Real-time Radiation Exposure Monitoring in the Cardiac Catheterization Laboratory Using a Digital RRPD Dosimeter

Occupational exposure to ionizing radiation remains an important concern for healthcare professionals working in x-ray-guided interventional environments. Conventional passive dosimetry provides retrospective dose assessment and does not permit immediate modification of operator behavior. We evaluated the feasibility and practical utility of a real-time radiation personal dosimeter (RRPD) during three chronic total occlusion (CTO) percutaneous coronary intervention procedures performed in a cardiac catheterization laboratory. Wearable dosimeters were positioned on the lead aprons of the primary and secondary operators and provided continuous wireless measurements of the dose rate and cumulative radiation exposure. Procedural parameters, including fluoroscopy time, air kerma, dose-area product (DAP), cine acquisition count, and operator dose, were recorded and compared with commonly reported reference ranges for CTO interventions. Radiation exposure increases with procedural complexity. Antegrade CTO procedures demonstrated fluoroscopy time, air kerma, and DAP values below the typical reference ranges, whereas a complex retrograde CTO procedure was associated with higher values consistent with prolonged fluoroscopy. Real-time visualization of radiation peaks was associated with timely operator adjustments without too much clinical interference, including reduced angulation and limitations of cine imaging. The primary operator exposure exceeded the secondary operator exposure in all cases. These findings indicate that real-time personal dosimetry enables continuous exposure monitoring and may support radiation-protective behaviors during high-dose interventional procedures.