Reviews of Environmental Contamination and Toxicology

Kesavachandran CN, Haamann F, Nienhaus A, Chandrasekharan Nair Kesavachandran, Frank Haamann, Albert Nienhaus, Kesavachandran, Chandrasekharan Nair, Haamann, Frank, Nienhaus, Albert

To the best of our knowledge, this chapter constitutes the first systematic review of radiation exposure to eyes, thyroid, and hands for Interventional Cardiology (IC) staff. We have concluded from our review that these anatomical locations are likely to be exposed to radiation as a result of the limited use of personal protective equipment (PPE) among IC staff as shown in Fig. 8. Our review also reveals that, with the exception of three eye exposure cases, the annual radiation dose to eyes, thyroid, and hands among IC staff was within recommended levels and limits. The As Low As Reasonably Achievable (ALARA) limit was not achieved in three cases for fingers/hands and four cases for eyes. However, an increased incidence of cataracts were reported for IC staff, and this gives rise to the concern that low-dose or unnoticed exposures may increase the risk of developing cataracts among cardiology staff. Clearly, the formation of cataracts among IC staff may be an issue and should be studied in more depth. Our review also disclosed that the two groups who receive excessive radiation doses (i.e., exceed the recommended limit) are physicians-in-training and junior staff physicians who work in cardiac catheterization laboratories. In particular, more attention should be given to assessing the effects of radiation exposure among IC staff who work in the Asia Pacific countries, because our review indicates that the number of IC procedures performed by IC staff in these countries is higher than for other continents. There is a huge demand for procedures conducted by IC staff in the Asia-Pacific area, for both treating patients and consulting with specialists. Our review also disclosed that recommended limits for per-procedure radiation doses are needed for IC staff. We recommend that such limits be established by the appropriate national and international agencies that are responsible for occupational radiation exposure. Although our review indicates that the current precautions against LDR exposure for IC staff are adequate in most cases, we are concerned about the relatively high incidence of cataracts reported to exist among IC staff. Therefore, we believe that there is a need for a strict implementation of radiation safety practices in cardiology laboratories and associated workplaces that utilize radiation. The action that is most important for protecting staff in the workplace against radiation exposure is the regular use of personal protective equipment or shielding. Working at a safe distance from instruments and assuring that such instruments are in the proper position are other techniques that can reduce the radiation dose received by IC staff.