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A dose of prevention for reducing radiation exposure

por Sean Ruck, Contributing Editor | August 12, 2020
Cardiology Risk Management
From the August 2020 issue of HealthCare Business News magazine

It’s well-established that radiation exposure can impact interventional cardiologists in multiple ways. HealthCare Business News spoke with Dr. Dipti Itchhaporia, ACC's vice president, an interventional cardiologist with Hoag Memorial Hospital Presbyterian and associate professor of Medicine at the University of California Irvine, to learn about the specific dangers radiation exposure introduces and how to mitigate those dangers.

To begin, Itchhaporia says there are many possible side effects of radiation. One is the higher incidence of cataracts, specifically posterior subscapular cataract, among interventional cardiologists. “That’s typically why we wear the lead-lined glasses,” she says.

There is also reported thyroid disease due to the result of radiation exposure. Reproductive problems have been reported as well. And most recently, there has been increased attention paid to reports of left-sided brain tumors among the specialty.

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While the body of research surrounding radiation risks to providers has grown over the years, the technology and methods to reduce the risks, while improving, has grown at a slower pace. “I can go back to training where the principles of ALARA were enshrined. It stands for ‘as low as reasonably achievable.’ that is what we were taught,” Itchhaporia says.

California, which leads the nation in identifying and labeling cancer risks of various materials, chemicals and products, requires a fluoroscopy license. “It’s meant to educate all of us in the cath lab or those who use fluoroscopy equipment to understand what the risks are and how best to mitigate our exposure,” Itchhaporia says.

But the best training only goes so far – individuals need to act on that training and continue to work to reduce their own exposure. Itchhaporia says the obvious first step is try not to expose yourself to radiation at all, unless it’s unavoidable. Turn to radiation-reliant imaging only when absolutely necessary. She also notes that fluoroscopy has less than 10 percent the radiation exposure compared to cine, delivering a significant decrease in dose. “Utilizing less steep angulation is also a way to reduce exposure, though that can be difficult in certain cases,” she says

She also says minimizing the use of magnification modes helps. “The younger interventionalists have really been attuned to these methods of decreasing exposure. They use less magnification, they use more flouroscopy than cine. They’re more interested in knowing what their exposure is, so they’re following their badges a little better than I think older interventionalists have.”

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