Physician Radiation Exposure During Endomyocardial Biopsy and Right Heart Catheterization
Renzo Y Loyaga-Rendon1, Sangjin Lee1, Michael G Dickinson1
1Advanced Heart Failure Section, Frederick Meijer Heart & Vascular Institute, Spectrum Health.
Insights
Physician radiation exposure during right heart catheterization (RHC) with endomyocardial biopsy (EMB) is similar to coronary angiography (CA). However, RHC and RHC with EMB show higher radiation doses when normalized to dose area product, necessitating enhanced protective measures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Occupational Health
Background:
- Cardiologists face health risks from chronic radiation exposure during procedures like coronary angiography (CA) and percutaneous coronary intervention (PCI).
- Physician radiation exposure during right heart catheterization (RHC) and endomyocardial biopsy (EMB) is less understood compared to CA and PCI.
Purpose of the Study:
- To assess physician radiation doses during RHC, with and without EMB.
- To compare these doses to those received during CA and PCI.
Main Methods:
- Real-time dosimeters measured head-level physician radiation doses.
- Compared radiation dose metrics (fluoroscopy time, air kerma, dose area product) and physician doses across RHC, RHC with EMB, CA, and PCI procedures.
Main Results:
- RHC with EMB and CA had comparable fluoroscopy times.
- Air kerma and dose area product increased progressively from RHC to RHC with EMB, CA, and PCI.
- Physician head doses were similar for RHC with EMB versus CA (P=0.07).
- When normalized to dose area product, RHC and RHC with EMB exhibited the highest physician radiation doses.
Conclusions:
- Physician head radiation doses during RHC with EMB are comparable to CA.
- Normalized to dose area product, RHC and RHC with EMB procedures result in significantly higher physician radiation doses than CA or PCI.
- Increased protective measures are recommended to reduce physician radiation exposure during RHC, especially when combined with EMB.
Background:
Cardiologists performing coronary angiography (CA) and percutaneous coronary intervention (PCI) are at risk of health problems related to chronic occupational radiation exposure. Unlike during CA and PCI, physician radiation exposure during right heart catheterization (RHC) and endomyocardial biopsy (EMB) has not been adequately studied. The objective of this study was to assess physicians' radiation doses during RHC with and without EMB and compare them to those of CA and PCI.
Methods:
Procedural head-level physician radiation doses were collected by real-time dosimeters. Radiation-dose metrics (fluoroscopy time, air kerma [AK] and dose area product [DAP]), and physician-level radiation doses were compared among RHC, RHC with EMB, CA, and PCI.
Results:
Included in the study were 351 cardiac catheterization procedures. Of these, 36 (10.3%) were RHC, 42 (12%) RHC with EMB, 156 (44.4%) CA, and 117 (33.3%) PCI. RHC with EMB and CA had similar fluoroscopy time. AK and DAP were progressively higher for RHC, RHC with EMB, CA, and PCI. Head-level physician radiation doses were similar for RHC with EMB vs CA (P = 0.07). When physicians' radiation doses were normalized to DAP, RHC and RHC with EMB had the highest doses.
Conclusion:
Physicians' head-level radiation doses during RHC with EMB were similar to those of CA. After normalizing to DAP, RHC and RHC with EMB were associated with significantly higher physician radiation doses than CA or PCI. These observations suggest that additional protective measures should be undertaken to decrease physicians' radiation exposure during RHC and, in particular, RHC with EMB.
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