Physician Radiation Exposure During Right Heart Catheterization With Endomyocardial Biopsies

Background Cardiologists performing left cardiac catheterization (LHC) and percutaneous coronary intervention (PCI) are at risk of health problems related to chronic radiation exposure. Unlike during LHC and PCI, radiation exposure during right heart catheterization (RHC) and endomyocardial biopsies (EMB) has not been adequately studied. The objective of our study was to compare physician radiation doses during RHC with EMB to those of LHC and PCI. Methods Head-level physician radiation doses during cardiac catheterization procedures were collected by real-time dosimeters. Patient characteristics, radiation dose metrics (fluoroscopy time, air kerma [AK] and dose area product [DAP]), and physician radiation doses were compared among RHC, RHC + EMB, LHC, and PCI. RHC and EMB were performed using the right internal jugular approach. Associations between patient or procedure related variables (shown in table) and physician radiation exposure was performed with multilinear regression analysis. Results A total of 351 cardiac catheterization procedures were included in the study. Of these, 36 (10.3%) were RHC, 42 (12%) RHC + EMB, 156 (44.4%) LHC, and 117 (33.3%) PCI. RHC + EMB and LHC had similar fluoroscopy time. AK and DAP were progressively higher for RHC, RHC + EMB, LHC, and PCI (Table). Head-level physician radiation exposure was not different between RHC + EMB versus LHC (p=0.0696). When the physician radiation exposure was normalized to DAP (MD dose/DAP), RHC and RHC + EMB had the highest doses (Table). Regression modeling identified RHC + EMB (+187.5%, p<0.0001) and RHC (+844.8%, p<0.0001) were associated with an increased physician radiation doses normalized to DAP (Table 1). Conclusion After normalizing physician doses to DAP, RHC and RHC + EMB were associated with significantly higher physician radiation doses than LHC or PCI. These observations suggest additional protective measures should be undertaken to decrease physician radiation exposure during RHC and RHC + EMB. Cardiologists performing left cardiac catheterization (LHC) and percutaneous coronary intervention (PCI) are at risk of health problems related to chronic radiation exposure. Unlike during LHC and PCI, radiation exposure during right heart catheterization (RHC) and endomyocardial biopsies (EMB) has not been adequately studied. The objective of our study was to compare physician radiation doses during RHC with EMB to those of LHC and PCI. Head-level physician radiation doses during cardiac catheterization procedures were collected by real-time dosimeters. Patient characteristics, radiation dose metrics (fluoroscopy time, air kerma [AK] and dose area product [DAP]), and physician radiation doses were compared among RHC, RHC + EMB, LHC, and PCI. RHC and EMB were performed using the right internal jugular approach. Associations between patient or procedure related variables (shown in table) and physician radiation exposure was performed with multilinear regression analysis. A total of 351 cardiac catheterization procedures were included in the study. Of these, 36 (10.3%) were RHC, 42 (12%) RHC + EMB, 156 (44.4%) LHC, and 117 (33.3%) PCI. RHC + EMB and LHC had similar fluoroscopy time. AK and DAP were progressively higher for RHC, RHC + EMB, LHC, and PCI (Table). Head-level physician radiation exposure was not different between RHC + EMB versus LHC (p=0.0696). When the physician radiation exposure was normalized to DAP (MD dose/DAP), RHC and RHC + EMB had the highest doses (Table). Regression modeling identified RHC + EMB (+187.5%, p<0.0001) and RHC (+844.8%, p<0.0001) were associated with an increased physician radiation doses normalized to DAP (Table 1). After normalizing physician doses to DAP, RHC and RHC + EMB were associated with significantly higher physician radiation doses than LHC or PCI. These observations suggest additional protective measures should be undertaken to decrease physician radiation exposure during RHC and RHC + EMB.