Cardiology fellows-in-training are exposed to relatively high levels of radiation in the cath lab compared with staff interventional cardiologists-insights from the RECAP trial.

W Vlastra,J P S Henriques,M A Beijk,M M Vis,J J Piek,K D Sjauw,B E Claessen,J J Wykrzykowska,G J Streekstra,R J De Winter,R Delewi,K T Koch

doi:10.1007/s12471-019-1254-1

W Vlastra, J P S Henriques + Show 10 more

Open Access

https://doi.org/10.1007/s12471-019-1254-1

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Abstract

BackgroundInterventional cardiologists are inevitably exposed to low-dose radiation, and consequently are at risk for radiation induced diseases like cataract and left-sided brain tumours. Operator behaviour may possibly be the largest influencer on radiation exposure. We hypothesised that awareness regarding radiation exposure grows as skill and the general experience in the catheterization laboratory increase.ObjectivesIn this study we determined the difference in the relative radiation exposure of staff interventional cardiologists compared with cardiology fellows-in-training.MethodsDuring this prospective trial the operator’s radiation exposure (E in µSv) was measured at chest height during 766 diagnostic catheterisations and percutaneous coronary interventions. Also, the patient exposure (DAP in mGy·cm2), representing the amount of radiation administered by the operator per procedure, was collected. The primary outcome of this study was the difference in relative exposure between staff interventional cardiologists versus cardiology fellows-in-training (E/DAP).ResultsFrom January to May 2017, staff interventional cardiologists performed 637 procedures and cardiology fellows-in-training 129 procedures. The performance of relatively complex procedures by staff interventional cardiologists resulted in a 74% higher use of radiation compared with fellows-in-training. Consequently, staff interventional cardiologists were exposed to 50% higher levels of actual radiation exposure. However, when correcting for the complexity of the procedure, by comparing the relative operator exposure (E/DAP), fellows-in-training were exposed to a 34% higher relative exposure compared with staff interventional cardiologists (p = 0.025).ConclusionsIn the current study, when corrected for complexity, cardiology fellows-in-training were exposed to significantly higher radiation levels than staff interventional cardiologists during catheterisation procedures.

Highlights

Despite the technological developments of the last decades, the profession of an interventional cardiologist is inevitably related to exposure to low-dose radiation
During the 4-month study period of the RECAP trial, staff interventional cardiologists were the primary operator during 637 coronary procedures, whereas cardiology fellows-in-training were the primary operator in 129 procedures
In the current study cardiology fellowsin-training were exposed to significantly higher radiation levels than staff interventional cardiologists during catheterisation procedures, when corrected for complexity

Summary

Introduction

Despite the technological developments of the last decades, the profession of an interventional cardiologist is inevitably related to exposure to low-dose radiation. Interventional cardiologists are at risk for developing radiation-induced diseases such as cataract and left-sided brain tumours [1, 2]. We hypothesised that awareness regarding radiation exposure among operators grows as skill and the general experience in the catheterisation laboratory increase. Interventional cardiologists are inevitably exposed to low-dose radiation, and are at risk for radiation induced diseases like cataract and left-sided brain tumours. Operator behaviour may possibly be the largest influencer on radiation exposure. We hypothesised that awareness regarding radiation exposure grows as skill and the general experience in the catheterization laboratory increase

Objectives

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Conclusion