Occupational Radiation Doses to Operators Performing Cardiac Catheterization Procedures

Abstract

Cardiac catheterization procedures using fluoroscopy reduce patient morbidity and mortality compared to operative procedures. These diagnostic and therapeutic procedures require radiation exposure to patients and physicians. The objectives of the present investigation were to provide a systematic comprehensive summary of the reported radiation doses received by operators due to diagnostic or interventional fluoroscopically-guided procedures, to identify the primary factors influencing operator radiation dose, and to evaluate whether there have been temporal changes in the radiation doses received by operators performing these procedures. Using PubMed, we identified all English-language journal articles and other published data reporting radiation exposures to operators from diagnostic or interventional fluoroscopically-guided cardiovascular procedures from the early 1970's through the present. We abstracted the reported radiation doses, dose measurement methods, fluoroscopy system used, operational features, radiation protection features, and other relevant data. We calculated effective doses to operators in each study to facilitate comparisons. The effective doses ranged from 0.02-38.0 microSv for DC (diagnostic catheterizations), 0.17-31.2 microSv for PCI (percutaneous coronary interventions), 0.24-9.6 microSv for ablations, and 0.29-17.4 microSv for pacemaker or intracardiac defibrillator implantations. The ratios of doses between various anatomic sites and the thyroid, measured over protective shields, were 0.9 +/- 1.0 for the eye, 1.0 +/- 1.5 for the trunk, and 1.3 +/- 2.0 for the hand. Generally, radiation dose is higher on the left side of an operator's body, because the operator's left side is closer to the primary beam when standing at the patient's right side. Modest operator dose reductions over time were observed for DC and ablation, primarily due to reduction in patient doses due to decreased fluoroscopy/cineradiography time and dose rate by technology improvement. Doses were not reduced over time for PCI. The increased complexity of medical procedures appears to have offset dose reductions due to improvements in technology. The large variation in operator doses observed for the same type of procedure suggests that optimizing procedure protocols and implementing general use of the most effective types of protective devices and shields may reduce occupational radiation doses to operators. We had considerable difficulty in comparing reported dosimetry results because of significant differences in dosimetric methods used in each study and multiple factors influencing the actual doses received. Better standardization of dosimetric methods will facilitate future analyses aimed at determining how well medical radiation workers are being protected.

Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology

“…The number of procedures performed annually throughout the world has increased over the past 20 years [1]. The benefits of interventional radiology to patients are both extensive and beyond dispute, but many of these procedures also have the potential to produce patient radiation doses high enough to cause radiation effects and occupational doses to interventional radiologists high enough to cause concern [1][2][3][4]. A joint SIR-CIRSE guideline on patient radiation management has addressed patient issues [3].…”

“…The radiation dose received by interventional radiologists can vary by more than an order of magnitude for the same type of procedure and for similar patient dose [4]. Recently, there has been particular concern regarding occupational dose to the lens of the eye in interventional radiologists [2].…”

“…It is especially important for image-guided medical procedures [4,9]. These procedures may involve high radiation dose rates in the interventional laboratory [10,11].…”

Autoimmune Thyroiditis Among Ionizing Radiation Exposed Workers in Cardiac Catheterization Units.

“…They postulated that occupational exposure to ionizing radiation is associated with a dose dependent risk of autoimmune thyroidits. Also, assessment of the effects of childhood radiation exposure on thyroid auto-antibodies and thyroid function [13][14][15] Another aspect of the study was to assess radiation dose received by the members of interventional cardiac catheterization team which can vary by many factors including the type of procedure and given patient dose (Kim et al, 2008). In this work, we tried to calculate the radiation dose received by each of physicians, nurses and technicians during both diagnostic and therapeutic cardiac procedures using digital dosimeter.…”

Avaliação da dose ocupacional oriunda dos procedimentos especiais guiados por fluoroscopia: cateterismo cardíaco

“…Um estudo relatado na Publicação UNSCEAR [9] avaliou as doses externas para diferentes partes do corpo e de acordo com o tipo de procedimento, conforme mostrado na posicionamento incorreto e uso irregular dos dosímetros [30].…”