Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
JAMA Netw Open. 2022 Jul 1;5(7):e2220597. doi: 10.1001/jamanetworkopen.2022.20597.
Transesophageal echocardiography during percutaneous left atrial appendage closure (LAAO) and transcatheter edge-to-edge mitral valve repair (TEER) require an interventional echocardiographer to stand near the radiation source and patient, the primary source of scatter radiation. Despite previous work demonstrating high radiation exposure for interventional cardiologists performing percutaneous coronary and structural heart interventions, similar data for interventional echocardiographers are lacking.
To assess whether interventional echocardiographers are exposed to greater radiation doses than interventional cardiologists and sonographers during structural heart procedures.
DESIGN, SETTING, AND PARTICIPANTS: In this single-center cross-sectional study, radiation doses were collected from interventional echocardiographers, interventional cardiologists, and sonographers at a quaternary care center during 30 sequential LAAO and 30 sequential TEER procedures from July 1, 2016, to January 31, 2018. Participants and study personnel were blinded to radiation doses through data analysis (January 1, 2020, to October 12, 2021).
Occupation defined as interventional echocardiographers, interventional cardiologists, and sonographers.
Measured personal dose equivalents per case were recorded using real-time radiation dosimeters.
A total of 60 (30 TEER and 30 LAAO) procedures were performed in 60 patients (mean [SD] age, 79 [8] years; 32 [53.3%] male) with a high cardiovascular risk factor burden. The median radiation dose per case was higher for interventional echocardiographers (10.6 μSv; IQR, 4.2-22.4 μSv) than for interventional cardiologists (2.1 μSv; IQR, 0.2-8.3 μSv; P < .001). During TEER, interventional echocardiographers received a median radiation dose of 10.5 μSv (IQR, 3.1-20.5 μSv), which was higher than the median radiation dose received by interventional cardiologists (0.9 μSv; IQR, 0.1-12.2 μSv; P < .001). During LAAO procedures, the median radiation dose was 10.6 μSv (IQR, 5.8-24.1 μSv) among interventional echocardiographers and 3.5 (IQR, 1.3-6.3 μSv) among interventional cardiologists (P < .001). Compared with interventional echocardiographers, sonographers exhibited low median radiation doses during both LAAO (0.2 μSv; IQR, 0.0-1.6 μSv; P < .001) and TEER (0.0 μSv; IQR, 0.0-0.1 μSv; P < .001).
In this cross-sectional study, interventional echocardiographers were exposed to higher radiation doses than interventional cardiologists during LAAO and TEER procedures, whereas sonographers demonstrated comparatively lower radiation doses. Higher radiation doses indicate a previously underappreciated occupational risk faced by interventional echocardiographers, which has implications for the rapidly expanding structural heart team.
经皮左心耳封堵术 (LAAO) 和经导管缘对缘二尖瓣修复术 (TEER) 期间的经食管超声心动图需要介入超声心动图医师站在辐射源和患者附近，而辐射源和患者是散射辐射的主要来源。尽管之前有研究表明介入心脏病专家在进行经皮冠状动脉和结构性心脏介入治疗时会受到高剂量辐射，但缺乏类似的介入超声心动图医师的辐射暴露数据。
评估在结构性心脏手术期间，介入超声心动图医师的辐射剂量是否大于介入心脏病专家和超声技师。
设计、设置和参与者：在这项单中心横断面研究中，从 2016 年 7 月 1 日至 2018 年 1 月 31 日，在一家四级护理中心，在 30 例连续的 LAAO 和 30 例连续的 TEER 手术期间，从介入超声心动图医师、介入心脏病专家和超声技师中收集了辐射剂量。通过数据分析（2020 年 1 月 1 日至 2021 年 10 月 12 日），参与者和研究人员对辐射剂量一无所知。
职业定义为介入超声心动图医师、介入心脏病专家和超声技师。
使用实时辐射剂量计记录每例患者的个人剂量当量。
共进行了 60 例（30 例 TEER 和 30 例 LAAO）手术，涉及 60 例患者（平均[标准差]年龄 79[8]岁；32[53.3%]为男性），心血管高危因素负担高。每例患者的中位辐射剂量为介入超声心动图医师（10.6 μSv；IQR，4.2-22.4 μSv）高于介入心脏病专家（2.1 μSv；IQR，0.2-8.3 μSv；P<.001）。在 TEER 期间，介入超声心动图医师的中位辐射剂量为 10.5 μSv（IQR，3.1-20.5 μSv），高于介入心脏病专家的中位辐射剂量（0.9 μSv；IQR，0.1-12.2 μSv；P<.001）。在 LAAO 手术期间，介入超声心动图医师的中位辐射剂量为 10.6 μSv（IQR，5.8-24.1 μSv），介入心脏病专家的中位辐射剂量为 3.5 μSv（IQR，1.3-6.3 μSv；P<.001）。与介入超声心动图医师相比，超声技师在 LAAO（0.2 μSv；IQR，0.0-1.6 μSv；P<.001）和 TEER（0.0 μSv；IQR，0.0-0.1 μSv；P<.001）中均显示出较低的中位辐射剂量。
在这项横断面研究中，与介入心脏病专家相比，介入超声心动图医师在 LAAO 和 TEER 手术期间受到的辐射剂量更高，而超声技师的辐射剂量则相对较低。较高的辐射剂量表明介入超声心动图医师面临着以前未被充分认识的职业风险，这对快速扩张的结构性心脏团队具有影响。
