Reducing clinicians’ exposure to radiation
A new systematic review finds that clinicians should be better protected from radiation doses during cardiac catheterisation.
The systematic review, ‘Safety and effectiveness of strategies to reduce radiation exposure to proceduralists performing cardiac catheterisation procedures’, examines the efficacy of various methods for protecting proceduralists during cardiac catheterisation involving fluoroscopy.
Fluoroscopy, a type of medical imaging, is used in cardiac catheterisation to enable the clinician to see the flow of blood through the coronary arteries to check for arterial blockages. Numerous x-ray images of the heart and coronary arteries are taken in quick succession. The practice is widely performed, although the radiation dose delivered to the patient during fluoroscopically guided cardiac catheterisation is high compared with other radiological exposures. Proceduralists working in cardiac catheterisation are exposed to radiation as deflected scatter from the patient. Over time, the radiation dose absorbed from the x-ray examinations can be harmful to the proceduralist, with some studies reporting skin damage, cataract formation or cancer from occupational radiation exposure.
Lead author of the systematic review is Professor Ritin Fernandez from the School of Nursing at the University of Wollongong, Australia. She states, ‘We have a duty of care not only for the patient, but also for the doctor conducting the procedure’.
Exposure to radiation during cardiac catheterisation presents an increasing health risk to proceduralists. Heart disease caused by blockage of the coronary arteries is rising globally, and with the growing demand of procedures, doctors are being exposed to increasing amount of radiation. Consequently, there are intensifying efforts to implement radiation protection strategies for clinicians working in this specialty. Professor Fernandez explains:
The International Basic Safety Standards for Protection Against Ionizing Radiation and the Safety of Radiation Sources have set rules to reduce the exposure of doctors to radiation. The basic protection used by doctors includes wearing radiation protective aprons, thyroid collars, eyewear and head caps. Other protection equipment includes ceiling-suspended and other moveable shields.
While standard protection for proceduralists, such as wearing lead garments, reduces radiation exposure, the evidence surrounding additional equipment is contradictory. Professor Fernandez and the team of researchers conducted the systematic review to examine which methods, other than the basic protection methods, are used to reduce the radiation dose to doctors performing cardiac catheterisation:
While there are developments made in treating coronary artery blockages, we wanted to see what developments were made to protect the doctor from the radiation exposure while conducting these procedures. We looked for evidence for all the additional radiation protection methods used globally. We checked the quality of the information and then examined the best-available evidence.
The researchers included 15 randomised controlled trials, which assessed six radiation protection strategies in addition to standard protective equipment. Their findings show that the use of leaded pelvic drapes placed on patients can significantly reduce the radiation dose to proceduralists:
Our results showed that there were various methods that were used to protect the doctor from radiation during the procedure. Using leaded drapes on the patient will protect the patient as well as the doctor by preventing scatter radiation. As leaded drapes are heavy, radiation-absorbing drapes made of lighter material, such as bismuth compound, are also beneficial. Checking the radiation dose received in real time is also beneficial to protect the doctor undertaking cardiac catheterisation.
The use of leaded pelvic drapes for patients as an additional radiation protection strategy for proceduralists while performing cardiac catheterisation is included in the systematic review’s recommendations for practice. However, Professor Fernandez cautions, ‘More needs to be done on protecting the doctor from radiation doses during cardiac catheterisation’.
Professor Fernandez says that clinicians should keep track of their exposure to radiation and adds, ‘Most importantly, clinicians should use the imaging techniques judiciously and wisely.’
Fernandez R, Ellwood L, Barrett D, Weaver J. Safety and effectiveness of strategies to reduce radiation exposure to proceduralists performing cardiac catheterization procedures: a systematic review. JBI Evid Synth. 2021;19(1):4-33.