Risk assessment for potential radiation-induced cancer after lung and bone marrow exposure during interventional cardiology procedures

Abstract

Interventional cardiology procedures (ICPs), while providing important benefits topatients, also contribute to their radiation exposure, in particular for the organs surrounding the heart. This paper addresses the issue of radiation exposure to the lung and bone marrow related to coronary interventions in terms of organ doses for coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA), and risk assessment of potential radiation-induced cancer. Dosimetric information on 2095 ICPs from French patients was collected. The median lung dose for CA alone was 34 mGy for men and 22 mGy for women and the median bone marrow dose was 8 mGy and 4 mGy, respectively; doses were slightly higher for CA and ad hoc PTCA and nearly twice as high for CA and elective PTCA. Based on the French national mortality registry and Biological Effects of Ionising Radiation VII models, spontaneous and radiation-induced lung cancers and leukaemia were estimated. For men and women aged at least 60 years old at the first ICP, excess risk of potentially fatal cancers attributable to radiation ranged from 0.4% to 4%. This study provides evidence of the potential risk of radiation-induced cancer after an ICP. The limitations of such calculations are due to the difficulty of taking into account patients' possibly shorter life expectancy than in the general population, linked to their comorbidities and coronary disease. Nevertheless, risk estimates can be used to illustrate the beneficial role of optimisation of doses delivered to the patient.

Reduction of patient radiation dose during percutaneous CT vertebroplasty: Impact of a new computer-assisted navigation (CAN) system

“…However, such dose limits may be exceeded in the operating room (Feghali et al, 2014), especially during percutaneous vertebroplasty because of potential repetition of scouting exposures due to a limited view of the surgical field (Komemushi et al, 2005;Synowitz and Kiwit, 2006). Thus both patients' and workers' dose reduction are necessary (Bernier et al, 2012;Bourguignon et al, 2017) to reduce the risk of cancer (Jacob et al, 2013).…”

Convolutional neural network-based image enhancement for x-ray percutaneous coronary intervention

“…The first is the risk of radiation-induced skin injuries, with also the possible development of radiation-induced cancer of chest organs. 2,3 The other is contrast-induced nephropathy due to the high concentration of contrast media injected into the patient. 4 These side effects can be reduced with lower doses of both x-rays and IRCA, but the resulting images suffer from higher noise level and weaker contrast compared with PCI images of high-dose x-rays and IRCA.…”