title: Physicians' radiation exposure in the catheterization lab: does the type of procedure matter?
abstract: OBJECTIVE
  This study sought to evaluate differences in radiation exposure of the operator depending on the type of catheterization lab procedure.
  
  
  BACKGROUND
  Invasive cardiologists and angiologists are exposed to long-term, low-dose occupational radiation. Increased workload and specialization require more detailed knowledge of the extent and cause of the radiation exposure.
  
  
  METHODS
  In this prospective single-center experience, radiation doses of 3 operators were measured by real-time dosimetry for body, neck, and hand during 284 procedures in 281 patients over a period of 14 weeks. To determine the association between the type of procedure and the doses and to draw a pairwise comparison between the procedures, 3 mixed models were used.
  
  
  RESULTS
  The type of procedure, the patient's body mass index, and the fluoroscopy time were independently associated with the operator's radiation exposure. Per procedure, the operators were exposed to a mean effective dose (E) of 2.2 ± 5.9 μSv. Compared with coronary angiography, E was 2.3-fold higher in pelvic procedures (95% confidence interval [CI]: 1.7 to 3.0, p < 0.001), 1.7-fold higher in upper limb procedures (95% CI: 1.3 to 2.1, p < 0.001), and 1.4-fold higher in below-the-knee procedures (95% CI: 1.1 to 2.0, p = 0.023). The mean eye dose was 19.1 ± 37.6 μSv. Eye doses were significantly higher in peripheral procedures than in coronary angiography procedures. The mean hand dose was 99.6 ± 196.0 μSv. Hand doses were significantly higher in pelvic than in coronary angiography, upper limb, and below-the-knee procedures.
  
  
  CONCLUSIONS
  Endovascular procedures for pelvic, upper limb, and below-the-knee disease are accompanied with a higher radiation exposure of the operator than with coronary procedures.
authors.affiliation: University Cardiovascular Center, Hamburg, Germany.
authors.forename: Maja
authors.initials: M
authors.lastname: Ingwersen
authors.forename: Anna
authors.initials: A
authors.lastname: Drabik
authors.forename: Ulrike
authors.initials: U
authors.lastname: Kulka
authors.forename: Ursula
authors.initials: U
authors.lastname: Oestreicher
authors.forename: Simon
authors.initials: S
authors.lastname: Fricke
authors.forename: Hans
authors.initials: H
authors.lastname: Krankenberg
authors.forename: Carsten
authors.initials: C
authors.lastname: Schwencke
authors.forename: Detlef
authors.initials: D
authors.lastname: Mathey
mesh_terms: D017023:Coronary Angiography / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005471:Fluoroscopy; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control; D016272:Occupational Health; D062645:Percutaneous Coronary Intervention; D010820:Physicians; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011834:Radiation Monitoring; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D015642:Radiology, Interventional / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016526:Workload
keywords: BMI; BTK; CAG; CI; DAP; E; FISH; ICRP; International Commission on Radiological Protection; NCRP; National Council on Radiation Protection and Measurements; PCI; UL; below the knee; biological dosimetry; body mass index; confidence interval; coronary angiography; dose area product; dose aware system; estimated effective dose; fluorescence in situ hybridization; occupational radiation exposure; percutaneous coronary intervention; radiation exposure in cardiology and angiology; real-time dosimetry; upper limb