Optimizing radiation exposure in interventional cardiology: are current doses appropriate?

Are the radiation doses we use in interventional procedures appropriate? Cardiologists should be able to answer this question, which is particularly important in pediatric patients. However, the answer matters not only to patients but also to the health professionals involved in these procedures. The occupational radiation doses received by health staff are associated with the doses received by patients, and “optimization” (keeping radiation doses to the minimum needed to achieve the clinical objective of the procedures involved) should be managed comprehensively for patients and professionals alike.1 The International Commission on Radiological Protection (ICRP) recommends using “diagnostic reference levels” (DRLs) to help in the optimization of imaging modalities with ionizing radiation (including interventional procedures).2 DRLs are indicative of “good clinical practice”. It is recommended that they be established for specific clinical indications and can be estimated for the local, national, or regional level by using the third quartile of the distribution of the median values of the dose indicators for patients from various centers representative of these clinical practices.2 The term “achievable dose value” has been proposed in the United States for the 50th percentile instead of the third quartile. Although the ICRP has stated that the median could be used as an additional...