Invasive Coronary angiography (CAG) is a common intervention technique for diagnosing acute coronary artery (CAD) diseases. However, the statistics presented by Farajollahi, Rahimi, Shal, et al (2014) claiming that arteriography examinations only constitutes 12% of all radiological examinations and a 48% average dose of radiation exposure per patient might be an understatement. The coronary stenting and Percutaneous transluminal coronary angioplasty (PTCA) procedure exposes the patients to four times the recommended radiation dosage ranging from 500mGy to 25 Gy per minute (Fransson & Persliden, 2000). Complex procedures such as elective stenting have been reported to take as long as 47 minutes for balloon angioplasty (Shah, Das, Subkovas, Buch, Rees & Bellamy, 2015, 114). These prolonged exposures to high radiation doses leave patients at risk of developing skin cancers and radiation poisoning.
Prevention of high radiation doses
Healthcare facilities can enhance the competence of their angiography physicians by installing simulation equipment for training on radiobiology and radiation safety. These simulated fluoroscopic machines will help reduce medical errors that comes with The use of medical simulators will also help health facilities evaluate technical and cognitive skills required to perform the interventional Coronary angiography (CAG) procedures (Lipner, Messenger, Kangilaski, Baim, Holmes, Williams & King, 2010) . This includes on the job training for improved maneuverability in guiding the catheters, angioplasty wires and balloon catheters.
Delegate your assignment to our experts and they will do the rest.
The training and certifications
An annual in training certifications should also be implemented in all hospitals to evaluate the physician’s proficiency in over 75 percutaneous coronary intervention (PCI) procedures (King, Aversano, Ballard, Beekman & Kellett et al., 2007). The American Board of Internal Medicine (ABIM) together with the Accreditation Council on Graduate Medical Education (ACGME) curriculum has implemented over 122 standardized and accredited cardiology intervention training programs (Shah, Das, Subkovas, Buch, Rees & Bellamy, 2015) . This includes ensuring patient safety by minimizing the radiation pulses, the use of lead shielding to protect the patients from high radiation doses and avoiding procedures than can lead to arterial rapture of the left ventricle.
The ALARA treatment technique
Pediatric radiologists have been reported to successfully implement the ALARA (‘as low as reasonably achievable’) techniques to reduce radiation treatment for children suffering from cancer, lymphoma, kidney diseases and urinary tract infections. This includes a reducing the use of fluoroscopic machines to for treatment and diagnostic procedures (Lee, Diamond & Chow, 2006) . Therefore the physician can be able to clear the pathways from the kidneys to the bladder without using a bladder catheterization that can result in significant renal damage. However, the use of digitally pulsed fluoroscopy is only effective for children at risk of adverse reactions or prolonged health challenges.
Student response
In health facilities that do not have an alternative to Coronary angiography (CAG) or percutaneous transluminal coronary angioplasty (PTCA) treatment options X-ray technologies has always been recommended as an alternative intervention procedure. According to Delichas et al (2003) using fluoroscopy screening options or fluoro modes to guide the rapid X-ray radiographic exposures (cine modes) have been reported to produce good quality images. However, this procedure also requires higher doses of fluoroscopy and serial imaging radiation. Inexperienced cardiologists end up prolonging the patient’s exposure to high levels of radiation materials (Archer & Wagner, 2000) . Another common problem occur when physicians direct the x-ray beams close to the patient’s skin therefore inducing serious radiation burns to the dermatitis that can lead to skin cancers.
References
Archer, B. R., & Wagner, L. K. (2000). Protecting patients by training physicians in fluoroscopic radiation management. Journal of applied clinical medical physics , 1 (1), 32-37.
Delichas, M. G., Psarrakos, K., Molyvda-Athanassopoulou, E., Giannoglou, G., Hatziioannou, K., & Papanastassiou, E. (2003). Radiation doses to patients undergoing coronary angiography and percutaneous transluminal coronary angioplasty. Radiation protection dosimetry , 103 (2), 149-154.
Farajollahi, A., Rahimi, A., Shal, E. K., Ghaffari, S., Ghojazadeh, M., Tajlil, A., & Aslanabadi, N. (2014). Patient’s Radiation Exposure in Coronary Angiography and Angioplasty: The Impact of Different Projections. Journal of cardiovascular and thoracic research , 6 (4), 247.
Fransson, S. G., & Persliden, J. (2000). Patient radiation exposure during coronary angiography and intervention. Acta Radiologica , 41 (2), 142-144.
King, S. B., Aversano, T., Ballard, W. L., Beekman, R. H., Cowley, M. J., Ellis, S. G., ... & Kellett, M. A. (2007). ACCF/AHA/SCAI 2007 update of the clinical competence statement on cardiac interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures). Journal of the American College of Cardiology , 50 (1), 82-108.
Lee, R. S., Diamond, D. A., & Chow, J. S. (2006). Applying the ALARA concept to the evaluation of vesicoureteric reflux. Pediatric radiology , 36 (2), 185-191.
Lipner, R. S., Messenger, J. C., Kangilaski, R., Baim, D. S., Holmes Jr, D. R., Williams, D. O., & King III, S. B. (2010). A technical and cognitive skills evaluation of performance in interventional cardiology procedures using medical simulation. Simulation in Healthcare , 5 (2), 65-74.
Shah, A., Das, P., Subkovas, E., Buch, A. N., Rees, M., & Bellamy, C. (2015). Radiation dose during coronary angiogram: relation to body mass index. Heart, Lung and Circulation , 24 (1), 21-25.
