Radiation Implications with Device Implantations

Background Transcatheter aortic valve implantation (TAVI) is fast becoming a standard treatment for diseased aortic valves. Catheter-mounted occluder devices may also be used to treat conditions less invasively than surgery, such as patent foramen ovale (PFO), atrial septal defect (ASD), and non-valvular atrial fibrillation. Fluoroscopic imaging is utilised to visualise anatomy and ensure appropriate device position. While it is useful for procedural guidance, it comes with potential adverse radiation implications to patients and staff. Little has been reported regarding the levels of radiation exposure during transcatheter device implantations. Methods Occupational dose was measured via Philips DoseAware badges worn on the left temple of the cardiologist (n=6), scrub nurse (n=17), and scout nurse (n=20) from February 2017 to August 2019. Patient air kerma (AK) and dose area product (DAP) were recorded. Dose data for TAVIs (n=25) and procedures implanting Amulet (n=6), Watchman (n=9), PFO (n=10), and ASD (n=1) closure devices were collected. Results TAVI procedures were correlated with a significantly higher scrub nurse dose (p=0.006), as well as DAP and AK (p Conclusion TAVI procedures are associated with increased radiation exposure to staff and patients compared with implantation of transcatheter closure devices. This may be a result of the use of digital subtraction angiography to image the pelvic vessels. Efforts should be made to minimise radiation exposure during X-ray-guided device implantations.