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Published in: Journal of Interventional Cardiac Electrophysiology 2/2019

01-11-2019

Occupational and patient radiation doses in a modern cardiac electrophysiology laboratory

Authors: Kevin A. Wunderle, Mina K. Chung, Sripriya Rayadurgam, Mark A. Miller, Nancy A. Obuchowski, Bruce D. Lindsay

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2019

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Abstract

Purpose

Technological advancements have greatly expanded the field of cardiac electrophysiology, requiring greater demands on imaging systems and potentially delivering higher radiation doses to patients and operators. With little contemporary research on occupational and patient radiation risk in the electrophysiology laboratory, the aim of this study was to analyze radiation doses, including occupational fetal doses, over approximately the last decade. We benchmarked the occupational data to our patient radiation dose data to allow for comparison and to put into perspective the associated radiation risks.

Methods

Occupational radiation dosimetry analyzed included data from an 11-year period for physicians, a 7-year period for nurses, and a 9-year period for fetal doses. Patient-related dose metrics over an 8-year period were also analyzed.

Results

In the physician and nursing groups, there was a nearly 70% decrease in the average occupational radiation doses over the given periods. Within the electrophysiology department, the average fetal occupational doses were very low, close to 0 μSv. The average reference point air kerma per patient for all electrophysiology procedures decreased from nearly 600 mGy/procedure in 2010 to just over 100 mGy/procedure in 2017.

Conclusions

Patient and occupational radiation doses in our laboratories significantly decreased over the periods analyzed as a result of clinical and technical staff efforts as well as advances in imaging technology. The radiation-related risk to individuals working in our electrophysiology laboratories, including pregnant women, is very low. Data reported herein could be used by other institutions to evaluate their occupational and patient radiation safety practices.
Literature
1.
go back to reference Calkins H, Niklason L, Sousa J, el-Atassi R, Langberg J, Morady F. Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections. Circulation. 1991;84(6):2376–82.CrossRef Calkins H, Niklason L, Sousa J, el-Atassi R, Langberg J, Morady F. Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections. Circulation. 1991;84(6):2376–82.CrossRef
2.
go back to reference Lindsay BD, Eichung JO, Ambos HD, Cain ME. Radiation exposure to patients and medical personnel during radiofrequency catheter ablation for supraventricular tachycardia. Am J Cardiol. 1992;70(2):218–23.CrossRef Lindsay BD, Eichung JO, Ambos HD, Cain ME. Radiation exposure to patients and medical personnel during radiofrequency catheter ablation for supraventricular tachycardia. Am J Cardiol. 1992;70(2):218–23.CrossRef
3.
go back to reference International Electrotechnical Commission. Medical electrical equipment–part 2-43: particular requirements for the basic safety and essential performance of X-ray equipment for interventional procedures. Geneva: IEC; 2010. International Electrotechnical Commission. Medical electrical equipment–part 2-43: particular requirements for the basic safety and essential performance of X-ray equipment for interventional procedures. Geneva: IEC; 2010.
4.
go back to reference Balter S, Miller DL. Patient skin reactions from interventional fluoroscopy procedures. AJR Am J Roentgenol. 2014;202(4):W335–42.CrossRef Balter S, Miller DL. Patient skin reactions from interventional fluoroscopy procedures. AJR Am J Roentgenol. 2014;202(4):W335–42.CrossRef
5.
go back to reference Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, et al. ICRP PUBLICATION 120: radiological protection in cardiology. Ann ICRP. 2013;42:1–125.CrossRef Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, et al. ICRP PUBLICATION 120: radiological protection in cardiology. Ann ICRP. 2013;42:1–125.CrossRef
6.
go back to reference Hirshfeld JW Jr, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT expert consensus document on optimal use of ionizing radiation in cardiovascular imaging-best practices for safety and effectiveness, Part 1: radiation physics and radiation biology: a report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol. 2018;71(24):2811–28.CrossRef Hirshfeld JW Jr, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT expert consensus document on optimal use of ionizing radiation in cardiovascular imaging-best practices for safety and effectiveness, Part 1: radiation physics and radiation biology: a report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol. 2018;71(24):2811–28.CrossRef
7.
go back to reference Hirshfeld JW Jr, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT expert consensus document on optimal use of ionizing radiation in cardiovascular imaging-best practices for safety and effectiveness, part 2: radiological equipment operation, dose-sparing methodologies, patient and medical personnel protection: a report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol. 2018;71(24):2829–55.CrossRef Hirshfeld JW Jr, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT expert consensus document on optimal use of ionizing radiation in cardiovascular imaging-best practices for safety and effectiveness, part 2: radiological equipment operation, dose-sparing methodologies, patient and medical personnel protection: a report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol. 2018;71(24):2829–55.CrossRef
8.
go back to reference Fetterly KA, Mathew V, Lennon R, Bell MR, Holmes DR Jr, Rihal CS. Radiation dose reduction in the invasive cardiovascular laboratory: implementing a culture and philosophy of radiation safety JACC Cardiovasc Interv 2012;5(8):866–873.PubMed Fetterly KA, Mathew V, Lennon R, Bell MR, Holmes DR Jr, Rihal CS. Radiation dose reduction in the invasive cardiovascular laboratory: implementing a culture and philosophy of radiation safety JACC Cardiovasc Interv 2012;5(8):866–873.PubMed
9.
go back to reference Casella M, Dello Russo A, Russo E, Catto V, Pizzamiglio F, Zucchetti M, et al. X-ray exposure in cardiac electrophysiology: a retrospective analysis in 8150 patients over 7 years of activity in a modern, large-volume laboratory. J Am Heart Assoc 2018;7(11):e008233. Casella M, Dello Russo A, Russo E, Catto V, Pizzamiglio F, Zucchetti M, et al. X-ray exposure in cardiac electrophysiology: a retrospective analysis in 8150 patients over 7 years of activity in a modern, large-volume laboratory. J Am Heart Assoc 2018;7(11):e008233.
10.
go back to reference Heidbuchel H, Wittkampf FH, Vanó E, Ernst S, Schilling R, Picano E, et al. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace. 2014;16(7):946–64.CrossRef Heidbuchel H, Wittkampf FH, Vanó E, Ernst S, Schilling R, Picano E, et al. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace. 2014;16(7):946–64.CrossRef
11.
go back to reference Michel R, Perle SC. Effective dose equivalent estimates in diagnostic radiology with single dosimetry. Health Phys. 2000;79(2 Suppl):S17–9.CrossRef Michel R, Perle SC. Effective dose equivalent estimates in diagnostic radiology with single dosimetry. Health Phys. 2000;79(2 Suppl):S17–9.CrossRef
12.
go back to reference Cowen AR, Davies AG, Sivananthan MU. The design and imaging characteristics of dynamic, solid-state, flat-panel x-ray image detectors for digital fluoroscopy and fluorography. Clin Radiol. 2008;63(10):1073–85.CrossRef Cowen AR, Davies AG, Sivananthan MU. The design and imaging characteristics of dynamic, solid-state, flat-panel x-ray image detectors for digital fluoroscopy and fluorography. Clin Radiol. 2008;63(10):1073–85.CrossRef
13.
go back to reference Webster EW. EDE for exposure with protective aprons. Health Phys. 1989;56(4):568–9.PubMed Webster EW. EDE for exposure with protective aprons. Health Phys. 1989;56(4):568–9.PubMed
14.
go back to reference National Council on Radiation Protection and Measurements. Report No. 122: Use of personal monitors to estimate effective dose equivalent and effective dose to workers for external exposure to low-LET radiation, Bethesda MD: NCRP; 1995. National Council on Radiation Protection and Measurements. Report No. 122: Use of personal monitors to estimate effective dose equivalent and effective dose to workers for external exposure to low-LET radiation, Bethesda MD: NCRP; 1995.
15.
go back to reference Balter S. Capturing patient doses from fluoroscopically based diagnostic and interventional systems. Health Phys. 2008;95(5):535–40.CrossRef Balter S. Capturing patient doses from fluoroscopically based diagnostic and interventional systems. Health Phys. 2008;95(5):535–40.CrossRef
16.
go back to reference Jones AK, Pasciak AS. Calculating the peak skin dose resulting from fluoroscopically guided interventions. Part I: methods [erratum in J Appl Clin Med Phys. 2014;15(4):402]. J Appl Clin Med Phys. 2011;12(4):3670.CrossRef Jones AK, Pasciak AS. Calculating the peak skin dose resulting from fluoroscopically guided interventions. Part I: methods [erratum in J Appl Clin Med Phys. 2014;15(4):402]. J Appl Clin Med Phys. 2011;12(4):3670.CrossRef
17.
go back to reference Fisher DR, Fahey FH. Appropriate use of effective dose in radiation protection and risk assessment. Health Phys. 2017;113(2):102–9.CrossRef Fisher DR, Fahey FH. Appropriate use of effective dose in radiation protection and risk assessment. Health Phys. 2017;113(2):102–9.CrossRef
18.
go back to reference Linet MS, Kitahara CM, Ntowe E, Kleinerman RA, Gilbert ES, Naito N, et al.; Multi-specialty occupational health group. Mortality in U.S. physicians likely to perform fluoroscopy-guided interventional procedures compared with psychiatrists, 1979 to 2008. Radiology 2017;284(2):482–494.CrossRef Linet MS, Kitahara CM, Ntowe E, Kleinerman RA, Gilbert ES, Naito N, et al.; Multi-specialty occupational health group. Mortality in U.S. physicians likely to perform fluoroscopy-guided interventional procedures compared with psychiatrists, 1979 to 2008. Radiology 2017;284(2):482–494.CrossRef
19.
go back to reference National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, DC: The National Academies Press; 2006. National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, DC: The National Academies Press; 2006.
20.
go back to reference Verdun FR, Bochud F, Gundinchet F, Aroua A, Schnyder P, Meuli R. Quality initiatives radiation risk: what you should know to tell your patient. Radiographics. 2008;28(7):1807–16.CrossRef Verdun FR, Bochud F, Gundinchet F, Aroua A, Schnyder P, Meuli R. Quality initiatives radiation risk: what you should know to tell your patient. Radiographics. 2008;28(7):1807–16.CrossRef
21.
go back to reference Fetterly K, Schueler B, Grams M, Sturchio G, Bell M, Gulati R. Head and neck radiation dose and radiation safety for interventional physicians. JACC Cardiovasc Interv. 2017;10(5):520–8.CrossRef Fetterly K, Schueler B, Grams M, Sturchio G, Bell M, Gulati R. Head and neck radiation dose and radiation safety for interventional physicians. JACC Cardiovasc Interv. 2017;10(5):520–8.CrossRef
22.
go back to reference Hall EJ. Radiobiology for the radiologist. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000. Hall EJ. Radiobiology for the radiologist. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
23.
go back to reference Wunderle KA, Rakowski JT, Dong FF. Approaches to interventional fluoroscopic dose curves. J Appl Clin Med Phys. 2016;17(1):342–52.CrossRef Wunderle KA, Rakowski JT, Dong FF. Approaches to interventional fluoroscopic dose curves. J Appl Clin Med Phys. 2016;17(1):342–52.CrossRef
24.
go back to reference National Council on Radiation Protection and Measurements. Report No. 168: Radiation dose management for fluoroscopically-guided interventional medical orocedures. Bethesda, MD: NCRP; 2010. National Council on Radiation Protection and Measurements. Report No. 168: Radiation dose management for fluoroscopically-guided interventional medical orocedures. Bethesda, MD: NCRP; 2010.
Metadata
Title
Occupational and patient radiation doses in a modern cardiac electrophysiology laboratory
Authors
Kevin A. Wunderle
Mina K. Chung
Sripriya Rayadurgam
Mark A. Miller
Nancy A. Obuchowski
Bruce D. Lindsay
Publication date
01-11-2019
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 2/2019
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-018-0462-8

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