Occupational exposure in the electrophysiology laboratory: quantifying and minimizing radiation burden

Fluoroscopically guided procedures in the electrophysiology room, such as radiofrequency catheter ablation and implantation of cardiac resynchronization devices, may result in high radiation exposure of electrophysiologists and assisting staff. Our aim was to provide accurate and applicable data on occupational doses to the electrophysiology laboratory personnel. We exposed fluoroscopically an anthropomorphic phantom at three projections common in electrophysiology studies. For each exposure, scattered radiation was measured at 182 sites of the cardiology room at four body levels. Effective dose values, eye lens, skin and gonadal doses to the laboratory staff were calculated. Our study has shown that a procedure requiring 40 min of fluoroscopy yields a maximum effective dose of 129 microSv and a maximum value of gonadal dose of 56.8 microSv to staff using a 0.35 mm lead-equivalent apron. A conservative estimate of the electrophysiologist's annual maximum permissible workload is 155 procedures. Staff effective dose values vary by a factor of 40 due to positioning during fluoroscopy and by a factor of 11 due to radiation protection equipment. Undercouch protective shields may reduce gonadal doses up to 98% and effective dose up to 25%. Consequently, radiation levels in the electrophysiology room are not negligible. Mitigation of occupational exposure is feasible through good fluoroscopy and working practices.