Occupational radiation exposure in contemporary cardiac electrophysiology and device therapy: a two-year prospective study with implications for pregnant operators

Introduction Despite considerable reductions in radiation doses achieved through modern equipment and technologies, including 3D mapping systems in invasive electrophysiology, concerns about occupational radiation exposure during cardiac procedures persist, especially among female physicians. International recommended dose limits include 1 mSv per year for the general population, 20 mSv per year for occupationally exposed persons and 1 mSv on the uterus during an entire pregnancy. However, there is a lack of real-world data on operator exposure during electrophysiological procedures and device implantations, and a lack of well-established diagnostic reference levels. To address these gaps, we conducted a two-year prospective analysis assessing radiation doses in a modern catheterization laboratory including personal dosimetry above and underneath the radiation protection apron. Methods All procedures performed in the catheterization laboratory of our Center over 24 months (August 2023-2025) were conducted using two continuously active electronic personal dosimeters measuring Hp(10), which was used as a conservative surrogate of organ dose, throughout the procedure (EPD TruDose, Thermo Scientific, Waltham, MA, USA). The primary operator wore one EPD above and one underneath the lead apron at the level of the lower abdomen. In between procedures, the EPDs were continuously kept turned-on in the control room. Radiation doses before and after each procedure, dose–area products (DAPs) and fluoroscopy times were analyzed. Statistical analysis was performed using SPSS. Results A total of 838 procedures were assessed (613 catheter ablations and 225 device implantations). Radiation doses varied significantly between different procedures. The overall median DAP was 143(0-2535) cGycm² for catheter ablations and 162 (0-6195) cGycm² for device implantations (p<0.001). The highest radiation doses were assessed during CRT implantations and pulmonary vein isolations using the cryo balloon (612 (154-2673) and 454 (151-2535) cGycm², respectively). The median personal radiation dose per procedure documented by the EPD underneath the lead apron was 0 mSv (0-0.001) for catheter ablations and 0.001 mSv (0-0.012) for device implantations (p<0.001). The median personal radiation dose per procedure documented by the EPD above the lead apron was 0.001 mSv (0-0.09) for catheter ablations and 0.08 mSv (0-0.102) for device implantations (p<0.001). Over the entire two-year study period, the cumulative radiation doses on the EDPs worn above and underneath the lead apron were 4.471 mSv and 0.924 mSv, respectively. Conclusion In a modern catheterization laboratory, occupational radiation exposure during cardiac electrophysiological procedures and device implantations varies between procedures and is lower than pre-existing diagnostic reference levels suggest. It remains far below recommended dose limits including for pregnant professionals.