Strategies to reduce radiation exposure for operators in percutaneous structural cardiac interventions.

In recent years the number of percutaneous structural heart interventions (SHI) has increased. Significant radiation exposure for patients and operators occurs in SHI. SHI have always been performed in catheterization laboratory (CL) under fluoroscopy and only recently with the support given by transesophageal echocardiography guidance (TEG). Recently, Italian legislation reduced the eye lens equivalent dose limit by about seven times.The TEG is done by the interventional imager (IM), a new figure in the CL staff. The IM, due to both the proximity to X-ray source and absence of dedicate protections, is subjected to high-radiation exposures. Aim of this work is to find strategies in terms of educational recommendations and dedicated equipment to reduce IM exposure. First, SHI parameters were retrospectively analyzed to find the most frequently adopted for each kind of procedure. Then, simulation study was performed with an anthropomorphic phantom in the CL to identify protective c-arm projections and locations for the IM. IM eye lens real time dosimetry, before and after adoption of protective projections and locations, was performed during clinical SHI to compare the radiation doses.