Dosimetric and radiation protection considerations based on some cases of patient skin injuries in interventional cardiology.

TLDR

Skin injuries have been reported in patients undergoing cardiac radiofrequency catheter ablation. The study proposes practical radiation protection measures to prevent future skin injuries during cardiac catheter ablation. The authors examined procedures performed on a biplane X‑ray system in a large Spanish hospital, describing the interventional techniques and resulting radiation lesions. Radiation lesions were mainly erythematous and chronic radiodermatitis, and dosimetric analysis showed high skin dose rates due to a short focus‑to‑skin distance and fixed beam orientation, with accumulated right‑side skin dose estimated at 11–15 Gy per procedure, while dose rates at the image intensifier entrance were within typical values.

Abstract

Recently, several cases of skin injuries have been detected in patients undergoing cardiac radiofrequency catheter ablation. These procedures were performed on a biplane X-ray system used in a large Spanish hospital for interventional cardiology procedures. Interventional procedures performed and radiation lesions produced on patients are described. The radiation lesions were mainly erythematous lesions and chronic radiodermatitis. Results of the dosimetric evaluations and an analysis of the operational aspects of radiological protection are discussed. Poor image quality could have influenced the length of the procedures. Dose rate at the image intensifier entrance was within usual reported values in literature. However, the focus-to-skin distance for the horizontal X-ray beam was too short, resulting in a high skin dose rate. Additionally, X-ray beams are of fixed orientation, and accumulated skin dose in the patient's right side has been estimated as 11-15 Gy per procedure. In conclusion, practical radiation protection considerations to avoid further incidents of this sort are proposed, concerning the use of X-ray systems specially designed for interventional radiology, the improvement of cardiologists' training in radiation protection and routine patient dose measurements for complex interventional procedures.