Abstract and Introduction
Abstract
The use of ionizing radiation is associated with a risk of inducing malignant disease and causing skin or eye damage to the patient and the personnel. This article focuses on the role of the operator in limiting the radiation exposure of the involved persons during interventional cardiology procedures. There is a great variation in radiation doses between different experienced operators. The operator is responsible for all excess radiation exposure during a given procedure. Measures contributing to radiation reduction by the operator are reviewed herein. It can be concluded that the current proposed reference level of the mean radiation dose for interventional procedures is twice as high as is reasonably achievable and three-to-four-times higher than can be achieved by operators dedicated to dose reduction. Thus, there is room for improvement, and this can be achieved by focused learning of radiation-reducing measures.
Introduction
Ionizing radiation is used extensively in cardiac diagnostic and percutaneous coronary interventional (PCI) procedures. The radiation is associated with a small but definite stochastic risk of inducing a malignant disease. However, low-dose radiation exposure has also been shown to induce an increase in the number of circulating lymphocytes and chromosome aberrations, which represent surrogate biomarkers of cancer risk. The long-term cancer risk increases with increasing cumulative dose and there is no known threshold value. Furthermore there is a deterministic risk of skin damage both to the patient and the operator, as well as a small risk of eye injury to the operator. The risk by radiation exposure to the operator is by no means negligible as there are many operators who carry out up to 400–800 PCI procedures per year for more than 20 years.
The radiation exposure in interventional cardiology is determined by a series of factors that are partly administered by each procedure and partly dependent on the conduct of the operator and other personnel. The radiation management by the operator is the most important modifiable factor in radiation protection when using a given equipment.