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Mar 22, 2011

Doctors Strive for Lowest Possible Radiation Dose During Angioplasty

What all patients should know about radiation safety before having angioplasty or stenting.

When interventional cardiologists perform angioplasty, they focus on the job at hand: safely guiding a slender tube into the arteries of the heart and inflating a tiny balloon to clear away cholesterol-filled blockages.

But even before the procedure begins, the real pros address another safety issue, the radiation dose from x-rays used to see inside the arteries.

Radiation dose is something patients should ask about when choosing an interventional cardiologist and deciding where to go for angioplasty and stenting—just as they would ask about success rates and the risk of complications.

“Interventional cardiologists have a variety of tasks to master, and management of radiation dose must be among them,” wrote Charles E. Chambers, M.D., in an editorial in the March 2011 issue of JACC: Cardiovascular Interventions. “All cardiac catheterization laboratories should have a radiation safety program and a goal to reduce radiation exposure as low as is reasonably achievable.”

According to Chambers, a professor of medicine and radiology at Penn State Hershey Medical Center in Hershey, PA, skilled interventional cardiologists in experienced medical centers plan ahead and make careful choices about the use of x-rays. Otherwise, patients could develop patches of reddened, irritated skin from too much radiation or even face an increased risk of cancer.

Advance planning is especially important with certain types of patients. A study from the Mayo Clinic, published in the same issue of JACC: Cardiovascular Interventions, found that the total radiation dose tends to be highest among patients with complex blockages in the coronary arteries, obesity, or artery disease throughout the body.

Before having angioplasty or stenting, ask your interventional cardiologist questions about radiation safety, including the following:

  • What is the average radiation dose for angioplasty and stenting procedures you perform in this cardiac catheterization laboratory?
  • Do you have a radiation safety program? Does the x-ray equipment in the cath lab have the ability to estimate, display, and adjust radiation dose?
  • If needed in a particular case, do you make adjustments in how pictures are captured and stored in order to keep radiation dose low?
  • What do you do to reduce the radiation dose in patients who are obese or who have complex arterial disease?
  • Do you inform patients after a procedure if the total x-ray time or radiation dose was high? What type of follow-up do you do to check for possible radiation injury?

Questions for You to Consider

  • Is it worth the radiation risk to have angioplasty and stenting?

  • In a word, yes. Skilled interventional cardiologists perform coronary procedures only when the benefits outweigh the overall risks, including any risks from radiation exposure. Keep in mind, we’re all exposed to radiation from the atmosphere as we go about our everyday lives. Background radiation comes to about 3 to 4 “milliSieverts” (mSv) a year. By comparison, the radiation dose from cardiology procedures such as cardiac catheterization and angioplasty is about 1 to 10 mSv. Still, it is important to talk with your doctor about plans for minimizing radiation dose as much as possible.

  • Why is the radiation dose higher in complex procedures and in people with artery disease?

  • It’s really a matter of the time the x-ray machine is used for creating pictures inside the arteries. Challenging procedures take longer to perform, which increases the total amount of x-rays passing through the body, and the total radiation dose. It’s the same situation with artery disease. If a person has had coronary bypass surgery in the past, angioplasty is more complicated and time-consuming. If the leg arteries are full of cholesterol deposits, it takes more time to thread a tube from a groin artery and into the heart. Both significantly increase the radiation dose.
  • Why is the radiation dose higher in people who are obese?

  • A stronger x-ray beam is needed to penetrate through a large body while still creating high-quality pictures of the coronary arteries. In addition the angles that are used for directing the x-ray beam into the body may be different in obese people. This can cause the x-rays to travel a longer path inside the body. Both of these factors increase the radiation dose.
  • Should I be worried about developing redness or other signs of a radiation burn on my skin after angioplasty?
  • Radiation burns are extremely rare. When they do happen, they are usually related to very long x-ray times or repeat procedures. However, if you notice skin redness on your back that looks like rash, even months after your angioplasty, tell your doctor. You may need to be referred to a skin specialist for treatment.

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