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Sustainability in the cardiac cath lab

  • Eugenio Picano
  • Gennaro Santoro
  • Eliseo Vano
Editorial Comment

Abstract

Use of radiation for medical examinations and test is the largest manmade source of radiation exposure. Interventional procedures are only 2% of all radiological procedures, but contribute to about 20% of the total collective dose per head per year. On average, a left ventriculography and coronary angiography corresponds to a radiation exposure for the patient of about 300, a coronary stent to 1,000, a peripheral artery intervention to 1,500 to 2,500, and a cardiac radiofrequency ablation to 900-1,500 chest x-rays. Invasive cardiology procedures increased tenfold in the last ten years and growth in the field has been accompanied by concern for the safety of the staff. Interventional cardiologists have an exposure per-head per year two- to three times higher than that of radiologists, with an annual exposure equivalent to around 250 chest x-rays per head. A reduction of occupational doses by a factor of ten can be achieved simply by and intensive training program. The awareness of radiation effects may be suboptimal in the medical community. It is recommended by professional guidelines and reinforced by the European law that the responsibility of all physicians is to minimize the radiation injury hazard to their patients, to their professional staff and to themselves.

Keywords

Catheterization Radiation Sustainability 

References

  1. 1.
    Rigatelli G, Cardaioli P, Roncon L et al (2006) Impact of intracardiac echocardiography on radiation exposure during adult congenital heart disease catheter-based interventions. Int J Cardiovasc Imaging Jul 5 (in press)Google Scholar
  2. 2.
    Hijazi Z, Wang Z, Cao Q et al (2001) Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography. Catheter Cardiovasc Interv 52:194–199PubMedCrossRefGoogle Scholar
  3. 3.
    United Nations. Sources and effects of ionising radiation. United Nations Scientific Committee on the Effects of Atomic Radiation, 1996. Report to the General Assembly with Scientific annexes. United Nations sales publication E.96.IX.3 United Nations, New York, 1996Google Scholar
  4. 4.
    Regulla DF, Eder H (2005) Patient exposure in medical X-ray imaging in Europe. Radiat Prot Dosim 114:11–25CrossRefGoogle Scholar
  5. 5.
    Picano E (2004) Sustainability of medical imaging. Brit Med J 328:578–580 (Review)PubMedCrossRefGoogle Scholar
  6. 6.
    Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363:345–351PubMedCrossRefGoogle Scholar
  7. 7.
    Picano E (2004) Risk of cancer from diagnostic X-rays. Lancet 363:1909–1910PubMedCrossRefGoogle Scholar
  8. 8.
    Togni M, Balmer F, Pfiffner D et al (2004) Working Group, Interventional Cardiology and Coronary Pathophysiology, European Society of Cardiology (2004). Percutaneous coronary interventions in Europe 1992–2001. Eur Heart J 25:1208–1213PubMedCrossRefGoogle Scholar
  9. 9.
    Neofistou V, Vano E, Padovani R et al (2003) Preliminary reference levels in interventional cardiology. Eur Radiol 13:2259–2263CrossRefGoogle Scholar
  10. 10.
    Picano E (2004) Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno. Brit Med J 329:849–851 (Review)PubMedCrossRefGoogle Scholar
  11. 11.
    Bonomo L, Del Favero C, Pesce B, Tamburrini O, Scotti G, Salvatore M, et al. Agenzia per i Servizi Sanitari Regionali. La diagnostica per immagini. Linee guida. http://www.sirm.org/professione/pdf_lineeguida/linee_diag_x_img.pdf
  12. 12.
    Kocinaj D, Cioppa A, Ambrosini G et al (2005) Radiation dose exposure during cardiac and peripheral arteries catheterisation. Int J Cardiol Dec 1 (in press)Google Scholar
  13. 13.
    Coles DR, Smail MA, Negus IS et al (2006) Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. J Am Coll Cardiol 47:1840–1845PubMedCrossRefGoogle Scholar
  14. 14.
    Bernardi G, Padovani R, Morocutti G et al (2000) Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: analysis in relation to radiation exposure parameters. Catheter Cardiovasc Interv 51:1–9PubMedCrossRefGoogle Scholar
  15. 15.
    International Commission on Radiological Protection (ICRP) (2005) Publication 99. Low-dose extrapolation of radiation-related cancer risk. Ann ICRP 35: 1–140Google Scholar
  16. 16.
    Health Risks from Exposure to low Levels of Ionising Radiation: BEIR VII 2005. Phase 2. books.nap.edu/catalog/11340.html.Google Scholar
  17. 17.
    European Commission. Radiation protection 118: referral guidelines for imaging. http://www.europa.eu.int/comm/environment/radprot/118/rp-118-en.pdf.
  18. 18.
    Martin DR, Semelka RC (2006) Health effects of ionising radiation from diagnostic CT. Lancet 367:1712–1714PubMedCrossRefGoogle Scholar
  19. 19.
    Tsapaki V, Kottou S, Vano E et al (2005) Correlation of patient and staff doses in interventional cardiology. Radiat Prot Dosim 117(1–3):26–29Google Scholar
  20. 20.
    Andreassi MG, Cioppa A, Botto N et al (2005) Somatic DNA damage in interventional cardiologists: a case-control study. FASEB J 19:998–999PubMedGoogle Scholar
  21. 21.
    Fenech M (2006) Cytokinesis-block micronucleus assay evolves into a “cytome” assay of chromosomal instability, mitotic dysfunction and cell death. Mutat Res Jul 3 (in press)Google Scholar
  22. 22.
    Rehani MM (2006) Training of interventional cardiologists in radiation protection-the IAEA’s initiatives. Int J Cardiol Mar 6 (in press)Google Scholar
  23. 23.
    Watson RM (1997) Radiation exposure: clueless in the cath lab, or sayonara ALARA. Cathet Cardiovasc Diag 42:126–127PubMedCrossRefGoogle Scholar
  24. 24.
    Vano E, Gonzalez L, Fernandez JM et al (2006) Occupational radiation doses in interventional cardiology: a 15-year follow-up. Br J Radiol 79:383–388PubMedCrossRefGoogle Scholar
  25. 25.
    Andreassi MG, Ati-Ali L, Botto N, et al (2006) Cardiac catheterization and long-term chromosomal damage in children with congenital heart disease. Eur Heart J May 17Google Scholar
  26. 26.
    Szili-Torok T, McFadden EP, Jordaens LJ et al (2004)Visualization of elusive structures using intracardiac echocardiography: insights from electrophysiology. Cardiovasc Ultrasound 2:6Google Scholar
  27. 27.
    Moore P (2005) MRI-guided congenital cardiac catheterization and intervention: the future? Catheter Cardiovasc Interv 66:1–8 (Review)PubMedCrossRefGoogle Scholar
  28. 28.
    Sturm A, Wackernagel M, Muller K (2000) The winners and losers in global competition: why eco-efficiency reinforces competitiveness: a study of 44 Nations. Verlag Ruegger, ZurichGoogle Scholar
  29. 29.
    Hirshfeld JW Jr, Balter S, Brinker JA et al American College of Cardiology Foundation; American Heart Association/; HRS; SCAI; American College of Physicians Task Force on Clinical Competence and Training (2005). ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Circulation 111:511–532Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  1. 1.CNRInstitute of Clinical PhysiologyPisaItaly
  2. 2.Interventional CardiologyCareggi HospitalFlorenceItaly
  3. 3.Radiology Department.Medicine School Complutense UniversityMadridSpain

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