Occupational Radiation Dose During Transcatheter Aortic Valve Implantation

Objectives: To examine the occupational radiation dose during transcatheter aortic valve implantation (TAVI) in both transfemoral and transapical approach. Background: Interventional fluoroscopic guided cardiac procedures lead inevitably to radiation exposure of workers, which over time may be associated with an increased incidence of cancer and cataract. Methods: Using thermoluminescence dosimeters, the radiation dose of the cardiothoracic surgeon, cardiologist, and two assistants was measured on the apron at chest height and on both feet. In addition, dose measurements were performed on the hands of the two operators and on the eyes of the cardiothoracic surgeon. This study involved 11 transapical and 11 transfemoral TAVIs. The effective dose was estimated from the dose measured on the apron. Results: In the transapical TAVI the cardiothoracic surgeon received a significantly higher equivalent hand dose (average +/- SD), 1.9 +/- 0.6 mSv, equivalent foot dose, 0.57 +/- 0.31 mSv, equivalent eye dose, 0.11 +/- 0.06 mSv, and effective dose, 0.03 +/- 0.02 mSv, than any staff member in the transfemoral TAVI, with highest average doses of 0.03 +/- 0.02 mSv, 0.22 +/- 0.19 mSv, 0.03 +/- 0.01 mSv, and 0.003 +/- 0.005 mSv, respectively. Conclusions: This study provides hitherto unavailable data on the radiation exposure of staff during transfemoral and transapical TAVIs. Relatively high doses were observed in the transapical approach. The dose of the right hand of the cardiothoracic surgeon will reach the annual limit within about 250 procedures per year, implying that hand dose measurements should become standard and that the number of procedures performed by the cardiothoracic surgeon involving X-rays may have to be limited.