Mean patient dose area products (DAP) in invasive cardiology are high and for specific interventional procedures vary greatly. For this reason patients may face serious radiation injuries and an increased risk of cancer in the future. Such increased risk is due less to inappropriate equipment than to inadequate operational technique and a lack of awareness of the potential for injury by individual cardiac interventionists.

This article focuses on the “as low as reasonably achievable” (ALARA) principle in invasive cardiology from the viewpoint of an experienced cardiologist, analysing the ranking and interdependency of those factors which influence patient radiation exposure—adequate length and number of radiographic runs, consistent collimation, adequate instead of best possible image quality, and basic knowledge about less irradiating angulations. Training in techniques to reduce radiation exposure enables patient doses to be achieved that are far below those used in non-invasive coronary imaging such as multislice computed tomography (MSCT). In addition, improved lead shielding is effective in maintaining operator radiation exposure below 1% of typical levels in advanced catheterisation laboratories. Traditional radiological convictions, misinterpreted and misleading since the early times of fluoroscopy guided cardiac interventions, will be disclosed and discussed.

RADIATION EXPOSURE IN INVASIVE CARDIOLOGY: WHAT IS THE CHALLENGE?

As early as 1925, FM Groedel, founder of both the German Cardiac Society and the American College of Cardiology, identified the following factors as playing a role in the adverse effects of x rays: excessively long fluoroscopic examinations, short focus skin distances, insufficient filtering of the x ray beam, and, not least, excessive numbers of radiographs made by insufficiently trained operators and assistants.1

In invasive cardiology, however, up to now these problems have been underappreciated: directives from the International Commission of Radiation Protection (ICRP) point out that “Unfortunately there is growing evidence that many interventionists have a less than ideal understanding of the risks of radiation-induced injuries from …