Quantifying Radiation Exposure Across Cardiac Catheterization Procedures

Background: Coronary angiography and percutaneous coronary intervention are essential procedures for managing coronary artery disease but expose patients and healthcare personnel to ionizing radiation. Radiation exposure varies with procedural complexity and vascular access route, and repeated occupational exposure in catheterization laboratories (cath-labs) has been linked to serious health hazards among operators. Objectives: Given the high procedural volume and limited routine monitoring at Bangladesh Medical University (BMU), Bangladesh, this study aimed to quantify operator radiation exposure and identify factors influencing radiation dose. Methods: This analytical cross-sectional study was conducted from November 2023 to April 2024 in two cardiac cath-labs at BMU using two Siemens Axiom Artis angiography systems. Patient, operator, and procedural data, including demographics, operator experience, procedure type, vascular access route, fluoroscopic view, procedure duration, and radiation exposure, were collected from randomly selected routine procedures. Operator radiation exposure was measured at four working positions using a dosimeter, and cumulative annual exposure was estimated based on procedural workload. Descriptive, univariable, and multivariable analyses were performed to identify factors associated with radiation exposure. Results: The study analyzed 776 procedures, in which most patients were aged 46-65 years and male. The majority of procedures were coronary angiography performed via the femoral route. On average, each procedure required 14.28 fluoroscopic views and lasted 8.16 min, with a mean radiation exposure of 1034.5 mGy. Procedural complexity, radial access, and stent use were associated with higher fluoroscopic views, longer procedure time, and increased radiation exposure. Multivariable analysis showed that procedure type and stent number are primarily determinants for the number of fluoroscopic views, while procedure time was mainly driven by imaging demand and vascular access route. Radiation exposure was strongly associated with both procedure time and the number of views, and was higher among male and older patients but slightly lower with femoral access and among older operators. Direct measurements showed higher radiation levels near the operator's X-ray beam, while estimated annual operator exposure remained low inside the lead apron (0.03-0.05 mSv) compared with outside the lead apron (0.6-1.1 mSv), which is within the limit of internationally accepted cumulative absorbed radiation. Conclusions: This study provides the first comprehensive evaluation of operator radiation exposure in a cardiac cath-lab in the country and the wider region. Procedural characteristics, particularly fluoroscopy use and procedural complexity, were the primary determinants of radiation exposure, while effective shielding and increased distance substantially reduced operator dose. These findings highlight the importance of imaging optimization and consistent implementation of the ALARA principle through structured radiation safety training and careful procedural planning to further minimize occupational exposure.