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Cardiac Fluoroscopy: Radiation Safety Considerations
Mark P. Bowes, PhD
*Medical Writer, Portland, Oregon.
Address correspondence to: Mark P. Bowes, PhD, Medical Writer, 7135 SE 18th Avenue, Portland, OR, 97202. E-mail: firstname.lastname@example.org.
Disclosure Statement: Dr Bowes reports having no financial or advisory relationships with corporate organizations related to this activity.
Each year, more than 1 million patients in the United States undergo fluoroscopy-guided cardiac procedures, including diagnostic cardiac catheterization and percutaneous coronary intervention (PCI) for blocked coronary arteries. Although these procedures are essential for improving patient health among those with cardiovascular disease, the accompanying radiation exposure is associated with an increased risk of adverse health outcomes for patients and healthcare professionals. Health effects of radiation may be classified as either deterministic or stochastic. Deterministic effects occur predictably once a dose threshold has been reached (eg, radiation-induced skin lesions), whereas stochastic effects occur with some probability even at low radiation dose levels (eg, an increased risk of cancer). Radiation doses and the risk of radiation-associated injury are typically higher with interventional procedures than with diagnostic catheterization due to the greater complexity and longer duration of fluoroscopy that is typically required. Clinical practice guidelines from several government agencies and professional societies have established safe radiation thresholds for patients undergoing cardiac imaging, as well as procedures that should be implemented when those thresholds are exceeded. Occupational radiation limits for radiographers have also been defined. Several methods are available to reduce radiation exposure associated with cardiac fluoroscopy for patients and imaging staff, including reduced fluoroscopy frame rates, beam filtration, stored fluoroscopy images, shielding, beam angulation, collimation, and others. Simple quality-improvement efforts to increase attention to optimal fluoroscopic use have been shown to significantly reduce radiation exposure to patients and medical staff without compromising image quality.
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