ABSTRACT
The first angiography was performed in 1896 (Figure 4b.1). In the course of time, however, it became evident that even low doses cannot be considered safe or harmless with respect to carcinogenesis.1 Currently mean patient radiation exposure due to percutaneous interventions is relatively high and varies greatly between different centers and interventionists2 (Figure 4b.2): for percutaneous cardiac interventions (PCIs), typical mean published dose area product values (DAPs), range from 73 up to 190 Gy × cm2.4
For special interventional procedures deterministic radiation effects like chronic radiodermatitis or even deep musculocutaneous injury may result,1,5 and represent a matter of serious concern (Figure 4b.3). For this reason, directives of the International Commission on Radiologic Protection (ICRP) and the EURATOM Council 6,7
stipulate that ‘All medical exposure for radiodiagnostic purposes . . . shall be kept as low as reasonably achievable’ (ALARA), even below accepted reference values recently proposed8 in consideration of both state of the art and individual circumstances. The ICRP indeed points out that, unfortunately, ‘many interventionists are not aware of the potential for injury from
procedures, their occurrence, or simple methods for decreasing their incidence utilising dose control strategies’1 and recommends credentialing radiation protection training programs for interventionists over and above that required by general radiologists.9,10 Up to today, however, there exists worldwide no validated educational course in radiation reducing techniques which has proven of significant benefit in reducing patient radiation exposure in daily routine.
