A comparison of patient dose and occupational eye dose to the operator and nursing staff during transcatheter cardiac and endovascular procedures

Abstract

The number and complexity of transcatheter procedures continue to increase, raising concerns regarding radiation exposure to patients and staff. Procedures such as transaortic valve implantations (TAVI) have led to cardiologists adopting higher dose techniques, such as digital subtraction angiography (DSA). This study compared the estimated patient and occupational eye dose during coronary angiography (CA), percutaneous coronary intervention (PCI), TAVI workups (TWU), TAVI, endovascular aneurysm repairs (EVAR), and other peripheral diagnostic (VD) and interventional (VI) vascular procedures. A quantitative analysis was performed on patient dose during 299 endovascular and 1498 cardiac procedures. Occupational dose was measured for the cardiologists (n = 24), vascular surgeons (n = 3), scrub (n = 32) and circulator nurses (n = 35). TAVI and EVAR were associated with the highest average dose for all staff, and significantly higher patient dose area product, probably attributable to the use of DSA. Scrub nurses were exposed to higher average doses than the operator and scout nurse during CA, VD and VI. Circulating nurses had the highest average levels of exposure during TAVI. This study has demonstrated that EVAR and TAVI have similar levels of occupational and patient dose, with a notable increase in circulator dose during TAVI. The use of DSA during cardiac procedures is associated with an increase in patient and staff dose, and cardiologists should evaluate whether DSA is necessary. Scrub nurses may be exposed to higher levels of occupational dose than the operator.