Comparison of Radiation Exposure Among Interventional Echocardiographers, Interventional Cardiologists, and
David A McNamara1, Rajus Chopra1, Jeffrey M Decker1
1Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
Insights
Interventional echocardiographers face higher radiation exposure during structural heart procedures like LAAO and TEER compared to cardiologists. This study highlights an underappreciated occupational risk for echocardiographers in the growing structural heart team.
Area of Science:
- Cardiology
- Medical Imaging
- Radiation Safety
Background:
- Transesophageal echocardiography is crucial for percutaneous left atrial appendage closure (LAAO) and transcatheter edge-to-edge mitral valve repair (TEER).
- Interventional echocardiographers performing these procedures are positioned near radiation sources, raising concerns about occupational exposure.
- Data on radiation doses for interventional echocardiographers are limited compared to interventional cardiologists.
Purpose of the Study:
- To quantify and compare radiation doses received by interventional echocardiographers, interventional cardiologists, and sonographers during LAAO and TEER procedures.
- To assess the occupational radiation risk for interventional echocardiographers in structural heart interventions.
Main Methods:
- A single-center cross-sectional study was conducted involving 60 sequential LAAO and TEER procedures.
- Radiation doses were measured using real-time dosimeters for interventional echocardiographers, interventional cardiologists, and sonographers.
- Participants and personnel were blinded to radiation dose data during analysis.
Main Results:
- Interventional echocardiographers received a median radiation dose of 10.6 μSv per case, significantly higher than interventional cardiologists (2.1 μSv).
- During TEER, echocardiographers received 10.5 μSv vs. cardiologists' 0.9 μSv; during LAAO, it was 10.6 μSv vs. 3.5 μSv.
- Sonographers had substantially lower radiation doses during both procedures (LAAO: 0.2 μSv; TEER: 0.0 μSv).
Conclusions:
- Interventional echocardiographers experience significantly higher radiation exposure than interventional cardiologists during LAAO and TEER.
- This study identifies a previously underappreciated occupational radiation hazard for interventional echocardiographers.
- Findings have critical implications for radiation safety protocols and team management in structural cardiology.
Importance:
Transesophageal echocardiography during percutaneous left atrial appendage closure (LAAO) and transcatheter edge-to-edge mitral valve repair (TEER) require an interventional echocardiographer to stand near the radiation source and patient, the primary source of scatter radiation. Despite previous work demonstrating high radiation exposure for interventional cardiologists performing percutaneous coronary and structural heart interventions, similar data for interventional echocardiographers are lacking.
Objective:
To assess whether interventional echocardiographers are exposed to greater radiation doses than interventional cardiologists and sonographers during structural heart procedures.
Design, Setting, And Participants:
In this single-center cross-sectional study, radiation doses were collected from interventional echocardiographers, interventional cardiologists, and sonographers at a quaternary care center during 30 sequential LAAO and 30 sequential TEER procedures from July 1, 2016, to January 31, 2018. Participants and study personnel were blinded to radiation doses through data analysis (January 1, 2020, to October 12, 2021).
Exposures:
Occupation defined as interventional echocardiographers, interventional cardiologists, and sonographers.
Main Outcomes And Measures:
Measured personal dose equivalents per case were recorded using real-time radiation dosimeters.
Results:
A total of 60 (30 TEER and 30 LAAO) procedures were performed in 60 patients (mean [SD] age, 79 [8] years; 32 [53.3%] male) with a high cardiovascular risk factor burden. The median radiation dose per case was higher for interventional echocardiographers (10.6 μSv; IQR, 4.2-22.4 μSv) than for interventional cardiologists (2.1 μSv; IQR, 0.2-8.3 μSv; P < .001). During TEER, interventional echocardiographers received a median radiation dose of 10.5 μSv (IQR, 3.1-20.5 μSv), which was higher than the median radiation dose received by interventional cardiologists (0.9 μSv; IQR, 0.1-12.2 μSv; P < .001). During LAAO procedures, the median radiation dose was 10.6 μSv (IQR, 5.8-24.1 μSv) among interventional echocardiographers and 3.5 (IQR, 1.3-6.3 μSv) among interventional cardiologists (P < .001). Compared with interventional echocardiographers, sonographers exhibited low median radiation doses during both LAAO (0.2 μSv; IQR, 0.0-1.6 μSv; P < .001) and TEER (0.0 μSv; IQR, 0.0-0.1 μSv; P < .001).
Conclusions And Relevance:
In this cross-sectional study, interventional echocardiographers were exposed to higher radiation doses than interventional cardiologists during LAAO and TEER procedures, whereas sonographers demonstrated comparatively lower radiation doses. Higher radiation doses indicate a previously underappreciated occupational risk faced by interventional echocardiographers, which has implications for the rapidly expanding structural heart team.
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