Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

Ionizing radiation management is among the most important safety issues in interventional cardiology. Multiple radiation protection measures allow the minimization of x-ray exposure during interventional procedures. Our purpose was to assess the utilization and effectiveness of radiation protection and optimization techniques among interventional cardiologists in Lithuania. Interventional cardiologists of five cardiac centres were interviewed by anonymized questionnaire, addressing personal use of protective garments, shielding, table/detector positioning, frame rate (FR), resolution, field of view adjustment and collimation. Effective patient doses were compared between operators who work with and without x-ray optimization. Thirty one (68.9%) out of 45 Lithuanian interventional cardiologists participated in the survey. Protective aprons were universally used, but not the thyroid collars; 35.5% ( n   =  11) operators use protective eyewear and 12.9% ( n   =  4) wear radio-protective caps; 83.9% ( n   =  26) use overhanging shields, 58.1% ( n   =  18)—portable barriers; 12.9% ( n   =  4)—abdominal patient's shielding; 35.5% ( n   =  11) work at a high table position; 87.1% ( n   =  27) keep an image intensifier/receiver close to the patient; 58.1% ( n   =  18) reduce the fluoroscopy FR; 6.5% ( n   =  2) reduce the fluoro image detail resolution; 83.9% ( n   =  26) use a 'store fluoro' option; 41.9% ( N   =  13) reduce magnification for catheter transit; 51.6% ( n   =  16) limit image magnification; and 35.5% ( n   =  11) use image collimation. Median effective patient doses were significantly lower with x-ray optimization techniques in both diagnostic and therapeutic interventions. Many of the ionizing radiation exposure reduction tools and techniques are underused by a considerable proportion of interventional cardiology operators. The application of basic radiation protection tools and techniques effectively reduces ionizing radiation exposure and should be routinely used in practice. (practical matter)