Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report.

BACKGROUND Occupational doses from fluoroscopy-guided interventional procedures are the highest ones registered among medical staff using x-rays. The aim of the present study was to evaluate the order of magnitude of cancer risk caused by professional radiation exposure in modern invasive cardiology practice. METHODS From the dosimetric Tuscany Health Physics data bank of 2006, we selected dosimetric data of the 26 (7 women, 19 men; age 46 +/- 9 years) workers of the cardiovascular catheterization laboratory with effective dose >2 mSv. Effective dose (E) was expressed in milliSievert, calculated from personal dose equivalent registered by the thermoluminescent dosimeter, at waist or chest, under the apron, according to the recommendations of National Council of Radiation Protection. Lifetime attributable risk of cancer was estimated using the approach of Biological Effects of Ionizing Radiation 2006 report VII. RESULTS Cardiac catheterization laboratory staff represented 67% of the 6 workers with yearly exposure >6 mSv. Of the 26 workers with 2006 exposure >2 mSv, 15 of them had complete records of at least 10 (up to 25) consecutive years. For these 15 subjects having a more complete lifetime dosimetric history, the median individual effective dose was 46 mSv (interquartile range = 24-64). The median risk of (fatal and nonfatal) cancer (Biological Effects of Ionizing Radiation 2006) was 1 in 192 (interquartile range = 1 in 137-1 in 370). CONCLUSIONS Cumulative professional radiological exposure is associated with a non-negligible Lifetime attributable risk of cancer for the most exposed contemporary cardiac catheterization laboratory staff.

[1]  Stephen Balter,et al.  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 , 2005, Circulation.

[2]  J. Zoetelief,et al.  Estimating effective dose for a cardiac catheterisation procedure with single or double personal dosemeters. , 2006, Radiation protection dosimetry.

[3]  F. Zakeri,et al.  Cytogenetic monitoring of personnel working in angiocardiography laboratories in Iran hospitals. , 2004, Mutation research.

[4]  M. Walsh,et al.  ACC expert consensus document. Radiation safety in the practice of cardiology. American College of Cardiology. , 1998, Journal of the American College of Cardiology.

[5]  E Vano,et al.  Correlation of patient and staff doses in interventional cardiology. , 2005, Radiation protection dosimetry.

[6]  E. Picano,et al.  Radiation dose exposure during cardiac and peripheral arteries catheterisation. , 2006, International journal of cardiology.

[7]  F. Violante,et al.  Spectrum of chromosomal aberrations in peripheral lymphocytes of hospital workers occupationally exposed to low doses of ionizing radiation. , 2004, Mutation research.

[8]  H. Chan,et al.  Interventional radiologists: occupational radiation doses and risks. , 1993, Radiology.

[9]  E. Vano,et al.  Preliminary reference levels in interventional cardiology , 2003, European Radiology.

[10]  Hugh Calkins,et al.  Radiation Exposure During Catheter Ablation of Atrial Fibrillation , 2004, Circulation.

[11]  R. Semelka,et al.  The American College of Radiology white paper on radiation dose in medicine:deep impact on the practice of cardiovascular imaging , 2007, Cardiovascular ultrasound.

[12]  Michael J Pentecost,et al.  American College of Radiology white paper on radiation dose in medicine. , 2007, Journal of the American College of Radiology : JACR.

[13]  E. Picano,et al.  Cumulative patient effective dose in cardiology. , 2008, The British journal of radiology.

[14]  W. Rutishauser,et al.  Radiation exposure during diagnostic catheterization and single- and double-vessel percutaneous transluminal coronary angioplasty. , 1987, The American journal of cardiology.

[15]  M. Walsh,et al.  Radiation safety in the practice of cardiology , 1998 .

[16]  E. Picano.  Sustainability of medical imaging , 2004, BMJ : British Medical Journal.

[17]  R. H. Chamberlain.  Medical radiation exposure. , 1962, The New physician.

[18]  E Vañó,et al.  Radiation exposure to medical staff in interventional and cardiac radiology. , 1998, The British journal of radiology.

[19]  D. Leaman,et al.  Operator radiation exposure during percutaneous transluminal coronary angioplasty. , 1984, Journal of the American College of Cardiology.

[20]  M A Hlatky,et al.  American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. , 2001 .

[21]  B. Cohen.  Catalog of risks extended and updated. , 1991, Health physics.

[22]  M. Walsh,et al.  Radiation Safety in the Practice of Cardiology WRITING GROUP MEMBERS , 1998 .

[23]  E Vano,et al.  Radiation exposure to cardiologists: how it could be reduced , 2003, Heart.

[24]  Eugenio Picano,et al.  Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno , 2004, BMJ : British Medical Journal.

[25]  M. Rehani.  Training of interventional cardiologists in radiation protection--the IAEA's initiatives. , 2007, International journal of cardiology.

[26]  N. Theocharopoulos,et al.  Fluoroscopically guided implantation of modern cardiac resynchronization devices: radiation burden to the patient and associated risks. , 2005, Journal of the American College of Cardiology.

[27]  K. Faulkner,et al.  Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis. , 2006, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[28]  H. Claycamp,et al.  Use of personal monitors to estimate effective dose equivalent and effective dose to workers for external exposure to low-LET radiation , 1995 .

[29]  W. A. Jennings.  Quantities and units in radiation protection dosimetry , 1994 .

[30]  P. Cleaton-jones,et al.  An ethical dilemma: availability of antiretroviral therapy after clinical trials with hiv infected patients are ended , 1997, BMJ.

[31]  M. Togni,et al.  Percutaneous coronary interventions in Europe 1992-2003. , 2004, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[32]  M. Togni,et al.  Percutaneous coronary interventions in Europe 1992-2001. , 2004, European heart journal.

[33]  K. L. Swinth.  Book Review: Use of personal monitors to estimate effective dose equivalent and effective dose to workers for external exposure to low-LET radiation. National Council on Radiation Protection and Measurements Report No. 122, December 1995. , 1996 .

[34]  A. Bozkurt,et al.  Simultaneous determination of equivalent dose to organs and tissues of the patient and of the physician in interventional radiology using the Monte Carlo method , 2007, Physics in medicine and biology.

[35]  E. Picano,et al.  Somatic DNA damage in interventional cardiologists: a case‐control study , 2005, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[36]  Bertil Olsson,et al.  Outcome parameters for trials in atrial fibrillation: executive summary. , 2007, European heart journal.

[37]  Z. Koreňová,et al.  Staff dosimetry in interventional cardiology: survey on methods and level of exposure. , 2008, Radiation protection dosimetry.

[38]  Stephen Balter,et al.  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 , 2004, Journal of the American College of Cardiology.

[39]  D L Ross,et al.  Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia. , 1998, Circulation.

[40]  H. Calkins,et al.  Predictors of fluoroscopy time and estimated radiation exposure during radiofrequency catheter ablation procedures. , 1998, The American journal of cardiology.

[41]  M. Zorzetto,et al.  Radiation exposure to patients and operators during diagnostic catheterization and coronary angioplasty. , 1997, Catheterization and cardiovascular diagnosis.

[42]  E. Vañó,et al.  Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: Analysis in relation to radiation exposure parameters , 2000, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[43]  S. Kaul,et al.  Task Force on Clinical Expert Consensus Documents Endorsed by the American Heart Association and the , 2022 .

[44]  V. Tsapaki,et al.  Personnel doses in haemodynamic units in Greece. , 2001, Radiation protection dosimetry.

[45]  R. Sievert,et al.  Book Reviews : Recommendations of the International Commission on Radiological Protection (as amended 1959 and revised 1962). I.C.R.P. Publication 6. 70 pp. PERGAMON PRESS. Oxford, London and New York, 1964. £1 5s. 0d. [TB/54] , 1964 .

[46]  Peter J. Ell,et al.  Nuclear medicine in clinical diagnosis and treatment , 2004 .

[47]  Division on Earth.  Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2 , 2006 .

[48]  E Vaño,et al.  Occupational radiation doses in interventional cardiology: a 15-year follow-up. , 2006, The British journal of radiology.

[49]  Adrian K. Dixon,et al.  Benefits and costs, an eternal balance , 2007 .

[50]  J. Valentin,et al.  Abstract: Avoidance of radiation injuries from medical interventional procedures, ICRP Publication 85 , 2000 .

[51]  L Bacarini,et al.  LA Diagnostica per Immagini , 1989 .

[52]  C. Cousins,et al.  Medical interventional procedures-reducing the radiation risks. , 2004, Clinical radiology.

[53]  D. Salat,et al.  Reference levels at European level for cardiac interventional procedures. , 2008, Radiation protection dosimetry.