Radiation Exposure to Health Professionals Performing Structural Heart Interventions

Jul 13, 2022
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Authors:
McNamara DA, Chopra R, Decker JM, et al.
Citation:
Comparison of Radiation Exposure Among Interventional Echocardiographers, Interventional Cardiologists, and Sonographers During Percutaneous Structural Heart Interventions. JAMA Netw Open 2022;5:e2220597.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • Interventional echocardiographers received significantly greater head-level radiation doses than interventional cardiologists during two commonly performed structural heart cases.
  • In more than a quarter of cases, the interventional echocardiographer received a dose that exceeded 20 μSv, which is roughly 10-fold higher than the previously reported mean personal dose equivalent received by interventional cardiologists across a variety of different procedures.
  • This study highlights a previously underrecognized occupational radiation exposure risk and has important implications for the rapidly expanding field of interventional echocardiography and for the structural heart team.

Study Questions:

What are the radiation doses for interventional echocardiographers compared with those of interventional cardiologists and sonographer controls during left atrial appendage occlusion (LAAO) and transcatheter edge-to-edge mitral valve repair (TEER) procedures?

Methods:

The investigators conducted a single-center cross-sectional study and collected radiation doses from interventional echocardiographers, interventional cardiologists, and sonographers at a quaternary care center during 30 sequential LAAO and 30 sequential TEER procedures from July 2016–January 2018. Participants and study personnel were blinded to radiation doses through data analysis. Measured personal dose equivalents per case were recorded using real-time radiation dosimeters. P values for comparison of continuous variables across the three occupations were derived from pairwise comparisons using the Wilcoxon rank sum test with a Bonferroni correction used to adjust the α for those tests as appropriate.

Results:

A total of 60 (30 TEER and 30 LAAO) procedures were performed (mean [standard deviation] age, 79 [8] years; 32 [53.3%] male) with a high cardiovascular risk factor burden. The median radiation dose per case was higher for interventional echocardiographers (10.6 μSv; interquartile range [IQR], 4.2-22.4 μSv) than for interventional cardiologists (2.1 μSv; IQR, 0.2-8.3 μSv; p < 0.001). During TEER, interventional echocardiographers received a median radiation dose of 10.5 μSv (IQR, 3.1-20.5 μSv), which was higher than the median radiation dose received by interventional cardiologists (0.9 μSv; IQR, 0.1-12.2 μSv; p < 0.001). During LAAO procedures, the median radiation dose was 10.6 μSv (IQR, 5.8-24.1 μSv) among interventional echocardiographers and 3.5 (IQR, 1.3-6.3 μSv) among interventional cardiologists (p < 0.001). Compared with interventional echocardiographers, sonographers exhibited low median radiation doses during both LAAO (0.2 μSv; IQR, 0.0-1.6 μSv; p < 0.001) and TEER (0.0 μSv; IQR, 0.0-0.1 μSv; p < 0.001).

Conclusions:

The authors reported that interventional echocardiographers were exposed to higher radiation doses than interventional cardiologists during LAAO and TEER procedures, whereas sonographers demonstrated comparatively lower radiation doses.

Perspective:

This cross-sectional study of occupational radiation exposure indicates that interventional echocardiographers received significantly greater head-level radiation doses than interventional cardiologists during two commonly performed structural heart cases. Furthermore, in more than a quarter of cases, the interventional echocardiographer received a dose that exceeded 20 μSv, which is roughly 10-fold higher than the previously reported mean personal dose equivalent received by interventional cardiologists across a variety of different procedures. Taken collectively, the findings of this study highlight a previously underrecognized occupational radiation exposure risk and has important occupational health implications for the rapidly expanding field of interventional echocardiography and for the structural heart team.

Clinical Topics: Geriatric Cardiology, Noninvasive Imaging, Valvular Heart Disease, Echocardiography/Ultrasound

Keywords: Atrial Appendage, Cardiology Interventions, Coronary Occlusion, Diagnostic Imaging, Echocardiography, Geriatrics, Heart Disease Risk Factors, Heart Valve Diseases, Health Personnel, Mitral Valve, Occupational Health, Radiation, Radiation Dosage, Risk Factors


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