Radiation risk to healthcare workers from diagnostic and interventional imaging procedures
- Reza Fazel, MD, MSc
Reza Fazel, MD, MSc
- Associate Physician
- Brigham and Women's Hospital
- Harvard Medical School
- Andrew J Einstein, MD, PhD, FACC, FAHA
Andrew J Einstein, MD, PhD, FACC, FAHA
- Herbert Irving Associate Professor of Medicine
- Columbia University Medical Center
- Section Editors
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
- Stephan Windecker, MD
Stephan Windecker, MD
- Section Editor — Coronary Heart Disease
- Professor of Medicine
- Department of Cardiology
- Bern University Hospital
- N A Mark Estes, III, MD
N A Mark Estes, III, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Tufts University School of Medicine
In addition to the patient, health care workers are exposed to significant amounts of radiation during cardiovascular imaging procedures. With advancing technology, the realm of procedures being performed percutaneously is steadily expanding. The increased anatomic and technical complexity of these procedures often requires longer fluoroscopy and image capture time and leads to greater radiation exposure to the patient and interventional laboratory staff . In addition, these procedures are exposing new groups of health care workers, including echocardiographers and anesthesiology and operating room staff, to radiation exposure from fluoroscopic imaging while assisting with these procedures. It is imperative that health care workers involved in these procedures be aware of the radiation exposure and are provided with the tools necessary to protect and monitor themselves .
This topic will present radiation risks related to occupational exposure in diagnostic and interventional imaging suites, the role of dosimetry, and tools for minimizing radiation exposure to health care workers. Other related topics, including discussions of radiation injury and radiation exposure in cardiovascular imaging, are presented separately. (See "Biology and clinical features of radiation injury in adults" and "Radiation-related risks of imaging studies" and "Radiation dose and risk of malignancy from cardiovascular imaging".)
Exposure to ionizing radiation can lead to tissue reactions (formerly known as deterministic effects) or stochastic effects (a stochastic effect represents an outcome for which the probability of occurrence, rather than severity, is determined by the dose). An example is radiation-induced carcinogenesis. (See "Radiation dose and risk of malignancy from cardiovascular imaging".)
When standard radiation protection tools are used in the cardiovascular interventional lab, doses to the operator and staff do not typically approach thresholds of tissue reactions and the principle risks to consider are the stochastic risks of induced cataract formation and cancer .
Cataracts — The lens of the eye is one of the most radiosensitive tissues in the body [4,5]. In spite of the well documented history of radiation-induced cataract, there is still considerable uncertainty surrounding the relationship between dose and radiation cataract development . Studies of exposed human subjects suggest that there is no clear threshold dose for cataract formation. It also appears that the latency period is inversely related to the exposure dose.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- RADIATION RISK
- MONITORING RADIATION EXPOSURE
- Quantities and units
- Occupational dose limits
- Dose limits during pregnancy
- RADIATION PROTECTION
- ROLE OF HOSPITAL/FACILITY
- TIPS FOR INTERVENTIONAL LAB STAFF
- TIPS FOR ECHOCARDIOGRAPHERS AND ANESTHESIA STAFF
- TIPS FOR NUCLEAR MEDICINE STAFF
- RECOMMENDATIONS OF OTHERS
- SUMMARY AND RECOMMENDATIONS