Protection of the Patient and the Staff from Radiation Exposure During Fluoroscopy-Guided Procedures in Cardiology

Abstract

The volume of diagnostic or therapeutic procedures in cardiology that require the use of ionizing radiation is increasing constantly. Currently, technological developments offer the possibility of exploring not only the cardiac function (measurement of ejection fraction, for example) but also the state of coronary and great vessels. In fact, the management of patients with heart disease often requires the use of investigative techniques using X-rays. For example 3.85 million cardiac catheterizations were performed in the United States in 2002 (Einstein et al., 2007). In Switzerland the last national survey on the exposure of the population by medical radiology revealed that nearly 34 000 coronary angiographies and more than 18 000 coronary dilatations were performed in 2008. They are associated to 65% of the collective dose related to interventional radiology and 8% to that related to all medical X-rays (Samara et al. 2011). The increase in radiological examinations using ionizing radiation has been mentioned for several years not only in medical journals for professionals but also in the press addressing the general public. For example, in its edition of 17 June, 2007, the New York Times questioned the public opinion about the justification of the increasing number of CT examinations. While most examinations deliver relatively low doses and thus add only a low risk to the procedure itself, there are situations where doses exceed the dose level where an excess risk of death from cancer has been demonstrated. In addition, some complex procedures may result in the occurrence of deterministic effects such as burns to the skin. The substantial increase of fluoroscopy-guided procedures in cardiology over the past few years has been accompanied by a parallel growth in concern for patient radiation safety and for the safety of the operators who perform these procedures. Thus, radiation safety has become a major issue in radiology departments. The aim of this chapter is: to recall the effects of ionizing radiation on the human body and the radiological risks; to introduce the dosimetric quantities (basic and operational) commonly used to quantify those risks; to briefly present the principles of radiation protection; to provide the tools (actions and means) necessary for operational radiation protection.