Perspective:

The past decade has seen increasing awareness of the cancer risk from diagnostic tests using ionizing radiation, as well as dramatic growth in percutaneous cardiac procedures that utilize both TEE and fluoroscopy. While primary operators typically have access to additional shielding during procedures, TEE operators often do not, and this study demonstrates the consequences of this, with TEE operators having the highest median radiation exposure among the procedural team (although the difference from the primary operator was not statistically significant). From personal experience, this study may underestimate radiation exposure; while performing TEE in crowded procedural rooms, I have often had to stand much closer to the radiation source than depicted in the diagram, while squeezing between anesthesia equipment and a moving C-arm. While this study indicates that TEE operators initially had access to a shield on wheels, this is often not helpful, as it may interfere with manipulation of the TEE probe during procedures. This study demonstrates the potential risk associated with current practice, and should prompt TEE operators to require additional shielding for these procedures.