Radiation Management During Chronic Total Occlusion Percutaneous Coronary Intervention

Radiation skin injury ( Fig. 10.1 ) is a rare complication of any invasive cardiac procedure, but is more likely to occur in the setting of complex procedures, such as chronic total occlusion (CTO) percutaneous coronary intervention (PCI), where large doses of radiation are often used. Radiation skin injury can lead to severe consequences for the patient, such as painful, nonhealing ulcers that may require months or even years to heal and in some cases may even require surgical debridement and plastic reconstruction.

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Example of radiation-induced skin injury after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Erythema and epilation developed on the patient’s back 1 month after CTO PCI, during which he received 11.8 Gy air kerma dose.

Reproduced with permission from Chambers CE. Radiation dose in percutaneous coronary intervention OUCH did that hurt? JACC Cardiovasc Interv 2011; 4 :344–6.

A plan for radiation dose management from the outset of all PCI cases, especially CTO PCI, is essential. Such a plan will not only lead to a lower radiation dose to the patient, but it will also reduce physician and staff dosing. Interventional cardiologists and staff are exposed to ionizing radiation on a daily basis over many years, which can increase their risk for developing cancer (such as, but not limited to, left-sided brain tumors ), cataracts, and other ailments, as well as orthopedic problems associated with protective garments.

Despite the obvious benefits in of limiting radiation exposure, observations from multiple cardiac catheterization laboratories have shown that sound radiation management practices are infrequently implemented, although progress has been documented by some programs. The goal of this chapter is to provide simple and practical tips and tricks for reducing both patient and operator radiation exposure.