Advertisement

Radiation Exposure and Adverse Health Effects of Interventional Cardiology Staff

  • Chandrasekharan Nair Kesavachandran
  • Frank Haamann
  • Albert Nienhaus
Part of the Reviews of Environmental Contamination and Toxicology book series (RECT, volume 222)

Abstract

Coronary angiography (CA), percutaneous coronary intervention (PCI), catheter-based structural heart intervention, electrophysiological studies, and arrhythmia ablation are procedures that help cardiologists ensure better clinical diagnosis and treatment (Dawkins et al. 2005). During these procedures, catheters, guide wires, and other devices are visualized and guided by using real-time fluoroscopy. Therefore, operators are inevitably exposed to radiation (Kim and Miller 2009). Compared to other departments (radiology, urology, operating rooms, etc.), the cardiovascular or catheterization laboratory is generally considered to be an area of high radiation exposure (Raza 2011). Interventional cardiology (IC) staff is exposed more radiation per year than are radiologists by a factor of two to three (Picano et al. 2007). Invasive cardiology procedures have increased tenfold in the past decade, and growth in the field has been accompanied by concern for the safety of such staff (Picano et al. 2007).

Keywords

Radiation Dose Percutaneous Coronary Intervention Personal Protective Equipment Catheterization Laboratory Interventional Cardiology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We wish to thank Dana Wendeler, Documentation officer, Department of Occupational Health Research, Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany, for her support with the management of the literature. This research project was funded by the Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany.

References

  1. Andreassi MG, Cioppa A, Botto N, Joksic G, Manfredi S, Federici C, Ostojic M, Rubino P, Picano E (2005) Somatic DNA damage in interventional cardiologists: a case–control study. FASEB J19(8):998–9Google Scholar
  2. Asian Network of Cardiologists in Radiation Protection—under RCA/IAEA project (2007) Newsletter (Issue N1): 1–2. Available via http: 77rpop.iaea.org/RPOP/RPoP/Content/AdditionalResources/Training/2_TrainingEvents/asian-network.htm. Accessed 23 Nov 2011Google Scholar
  3. Bjelac CO, Rehani MM, Sim KH, Liew HB, Vano E, Kleiman NJ (2010) Risk for radiation induced cataract for staff in interventional cardiology: Is there reason for concern? Catheter Cardiovasc Interv 76:826–834CrossRefGoogle Scholar
  4. Balter S (1993) Guidelines for personnel radiation monitoring in the cardiac catheterisation laboratory. Cathet Cardiovasc Diagn 30:277–279CrossRefGoogle Scholar
  5. Calkins H, Niklason L, Sousa J, El-Atassi R, Langberg J, Morady F (1991) Radiation exposure during radiofrequency catheter ablation of accessory atrio ventricular connections. Circulation 84:2376–82CrossRefGoogle Scholar
  6. Camm AJ, Reid J, Raphael M, Wilde P, Boyle R, Clarke M, Qureshi S, Rothman M, Shaw A (1993) Radiation hazards to the cardiologist—a report of a Subcommittee of the British Cardiac Society. Br Heart J 70:489–496CrossRefGoogle Scholar
  7. Dawkins KD, Gershlick T, de Belder M (2005) Percutaneous coronary intervention: Recommendations for good practice and training. Heart 91(6):1–27CrossRefGoogle Scholar
  8. Damilakis J, Koulourakis M, Hatjidakis S, Karabekios S, Gourtsoyiannis N (1995) Radiation exposure to the hands of operators during angiographic procedures. Br J Radiol 21:72–5Google Scholar
  9. Domienik J, Brodecki M, Carinou E, Donadille L, Jankowski J, Koukorava C, Krim S, Nikodemova D, Ruiz Lopez N, Sans Merce M, Struelens L, Vanhavere F (2011) Extremity and eye lens doses in interventional radiology and cardiology procedures. First results of the oramed project. Radiat Prot Dosim 144(1–4):442–447CrossRefGoogle Scholar
  10. Delichas M, Psarrakos K, Molyvda-Athanassopoulou E, Giannoglou G, Sioundas A, Hatziioannou K, Papanastassiou E (2003) Radiation exposure to cardiologists performing interventional cardiology procedures. Eur J Radiol 48:268–273CrossRefGoogle Scholar
  11. Duran D, Duran G, Ramirez R, Vano E, Kleinman N, Echeverri D, Gomez G, Cabrera M (2009) Cataracts in interventional cardiology personnel. Retrospective evaluation study of lens injuries and dose (RELID Study). Eur Heart J 30:872Google Scholar
  12. Efstathopoulos E, Makrygiannis SS, Kottou S, Karvouni E, Giazitzoglou E, Korovesis S, Tzanalaridon E, Rapton PD, Katritsis DG (2003) Medical personnel and patient dosimetry during coronary angiography and intervention. Phys Med Biol 48:3059–68CrossRefGoogle Scholar
  13. Efstathopoulos EP, Pantos I, Andreou M, Gkatzis A, Carinou E, Koukorava C, Kelekis NL, Brountzos E (2011) Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures. Br J Radiol 84:70–77CrossRefGoogle Scholar
  14. Finkelstein MM (1998) Is brain cancer an occupational disease of cardiologists? Can J Cardiol 14:1385–1388Google Scholar
  15. German Guidelines (2003) Bekanntmachung der Neufassung der Röntgenverordnung vom 30. April 2003. Bundesgesetzblatt 2003; Teil 1:604–635Google Scholar
  16. Goni H, Papadopoulou D, Yakoumakis E, Stratigis N, Benos J, Siriopoulou V, Makri T, Georgiou E (2005) Investigation of occupational radiation exposure during interventional cardiac catheterisations performed via radial artery. Radiat Prot Dosim 117:107–110CrossRefGoogle Scholar
  17. Grant SCD, Faragher EB, Hufton AP, Bennett DH (1993) Use of a remotely controlled mechanical pump for coronary arteriography—a study of radiation exposure and quality implications. Br Heart J70:479–484CrossRefGoogle Scholar
  18. Hafez MA, Smith RM, Matthews SJ, Kalap G, Sherman KP (2005) Radiation exposure to the hands of orthopaedic surgeons: are we underestimating the risk? Arch Orthop Trauma Surg 125:330–335CrossRefGoogle Scholar
  19. Haskal ZJ (2004) Interventional radiology carries occupational risk for cataracts. RSNA News 14:5–6Google Scholar
  20. International Commission on Radiological Protection (2000) Avoidance of radiation injuries from medical interventional procedures. ICRP Publication 85. Ann ICRP 230:7–67Google Scholar
  21. International Commission on Radiological Protection (2011) Tissue reactions and other non-cancer effects of radiation. Elsevier. Ann ICRP Ref 4834-1783-0153Google Scholar
  22. Junk A, Haskal Z, Worgul B (2004) Cataract in interventional radiology—An occupational hazard? Invest Ophthalmol Vis Sci 388:45Google Scholar
  23. Jacob S, Bertrand A, Bernier MO (2011) Occupational cataracts and lens opacities in interventional cardiology: The O’CLOC study. Towards convergence of technical nuclear safety practice in Europe. Available via http://www.eurosafe-forum.org/userfiles/2_10_Paper_EUROSAFE_SJ.pdf. Accessed 4 Dec 2011
  24. Jeans SP, Faulkner K, Love HG, Bardsley RA (1985) An investigation of the radiation-dose to staff during cardiac radiological studies. Br J Radiol 58:419–428CrossRefGoogle Scholar
  25. Kim KP, Miller DL (2009) Minimising radiation exposure to physicians performing fluoroscopically guided cardiac catheterisation procedures: A review. Rad Prot Dosimetry 133:227–233CrossRefGoogle Scholar
  26. Kim KP, Miller DL, Balter S, Kleinerman RA, Linet MS, Kwon D (2008) Occupational radiation doses to operators performing cardiac catheterisation procedures. Health Phys 94:211–227CrossRefGoogle Scholar
  27. Karppinen J, Parviainen T, Servomaa A, Komppa T (1995) Radiation risk and exposure of radiologists and patients during coronary angiography and PTCA. Radiat Prot Dosim 57:481–5Google Scholar
  28. Klein LW, Miller DL, Blater S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA, Joint Inter-Society Task Force on Occupational Hazards in the Interventional Laboratory (2009) Occupational health hazards in the interventional laboratory: Time for a safe environment. J Vasc Interv Radiol 20(7 Suppl):S278–83CrossRefGoogle Scholar
  29. Kottou S, Neofotistou V, Tsapaki V, Lobotessi H, Manetou A, Molfetas MG (2001) Personnel doses in haemodynamic units in Greece. Radiat Prot Dosim 94:121–124CrossRefGoogle Scholar
  30. Kuon E, Günther M, Gefeller O, Dahm JB (2003) Standardization of occupational dose to patient DAP enables reliable assessment of radiation-protection devices in invasive cardiology. Rofo 175:1545–50CrossRefGoogle Scholar
  31. Kuon E, Empen K, Rohde D, Dahm JB (2004) Radiation exposure to patients undergoing percutaneous coronary interventions. Are the current reference values too high? Herz 29:208–17CrossRefGoogle Scholar
  32. Lie OO, Paulson GU, Wohni T (2008) Assessment of the effective dose and dose to the lens of the eye for the interventional cardiologist. Radiat prot Dosimetry 132(3):313–318CrossRefGoogle Scholar
  33. Lange HW, von Boetticher H (2006) Randomized comparison of operator radiation exposure during coronary angiography and intervention by radial or femoral approach. Catheter Cardiovasc Interv 67:12–16CrossRefGoogle Scholar
  34. Limacher MC, Douglas PS, Germano G, Laskey WK, Lindsay BD, McKetty MH, Moore ME, Park JK, Prigent FM, Walsh MN (1988) Radiation safety in the practice of cardiology. J Am Coll Cardiol 31:892–913Google Scholar
  35. Lindsay BD, Eichling JO, Ambos HD, Cain ME (1992) Radiation exposure to patients and medical personnel during radiofrequency catheter ablation for supraventricular tachycardia. Am J Cardiol 70:218–223CrossRefGoogle Scholar
  36. Maffei F, Angelini S, Forti GC, Violante FS, Lodi V, Mattioli S, Hrelia P (2004) Spectrum of chromosomal aberrations in peripheral lymphocytes of hospital workers occupationally exposed to low doses of ionizing radiation. Mutat Res 547:91–9CrossRefGoogle Scholar
  37. Maeder M, Verdun FR, Stauffer JC, Ammann P, Rickli H (2005) Radiation exposure and radiation protection in interventional cardiology. Kardiovaskuläre Medizin 8:124–132Google Scholar
  38. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med6:e1000097. doi: 10.1371/journal.pmed.1000097
  39. Marshall NW, Noble J, Faulkner K (1995) Patient and staff dosimetry in neuroradiological procedures. Br J Radiol 68:495–501CrossRefGoogle Scholar
  40. Miller DL, Vano E, Bartal G, Balter S, Dixon R, Padovani R, Schueler B, Cardella JF, de Baere T (2010) Occupational radiation protection in interventional radiology: A joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cardiovasc Intervent Radiol 33:230–239CrossRefGoogle Scholar
  41. Mann JT, Cubeddu G, Arrowood M (1996) Operator radiation exposure in PTCA: comparison of radial and femoral approaches. J Invasive Cardiol 8:D22–D25Google Scholar
  42. McCormick VA, Schultz CC, Hollingsworth-Schuler V, Campbell JM, O’Neill WW, Ramos R (2002) Reducing radiation dose in the cardiac catheterization laboratory by design alterations and staff education. Am J Cardiol 90:903–905CrossRefGoogle Scholar
  43. Picano E, Santoro G, Vano E (2007) Sustainability in the cardiac cath lab. Int J Cardiovasc Imaging 23(2):143–7CrossRefGoogle Scholar
  44. Pratt TA, Shaw AJ (1993) Factors affecting the radiation dose to the lens of the eye during cardiac catheterisation procedures. Br J Radiol 66:346–350CrossRefGoogle Scholar
  45. Petersen S, Peto V, Rayner M (2003) Congenitial heart disease statistics 2003. British Heart Foundation statistics. Available via http://www.bhf.org.uk/idoc.ashx?docid=b41e291d-0dec-41f6-b726-10b609299aa&version=−1. Accessed 13 Aug 2011Google Scholar
  46. Pitney MR, Allan RM, Giles RW, Mclean D, Mccredie M, Randell T, Walsh WF (1994) Modifying fluoroscopic views reduces operator radiation exposure during coronary angioplasty. J Am Coll Cardiol 24:1660–1663CrossRefGoogle Scholar
  47. Raza SMS (2011) Radiation exposure in the cath lab-safety and precautions. Available via http://priory.com/med/radiation.htm. Accessed 20 July 2011
  48. Rotter M, Pfiffner D, Maier W, Zeiher AM, Meier B (2003) Working Group Interventional Cardiology and Coronary Pathophysiology, European Society of Cardiology. Interventional cardiology in Europe 1999. Eur Heart J24:1164–70CrossRefGoogle Scholar
  49. Renaud L (1992) A 5-year follow-up of the radiation exposure to in-room personnel during cardiac catheterization. Health Phys 62:10–15CrossRefGoogle Scholar
  50. Rehani MM, Vano E, Bjelac OC, Kleiman NJ (2011) Radiation and cataract. Radiat Prot Dosim. doi:  10.1093/rpd/ncr299
  51. Russo LG, Tedesco I, Russo M, Cioppa A, Andreassi MG, Picano E (2011) Cellular adaptive response to chronic radiation exposure in interventional cardiologists. Eur Heart J23. doi:  10.1093/eurheart/ehr263
  52. Sim KH, Rehani M, Kleiman N, Bjelac OC, Vano E (2010) Radiation induced lens opacities in the eyes of cath lab staff. J Am Coll Cardiol 55(A201):E1888Google Scholar
  53. Short CP, Al Hashinii H, Malone L, Lee MJ (2007) Staff radiation doses to the lower extremities in interventional radiology. Cardiovasc Intervent Radiol 30:1206–9CrossRefGoogle Scholar
  54. Steffenino G, Rossetti V, Dellavalle A, Garbarino M, Cerati R, Norbiato A, Uslenghi E (1996) Staff dose reduction during coronary angiography using low framing speed. Br J Radiol 69:860–4CrossRefGoogle Scholar
  55. Tsapaki V, Ghulam MF, Lim ST, Minh HN, Nwe N, Sharma A, Sim KH, Srimahachota S, Rehani MM (2011) Status of radiation protection in various interventional cardiology procedures in the Asia Pacific region. Heart Asia 3:16–24CrossRefGoogle Scholar
  56. Tsapaki V, Patsilinakos S, Voudris V, Magginas A, Pavlidis S, Maunis T (2008) Level of patient and operator dose in the largest cardiac centre in Greece. Radiat Prot Dosimetry 129:71–3CrossRefGoogle Scholar
  57. Vano E, Gonzalez L, Beneytez F, Moreno F (1998a) Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories. Br J Radiol 71:728–33Google Scholar
  58. Vano E, KleimanNJ DA, Rehani MM, Eche D, Cabrera M (2010a) Radiation cataract risk in interventional cardiology personnel. Rad Res 174(4):490–495CrossRefGoogle Scholar
  59. Vano E, Gonzalez L, Guibelalde E, Fernandez JM, Ten JI (1998b) Radiation exposure to medical staff in interventional and cardiac radiology. Br J Radiol 71:954–60Google Scholar
  60. Vano E, Kleiman NJ, Duran A, Rehani MM, Echeverri D, Cabrera M (2010b) Radiation cataract risk in interventional cardiology personnel. Rad Res 174(4):490–495CrossRefGoogle Scholar
  61. Vano E (2003) Radiation exposure to cardiologists: how it could be reduced. Heart 89:1123–4CrossRefGoogle Scholar
  62. Vano E, Gonzalez L, Fernandez JM (2008) Eye lens exposure to radiation in interventional suites: caution is warranted. Radiology 248(3):945–953CrossRefGoogle Scholar
  63. Vano E, Gonzalez L, Fernandez JM, Alfonso F, Macaya C (2006a) Occupational radiation doses in interventional cardiology: a 15 year follow up. Br J Radiol 79:383–388CrossRefGoogle Scholar
  64. Vano E, Gonzalez L, Fernandez JM, Prieto C, Guibelade E (2006b) Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology. Radiat Prot Dosimetry 118(3):325–330CrossRefGoogle Scholar
  65. Vano E, Faulkner K (2005) ICRP special radiation protection issues in interventional radiology, digital and cardiac imaging. Radiat Protect Dosim 117(1–3):13–17Google Scholar
  66. Venneri L, Rossi F, Botto N, Andreassi MG, Salcone N, Emad A, Lazzeri M, Gori C, Vano E, Picano E (2009) Cancer risk from professional exposure in staff working in cardiac catheterisation laboratory: Insights from the National Research Council Biological effects of ionizing radiation VII report. Am Heart J157:118–24CrossRefGoogle Scholar
  67. Watson LE, Riggs MW, Bourland PD (1997) Radiation exposure during cardiology fellowship training. Health Phys 73:690–693CrossRefGoogle Scholar
  68. Wu JR, Huang TY, Wu DK, Hsu PC, Weng PS (1991) Radiation exposure of pediatric patients and physicians during cardiac catheterisation and balloon pulmonary valvuloplasty. Am J Cardiol 68:221–225CrossRefGoogle Scholar
  69. Whitby M, Martin CJ (2005) A study of the distribution of dose across the hands of interventional radiologists and cardiologists. Br J Radiol 78:219–229CrossRefGoogle Scholar
  70. Williams JR (1997) The interdependence of staff and patient doses in interventional radiology. Br J Radiol 70:498–503Google Scholar
  71. Wyart P, Dumant D, Gourdier M, Nassar F, Bouthillon JC, Chestier Y (1997) Contribution of self-surveillance of the personnel by electronic radiation dosimeters in invasive cardiology. Arch Mal Coeur Vaiss 90:233–238Google Scholar
  72. Yuan MK, Chien CW, Lee SK, Hsu NW, Chang SC, Chang SC, Tang GJ (2010) Health effects of medical radiation on cardiologists who perform cardiac catheterisation. J Chin Med Assoc 73(4):199–204CrossRefGoogle Scholar
  73. Zakeri F, Assaei RG (2004) Cytogenetic monitoring of personnel working in angiocardiography laboratories in Iran hospitals. Mutat Res 562:1–9CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Chandrasekharan Nair Kesavachandran
    • 1
    • 2
  • Frank Haamann
    • 3
  • Albert Nienhaus
    • 1
    • 3
  1. 1.Centre for Epidemiology and Health Services Research in the Nursing Profession (CV care)University Medical Centre Hamburg-EppendorfHamburgGermany
  2. 2.Epidemiology DivisionCSIR-Indian Institute of Toxicology ResearchLucknowIndia
  3. 3.Department of Occupational Health ResearchInstitute for Statutory Accident Insurance and Prevention in the Health and Welfare ServicesHamburgGermany

Personalised recommendations