Comparison of patient and staff temple dose during fluoroscopically guided coronary angiography, implantable cardiac devices, and electrophysiology procedures

There is a paucity of literature comparing patient and staff dose during coronary angiography (CA), implantable cardiac devices, permanent pacemakers (PPM) and electrophysiology (EP) procedures and little noting dose to staff other than cardiologists. This study sought to compare patient and occupational dose during a range of fluoroscopically guided cardiac procedures. Radiation dose levels for the patients (n = 1651), cardiologists (n = 24), scrub (n = 32) and scout nurses (n = 35) were measured in a prospective single-centre study between February 2017 and August 2019. A comparison of dose during CA, device implantation, PPM insertion and EP studies was performed. Three angiographic units were used, with dosimeters worn on the temple of staff. Results indicated that occupational dose during PPM was significantly higher than other procedures. The cardiologist had the highest mean dose during biventricular implantable cardioverter-defibrillators; levels were approximately five times that of ‘normal’ pacemaker insertions. Transcatheter aortic valve implantations (TAVI) were associated with relatively high mean doses for both staff and patients and had a statistically significant higher (>2 times) mean patient dose area product than all other categories. TAVI workups were also related to higher mean cardiologist and scrub nurse dose. It was observed that the mean scrub nurse dose can exceed that of the cardiologist. The highest mean dose for Scout nurses were recorded during EP studies. Given the significantly higher temple dose associated with PPM insertion, cardiologists should consider utilizing ceiling mounted lead shields, lead glasses and/or skull caps where possible. Efforts should also be made to minimize the use of DSA during TAVI and TAVI workups to reduce cardiologist, nurse and patient dose.