Shield yourself (ideally behind a cabin or suspended system that also protects your head) and shield other cathlab personnel. Report the procedural effective dose in the patient chart and to your team at the end of the procedure: daily feedback is the best motivator to improve on radiation dose reduction. Over the last 20 years, interventional electrophysiology (EP) has expanded significantly, both in the field of diagnostic studies, ablations, and device implantation. ![]() Most of those interventions are being performed under fluoroscopic guidance. Moreover, newer X-ray based technology, that offer highly accurate three-dimensional (3D) images, are often used to improve the anatomical information in combination with the mapping systems or in the 2D–3D fluoroscopic solutions (‘merging’). Combined with more procedures and more complex anatomical situations, this evolution leads to a higher cumulative radiation exposure, both of the patients and the staff. The patients may develop acute radiation injury, or have an increased risk of lifetime malignancy. Also, the staff are exposed to increasing radiation hazards, ranging from cataract to malignancy. Recent reports have for instance revealed that there may be an excess risk of brain tumours among interventional cardiologists. On the other hand, there are many technological tools and new developments that may help to reduce patient and operator exposure. Different systems allow for non-fluoroscopic (‘electroanatomical’) localization of the catheters and the creation of 3D images. Magnetic resonance imaging is being used offline for 3D imaging, and being pioneered for online imaging during EP procedures as well. ![]() Moreover, also for the X-ray use, which will remain a mainstay of the EP procedures in the near future, there are possibilities for filtration, pulsed fluoroscopy, collimation, real-time digital fluoro processing, and more, that should be used in all the labs. Indeed, by properly implementing these techniques, electrophysiologists can reduce the radiation dose dramatically. Radiation should always be reduced according to the ALARA principle, i.e. ![]() This does not mean that no radiation is the ultimate goal, since appropriate imaging is often crucial in performing complex EP procedures effectively and safely. The risk of radiation exposure always needs to be balanced vs.
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