Physicians' radiation exposure in the catheterization lab: does the type of procedure matter?

Abstract

Objectives: This study sought to evaluate differences in radiation exposure of the operator depending on the type of catheterization lab procedure.

Background: Invasive cardiologists and angiologists are exposed to long-term, low-dose occupational radiation. Increased workload and specialization require more detailed knowledge of the extent and cause of the radiation exposure.

Methods: In this prospective single-center experience, radiation doses of 3 operators were measured by real-time dosimetry for body, neck, and hand during 284 procedures in 281 patients over a period of 14 weeks. To determine the association between the type of procedure and the doses and to draw a pairwise comparison between the procedures, 3 mixed models were used.

Results: The type of procedure, the patient's body mass index, and the fluoroscopy time were independently associated with the operator's radiation exposure. Per procedure, the operators were exposed to a mean effective dose (E) of 2.2 ± 5.9 μSv. Compared with coronary angiography, E was 2.3-fold higher in pelvic procedures (95% confidence interval [CI]: 1.7 to 3.0, p < 0.001), 1.7-fold higher in upper limb procedures (95% CI: 1.3 to 2.1, p < 0.001), and 1.4-fold higher in below-the-knee procedures (95% CI: 1.1 to 2.0, p = 0.023). The mean eye dose was 19.1 ± 37.6 μSv. Eye doses were significantly higher in peripheral procedures than in coronary angiography procedures. The mean hand dose was 99.6 ± 196.0 μSv. Hand doses were significantly higher in pelvic than in coronary angiography, upper limb, and below-the-knee procedures.

Conclusions: Endovascular procedures for pelvic, upper limb, and below-the-knee disease are accompanied with a higher radiation exposure of the operator than with coronary procedures.

Keywords: BMI; BTK; CAG; CI; DAP; E; FISH; ICRP; International Commission on Radiological Protection; NCRP; National Council on Radiation Protection and Measurements; PCI; UL; below the knee; biological dosimetry; body mass index; confidence interval; coronary angiography; dose area product; dose aware system; estimated effective dose; fluorescence in situ hybridization; occupational radiation exposure; percutaneous coronary intervention; radiation exposure in cardiology and angiology; real-time dosimetry; upper limb.