McGill University Health Center, Division of Cardiology, Montréal, Québec, Canada.
McGill University Health Center, Medical Physics Unit, Montréal, Québec, Canada.
Can J Cardiol. 2019 Apr;35(4):535-538. doi: 10.1016/j.cjca.2019.01.006. Epub 2019 Jan 25.
Fluoroscopy-guided procedures constitute a major part in the practice of cardiology. These procedures are also a source of human-made ionizing radiation. Although the benefits of performing the procedure surpass the radiogenic risks in most cases, the risks are not negligible. Exposure to ionizing radiation may lead to tissue injuries and potential increase in risk of cancer. Both patients and operating physicians are exposed to these risks in variable degrees. The institution of radiation safety practices alone significantly reduces radiation exposure. Beyond the interventional laboratory, increasing physicians' awareness to health-related risks of ionizing radiation is crucial in reducing unnecessary testing and increases receptiveness to patient risks. Incorporating the radiogenic risks of a future procedure in patient-informed consent also increases patients' awareness to potential consequences. Innovation in imaging technology resulted in a plethora of alternate modalities. Electroanatomical mapping, magnetic navigation systems, robotic and magnetic resonance imaging (MRI)-assisted techniques are examples of clinically used modalities that limit the exposure of patients and operating physicians to radiation. Documentation of patients' exposure in their medical records is essential. Tracking of patients' cumulative exposure can be implemented at an institutional level. Identifying patients with the highest exposure would help shed light on a blind spot in our current practice, as the implications are unclear.
荧光透视引导的程序构成了心脏病学实践的主要部分。这些程序也是人为电离辐射的来源。尽管在大多数情况下,进行该程序的益处超过了放射性风险,但这些风险并非微不足道。电离辐射的暴露可能导致组织损伤,并潜在增加癌症风险。患者和操作医生都以不同程度暴露于这些风险之中。辐射安全实践的实施本身就显著降低了辐射暴露。除了介入实验室之外,提高医生对电离辐射相关健康风险的认识对于减少不必要的检查和提高对患者风险的接受程度至关重要。在患者知情同意中纳入未来程序的放射性风险也会提高患者对潜在后果的认识。成像技术的创新带来了大量替代方式。电解剖图、磁导航系统、机器人和磁共振成像(MRI)辅助技术是临床应用的方式的例子,它们限制了患者和操作医生的辐射暴露。在病历中记录患者的暴露情况至关重要。可以在机构层面上实施对患者累积暴露的跟踪。确定暴露量最高的患者有助于揭示我们当前实践中的盲点,因为其影响尚不清楚。