Body Surface Radiation Exposure in Interventional Echocardiographers During Structural Heart Disease Procedures

Akihisa Kataoka; Takeshi Takata; Ayaka Yanagawa; Kento Kito; Masataka Arakawa; Ruri Ishibashi; Taiga Katayama; Miho Mitsui; Fukuko Nagura; Hideyuki Kawashima; Hirofumi Hioki; Yusuke Watanabe; Ken Kozuma; Jun'ichi Kotoku

doi:10.1016/j.jacasi.2022.12.008

Body Surface Radiation Exposure in Interventional Echocardiographers During Structural Heart Disease Procedures

JACC Asia. 2023 Mar 28;3(2):301-309. doi: 10.1016/j.jacasi.2022.12.008. eCollection 2023 Apr.

Authors

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan.
² Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan.
³ Department of Anesthesia, Teikyo University, Tokyo, Japan.
⁴ Department of Cardiovascular Medicine, Asahi General Hospital, Tokyo, Japan.
⁵ Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan.

Abstract

Background: The distribution of radiation exposure on the body surface of interventional echocardiographers during structural heart disease (SHD) procedures is unclear.

Objectives: This study estimated and visualized radiation exposure on the body surface of interventional echocardiographers performing transesophageal echocardiography by computer simulations and real-life measurements of radiation exposure during SHD procedures.

Methods: A Monte Carlo simulation was performed to clarify the absorbed dose distribution of radiation on the body surface of interventional echocardiographers. The real-life radiation exposure was measured during 79 consecutive procedures (44 transcatheter edge-to-edge repairs of the mitral valve and 35 transcatheter aortic valve replacements [TAVRs]).

Results: The simulation demonstrated high-dose exposure areas (>20 μGy/h) in the right half of the body, especially the waist and lower body, in all fluoroscopic directions caused by scattered radiation from the bottom edge of the patient bed. High-dose exposure occurred when obtaining posterior-anterior and cusp-overlap views. The real-life exposure measurements were consistent with the simulation estimates: interventional echocardiographers were more exposed to radiation at their waist in transcatheter edge-to-edge repair than in TAVR procedures (median 0.334 μSv/mGy vs 0.053 μSv/mGy; P < 0.001) and in TAVR with self-expanding valves than in those with balloon-expandable valves (median 0.067 μSv/mGy vs 0.039 μSv/mGy; P < 0.01) when the posterior-anterior or the right anterior oblique angle fluoroscopic directions were used.

Conclusions: During SHD procedures, the right waist and lower body of interventional echocardiographers were exposed to high radiation doses. Exposure dose varied between different C-arm projections. Interventional echocardiographers, especially young women, should be educated regarding radiation exposure during these procedures. (The development of radiation protection shield for catheter-based treatment of structural heart disease [for echocardiologists and anesthesiologists]; UMIN000046478).

Keywords: echocardiologist; female doctor; interventional echocardiographer; radiation exposure; structural heart disease; transesophageal echocardiography.