Radiation Exposure in Cardiac Catheterization: Operator Behavior Matters.

Ionizing radiation has detrimental effects on exposed human tissues. These effects are dose-related and include both tissue reactions, such as skin necrosis, and increased risk for stochastic events, such as radiation-induced cancer. See Article by Georges et al The development and refinement of advanced invasive cardiovascular procedures over the past 2 decades has led to increased exposure to both patients and to medical personnel. At the population level, between 1987 and 2006, exposure to medical radiation increased from 0.6 millisieverts (mSv) per year to 4 mSv per year.1 This exposure now exceeds that because of background radiation (average 3 mSv per year). Patient exposure during an interventional cardiology procedure averages 8 to 10 mSv, with some complex procedures using substantially greater doses. Interventional operators receive an average effective dose of 1.2 microsieverts (μSv) per procedure for femoral access and 2.3 μSv for radial access.2 Consequently, a busy interventionalist performing 300 procedures a year with 80% radial access may accumulate 0.6 mSv occupational exposure in a year. Over a 30-year career, an operator would incur an exposure of 18 mSv. Exposures of these magnitudes for both patients and operators, while considered acceptable, are not trivial. While the great clinical value of x-ray fluoroscopically guided invasive cardiovascular procedures is considered to justify the modest hazard conferred by the attendant radiation exposure, the hazard magnitude is directly related to dose with no known threshold for stochastic effects. The ALARA principle (As Low As Reasonably Achievable) states that it is axiomatic that exposure to both patients and medical personnel should be minimized. This principle fosters an ongoing endeavor to reduce patient and operator dose without importantly compromising study quality. We congratulate the authors of the study entitled “Time-Course Reduction in Patient Exposure to Radiation From Coronary Interventional Procedures: The Greater Paris Area …