ICRP Publication 120: Radiological Protection in Cardiology

Abstract

Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff(1) in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission's published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy.

Multicenter Long-Term Validation of a Minicourse in Radiation-Reducing Techniques in the Catheterization Laboratory

“…Some interventionalists, however, proceed without knowing how an image is produced after using the cine or fluoroscopy pedal. 7,29 Traditional suboptimal radiation practices that have become established throughout a long professional life may well prove likewise to be just as difficult to overcome as unhealthy eating habits, smoking, or lack of exercise. Wherever necessary, the cardiology community should consequently face the task of more effectively training both interventionists and their trainers toward new autonomy in radiation safety.…”

Approaches to Enhancing Radiation Safety in Cardiovascular Imaging

“…Ideally, the imaging physician and facility should also be engaged in this process and share the responsibility for informing the patient. 30 This information should be put in context by clearly explaining the expected benefit from the test and how the information gathered would be used in the patient's clinical management. It is also important to discuss risks that may be incurred by not performing the imaging study, including the potential consequences of missed or delayed diagnoses, and the risks of alternate procedures, such as those related to conscious sedation or the use of gadolinium-based contrast agents.…”

Radiation reduction and faster acquisition times with SPECT gated blood pool scans using a high-efficiency cardiac SPECT camera

“…12 Estimation of possible radioisotope dose reduction is possible by analyzing List Mode images at 1-5 minutes of acquisition time allowing for the simulation of reducing injected activity by decreasing the total number of counts processed. A decrease in the total number of counts obtained of 50% is postulated to translate into a 50% decrease in injected activity.…”