Radiaion safety in the cardiac catheterizaion laboratory: our responsibility to change

1Eugenio Picano, 2Emanuela Piccaluga, 3Renato Padovani, 4Claudio Antonio Traino, maria Grazia Andreassi, 5Giulio Guagliumi
1CNR, Insitute of Clinical Physiology, Pisa, Italy; 2Cardiology Unit, Hospital Sacco, Milan, Italy; 3Medical Physics Department, University Hospital, Udine, Italy; 4Division of Health Physics University Hospital of Pisa, Pisa, Italy; 5Intervenional Cardiology Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy

Medical radiaion from x-rays and nuclear medicine is the largest manmade source of radiaion exposure in Western countries, and accounts for a mean efecive dose of 3.0 milliSievert (mSv) per person per year, equivalent to the radiological risk of 150 chest x-rays. Of these, 0.43 mSv come from intervenional radiology (0.20 mSv) and intervenional cardiology (0.23 mSv). Among adult cardiology paients, luoroscopically-guided diagnosis and intervenion account for 12% of all radiological examinaions performed, and 48% of their total collecive dose. On average, a diagnosic invasive angiogram corresponds to a paient radiaion exposure of about 7 mSv (range 2-16), while coronary stening corresponds to 15 mSv (range 7-57). Progressively higher efecive doses are observed for transcutaneous aoric valvuloplasty (39 mSv), dilaion of total occlusion of coronary arteries (81 mSv, range 17-194) and endovascular thoraco-abdominal aneurysm repair procedure (76-190 mSv). Most experienced (and most exposed) intervenional cardiologists have an exposure per annum of around 5 mSv, two to three imes higher than diagnosic radiologists, with a typical cumulaive lifeime cumulaive exposure around 100 mSv and atributable risk in the order of magnitude of 1 cancer (fatal and non-fatal) per 100 exposed subjects. However, adequate radiaion protecion training and diligent protecion can reduce this radiaion exposure by 90%. Atenion to radiaion protecion is one aspect - and not the least important - of good pracice of intervenional cardiology.




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