Radiation safety in catheter ablation: clinical value of real-time operator dosimetry

Advances in interventional cardiology have increased procedural complexity, raising concerns about radiation exposure-especially for women operators of reproductive age, who are subject to stricter dose limits. Standard dosimeters provide only delayed cumulative data, limiting timely risk assessment. Real-time personal dosimetry offers immediate feedback, but its clinical utility during catheter ablation (CA) remains underexplored. We retrospectively analyzed 82 CA procedures performed between January and May 2024. First operators wore real-time dosimeters positioned at the waist under lead aprons. Radiation exposure and procedural characteristics were recorded and analyzed. The median operator radiation dose per procedure was 2 [1, 3] µSv, while the median patient dose was 0.163 [0.082, 0.324] Gy. A procedure-related cardiac tamponade requiring pericardiocentesis resulted in the highest operator dose (50 µSv). Higher patient BMI (≥ 25 kg/m²) and longer fluoroscopy time were independently associated with increased operator exposure (OR: 1.238, P = 0.008; OR: 1.056, P = 0.022), though no linear correlation was observed between BMI and operator dose (r = 0.029, P = 0.797). Radiation exposure to operators during CA is generally low but may increase significantly in the event of complications or with higher-risk patient characteristics. Real-time dosimetry provides valuable immediate feedback and may be especially important for radiation-sensitive operators, supporting safer practice in the evolving field of interventional electrophysiology.