UT) containing barium sulfate and bismuth oxide. All caps were fitted with 6 dosimeters to measure radiation exposure on the outside and inside of the cap.

A Little More on the Left

Total exposure on the outside of the cap was numerically higher on the left than center location (106.1 vs 83.1 mrad; P = .075), but exposure in both areas was higher than on the right side (50.2 mrad; P < .001 for both). Total exposure inside the cap was similar for all 3 locations—ranging from 41.8 to 42.3 mrad—and was only slightly higher than that measured by the ambient controls (38.3 mrad; P = .046).

After accounting for the ambient radiation, outside left exposure was 16 times higher than exposure on inside left and 4.7 times higher than that on the outside right (P < .001 for both). Exposure on the outside center was 11 times higher than on the inside center of the cap (P < .001), but no difference was seen between outside and inside doses on the right side.

Among a variety of factors—including patient weight, patient BMI, operator height, operator weight, percentage of radial cases, fluoroscopy time, and dose area product—only operator training level (fellow in training or attending cardiologist) predicted the extent of radiation exposure on the outside left and center locations.

Attending cardiologists—who tend to stand in the secondary position farther from the radiation source—received more outside left and center radiation than did fellows, who usually stand in the primary position (P = .002 and P = .01, respectively). “Despite the decreased exposure to the second operator as explained by the inverse square law, the optimal use of shielding in favor of the primary operator may overcome the protection offered by the increased distance,” Dr. Mahmud and colleagues suggest.

The Cap is Only the Beginning

In a telephone interview with TCTMD, Dr. Mahmud said the value of the study is “not as much about the cap as the concept.” Regardless of what protection operators may or may not use, “the most important message of this paper is that the left side of the brain gets tremendously greater exposure to radiation,” he said.

“We’re not doing a whole lot to protect ourselves… whether it’s in the primary or secondary position,” Dr. Mahmud continued. “One option is this cap, but the reality is we need to do a lot more to further understand and design equipment… or to look at alternative ways to do the procedure.”

Stephen Balter, PhD, of Columbia University Medical Center (New York, NY), told TCTMD in a telephone interview that the overall exposure reported outside the cap in the study is “reasonable” and well within the regulatory guidelines of 15,000 total mrad per year.

That said, using the cap “certainly doesn’t hurt,” he commented, and the fact that it can be used multiple times makes it less expensive than other options.

It is well known that radiation exposure is greater on the left than right side of cath lab operators, Dr. Balter explained. “It’s just how they stand and how they look at the monitors.” But “tracking people and understanding what’s happening is very relevant,” he said, adding that more specific results should come in time with theoretical modeling studies.

There will never be enough epidemiological research to show whether the XPF cap and other protections are increasing safety, Dr. Balter said. “There is a theoretical gain based on the radiobiology of models,” he added. “But it’s a small gain based on these numbers.”

All About Education

Dr. Mahmud said his team is planning another study, known as BRAIN 2, to further examine the phenomenon of how operator position affects radiation exposure. “The primary position is actually often better protected than the secondary position, where you’re a little bit further away but you might get more exposure to scatter,” he explained. “This is probably the first time this has ever been measured and ascertained.”

The second study will assess the validity of the difference between positions, Dr. Mahmud said. “We’re actually going to measure in a very systematic manner the radiation exposure for operators in the primary and secondary positions and behind and in front of shields.” BRAIN 2 will require the operators to stay in the same position throughout the course of each procedure, he explained.

But all of these studies, present and future, are meant to educate, Dr. Mahmud observed. “I am always shocked as to how few people seem to even admit that [radiation] is an issue. So I think it’s going to take more and more information, knowledge, and dissemination,” about the potential risk and any preventative options available, he said.

 


Source:
Reeves RR, Ang L, Bahadorani J, et al. Invasive cardiologists are exposed to greater left sided cranial radiation: the BRAIN study (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures). J Am Coll Cardiol Intv. 2015;8:1197-1206.

Disclosures:

  • Dr. Mahmud reports receiving clinical trial support from Boston Scientific, Corindus, and Gilead; serving as a consultant to The Medicines Company; and serving on the speakers bureau of Medtronic.
  • Dr. Balter reports no relevant conflicts of interest.