Highlights
- •Right heart catheterizations (RHC) and endomyocardial biopsies (EMB) are frequently performed using the internal jugular (IJ) approach.
- •The physician radiation exposure during RHC with EMB using the IJ approach is similar to that of coronary angiography.
- •Education regarding this occupational risk to cardiologists performing RHC and EMB is necessary.
ABSTRACT
Background
Cardiologists performing coronary angiography (CA) and percutaneous coronary intervention
(PCI) are at risk of health problems related to chronic occupational radiation exposure.
Unlike during CA and PCI, physician radiation exposure during right heart catheterization
(RHC) and endomyocardial biopsy (EMB) has not been adequately studied. The objective
of this study was to assess physicians’ radiation doses during RHC with and without
EMB and compare them to those of CA and PCI.
Methods
Procedural head-level physician radiation doses were collected by real-time dosimeters.
Radiation-dose metrics (fluoroscopy time, air kerma [AK] and dose area product [DAP]),
and physician-level radiation doses were compared among RHC, RHC with EMB, CA, and
PCI.
Results
Included in the study were 351 cardiac catheterization procedures. Of these, 36 (10.3%)
were RHC, 42 (12%) RHC with EMB, 156 (44.4%) CA, and 117 (33.3%) PCI. RHC with EMB
and CA had similar fluoroscopy time. AK and DAP were progressively higher for RHC,
RHC with EMB, CA, and PCI. Head-level physician radiation doses were similar for RHC
with EMB vs CA (P = 0.07). When physicians’ radiation doses were normalized to DAP, RHC and RHC with
EMB had the highest doses.
Conclusion
Physicians’ head-level radiation doses during RHC with EMB were similar to those of
CA. After normalizing to DAP, RHC and RHC with EMB were associated with significantly
higher physician radiation doses than CA or PCI. These observations suggest that additional
protective measures should be undertaken to decrease physicians’ radiation exposure
during RHC and, in particular, RHC with EMB.
Graphical abstract
Graphical Abstract
Key Words
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References
- Risk of cataract among interventional cardiologists and catheterization lab staff: a systematic review and meta-analysis.Cath Cardiovasc Interven. 2017; 90: 1-9
- Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff.JACC Cardiovasc Interven. 2015; 8: 616-627
- Brain and neck tumors among physicians performing interventional procedures.Am J Cardiol. 2013; 111: 1368-1372
- Patient body mass index and physician radiation dose during coronary angiography.Circulat Cardiovasc Interven. 2019; 12e006823
- Suspended lead suit and physician radiation doses during coronary angiography.Cath Cardiovasc Interven. 2022; 99: 981-988
- Radiation protection in the cardiac catheterization laboratory.J Thor Dis. 2020; 12: 1648-1655
- Impact of robotics and a suspended lead suit on physician radiation exposure during percutaneous coronary intervention.Cardiovasc Revasc Med. 2017; 18: 190-196
- Radiation exposure among scrub technologists and nurse circulators during cardiac catheterization: the impact of accessory lead shields.JACC Cardiovasc Interven. 2018; 11: 206-212
- Increased mitochondrial DNA4977-bp deletion in catheterization laboratory workers with long-term low-dose exposure to ionizing radiation.Eur J PreventcCardiol. 2019; 26: 976-984
- Somatic DNA damage in interventional cardiologists: a case-control study.FASEB J. 2005; 19: 998-999
- Radiation-induced DNA damage in operators performing endovascular aortic repair.Circulation. 2017; 136: 2406-2416
- Role of experience, leadership and individual protection in the cath lab: a multicenter questionnaire and workshop on radiation safety.RoFo. 2015; 187: 899-905
- Radiation safety in the cardiac catheterization laboratory: operational radiation safety.Cathe Cardiovasc Interven. 1999; 47: 347-353
- Radiation exposure levels according to vascular access sites during PCI: a prospective controlled study.Herz. 2019; 44: 330-335
- Operator radiation and the efficacy of ceiling-suspended lead screen shielding during coronary angiography: an anthropomorphic phantom study using real-time dosimeters.Sci Rep. 2017; 7: 42077
- Comparison of radiation exposure among interventional echocardiographers, interventional cardiologists, and sonographers during percutaneous structural heart interventions.JAMA netw open. 2022; 5e2220597
- Occupational radiation doses to operators performing cardiac catheterization procedures.Health Physics. 2008; 94: 211-227
- Pediatric patient radiation dosage during endomyocardial biopsies and right heart catheterization using a standard "ALARA" radiation reduction protocol in the modern fluoroscopic era.Cath Cardiovas Interven. 2014; 83: 80-83
- Strategies for radiation exposure-sparing in fluoroscopically guided invasive cardiovascular procedures.Cath Cardiovasc Intervent. 2020; 95: 118-127
- Echocardiography-guided endomyocardial biopsy: a 5-year experience.Circulation. 1988; 78 (99–102)
Article info
Publication history
Published online: October 01, 2022
Accepted:
September 16,
2022
Received in revised form:
September 15,
2022
Received:
August 10,
2022
Grand Rapids, MichiganPublication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc.
