Occupational Pelvic and Chest-Level Radiation Exposure Among Interventional Echocardiographers During Percutaneous
Priscilla Wessly1, Jeremiah Haines1, Emily Jimenez2
1Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA; Department of Cardiovascular Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
Background:
Rapid expansion of transcatheter structural heart interventions has increased occupational radiation exposure for interventional echocardiographers (IEs).
Objectives:
The authors aimed to quantify real-time underlead pelvic and chest-level radiation exposure to IEs during left atrial appendage occlusion (LAAO), transcatheter mitral valve intervention (TMVI), and transcatheter tricuspid valve intervention (TTVI); estimate implications for fetal safety; and identify independent predictors of higher chest dose.
Methods:
This prospective, single-center study quantified radiation exposure during 118 LAAO, 59 TMVI, and 53 TTVI procedures from February 2025 to February 2026. Multivariable linear regression on log-transformed chest-level dose identified independent predictors. Comparisons used Kruskal-Wallis, Mann-Whitney U, and Spearman tests.
Results:
Pelvic dose was 0 μSv in 98.7% of cases; estimated dose for full pregnancy was ∼2.3 μSv, well below the recommended limit. Median raw chest-level exposure was 9.0 μSv (IQR: 3.2-21.0) for LAAO, 18.0 μSv (7.5-43.5) for TMVI, and 36.0 μSv (16-116) for TTVI (P < 0.001). IEs received 10- to 50-fold higher doses than sonographers (P < 0.001). Independent predictors of higher chest-level dose were higher log(dose-area product) (1.57; 95% CI: 1.29-1.91), head-of-bed positioning (2.17; 95% CI: 1.06-4.43), TMVI (2.27; 95% CI: 1.44-3.58), and TTVI (2.70; 95% CI: 1.35-5.40) vs LAAO, and half-shield-only use (3.78; 95% CI: 1.51-9.44) (all P ≤ 0.035).
Conclusions:
The near absence of detectable under-lead pelvic radiation with standard lead apparel and shielding provides strong reassurance regarding reproductive safety. IEs sustain higher chest-level radiation exposure during TMVI and TTVI than LAAO. Head-of-bed positioning and half-shield-only use are key modifiable drivers, underscoring the need for standardized full-shielding protocols and positional awareness.
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