A summary of recommendations for occupational radiation protection in interventional cardiology

Abstract

The radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures, and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational radiation protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational radiation dose include minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance program; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. These recommendations for occupational radiation protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.

Occupational Radiation Protection of Pregnant or Potentially Pregnant Workers in IR: A Joint Guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe

“…As efforts to effectively manage the dose that the patient receives from such procedures continue (10), the dose to the performing physician should also decrease as a result of the strong relationship between patient and operator dose (61)(62)(63)(64). Decreasing patient dose will typically result in a proportional decrease in scatter dose to the operator and other personnel in the room (48,65,66). Therefore, techniques that reduce patient dose will generally also reduce dose to the conceptus of pregnant occupational workers.…”

“…In addition, the practice of maintaining as great a distance as possible from the source of radiation consistent with providing good medical care should be employed when possible (5,10,73,74). Protective wraparound aprons with thyroid shields are the principal radiation protection tool for workers in interventional radiology and cardiology (48,65,66). They should be used at all times.…”

“…Indeed, the exclusion of pregnant workers from fluoroscopic procedures solely on the basis of radiation risks to the conceptus cannot be justified on scientific grounds, may alter the contribution that female employees Table 1 . Practical Actions to Control Dose to the Pregnant Patient and Conceptus When Performing Image-Guided Fluoroscopic Interventions (10,24,38,43,48,60,(66)(67)(68)(69)(70)(71) Use all available information to plan the interventional procedure. Use available patient dose-reduction technologies.…”

“…10,24,38,43,48,60,[66][67][68][69][70][71] provides a list of key considerations for dose reduction.…”

Commentary: Worldwide Knowledge and Attitude of Spine Surgeons Regarding Radiation Exposure

“…In addition, the use of collimation is a simple practice that should be adopted in order to reduce scattered radiation. 35 …”