Radiation Doses to Interventional Echocardiographers During Percutaneous Structural Heart Interventions

Background: The use of transesophageal echocardiography during percutaneous left atrial appendage closure (LAAO) and transcatheter edge-to-edge repair of the mitral valve (TEER) requires an interventional echocardiographer (IE) to stand near the radiation source. The occupational radiation exposure of IEs remains understudied. Hypothesis: IE experience higher radiation doses than interventional cardiologists and sonographers. Methods: Prospective, blinded radiation doses were collected by dosimeters worn by IEs, interventional cardiologists, and sonographers during 30 consecutive LAAO and 30 TEER structural heart cases at a tertiary care center. Measured personal dose equivalents per case were compared among the three groups. Results: Over the 60 procedures, the median radiation dose per case was 5-fold higher for IEs than interventional cardiologists (10.6 [4.2, 22.4] μSv versus 2.1 [0.2, 8.3] μSv, p<0.0005). During TEER, IEs received a median radiation dose of 10.5 [2.3, 20.9] μSv, which was 11-fold higher than interventional cardiologists (0.8 [0.0, 12.1] μSv, p = 0.0005). During LAAO procedures, the median radiation dose was 10.8 [5.9, 24.6] μSv among IEs and 3.6 [1.4, 6.5] μSv among interventional cardiologists, representing a 3.0-fold greater radiation dose to echocardiographers (p<0.0001). Compared to IEs, sonographers exhibited low radiation doses during both LAAO (0.2 [0.0, 1.6] μSv, p<0.001) and TEER (0.03 [0.00, 0.15] μSv, p<0.0001). Conclusions: During LAAO and TEER procedures, IEs were exposed to 3-fold and 11-fold higher radiation doses than interventional cardiologists, respectively. These comparatively higher radiation doses indicate an important occupational risk faced by IEs, which has implications for the rapidly expanding structural heart team.