Assessment of radiation doses to cardiologists during interventional examinations

Abstract

The accuracy of two on line dosimetric techniques was investigated for the estimation of cardiologist doses. The first technique involves the establishment of a database relating the cardiologist extremity doses to patient DAP values. Doses of nine cardiologists were measured together with patient doses during the interventional cardiac examinations of 166 patients for this purpose. Data were collected from five cardiology departments. The mean of the eye, thyroid, waist, right-left wrist, and right-left leg doses per procedure were measured as 72.4 (31.6-107.1), 68.5 (13.3-174.6), 11.2 (0.9-28.4), 67.8 (21.9-120.3) to 216 (52.7-425.4), and 137 (51.4-386.2) to 384 (135-1168.3) microGy/procedure. The effective doses were calculated according to the use of protection tools and a mean value of 12.14 (1.2-30.2) microSv/procedure was found. The ratios of staff dose to patient DAP were found to be within the range of 0.14-3.75 for each procedure. In the second method, cardiologist doses were calculated and compared with the measured values. Scatter doses were measured at the positions of cardiologists from Rando phantom exposures using similar conditions with patient procedures for this purpose. The parameters obtained from these exposures and patient examinations were used to calculate the doses to cardiologists.

Occupational radiation dose during transcatheter aortic valve implantation

“…The same is true in comparison with standard interventional cardiac procedures [5,7,8,13,23]. The working field of the cardiothoracic surgeon is located near the apex of the heart and thus very close to the X-ray beam.…”

“…The hand doses for cardiologist and cardiothoracic surgeon remained below 0.050 mSv per procedure in the transfemoral TAVI and fall in the low range of doses reported for standard cardiac interventions (0.020-4.16 mSv per procedure) [5,7,8,10,13].…”

“…The effective dose (limit 20 mSv/year [22]) for the cardiothoracic surgeon during the transapical TAVI was 10 times the dose during the transfemoral TAVI, and about twice the dose of standard interventional cardiological interventions [7,24]. This higher dose is a consequence of the smaller distance to the X-ray beam and the absence of protection above the table because the cardiothoracic surgeon needs free access to the apex of the heart.…”

“…In the literature effective doses between 0.02 and 31.2 lSv/procedure have been reported, while reported equivalent extremity doses ranged between 50 and 4,160 lSv/procedure [5]. For more details on the current extremity radiation levels in interventional cardiology we refer to the literature [6][7][8][9][10]. It is noted that accidentally placing the hands in the X-ray beam can cause very high doses, and that the lower extremities will receive high doses if protective drapes below the patient table are missing in case of the commonly used under-table tube.…”

Recommendations for occupational radiation protection in interventional cardiology

“…Workers' recorded dose levels should be compared to their own past dose levels and to the average dose levels of others doing similar work and workloads at the same facility or at other facilities. Typical staff dose readings for different interventional cardiology procedures have been published in the literature . Depending on the type of cardiac procedure and the technique used, the operator dose, per procedure, typically ranges from 5 to 500 μSv at the neck over protective clothing (with the highest values occurring when a protective screen is not used), from < 1 to 50 μSv at the waist or chest under protective clothing, and from 50 to > 2000 μSv at the hand.…”