DESCRIPTION:
Abstract- Cardiac nuclear medicine, cardiac CT, interventional cardiology procedures and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff in cardiac catheterization laboratories may receive high radiation doses if radiological protection tools are not used properly.
The Commission has provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission""s published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission.
This report provides guidance to assist the cardiologist with justification procedures and optimization of protection in cardiac CT studies, cardiac nuclear medicine studies and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training and establishment of a quality assurance programme for cardiac imaging and intervention.
Because tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programs for interventional fluoroscopy.
CONTENTS:
1. INTRODUCTION
1.1. Introduction
1.2. Fluoroscopically guided procedures
1.3. Cardiac CT
1.4. Nuclear cardiology
1.5. Occupational radiation risk
1.6. Summary
2. THE BIOLOGICAL EFFECTS OF RADIATION
2.1. Types of radiation effects
2.2. Background
2.3. Radiation Effects and the Skin
2.4. The Lens of the Eye and Radiation
2.5. Cardiovascular effects of radiation exposure
2.6. Occupational radiation exposure and intracranial neoplasms
3. CLINICAL EXAMPLES OF TISSUE REACTIONS DUE TO FLUOROSCOPICALLY GUIDED CARDIOLOGY PROCEDURES
3.1. Introduction
3.2. Case 1 (Vliestra et al., 2004)
3.3. Case 2 (Koenig et al., 2001)
3.4. Case 3 (Wagner and Archer, 1997)
3.5. Case 4 (Vliestra et al., 2004)
3.6. Case 5 (Vañó et al., 1998a)
3.7. Case 6 (Courtesy of Dr. M. Portas, Buenos Aires, Argentina)
4. PRINCIPLES OF RADIOLOGICAL PROTECTION IN MEDICINE
4.1. Introduction
4.2. Justification
4.3. Optimization of protection
4.4. Dose limits
5. MANAGING PATIENT DOSE IN FLUOROSCOPICALLY GUIDED INTERVENTIONS
5.1. Introduction
5.2. Before the Procedure
5.3. During the Procedure
5.4. After the procedure
5.5. Paediatric Patients
6. PROTECTION OF STAFF DURING INTERVENTIONAL FLUOROSCOPY
6.1. Introduction
6.2. Comparison of radiation exposure with that of other staff
6.3. The essentials of occupational radiological protection
6.4. Personal protective devices
6.5. Equipment-mounted shields
6.6. Occupational exposure from fluoroscopy
6.7. Personal dosimetry
7. RADIOLOGICAL PROTECTION FOR NUCLEAR CARDIOLOGY
7.1. Introduction
7.2. Radiopharmaceuticals
7.3. Dosimetry for nuclear cardiology
7.4. Current dosimetry estimates
7.5. Uncertainty in dosimetry
7.6. Discrepancies between ICRP dosimetry and information from manufacturers
7.7. Radiological protection of patients in nuclear cardiology
7.8. Advice to patients
7.9. Current research areas
8. RADIOLOGICAL PROTECTION FOR CARDIAC CT
8.1. Introduction
8.2. Types of CT scanners
8.3. Dosimetric Quantities
8.4. Factors affecting patient dose
8.5. Current Dosimetry Estimates
8.6. Radiological Protection of Patients in Cardiac CT
9. RADIOLOGICAL PROTECTION TRAINING FOR CARDIOLOGISTS
9.1. Introduction
9.2. Requirements on Radiological protection
9.3. Interventional fluoroscopy
10. QUALITY ASSURANCE PROGRAMMES
10.1. Introduction
10.2. Facilities
10.3. Acceptance and constancy testing
10.4. Staff
10.5. Training
10.6. Follow-up for possible radiation-induced skin injuries for interventional fluoroscopy procedures
10.7. Dose audits
