Elsevier

American Heart Journal

Volume 157, Issue 1, January 2009, Pages 118-124
American Heart Journal

Clinical Investigation
Interventional Cardiology
Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: Insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report

https://doi.org/10.1016/j.ahj.2008.08.009Get rights and content

Background

Occupational doses from fluoroscopy-guided interventional procedures are the highest ones registered among medical staff using x-rays. The aim of the present study was to evaluate the order of magnitude of cancer risk caused by professional radiation exposure in modern invasive cardiology practice.

Methods

From the dosimetric Tuscany Health Physics data bank of 2006, we selected dosimetric data of the 26 (7 women, 19 men; age 46 ± 9 years) workers of the cardiovascular catheterization laboratory with effective dose >2 mSv. Effective dose (E) was expressed in milliSievert, calculated from personal dose equivalent registered by the thermoluminescent dosimeter, at waist or chest, under the apron, according to the recommendations of National Council of Radiation Protection. Lifetime attributable risk of cancer was estimated using the approach of Biological Effects of Ionizing Radiation 2006 report VII.

Results

Cardiac catheterization laboratory staff represented 67% of the 6 workers with yearly exposure >6 mSv. Of the 26 workers with 2006 exposure >2 mSv, 15 of them had complete records of at least 10 (up to 25) consecutive years. For these 15 subjects having a more complete lifetime dosimetric history, the median individual effective dose was 46 mSv (interquartile range = 24-64). The median risk of (fatal and nonfatal) cancer (Biological Effects of Ionizing Radiation 2006) was 1 in 192 (interquartile range = 1 in 137-1 in 370).

Conclusions

Cumulative professional radiological exposure is associated with a non-negligible Lifetime attributable risk of cancer for the most exposed contemporary cardiac catheterization laboratory staff.

Section snippets

Selection of subjects

We initially considered all health professionals included in 2006 in the Tuscany Region dosimetric data bank, collected in the Health Physics Departments of Pisa and Florence and composed of >50 hospitals, including 11 high volume cardiac catheterization laboratories. From this initial set of 5,164 workers, we selected cardiac catheterization laboratory staff (interventional cardiologists, cardiac electrophysiologists, interventional radiologists, nurses, technicians) and analyzed the yearly

Results

For the total population of 5,164 workers, we assessed the yearly exposure as distributed throughout the medical specialties. Cardiac catheterization laboratory workers represented 67% of workers with yearly exposure >6 mSv and 31% of those with exposure >1 mSv (Figure 1). When the full population of cardiac catheterization laboratory personnel is considered, the exposure levels are relatively low and comparable with those of other specialties with radiation exposure (Figure 2). The 2006 dose

Discussion

In contemporary medical practice, catheterization laboratory workers comprised most of those with high levels of exposure. For the most experienced (and most exposed) staff working in the cardiac catheterization laboratory, with a range of exposures in between 2 and 5 mSv per year, a typical cumulative 15-year radiological exposure around the equivalent of 50 mSv is associated with a nonnegligible LAR of cancer in the order of magnitude of 1 cancer in 200 exposed subjects. This applies,

Conclusions

The number of interventional radiological (and especially cardiological) procedures has been increasing during the last years. The number of involved professionals (cardiologists, nurses, and technicians) is also substantially increasing. The highest doses to staff (and to patients) are usually recorded in these laboratories. With current staff exposure levels, professional risk cannot be considered negligible, for the most exposed personnel workers in the cardiac catheterization laboratories,

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    The study was endorsed and partially funded by ANMCO and is a part (IntercardioRisiko subproject) of the IntercardioReproStudy.

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