ABSTRACT

Radiation protection The health risks associated with prolonged fluoroscopic imaging during interventional cardiology procedures are very real and should not be ignored. Both the patient, the operator and his assistants are at risk. Monitoring bodies in Europe and the USA have received numerous reports of serious radiation-induced skin injuries resulting from prolonged fluoroscopic imaging during interventional therapeutic procedures1 (Fig. 3.1). These procedures mainly involve (although are not exclusive to) coronary angioplasty and radiofrequency cardiac catheter ablation. In many of the reports, the physicians performing the procedures have been

unaware that radiation doses exceeded the expected threshold for injury, or were unaware of the intensity of the fluoroscopic beam.2 It is very important to note that the onset of these injuries is usually delayed up to 2 weeks, so that the physician cannot discern the damage by observing the patient immediately after treatment. The radiation dose required to cause skin injury depends on a number of factors, including the type of injury, the area of skin exposed, the age of the patient (and other patient-specific characteristics) as well as the circumstances of the exposure. In addition to these acute effects, very large doses can lead to an increased risk of delayed effects such as malignancy.