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Utilization of a Radiation Safety Time-Out Reduces Radiation Exposure During Electrophysiology Procedures

Aizer, Anthony; Qiu, Jessica K; Cheng, Austin V; Wu, Patrick B; Holmes, Douglas S; Wagner, Steven R; Bernstein, Scott A; Park, David S; Cartolano, Barbara; Barbhaiya, Chirag R; Chinitz, Larry A
OBJECTIVES/OBJECTIVE:This study sought to determine whether a radiation safety time-out reduces radiation exposure in electrophysiology procedures. BACKGROUND:Time-outs are integral to improving quality and safety. The authors hypothesized that a radiation safety time-out would reduce radiation exposure levels for patients and the health care team members. METHODS:The study was performed at the New York University Langone Health Electrophysiology Lab. Baseline data were collected for 6 months prior to the time-out. On implementation of the time-out, data were collected prospectively with analyses to be performed every 3 months. The primary endpoint was dose area product. The secondary endpoints included reference point dose, fluoroscopy time, use of additional shielding, and use of alternative imaging such as intracardiac and intravascular ultrasound. RESULTS:, representing a 21% reduction (p = 0.007). The median reference point dose prior to time-out was 163 mGy, and during the time-out was 122 mGy (p = 0.011). The use of sterile disposable protective shields and ultrasound imaging for access increased significantly during the time-out. CONCLUSIONS:A radiation safety time-out significantly reduces radiation exposure in electrophysiology procedures. Electrophysiology laboratories, as well as other areas of cardiovascular medicine using fluoroscopy, should strongly consider the use of radiation safety time-outs to reduce radiation exposure and improve safety.
PMID: 31122386
ISSN: 2405-5018
CID: 3899572

Utilization of a radiation safety time out significantly reduces radiation exposure during electrophysiology procedures [Meeting Abstract]

Aizer, A; Cheng, A V; Wu, P; Holmes, D; Fowler, S J; Bernstein, S A; Park, D S; Wagner, S R; Barbhaiya, C R; Chinitz, L A
Background: Pre-procedure time outs are integral to medicine to improve quality and safety. We hypothesized that a radiation safety time out for EP procedures would reduce radiation exposure levels for patients and staff. Objective: To design, implement and assess the effect of a radiation safety time out on radiation exposure in the EP lab. Methods: Baseline data on all adult EP procedures were collected for 6 months prior to implementation of the radiation safety time out. Upon implementation of the time out, data were collected prospectively with analyses to be performed every 3 months for up to 12 months. The primary endpoint was mean dose area product (DAP). Secondary endpoints were reference dose, fluoroscopy time, use of additional shielding, and use of alternative imaging. Results: The study was halted after three months. In total, 592 cases prior to the time out and 448 cases during implementation of the time out were included. Use of the time out resulted in a 22% reduction in the DAP (p = 0.013). The mean reference dose was also reduced by 26%. The use of additional radiation shields and ultrasound imaging for venous access increased significantly during the time out period. These differences remained significant when adjusted for BMI, proceduralist, and procedure type. There was no increase in procedure time or complications with the time out (Table). Conclusion: Implementation of a radiation safety time out significantly reduces radiation exposure during EP procedures. EP laboratories, as well as other areas of medicine that use fluoroscopy, should strongly consider the use of radiation safety time outs to reduce radiation exposures and improve safety. (Table presented)
EMBASE:617042238
ISSN: 1556-3871
CID: 2620902

Quantifying the Increase in Radiation Exposure Associated with SPECT/CT Compared to SPECT Alone for Routine Nuclear Medicine Examinations

Larkin, Ann M; Serulle, Yafell; Wagner, Steven; Noz, Marilyn E; Friedman, Kent
Purpose. We quantify the additional radiation exposure in terms of effective dose incurred by patients in the CT portion of SPECT/CT examinations. Methods. The effective dose from a variety of common nuclear medicine procedures is calculated and summarized. The extra exposure from the CT portion of the examination is summarized by examination and body part. Two hundred forty-eight scans from 221 patients are included in this study. The effective dose from the CT examination is also compared to average background radiation. Results. We found that the extra effective dose is not sufficient to cause deterministic effects. However, the stochastic effects may be significant, especially in patients undergoing numerous follow-up studies. The cumulative effect might increase the radiation exposure compared to patient management with SPECT alone. Conclusions. While the relative increase in radiation exposure associated with SPECT/CT is generally considered acceptable when compared with the benefits to the patient, physicians should make every effort to minimize this effect by using proper technical procedures and educating patients about the exposure they will receive.
PMCID:3132661
PMID: 21755054
ISSN: 2090-1720
CID: 159166

GABA-induced current and circadian regulation of chloride in neurones of the rat suprachiasmatic nucleus

Wagner, S; Sagiv, N; Yarom, Y
1. We have shown previously that GABA, the main neurotransmitter in the suprachiasmatic nucleus (SCN), has dual effects on SCN neurones, excitatory during the day and inhibitory at night. This duality has been attributed to changes in [Cl(-)](i) during the circadian cycle. To unravel the processes underlying these changes we investigated the biophysical properties of the GABAergic receptors and the regulation of [Cl(-)](i) in SCN neurones. 2. We used voltage-clamp methodology in conjunction with local application of GABA to characterise the current induced by GABA in SCN neurones within acute brain slices. This current, mediated via GABA(A) receptors, shows moderate voltage dependence, does not desensitise and can significantly alter [Cl(-)](i). 3. Loading or depletion of intracellular Cl(-) was induced by a train of GABA pulses. The recovery of intracellular Cl(-) was deduced from the change in [Cl(-)](i) calculated from the response to a test GABA pulse presented at different intervals after the conditioning train of GABA application. The time course of recovery was described by an exponential curve. Recovery following Cl(-) depletion was slower than recovery from Cl(-) loading and was further delayed during the subjective night. 4. We concluded that: (a) SCN neurones express a large number of somatic GABA(A) receptors, which give rise to a modifiable, tonic Cl(-) conductance that modulates cell excitability; (b) two Cl(-) transport mechanisms operate in SCN neurones, one that replenishes the cell with Cl(-) following Cl(-) depletion and another that removes Cl(-) after Cl(-) loading; (c) the efficiency of the replenishing mechanism is reduced during the subjective night; and (d) this reduction explains a lower [Cl(-)](i) during the night phase of the circadian cycle.
PMCID:2279012
PMID: 11744760
ISSN: 0022-3751
CID: 176593

GABA in the mammalian suprachiasmatic nucleus and its role in diurnal rhythmicity

Wagner, S; Castel, M; Gainer, H; Yarom, Y
Mammals manifest circadian behaviour timed by an endogenous clock in the hypothalamic suprachiasmatic nucleus (SCN). Considerable progress has been made in identifying the molecular basis of the circadian clock, but the mechanisms by which it is translated into cyclic firing activity, high during the day and low at night, are still poorly understood. GABA (gamma-aminobutyric acid), a common inhibitory neurotransmitter in the central nervous system, is particularly densely distributed within the SCN, where it is located in the majority of neuronal somata and synaptic terminals. Using an in vitro brain-slice technique, we have now studied the effect of bath-applied GABA on adult SCN neurons at various times of the day. We find that GABA acts as an inhibitory neurotransmitter at night, decreasing the firing frequency; but during the day GABA acts as an excitatory neurotransmitter, increasing the firing frequency. We show that this dual effect, which is mediated by GABA(A) receptors, may be attributed to an oscillation in intracellular chloride concentration. A likely explanation is that the amplitude of the oscillation in firing rate, displayed by individual neurons, is amplified by the dual effect of GABA in the SCN's GABAergic network.
PMID: 9177347
ISSN: 0028-0836
CID: 176606

The suprachiasmatic nucleus in stationary organotypic culture

Belenky, M; Wagner, S; Yarom, Y; Matzner, H; Cohen, S; Castel, M
Suprachiasmatic nuclei, derived from neonate rats, were maintained for several weeks in stationary organotypic culture. Hypothalamic slice explants, supported by Millicell filters and incubated in Petri dishes containing serum-based medium, flattened appreciably, yet preserved the organization of the suprachiasmatic nucleus and the surrounding hypothalamic tissue. After two to three weeks, cultures were fixed, and three neuronal sub-populations were identified as vasopressinergic, vasoactive intestinal peptide-containing, or GABA-containing. The GABAergic component of the cultured suprachiasmatic nucleus was particularly profuse, projecting extensively into the hypothalamic slice. Unilateral ablation of the nucleus in the explant dramatically reduced ipsilateral GABA-immunoreactivity in the slice. Explants in which an incision separated the bilateral suprachiasmatic nucleus from the paraventricular nucleus, deprived the latter of its fine-caliber GABA-immunoreactive input. Extra- or intra-cellular electrophysiological recordings from the suprachiasmatic nucleus were obtained in 51 of 58 cultures. The electrical properties of the long-term cultured suprachiasmatic nucleus were similar to those recorded in acute slices from adult rats. In six cultures recordings were extended for up to 10-24 h. Within long-term stationary organotypic cultures of the suprachiasmatic nucleus, sub-populations of neurons, intrinsic to the nucleus in vivo, were identified immunocytochemically. Lesion studies supported the observation that the main source of the GABAergic innervation within the entire hypothalamic slice explant appeared to be the suprachiasmatic nucleus. Electrophysiological studies confirmed the viability of the long-term cultured nucleus and revealed changes in spontaneous electrical activity that may indicate circadian fluctuation.
PMID: 8848118
ISSN: 0306-4522
CID: 176611

Specialized extended hospital treatment for borderline patients [Case Report]

Tucker, L; Bauer, S F; Wagner, S; Harlam, D; Sher, I
The intensive psychoanalytically oriented hospital treatment described by the authors was developed specifically for borderline patients. This unique treatment, an integrated multimodal approach, is based on the theory that the disturbed behaviors and relationships of borderline patients are manifestations of intrapsychic impairment. The authors use a detailed case report to illustrate how the theory is transformed into technical precepts and applied to all aspects of the treatment.
PMID: 1422523
ISSN: 0025-9284
CID: 177881

Long-term hospital treatment of borderline patients: a descriptive outcome study

Tucker, L; Bauer, S F; Wagner, S; Harlam, D; Sher, I
The authors report a prospective 2-year outcome study of 40 inpatients with severe personality disorders who were treated on a specialized long-term unit for patients with "borderline conditions." Treatment goals included improving interpersonal relationships and facilitating a lasting discharge from the hospital. Data were collected at admission, discharge, and 1 and 2 years after discharge. The data reflect change from admission to follow-up in impulsivity, psychotherapy, and social adjustment. Mediating effects of length of stay on outcome are discussed.
PMID: 3674226
ISSN: 0002-953x
CID: 177883