Efficacy of a Protective Sheet for Reducing Ocular Radiation Exposure During Transcatheter Aortic Valve Implantation

Background: The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use X-ray fluoroscopy is a fundamental problem not only for patients but also for surgeons and interventional cardiologists, increasing t...

Full description

Saved in:
Bibliographic Details
Published inCirculation Journal Vol. 86; no. 11; pp. 1764 - 1768
Main Authors Yokota, Junki, Kuratani, Toru, Shimamura, Kazuo, Maeda, Koichi, Kawamura, Ai, Yamashita, Kizuku, Mizote, Isamu, Nakamura, Daisuke, Mukai, Takashi, Sakata, Yasushi, Miyagawa, Shigeru
Format Journal Article
LanguageEnglish
Published Japan The Japanese Circulation Society 25.10.2022
Subjects
Aortic Valve - surgery
Aortic Valve Stenosis - surgery
Eyes
Fluoroscopy - adverse effects
Humans
Radiation Dosage
Radiation exposure
Radiation Exposure - adverse effects
Radiation Exposure - prevention & control
Radiation protection
Risk Factors
Transcatheter aortic valve implantation
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - methods
Treatment Outcome
Transcatheter aortic valve implantation
Radiation exposure
Eyes
Radiation protection
Online AccessGet full text

Cover

Abstract Background: The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use X-ray fluoroscopy is a fundamental problem not only for patients but also for surgeons and interventional cardiologists, increasing the risk of cataracts among operators. We investigated the efficacy of leaded glasses and protective sheets for ocular radiation protection.Methods and Results: Between January 2020 and February 2021 we enrolled 54 TAVI procedures using the transfemoral approach. The subjects were divided into a curtain protection group (Group C, n=20), glass protection group (Group G, n=17), and sheet protection group (Group S, n=17). The cumulative dose (CD) of the operators showed a decreasing trend in Group S compared with the other two groups. The CD normalized by dose area product (CD/DAP) of the operators was significantly reduced in Group S compared with Group C. However, Group G showed no significant difference compared with Group C. Regarding the distribution of CD/DAP, Group S had a significantly lower distribution than that in groups C and G.Conclusions: Protective sheets provide more stable radiation protection than conventional curtains or leaded glasses.
AbstractList Background: The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use X-ray fluoroscopy is a fundamental problem not only for patients but also for surgeons and interventional cardiologists, increasing the risk of cataracts among operators. We investigated the efficacy of leaded glasses and protective sheets for ocular radiation protection.Methods and Results: Between January 2020 and February 2021 we enrolled 54 TAVI procedures using the transfemoral approach. The subjects were divided into a curtain protection group (Group C, n=20), glass protection group (Group G, n=17), and sheet protection group (Group S, n=17). The cumulative dose (CD) of the operators showed a decreasing trend in Group S compared with the other two groups. The CD normalized by dose area product (CD/DAP) of the operators was significantly reduced in Group S compared with Group C. However, Group G showed no significant difference compared with Group C. Regarding the distribution of CD/DAP, Group S had a significantly lower distribution than that in groups C and G.Conclusions: Protective sheets provide more stable radiation protection than conventional curtains or leaded glasses.
The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use X-ray fluoroscopy is a fundamental problem not only for patients but also for surgeons and interventional cardiologists, increasing the risk of cataracts among operators. We investigated the efficacy of leaded glasses and protective sheets for ocular radiation protection.BACKGROUNDThe use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use X-ray fluoroscopy is a fundamental problem not only for patients but also for surgeons and interventional cardiologists, increasing the risk of cataracts among operators. We investigated the efficacy of leaded glasses and protective sheets for ocular radiation protection.Between January 2020 and February 2021 we enrolled 54 TAVI procedures using the transfemoral approach. The subjects were divided into a curtain protection group (Group C, n=20), glass protection group (Group G, n=17), and sheet protection group (Group S, n=17). The cumulative dose (CD) of the operators showed a decreasing trend in Group S compared with the other two groups. The CD normalized by dose area product (CD/DAP) of the operators was significantly reduced in Group S compared with Group C. However, Group G showed no significant difference compared with Group C. Regarding the distribution of CD/DAP, Group S had a significantly lower distribution than that in groups C and G.METHODS AND RESULTSBetween January 2020 and February 2021 we enrolled 54 TAVI procedures using the transfemoral approach. The subjects were divided into a curtain protection group (Group C, n=20), glass protection group (Group G, n=17), and sheet protection group (Group S, n=17). The cumulative dose (CD) of the operators showed a decreasing trend in Group S compared with the other two groups. The CD normalized by dose area product (CD/DAP) of the operators was significantly reduced in Group S compared with Group C. However, Group G showed no significant difference compared with Group C. Regarding the distribution of CD/DAP, Group S had a significantly lower distribution than that in groups C and G.Protective sheets provide more stable radiation protection than conventional curtains or leaded glasses.CONCLUSIONSProtective sheets provide more stable radiation protection than conventional curtains or leaded glasses.
The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use X-ray fluoroscopy is a fundamental problem not only for patients but also for surgeons and interventional cardiologists, increasing the risk of cataracts among operators. We investigated the efficacy of leaded glasses and protective sheets for ocular radiation protection. Between January 2020 and February 2021 we enrolled 54 TAVI procedures using the transfemoral approach. The subjects were divided into a curtain protection group (Group C, n=20), glass protection group (Group G, n=17), and sheet protection group (Group S, n=17). The cumulative dose (CD) of the operators showed a decreasing trend in Group S compared with the other two groups. The CD normalized by dose area product (CD/DAP) of the operators was significantly reduced in Group S compared with Group C. However, Group G showed no significant difference compared with Group C. Regarding the distribution of CD/DAP, Group S had a significantly lower distribution than that in groups C and G. Protective sheets provide more stable radiation protection than conventional curtains or leaded glasses.
ArticleNumber CJ-22-0400
Author Kawamura, Ai
Mizote, Isamu
Maeda, Koichi
Yamashita, Kizuku
Kuratani, Toru
Mukai, Takashi
Yokota, Junki
Nakamura, Daisuke
Miyagawa, Shigeru
Shimamura, Kazuo
Sakata, Yasushi
Author_xml – sequence: 1
  fullname: Yokota, Junki
  organization: Department of Cardiovascular Surgery, Osaka University, Graduate School of Medicine
– sequence: 2
  fullname: Kuratani, Toru
  organization: Department of Cardiovascular Surgery, Osaka University, Graduate School of Medicine
– sequence: 3
  fullname: Shimamura, Kazuo
  organization: Department of Cardiovascular Surgery, Osaka University, Graduate School of Medicine
– sequence: 4
  fullname: Maeda, Koichi
  organization: Department of Cardiovascular Surgery, Osaka University, Graduate School of Medicine
– sequence: 5
  fullname: Kawamura, Ai
  organization: Department of Cardiovascular Surgery, Osaka University, Graduate School of Medicine
– sequence: 6
  fullname: Yamashita, Kizuku
  organization: Department of Cardiovascular Surgery, Osaka University, Graduate School of Medicine
– sequence: 7
  fullname: Mizote, Isamu
  organization: Department of Cardiology, Osaka University, Graduate School of Medicine
– sequence: 8
  fullname: Nakamura, Daisuke
  organization: Department of Cardiology, Osaka University, Graduate School of Medicine
– sequence: 9
  fullname: Mukai, Takashi
  organization: Department of Cardiology, Osaka University, Graduate School of Medicine
– sequence: 10
  fullname: Sakata, Yasushi
  organization: Department of Cardiology, Osaka University, Graduate School of Medicine
– sequence: 11
  fullname: Miyagawa, Shigeru
  organization: Department of Cardiovascular Surgery, Osaka University, Graduate School of Medicine
BackLink https://www.ncbi.nlm.nih.gov/pubmed/36184556$$D View this record in MEDLINE/PubMed
BookMark eNpFkE1v1DAQhi1URD_gzgn5yCXFn4lzrJaltKpUBIWrNeuMu15l48V2EP33JLtLexmPped9NHrPyckQByTkPWeXXGj5yYXkNpeL20qIiinGXpEzLlVTKSPYyX6vq9YoeUrOc94wJlqm2zfkVNbcKK3rM1KW3gcH7olGT4F-S7GgK-EP0h9rxEJ9TPQ7dqMLwyO9d2MP0x-6ACXEgS7_7mIeE9LPY5qBhwRDdlDWWDDRq5hKcPQX9JPuZrvrYSj73Fvy2kOf8d3xvSA_vywfFl-ru_vrm8XVXeW0FKXSNdSynS4FpmFVu05zbwzramO8aoE1RqxUJ2oJHWjOZadQNlxIr73zqmvkBfl48O5S_D1iLnYbssN-OgTjmK1oBGvFFBUTyg6oSzHnhN7uUthCerKc2blru-_aLm6tEHbueop8ONrH1Ra758D_cifg-gBscoFHfAZgrqXHo9HUlvN5vqhfiDUki4P8B8xYl4Q
Cites_doi 10.1088/0952-4746/34/3/509
10.1253/circj.CJ-21-0379
10.4244/EIJ-D-17-00759
10.1016/j.icrp.2012.09.001
10.1093/rpd/ncq508
10.1161/CIRCINTERVENTIONS.115.002384
10.1016/j.amjcard.2016.04.045
10.1016/j.radmeas.2011.07.028
10.1177/0846537120911755
10.1007/s00270-013-0766-0
10.13075/ijomeh.1896.01456
10.1007/s11748-021-01701-6
10.2106/JBJS.L.00893
10.1161/CIRCINTERVENTIONS.117.006058
10.1667/RR2207.1
10.4244/EIJV11I1A9
ContentType Journal Article
Copyright 2022, THE JAPANESE CIRCULATION SOCIETY
Copyright_xml – notice: 2022, THE JAPANESE CIRCULATION SOCIETY
DBID CGR
CUY
CVF
ECM
EIF
NPM
AAYXX
CITATION
7X8
DOI 10.1253/circj.CJ-22-0400
DatabaseName Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
CrossRef
MEDLINE - Academic
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
CrossRef
MEDLINE - Academic
DatabaseTitleList
MEDLINE - Academic
MEDLINE
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: EIF
  name: MEDLINE
  url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search
  sourceTypes: Index Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EISSN 1347-4820
EndPage 1768
ExternalDocumentID 10_1253_circj_CJ_22_0400
36184556
article_circj_86_11_86_CJ_22_0400_article_char_en
Genre Journal Article
GroupedDBID ---
.55
29B
2WC
53G
5GY
5RE
6J9
ACGFO
ADBBV
AENEX
ALMA_UNASSIGNED_HOLDINGS
BAWUL
CS3
DIK
DU5
E3Z
EBS
EJD
F5P
GX1
JSF
JSH
KQ8
M~E
OK1
P2P
RJT
RNS
RZJ
TR2
W2D
X7M
XSB
ZXP
CGR
CUY
CVF
ECM
EIF
NPM
AAYXX
CITATION
7X8
ID FETCH-LOGICAL-c532t-56a639184a05ab6cd51f880d688f49a0782b4d263ada5113d4e37123f5fcf4d73
ISSN 1346-9843
1347-4820
IngestDate Fri Sep 06 20:24:02 EDT 2024
Fri Aug 23 02:59:15 EDT 2024
Sun Oct 13 09:49:27 EDT 2024
Thu Aug 17 20:32:03 EDT 2023
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 11
Keywords Transcatheter aortic valve implantation
Radiation exposure
Eyes
Radiation protection
Language English
LinkModel OpenURL
MergedId FETCHMERGED-LOGICAL-c532t-56a639184a05ab6cd51f880d688f49a0782b4d263ada5113d4e37123f5fcf4d73
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
OpenAccessLink https://www.jstage.jst.go.jp/article/circj/86/11/86_CJ-22-0400/_article/-char/en
PMID 36184556
PQID 2720925112
PQPubID 23479
PageCount 5
ParticipantIDs proquest_miscellaneous_2720925112
crossref_primary_10_1253_circj_CJ_22_0400
pubmed_primary_36184556
jstage_primary_article_circj_86_11_86_CJ_22_0400_article_char_en
PublicationCentury 2000
PublicationDate 2022-10-25
PublicationDateYYYYMMDD 2022-10-25
PublicationDate_xml – month: 10
  year: 2022
  text: 2022-10-25
  day: 25
PublicationDecade 2020
PublicationPlace Japan
PublicationPlace_xml – name: Japan
PublicationTitle Circulation Journal
PublicationTitleAlternate Circ J
PublicationYear 2022
Publisher The Japanese Circulation Society
Publisher_xml – name: The Japanese Circulation Society
References 13. van Rooijen BD, de Haan MW, Das M, Arnoldussen CW, de Graaf R, van Zwam WH, et al. Efficacy of radiation safety glasses in interventional radiology. Cardiovasc Intervent Radiol 2014; 37: 1149–1155, doi:10.1007/s00270-013-0766-0.
17. Vlastra W, Delewi R, Sjauw KD, Beijk MA, Claessen BE, Streekstra GJ, et al. Efficacy of the RADPAD protection drape in reducing operators’ radiation exposure in the catheterization laboratory: A sham-controlled randomized trial. Circ Cardiovasc Interv 2017; 10: e006058, doi:10.1161/circinterventions.117.006058.
5. Yokota J, Kuratani T, Shimamura K, Shijo T, Yamashita K, Ide T, et al. Impact of radiation to the eye of operators during endo-cardiovascular surgery and the importance of protection. Gen Thorac Cardiovasc Surg 2022; 70: 347–351, doi:10.1007/s11748-021-01701-6.
3. Della Vecchia E, Modenese A, Loney T, Muscatello M, Silva Paulo M, Rossi G, et al. Risk of cataract in health care workers exposed to ionizing radiation: A systematic review. Med Lav 2020; 111: 269–284, doi:10.23749/mdl.v111i4.9045.
2. Domienik-Andrzejewska J, Kałużny P, Piernik G, Jurewicz J. Occupational exposure to ionizing radiation and lens opacity in interventional cardiologists. Int J Occup Med Environ Health 2019; 32: 663–675, doi:10.13075/ijomeh.1896.01456.
10. Uthoff H, Quesada R, Roberts JS, Baumann F, Schernthaner M, Zaremski L, et al. Radioprotective lightweight caps in the interventional cardiology setting: A randomised controlled trial (PROTECT). EuroIntervention 2015; 11: 53–59, doi:10.4244/eijv11i1a9.
15. Domienik J, Brodecki M, Carinou E, Donadille L, Jankowski J, Koukorava C, et al. Extremity and eye lens doses in interventional radiology and cardiology procedures: First results of the ORAMED project. Radiat Prot Dosimetry 2011; 144: 442–447, doi:10.1093/rpd/ncq508.
4. Honorio da Silva E, Vanhavere F, Struelens L, Covens P, Buls N. Effect of protective devices on the radiation dose received by the brains of interventional cardiologists. EuroIntervention 2018; 13: e1778–e1784, doi:10.4244/eij-d-17-00759
7. Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, et al. ICRP Publication 120: Radiological protection in cardiology. Ann ICRP 2013; 42: 1–125, doi:10.1016/j.icrp.2012.09.001.
6. Kallinikou Z, Puricel SG, Ryckx N, Togni M, Baeriswyl G, Stauffer JC, et al. Radiation exposure of the operator during coronary interventions (from the RADIO Study). Am J Cardiol 2016; 118: 188–194, doi:10.1016/j.amjcard.2016.04.045.
8. Kozuma K, Chikamori T, Hashimoto J, Honye J, Ikeda T, Ishiwata S, et al. JCS 2021 guideline on radiation safety in cardiology. Circ J 2022; 86: 1148–1203, doi:10.1253/circj.CJ-21-0379.
16. Koukorava C, Farah J, Struelens L, Clairand I, Donadille L, Vanhavere F, et al. Efficiency of radiation protection equipment in interventional radiology: A systematic Monte Carlo study of eye lens and whole body doses. J Radiol Prot 2014; 34: 509–528, doi:10.1088/0952-4746/34/3/509.
9. Alazzoni A, Gordon CL, Syed J, Natarajan MK, Rokoss M, Schwalm JD, et al. Randomized controlled trial of radiation protection with a patient lead shield and a novel, nonlead surgical cap for operators performing coronary angiography or intervention. Circ Cardiovasc Interv 2015; 8: e002384, doi:10.1161/circinterventions.115.002384.
12. Burns S, Thornton R, Dauer LT, Quinn B, Miodownik D, Hak DJ. Leaded eyeglasses substantially reduce radiation exposure of the surgeon’s eyes during acquisition of typical fluoroscopic views of the hip and pelvis. J Bone Joint Surg Am 2013; 95: 1307–1311, doi:10.2106/jbjs.L.00893.
1. Vano E, Kleiman NJ, Duran A, Rehani MM, Echeverri D, Cabrera M. Radiation cataract risk in interventional cardiology personnel. Radiat Res 2010; 174: 490–495, doi:10.1667/rr2207.1.
11. Geber T, Gunnarsson M, Mattsson S. Eye lens dosimetry for interventional procedures: Relation between the absorbed dose to the lens and dose at measurement positions. Radiation Measurements 2011; 46: 1248–1251, doi:10.1016/j.radmeas.2011.07.028.
14. Merrachi NA, Bouchard-Bellavance R, Perreault P, Gilbert P, Soulez G, Bouchard L, et al. Eye lens dosimetry in interventional radiology: Assessment with dedicated Hp(3) dosimeters. Can Assoc Radiol J 2021; 72: 317–323, doi:10.1177/0846537120911755.
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
9
10
References_xml – ident: 3
– ident: 16
  doi: 10.1088/0952-4746/34/3/509
– ident: 8
  doi: 10.1253/circj.CJ-21-0379
– ident: 4
  doi: 10.4244/EIJ-D-17-00759
– ident: 7
  doi: 10.1016/j.icrp.2012.09.001
– ident: 15
  doi: 10.1093/rpd/ncq508
– ident: 9
  doi: 10.1161/CIRCINTERVENTIONS.115.002384
– ident: 6
  doi: 10.1016/j.amjcard.2016.04.045
– ident: 11
  doi: 10.1016/j.radmeas.2011.07.028
– ident: 14
  doi: 10.1177/0846537120911755
– ident: 13
  doi: 10.1007/s00270-013-0766-0
– ident: 2
  doi: 10.13075/ijomeh.1896.01456
– ident: 5
  doi: 10.1007/s11748-021-01701-6
– ident: 12
  doi: 10.2106/JBJS.L.00893
– ident: 17
  doi: 10.1161/CIRCINTERVENTIONS.117.006058
– ident: 1
  doi: 10.1667/RR2207.1
– ident: 10
  doi: 10.4244/EIJV11I1A9
SSID ssj0029059
Score 2.4034023
Snippet Background: The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures...
The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use...
SourceID proquest
crossref
pubmed
jstage
SourceType Aggregation Database
Index Database
Publisher
StartPage 1764
SubjectTerms Aortic Valve - surgery
Aortic Valve Stenosis - surgery
Eyes
Fluoroscopy - adverse effects
Humans
Radiation Dosage
Radiation exposure
Radiation Exposure - adverse effects
Radiation Exposure - prevention & control
Radiation protection
Risk Factors
Transcatheter aortic valve implantation
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - methods
Treatment Outcome
Title Efficacy of a Protective Sheet for Reducing Ocular Radiation Exposure During Transcatheter Aortic Valve Implantation
URI https://www.jstage.jst.go.jp/article/circj/86/11/86_CJ-22-0400/_article/-char/en
https://www.ncbi.nlm.nih.gov/pubmed/36184556
https://www.proquest.com/docview/2720925112/abstract/
Volume 86
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
ispartofPNX Circulation Journal, 2022/10/25, Vol.86(11), pp.1764-1768
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3db9MwELfKQNNeEN90fMhIvKAqpXXspHljGkVTpQEaHepb5NgJbUebqksktP-K_5A72_nYoBLwEkWJEyu5n3139t3vCHktWBYJUFNeKlTkcRExL1LC93QSgsYIlFYmUfj0Y3ByziczMet0frailsoi6aurP-aV_I9U4RrIFbNk_0Gy9UvhApyDfOEIEobjX8l4jPwPWK_dJDl-tpQLGAr0ZY5bzRhBeIbUrLgc8MkGnJ4hF4GR-fjHJsflwd57m6lotJZhcUXexKMcu-t9ld_hdUghLNetTfuK2mCxVa78V01BsYuXAg3cCWhmrHjZaz_o4kab6ecitxbtpFxfLFpbTbKw9ad603xb1itD88VKrsqty2y7KvNmjT3V9mq-UPNFe3kDPGPQCzYVup_aKdnnocdHbNCesx19tsPmsDUDD0PLiv6bamCmvoeC71v21dKDnnD-ajeFH7RZGaj4WAZHiBsc3Vbru1u3yG0WAswxv3xWRxWxCMxVtxsOHb692d0B2a9ecM0QurMEX-BbutvNMebO9B656_wUemRBd5900vUDsn_qIjEekqLCHs0zKmmDPWqwRwF7tMIetdijNfZohT1qsUevYY9a7FGDPdrG3iNy_mE8PT7xXAUPD8Y7KzwRSLCA4XvlQMgERr4YZqAwdDAaZTySaJ4mXLPAl1qC5e9rnvoh2FKZyFTGdeg_JnvrfJ0-JTRMfDHSA-lznnKVhRE8mDA99CUHJ0APu-RN9TvjjSVqidHBBSnERgrx8SRmLEYpdMk7-7_rlm4Iu5ajABxjPDaPNC3mcgtzT5e8qiQVw4SMu2wwgPLyMsbAhggdd9YlT6wI624q2R_uvPOMHDSj4DnZK7Zl-gLM3iJ5aYD2C_9Vs7Y
link.rule.ids 315,786,790,27955,27956
linkProvider Geneva Foundation for Medical Education and Research
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Efficacy+of+a+Protective+Sheet+for+Reducing+Ocular+Radiation+Exposure+During+Transcatheter+Aortic+Valve+Implantation&rft.jtitle=Circulation+journal+%3A+official+journal+of+the+Japanese+Circulation+Society&rft.au=Yokota%2C+Junki&rft.au=Kuratani%2C+Toru&rft.au=Shimamura%2C+Kazuo&rft.au=Maeda%2C+Koichi&rft.date=2022-10-25&rft.eissn=1347-4820&rft.volume=86&rft.issue=11&rft.spage=1764&rft_id=info:doi/10.1253%2Fcircj.cj-22-0400&rft_id=info%3Apmid%2F36184556&rft.externalDocID=36184556
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1346-9843&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1346-9843&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1346-9843&client=summon