exposition cardiology

Comparison of Radiation Exposure Among Interventional Echocardiographers, Interventional Cardiologists, and Sonographers During Percutaneous Structural Heart Interventions

David A. McNamara, MD, MPH; Rajus Chopra, MD; JeffreyM. Decker, MD; Michael W. McNamara, MD; Stacie M. VanOosterhout, MEd; Duane C. Berkompas, MD; Musa I. Dahu, MD; Mohamad A. Kenaan, MD; Wassim I. Jawad, MD; William M. Merhi, DO; Jessica L. Parker, MS; Ryan D. Madder, MD.
July 2022

Transesophageal echocardiography during percutaneous left atrial appendage closure (LAAO) and transcatheter edge-to-edge mitral valve repair (TEER) require an interventional echocardiographer to stand near the radiation source and patient, the primary source of scatter radiation. Despite previous work demonstrating high radiation exposure for interventional cardiologists performing percutaneous coronary and structural heart interventions, similar data for interventional echocardiographers are lacking.


Assess whether interventional echocardiographers are exposed to greater radiation doses than interventional cardiologists and sonographers during structural heart procedures


Measured personal dose equivalents per case were recorded using real-time radiation dosimeters.


A total of 60 (30 TEER and 30 LAAO) procedures were performed in 60 patients (mean [SD] age, 79 [8] years; 32 [53.3%] male) with a high cardiovascular risk factor burden:

  • The median radiation dose per case was higher for interventional echocardiographers (10.6 μSv; IQR, 4.2-22.4 μSv) than for interventional cardiologists (2.1 μSv; IQR, 0.2-8.3 μSv; P < .001).
  • During TEER, interventional echocardiographers received a median radiation dose of 10.5 μSv (IQR, 3.1-20.5 μSv), which was higher than the median radiation dose received by interventional cardiologists (0.9 μSv; IQR, 0.1-12.2 μSv; P < .001).
  • During LAAO procedures, the median radiation dose was 10.6 μSv (IQR, 5.8-24.1 μSv) among interventional echocardiographers and 3.5 (IQR, 1.3-6.3 μSv) among interventional cardiologists (P < .001).
  • Compared with interventional echocardiographers, sonographers exhibited low median radiation doses during both LAAO (0.2 μSv; IQR, 0.0-1.6 μSv; P < .001) and TEER (0.0 μSv; IQR, 0.0-0.1 μSv; P < .001).


In this cross-sectional study, interventional echocardiographers were exposed to higher radiation doses than interventional cardiologists during LAAO and TEER procedures, whereas sonographers demonstrated comparatively lower radiation doses.

Higher radiation doses indicate a previously underappreciated occupational risk faced by interventional echocardiographers, which has implications for the rapidly expanding structural heart team

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