Strategies to Reduce Radiation Exposure in Electrophysiology and Interventional Cardiology

Abstract

Clinical diagnosis sometimes involves the use of medical instruments that employ ionizing radiation. However, ionizing radiation exposure is a workplace hazard that goes undetected and is detrimental to patients and staff in the catheterization laboratory. Every possible effort should be made to reduce the amount of radiation, including scattered radiation. Implementing radiation dose feedback may have a role in reducing exposure. In medicine, it is important to estimate the potential biologic effects on, and the risk to, an individual. In general, implantation of cardiac resynchronization devices is associated with one of the highest operator exposure doses due to the proximity of the operator to the radiation source. All physicians should work on the principle of as low as reasonably achievable. Methods for reducing radiation exposure must be implemented in the catheterization laboratory. In this article, we review the available tools to lower the radiation exposure dose to the operator during diagnostic, interventional, and electrophysiological cardiac procedures.

Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology

“… Approximated patient radiation exposure for different x-ray-based imaging modalities in cardiac imaging. 9–11 AF, atrial fibrillation; CCT, cardiac computed tomography; LAA, left atrial appendage; mSv, millisievert; VT, ventricular tachycardia. a highly dependent on scan protocol and triggering.…”

“… Approximated patient radiation exposure for different x-ray-based imaging modalities in cardiac imaging. 9–11 …”

Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory?

“…Lead caps may be uncomfortable to wear due to their weight, which can contribute to neck and back pain. 8 , 32 There is evidence that wearing lead-based protective equipment for long periods leads to lower back and neck pain in interventional radiologists and cardiologists. 33 A lead cap may weigh around 1,140 g, which may manifest as orthopaedic problems in operators.…”

Impact of dose reducing software on patient and staff temple dose during fluoroscopically guided pacemaker insertion, closure devices implantation and coronary angiography procedures

“…The rising number of high dose imaging investigations increases the stochastic risk of oncogenesis with lengthy procedures also resulting in patient skin erythema [ 1 ]. Radiation exposure in the catheterization laboratory (cath lab) is notably higher than that of other fluoroscopic departments [ 2 ], and increased rates of subcapsular cataracts have been reported in cath lab staff [ 3 ]. There is also a suspected causal relationship between occupational exposure and the incidence of breast, brain, and skin cancer [ 4 , 5 ].…”