Radiation safety in the cardiac catheterization laboratory: Our responsibility to change

Abstract

Medical radiation from x-rays and nuclear medicine is the largest manmade source of radiation exposure in Western countries, and accounts for a mean effective dose of 3.0 milliSievert (mSv) per person per year, equivalent to the radiological risk of 150 chest x-rays. Of these, 0.43 mSv come from interventional radiology (0.20 mSv) and interventional cardiology (0.23 mSv). Among adult cardiology patients, fluoroscopically-guided diagnosis and intervention account for 12% of all radiological examinations performed, and 48% of their total collective dose. On average, a diagnostic invasive angiogram corresponds to a patient radiation exposure of about 7 mSv (range 2-16), while coronary stenting corresponds to 15 mSv (range 7-57). Progressively higher effective doses are observed for transcutaneous aortic valvuloplasty (39 mSv), dilation of total occlusion of coronary arteries (81 mSv, range 17-194) and endovascular thoraco-abdominal aneurysm repair procedure (76-190 mSv). Most experienced (and most exposed) interventional cardiologists have an exposure per annum of around 5 mSv, two to three times higher than diagnostic radiologists, with a typical cumulative lifetime cumulative exposure around 100 mSv and attributable risk in the order of magnitude of 1 cancer (fatal and non-fatal) per 100 exposed subjects. However, adequate radiation protection training and diligent protection can reduce this radiation exposure by 90%. Attention to radiation protection is one aspect - and not the least important - of good practice of interventional cardiology.