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Radiation protection in the cardiac catheterisation lab: best practice
  1. Ariel Roguin1,
  2. James Nolan2
  1. 1 2 Hillel Yaffe Medical Centre, Technion – Israel Institute of Technology, Hadera, Israel
  2. 2 Department of Cardiology, Royal Stoke University Hospital and Keele University, Stoke-on-Trent, Staffordshire, UK
  1. Correspondence to Professor James Nolan, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, UK; james.nolan{at}

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Learning objectives

  • Understand the factors that influence patient and operator exposure to ionising radiation in the catheterisation laboratory.

  • Learn the potential hazards of radiation exposure.

  • Understand methods to minimise radiation exposure to patients and staff.


Occupational doses of radiation in cardiac procedures guided by fluoroscopy are the highest registered among medical staff using X-rays.1–5 Electrophysiologists and interventional cardiologists are the group with the highest exposure. Patient and operator exposure are closely related. Higher doses to the patient results in more scatter radiation and increased exposure to the operator. Patients with an elevated body mass index are frequently encountered in the catheterisation laboratory and need more radiation energy to obtain a good quality image, resulting in increased scatter radiation generation during the procedure.6 Patient exposure to low-dose ionising radiation from cardiac procedures may be associated with increased risk, mainly if the exposure occurs at a young age.7 While every effort should be taken to obtain high-quality images, it is important to try and decrease the amount of procedure-related radiation exposure and protect the working staff (ie, cardiologists, cardiac technicians, radiographers, nurses and trainees) in the cardiac catheterisation laboratory. In this article we discuss these issues and outline strategies to reduce patient and staff exposure.

Background radiation

We are all constantly exposed to background radiation. This background radiation arises from natural and artificial sources. Natural sources of background radiation include cosmic rays, rocks and living things. Some rocks are radioactive and also release radioactive radon gas into the environment. Variation in the distribution of this type of rock accounts for significant geographical variation in local levels of background radiation. Plants absorb radioactive materials from the soil and these pass up the food chain into the human population. Exposure to cosmic rays is increased in communities that live at high altitude due to a …

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  • Collaborators There are no collaborators apart from the two authors.

  • Contributors The first draft of the manuscript was prepared by AR and then reviewed and edited by both authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work

  • Author note References which include a * are considered to be key references.