Radiation Exposure and Protection for (Assumed) Pregnant Interventional Cardiologists and Electrophysiologists

Abstract

Background: Concern about fetus radiation dose and assumed health effects remains a barrier for women considering a career in invasive cardiology. However, there is a lack of real-world fetus exposure data that can be used to support career decisions. The purpose of this work was to measure radiation exposure to invasive cardiologists which would contribute to dose to the fetus during pregnancy.

Methods: Radiation exposure to 42 female and male interventional cardiologists and electrophysiologists was monitored during their clinical routine. Multivariate analysis was used to assess the influences of patient radiation exposure, radioprotective garment material thickness (0.25, 0.35, 0.5 mm Pb equivalent), and cardiologist sex, height, and clinical role on occupational radiation exposure to the abdomen.

Results: Exposure to the abdomen of invasive cardiologists increased proportional to patient exposure and decreased predictably with increasing radioprotective material thickness. The median abdomen exposure when covered with a 0.5 mm Pb equivalent radioprotective material over a 40-week period was 0.22 mGy (95th percentile, 0.8 mGy). Physician sex, height, and clinical role did not influence occupational exposure.

Conclusions: The use of a 0.5 mm Pb equivalent radioprotective garment covering the abdomen, combined with appropriate radiation safety practices, can ensure that fetus radiation dose is below both US and international limits. Assumed fetus risk due to very low occupational radiation exposure is likely inconsequential in light of other known pregnancy risks.

Keywords: fetus radiation exposure; occupational health; pregnancy; radiation safety.

Figure 1

Construction and placement of radioprotective material pockets and exposure monitors. (A) Pockets in which the exposure monitors were placed were made of fabric only (0 mm) or 0.25, 0.35, and 0.5 mm Pb-equivalent radioprotective material. Lower-right: exposure monitor, including extended arm to show the exposure absorbing element. (B) The pockets were secured to the outside of the radioprotective garment at the shoulder (1) and the abdomen (4). Note that the illustration does not include the radioprotective glasses which were routinely worn.

Figure 2

Measured exposure values versus physician-specific patient air-kerma area product (KAP) administered over the study period. All data extrapolated to a 40-week term. (A) Uncovered at left shoulder; (B) uncovered at abdomen; (C) 0.25 mm Pb equivalent material at abdomen; (D) 0.5 mm Pb equivalent material at abdomen.

Central Illustration

This study of 42 cardiac catheterization and heart rhythm services cardiologists demonstrated that fetus dose of cardiologists performing invasive procedures can be maintained at very low levels.