vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»vestar-743Research ArticleОБЗОРЫREVIEWSФЛЮОРОСКОПИЯ В ИНТЕРВЕНЦИОННОЙ КАРДИОЛОГИИ. ЕСТЬ ЛИ ПОВОД ЗАДУМАТЬСЯ?FLUOROSCOPY IN INTERVENTIONAL CARDIOLOGY: DO WE HAVE FOOD FOR THOUGHT?КропоткинЕ. Б.KropotkinE. B.noemail@neicon.ruИваницкийЭ. А.IvanitskyE. A.noemail@neicon.ruВерхотуровМ. К.VerkhoturovM. K.noemail@neicon.ruДроботД. Б.DrobotD. B.noemail@neicon.ruСаковичВ. А.SakovichV. A.noemail@neicon.ruАбдрахмановА. С.AbdrakhmanovA. S.noemail@neicon.ruЛянЕ. В.LyanE. V.noemail@neicon.ruФедеральный центр сердечно-сосудистой хирургииRussian FederationНациональным научный кардиохирургический центрRussian FederationПервый Санкт-Петербургский Государственный Медицинский Университет им. академика И.П. ПавловаRussian Federation2015230920200812732Copyright © Кропоткин Е.Б., Иваницкий Э.А., Верхотуров М.К., Дробот Д.Б., Сакович В.А., Абдрахманов А.С., Лян Е.В., 20202020Кропоткин Е.Б., Иваницкий Э.А., Верхотуров М.К., Дробот Д.Б., Сакович В.А., Абдрахманов А.С., Лян Е.В.Kropotkin E.B., Ivanitsky E.A., Verkhoturov M.K., Drobot D.B., Sakovich V.A., Abdrakhmanov A.S., Lyan E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/743

Рассматриваются вопросы безопасности применения флюороскопического контроля при проведении чрез-кожных диагностических и лечебных вмешательств, анализируется частота возникновения радиационных дерматитов и онкологических заболеваний у медицинского персонала, участвующего в их проведении.

The problem of safety of fluoroscopic guidance during percutaneous diagnostic and therapeutic interventions is considered; the incidence of radiation dermatitis and neoplasms in the medical staff who take part in the procedures is analyzed.

радиочастотная катетерная аблацияфлюороскопиярентгеновское излучениерадиационный дерматитлучевая катарактановообразованиеradiofrequency catheter ablationfluoroscopyX-radiationradiation dermatitisradiation cataractneoplasmReferencesForssmann W. The catheterization of the right side of the heart // Klin Wochenschr 1929; 8: 2085.Forssmann W. The catheterization of the right side of the heart // Klin Wochenschr 1929; 8: 2085.King S.B. The development of interventional cardiology // J Am Col Cardiol 1998; 31: 64 - 88.King S.B. The development of interventional cardiology // J Am Col Cardiol 1998; 31: 64 - 88.United Nations Scientific Committee on the effects of Atomic Radiation sources and effects of ionizing radiation // New York: United nations, 2000.United Nations Scientific Committee on the effects of Atomic Radiation sources and effects of ionizing radiation // New York: United nations, 2000.Kim K.P., Miller D.L., Balter S. et al. Occupational radiation doses to operators performing cardiac catheterization procedures // Health Physics 2008; 94: 211-227.Kim K.P., Miller D.L., Balter S. et al. Occupational radiation doses to operators performing cardiac catheterization procedures // Health Physics 2008; 94: 211-227.Einstein A.J., Moser K.W., Thompson R.C., Cerqueira M.D., and Henzlova M.J. Radiation dose to patients from cardiac diagnostic imaging // Circulation 2007; 116: 1290 -1305.Einstein A.J., Moser K.W., Thompson R.C., Cerqueira M.D., and Henzlova M.J. Radiation dose to patients from cardiac diagnostic imaging // Circulation 2007; 116: 1290 -1305.Vano E., Sanchez R., Fernandez J.M. et al. Patient dose reference levels for interventional radiology: a national approach // CardioVascular and Interventional Radiology 2009; 32: 19-24.Vano E., Sanchez R., Fernandez J.M. et al. Patient dose reference levels for interventional radiology: a national approach // CardioVascular and Interventional Radiology 2009; 32: 19-24.Picano E.,Vano E., Semelka R., and Regulla D. The American College of Radiology white paper on radiation dose in medicine: deep impact on the practice of cardiovascular imaging // Cardiovascular Ultrasound 2007; 5: article 37.Picano E.,Vano E., Semelka R., and Regulla D. The American College of Radiology white paper on radiation dose in medicine: deep impact on the practice of cardiovascular imaging // Cardiovascular Ultrasound 2007; 5: article 37.Rehani M.M. and Ortiz-Lopez P. Radiation effects in fluoroscopically guided cardiac interventions-keeping them under control // International Journal of Cardiology 2006; 109: no. 147-151.Rehani M.M. and Ortiz-Lopez P. Radiation effects in fluoroscopically guided cardiac interventions-keeping them under control // International Journal of Cardiology 2006; 109: no. 147-151.Ross A.M., et al. Prevalence of spinal disk desease among interventional cardiologist // Am J Cardiol 1997; 79: 68 - 70.Ross A.M., et al. Prevalence of spinal disk desease among interventional cardiologist // Am J Cardiol 1997; 79: 68 - 70.David K.B. Poor ergonomics takes heavy tool after years in the cath lab. The society for cardiovascular angiography and interventions // Betheda; MD 20814.David K.B. Poor ergonomics takes heavy tool after years in the cath lab. The society for cardiovascular angiography and interventions // Betheda; MD 20814.Aerts A. Decraene Tvan den Oord JJ et al. Chronic radiodermatitis following percutaneous coronary interventions: a report of two cases // J Eur Acad Dermatol Venereol 2003; 17: 340-343.Aerts A. Decraene Tvan den Oord JJ et al. Chronic radiodermatitis following percutaneous coronary interventions: a report of two cases // J Eur Acad Dermatol Venereol 2003; 17: 340-343.Lee J. Hoss Phillips D. TJ Fluoroscopy-induced skin necrosis // Arch Dermatol 2003; 139: 140-141.Lee J. Hoss Phillips D. TJ Fluoroscopy-induced skin necrosis // Arch Dermatol 2003; 139: 140-141.Stone M.S., Robson K.J. , LeBoit P.E. Subacute radiation dermatitis from fluoroscopy during coronary artery stenting: evidence for cytotoxic lymphocyte mediated apoptosis // J Am Acad Dermatol 1998; 38: 333-336.Stone M.S., Robson K.J. , LeBoit P.E. Subacute radiation dermatitis from fluoroscopy during coronary artery stenting: evidence for cytotoxic lymphocyte mediated apoptosis // J Am Acad Dermatol 1998; 38: 333-336.Lichtenstein D.A., Klapholz L., Vardy D.A. et al. Chronic radiodermatitis following cardiac catheterization // Arch Dermatol 1996; 132: 663-667.Lichtenstein D.A., Klapholz L., Vardy D.A. et al. Chronic radiodermatitis following cardiac catheterization // Arch Dermatol 1996; 132: 663-667.Sajben F.P., Schoelch S.B., Barnette D.J. Fluoroscopic-induced radiation dermatitis // Cutis 1999; 64: 57-59.Sajben F.P., Schoelch S.B., Barnette D.J. Fluoroscopic-induced radiation dermatitis // Cutis 1999; 64: 57-59.Kawakami T., Saito R., Miyazaki S. Chronic radiodermatitis following repeated percutaneous transluminal coronary angioplasty // Br J Dermatol 1999; 141: 150-153.Kawakami T., Saito R., Miyazaki S. Chronic radiodermatitis following repeated percutaneous transluminal coronary angioplasty // Br J Dermatol 1999; 141: 150-153.D’Incan M., Roger H.Radiodermatitis following cardiac catheterization // Arch Dermatol 1997; 133: 242- 243.D’Incan M., Roger H.Radiodermatitis following cardiac catheterization // Arch Dermatol 1997; 133: 242- 243.Dandurand M., Huet P., Guillot B. Secondary radiodermatitis caused by endovascular explorations // Ann Dermatol Venereol 1999; 126: 413-417.Dandurand M., Huet P., Guillot B. Secondary radiodermatitis caused by endovascular explorations // Ann Dermatol Venereol 1999; 126: 413-417.Fierens H., ,Goffette P., Tennstedt D., Lachapelle J. Radiodermatitis after transjugular intrahepatic portosystemic shunt: 4 cases // Ann Dermatol Venereol 2000; 127: 619-623.Fierens H., ,Goffette P., Tennstedt D., Lachapelle J. Radiodermatitis after transjugular intrahepatic portosystemic shunt: 4 cases // Ann Dermatol Venereol 2000; 127: 619-623.Gironet N.Jan., Machet V., Machet M.C., LoretteL., Vaillant G.L., Chronic radiodermatitis after heart catheterization: the contributing role of clofibrate (Lipanor) // Ann Dermatol Venereol 1998; 125598-600Gironet N.Jan., Machet V., Machet M.C., LoretteL., Vaillant G.L., Chronic radiodermatitis after heart catheterization: the contributing role of clofibrate (Lipanor) // Ann Dermatol Venereol 1998; 125598-600Granel F., Barbaud A., Gillet-Terver M.N., et al. Chronic radiodermatitis after interventional cardiac catheterization: four cases // Ann Dermatol Venereol 1998; 125405-407Granel F., Barbaud A., Gillet-Terver M.N., et al. Chronic radiodermatitis after interventional cardiac catheterization: four cases // Ann Dermatol Venereol 1998; 125405-407Stone M.S., Robson K.J., LeBoit P.E., Subacute radiation dermatitis from fluoroscopy during coronary artery stenting: evidence for cytotoxic lymphocyte mediated apoptosis. // J Am Acad Dermatol 1998; 38333-336Stone M.S., Robson K.J., LeBoit P.E., Subacute radiation dermatitis from fluoroscopy during coronary artery stenting: evidence for cytotoxic lymphocyte mediated apoptosis. // J Am Acad Dermatol 1998; 38333-336Hivnor C.M.,Seykora J.T.,Junkins-Hopkins J. et al. Subacute radiation dermatitis // Am J Dermatopathol 2004; 26210- 212Hivnor C.M.,Seykora J.T.,Junkins-Hopkins J. et al. Subacute radiation dermatitis // Am J Dermatopathol 2004; 26210- 212Nahass G.T., Acute radiodermatitis after radiofrequency catheter ablation. // J Am Acad Dermatol 1997; 36881- 884Nahass G.T., Acute radiodermatitis after radiofrequency catheter ablation. // J Am Acad Dermatol 1997; 36881- 884Schecter A.K., Cardiac catheterization-induced acute radiation dermatitis presenting as a fixed drug eruption. // J Drugs Dermatol 2003; 2425-427Schecter A.K., Cardiac catheterization-induced acute radiation dermatitis presenting as a fixed drug eruption. // J Drugs Dermatol 2003; 2425-427D’Incan M., Roger H., Gabrillargues J. et al. Radiation-induced temporary hair loss after endovascular embolization of the cerebral arteries: six cases. // Ann Dermatol Venereol 2002; 129703-706D’Incan M., Roger H., Gabrillargues J. et al. Radiation-induced temporary hair loss after endovascular embolization of the cerebral arteries: six cases. // Ann Dermatol Venereol 2002; 129703-706Koenig T.R., Mettler F.A., Wagner L.K., Skin injuries from fluoroscopically guided procedures: part 2, review of 73 cases and recommendations for minimizing dose delivered to patient. // AJR Am J Roentgenol 2001; 17713-20Koenig T.R., Mettler F.A., Wagner L.K., Skin injuries from fluoroscopically guided procedures: part 2, review of 73 cases and recommendations for minimizing dose delivered to patient. // AJR Am J Roentgenol 2001; 17713-20Rohrschneider W. Vol. 106. In German: Arch f Augenh; 1932. // Studies on the formation and the morphology of Rontgen-radiation cataract in humans; pp. 221-54.Rohrschneider W. Vol. 106. In German: Arch f Augenh; 1932. // Studies on the formation and the morphology of Rontgen-radiation cataract in humans; pp. 221-54.Otake M., Schull W. The relationship of gamma and neutron radiation to posterior lenticular opacities among atomic bomb survivors in Hiroshima and Nagasaki. // Radiat Res. 1982; 92: 574-95.Otake M., Schull W. The relationship of gamma and neutron radiation to posterior lenticular opacities among atomic bomb survivors in Hiroshima and Nagasaki. // Radiat Res. 1982; 92: 574-95.Miller R.J., Fujino T., Nefzger M.D. Lens findings in atomic bomb survivors: a review of major ophthalmic surveys at the Atomic Bomb Casualty Commission (1949 -1962) // Arch Ophthalmol. 1967; 78: 697-704.Miller R.J., Fujino T., Nefzger M.D. Lens findings in atomic bomb survivors: a review of major ophthalmic surveys at the Atomic Bomb Casualty Commission (1949 -1962) // Arch Ophthalmol. 1967; 78: 697-704.Nefzger M.D., Miller R.J., Fujino T. Eye findings in atomic bomb survivors of Hiroshima and Nagasaki: 1963 -1964. // Am J Epidemiol. 1969; 89: 129-38.Nefzger M.D., Miller R.J., Fujino T. Eye findings in atomic bomb survivors of Hiroshima and Nagasaki: 1963 -1964. // Am J Epidemiol. 1969; 89: 129-38.Chen W., Hwang J., Hu T., et al. Lenticular opacities in populations exposed to chronic low-dose-rate gamma radiation from radiocontaminated buildings in Taiwan. // Radiat Res. 2001; 156: 71-7.Chen W., Hwang J., Hu T., et al. Lenticular opacities in populations exposed to chronic low-dose-rate gamma radiation from radiocontaminated buildings in Taiwan. // Radiat Res. 2001; 156: 71-7.Day R., Gorin M.B., Eller A.W. Prevalence of lens changes in Ukrainian children residing around Chernobyl. // Health Phys. 1995; 68: 632-42.Day R., Gorin M.B., Eller A.W. Prevalence of lens changes in Ukrainian children residing around Chernobyl. // Health Phys. 1995; 68: 632-42.Rafnsson V., Olafsdottir E., Hrafnkelsson J., et al. Cosmic radiation increases the risk of nuclear cataract in airline pilots: a population-based case-control study. // Arch Ophthalmol. 2005; 123: 1102-5.Rafnsson V., Olafsdottir E., Hrafnkelsson J., et al. Cosmic radiation increases the risk of nuclear cataract in airline pilots: a population-based case-control study. // Arch Ophthalmol. 2005; 123: 1102-5.Cucinotta F.A., Manuel F.K., Jones J., et al. Space radiation and cataracts in astronauts. // Radiat Res. 2001; 156: 460-6.Cucinotta F.A., Manuel F.K., Jones J., et al. Space radiation and cataracts in astronauts. // Radiat Res. 2001; 156: 460-6.Klein B., Klein R., Linton K., et al. Diagnostic x-ray exposure and lens opacities: the Beaver Dam Eye Study. // Am J Public Health. 1993; 83: 588-90.Klein B., Klein R., Linton K., et al. Diagnostic x-ray exposure and lens opacities: the Beaver Dam Eye Study. // Am J Public Health. 1993; 83: 588-90.Klein B., Klein R., Moss S. Exposure to diagnostic x-rays and incident age-related eye disease. // Ophthalmic Epidemiol. 2000; 7: 61-5.Klein B., Klein R., Moss S. Exposure to diagnostic x-rays and incident age-related eye disease. // Ophthalmic Epidemiol. 2000; 7: 61-5.Pratt T.A., Shaw A.J. Factors affecting the radiation dose to the lens of the eye during cardiac catheterization procedures. // Br J Radiol 1993; 66: 346 - 350.Pratt T.A., Shaw A.J. Factors affecting the radiation dose to the lens of the eye during cardiac catheterization procedures. // Br J Radiol 1993; 66: 346 - 350.Junk A.K., Haskal Z., Worgul B.V. Cataract in interventional radiology - an occupational hazard // Invest Oph-talmol Vis Sci 2004; 45(suppl): 388.Junk A.K., Haskal Z., Worgul B.V. Cataract in interventional radiology - an occupational hazard // Invest Oph-talmol Vis Sci 2004; 45(suppl): 388.Vano E., Gonzalez L., Fernandez J.M., et al. Eye lens expoosure to radiation in interventional suits: caution is warranted. // Radiology 2008; 248: 945 - 953.Vano E., Gonzalez L., Fernandez J.M., et al. Eye lens expoosure to radiation in interventional suits: caution is warranted. // Radiology 2008; 248: 945 - 953.Vano E., Kleiman N.J., Duran A., et al. Radiation cataract risk in interventional cardiology personnel. // Radiat Res 2010; 174: 490 - 495.Vano E., Kleiman N.J., Duran A., et al. Radiation cataract risk in interventional cardiology personnel. // Radiat Res 2010; 174: 490 - 495.Ciraj-Bjelak O., Rehani M.M., Sim K.H., et al. Risk for radiation induced cataract for staff in interventional cardiology: is there reason for concern // Catheter Cardiovasc Interv 2010; 76: 826 - 834.Ciraj-Bjelak O., Rehani M.M., Sim K.H., et al. Risk for radiation induced cataract for staff in interventional cardiology: is there reason for concern // Catheter Cardiovasc Interv 2010; 76: 826 - 834.Jacob S., Boveda S., Bar O., et al. Interventional cardiologists and risk of radiation induced cataract: results of a French multi center observational study. // Int Cardiol 2012; May 17 [Epub ahead of print].Jacob S., Boveda S., Bar O., et al. Interventional cardiologists and risk of radiation induced cataract: results of a French multi center observational study. // Int Cardiol 2012; May 17 [Epub ahead of print].Guidelines for the Diagnosis and Treatment of Cardiovascular Diseases (2004 - 2005 Joint Working Groups Report). Guidelines for Radiation Safety in Interventional Cardiology (JCS 2006). // Circ J 2006; 70 (Suppl VI): 1247 - 1299 (in Japanese).Guidelines for the Diagnosis and Treatment of Cardiovascular Diseases (2004 - 2005 Joint Working Groups Report). Guidelines for Radiation Safety in Interventional Cardiology (JCS 2006). // Circ J 2006; 70 (Suppl VI): 1247 - 1299 (in Japanese).JCS Joint Working Group. Guidelines for radiation safety in interventional cardiology (JCS 2006) Digest version. // Circ J 2010; 74: 2760 - 2785.JCS Joint Working Group. Guidelines for radiation safety in interventional cardiology (JCS 2006) Digest version. // Circ J 2010; 74: 2760 - 2785.Awai K., Aoki Y., Ito T., et al. Study reports in radiation exposure for a medical workers and protective clothing in recent X - ray study. // Japanese Journal of Radiological Technology 1998; 54: 687 - 696.Awai K., Aoki Y., Ito T., et al. Study reports in radiation exposure for a medical workers and protective clothing in recent X - ray study. // Japanese Journal of Radiological Technology 1998; 54: 687 - 696.Finkelstein M.M. Is brain cancer an occupational disease of cardiologists // Can J Cardiol 1998; 14: 1385 - 8.Finkelstein M.M. Is brain cancer an occupational disease of cardiologists // Can J Cardiol 1998; 14: 1385 - 8.Hardell L., Mild K.H., Pahlson A., et al. Ionizing radiation, cellular telephones and the risk of brain tumors. // Eur J Cancer Prev 2001; 10: 523 - 9.Hardell L., Mild K.H., Pahlson A., et al. Ionizing radiation, cellular telephones and the risk of brain tumors. // Eur J Cancer Prev 2001; 10: 523 - 9.Roguin A., Golgstein J., Bar O. Brain tumors among interventional cardiologists: a cause for alarm. Report of four new cases from two new cities and a review of the literature. // Eurointervention 2012; 7: 1081 - 1086.Roguin A., Golgstein J., Bar O. Brain tumors among interventional cardiologists: a cause for alarm. Report of four new cases from two new cities and a review of the literature. // Eurointervention 2012; 7: 1081 - 1086.Roguin A., Golgstein J., Bar O., et al. Brain and neck tumors among physicians performing interventional procedures. // Am J Cardiol 2013; 111(9): 1368 - 72.Roguin A., Golgstein J., Bar O., et al. Brain and neck tumors among physicians performing interventional procedures. // Am J Cardiol 2013; 111(9): 1368 - 72.Merriam G.R., Worgul B.V. Experimental radiation cataract-its clinical relevance. // Bull N Y Acad Med. 1983; 59: 372-92.Merriam G.R., Worgul B.V. Experimental radiation cataract-its clinical relevance. // Bull N Y Acad Med. 1983; 59: 372-92.Worgul B.V, Kundiyev Y., Sergiyenko N., et al. Cataract among Chernobyl cleanup workers: implications regarding permissible eye exposure. // Radiat Res. 2007; 167: 233-43.Worgul B.V, Kundiyev Y., Sergiyenko N., et al. Cataract among Chernobyl cleanup workers: implications regarding permissible eye exposure. // Radiat Res. 2007; 167: 233-43.Chodick G., Bekiroglu N., Hauptmann M., et al. Risk of Cataract after Exposure to Low Doses of Ionizing Radiation: A 20-Year Prospective Cohort Study among US Radiologic Technologists. // Am J Epidemiol. 2008 Sep 15; 168(6): 620-631.Chodick G., Bekiroglu N., Hauptmann M., et al. Risk of Cataract after Exposure to Low Doses of Ionizing Radiation: A 20-Year Prospective Cohort Study among US Radiologic Technologists. // Am J Epidemiol. 2008 Sep 15; 168(6): 620-631.Mettler Jr.F.A., Bhargavan M., Faulkner K. et al., “Radiologic and nuclear medicine studies in the United States and world- wide: frequency, radiation dose, and comparison with other radiation sources, 1950-2007,” // Radiology, vol. 253, no. 2, pp. 520-531, 2009.Mettler Jr.F.A., Bhargavan M., Faulkner K. et al., “Radiologic and nuclear medicine studies in the United States and world- wide: frequency, radiation dose, and comparison with other radiation sources, 1950-2007,” // Radiology, vol. 253, no. 2, pp. 520-531, 2009.International Atomic Energy Agency. Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards (BSS) - Interim Edition, IAEA Safety Standards Series GSR Part 3 (Interim). // Vienna: IAEA; 2011.International Atomic Energy Agency. Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards (BSS) - Interim Edition, IAEA Safety Standards Series GSR Part 3 (Interim). // Vienna: IAEA; 2011.European Commission. Proposal for a Council Directive laying down basic safety standards for protection against the dangers arising from exposure to ionizing radiation. // Brussels, 30.05.2012. COM(2012) 242 final.European Commission. Proposal for a Council Directive laying down basic safety standards for protection against the dangers arising from exposure to ionizing radiation. // Brussels, 30.05.2012. COM(2012) 242 final.Estner H.L., Bongiorni M.G., Chen J., et al. Use of fluoroscopy in clinical electrophysiology in Europe: Results of the European Heart Rhythm Association Survey. // Europe 2015; 17: 1149 - 1152.Estner H.L., Bongiorni M.G., Chen J., et al. Use of fluoroscopy in clinical electrophysiology in Europe: Results of the European Heart Rhythm Association Survey. // Europe 2015; 17: 1149 - 1152.Berington de Gonzalez A., Darby S. Risk of cancer from diagnostic X - rays: estimates for the UK and 14 other countries. // Lancet 2004; 363: 345 - 351.Berington de Gonzalez A., Darby S. Risk of cancer from diagnostic X - rays: estimates for the UK and 14 other countries. // Lancet 2004; 363: 345 - 351.Aril T., Uchino S., Kubo Y, et al. Radiation exposure to anaeshesists during endovascular procedures. // Anaesthesia 2015; 70: 47 - 50.Aril T., Uchino S., Kubo Y, et al. Radiation exposure to anaeshesists during endovascular procedures. // Anaesthesia 2015; 70: 47 - 50.

The authors declare that there are no conflicts of interest present.