Radiation Exposure of Operators Performing Transesophageal Echocardiography During Percutaneous Structural Cardiac Interventions

Abstract Background Transesophageal echocardiography operators (TEEOP) provide critical imaging support for percutaneous structural cardiac intervention procedures. They stand close to the patient and the associated scattered radiation. Objectives This study sought to investigate TEEOP radiation dose during percutaneous structural cardiac intervention. Methods Key personnel (TEEOP, anesthetist, primary operator [OP1], and secondary operator) wore instantly downloadable personal dosimeters during procedures requiring TEE support. TEEOP effective dose ( E ) and E per unit Kerma area product ( E /KAP) were calculated. E /KAP was compared with C-arm projections. Additional shielding for TEEOP was implemented, and doses were measured for a further 50 procedures. Multivariate linear regression was performed to investigate independent predictors of radiation dose reduction. Results In the initial 98 procedures, median TEEOP E was 2.62 μSv (interquartile range [IQR]: 0.95 to 4.76 μSv), similar to OP1 E : 1.91 μSv (IQR: 0.48 to 3.81 μSv) (p = 0.101), but significantly higher than secondary operator E : 0.48 μSv (IQR: 0.00 to 1.91 μSv) (p  E : 0.48 μSv (IQR: 0.00 to 1.43 μSv) (p  E /KAP (p = 0.041). In a further 50 procedures, with additional TEEOP shielding, TEEOP E was reduced by 82% (2.62 μSv [IQR: 0.95 to 4.76] to 0.48 μSv [IQR: 0.00 to 1.43 μSv] [p  Conclusion TEE operators are exposed to a radiation dose that is at least as high as that of OP1 during percutaneous cardiac intervention. Doses were higher with procedures using predominantly RAO projections. Radiation doses can be significantly reduced with the use of an additional ceiling-suspended lead shield.