Attigah N, Oikonomou K, Hinz U, et al. Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms. J Vasc Surg. 2016 Jan;63(1):198-203.

The purpose of this study was to evaluate the radiation exposure of vascular surgeons’ eye lens and fingers during complex endovascular procedures in modern hybrid operating rooms. Interventions were classified into six treatment categories: endovascular repair of infrarenal abdominal aneurysm (n = 65), thoracic endovascular aortic repair (n = 32), branched endovascular aortic repair for thoracoabdominal aneurysms (n = 17), fenestrated endovascular aortic repair for complex abdominal aortic aneurysm, (n = 25), iliac branched device (n = 8), and peripheral interventions (n = 24). There was a significant correlation in DAP between both lens (P < .01; r = 0.55) and finger (P < .01; r = 0.56) doses.

Anselmino M, Sillano D, Casolati D, et al. A new electrophysiology era: zero fluoroscopy. J Cardiovasc Med (Hagerstown). 2013 Mar;14(3):221-7.

Catheter ablations are traditionally performed under fluoroscopic guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic and deterministic effects on health. These effects are cumulative and lifelong and raise great concerns especially in the younger population. A document of the American College of Cardiology recommends that all catheterization laboratories adopt the principles of ‘ALARA’ (radiation doses ‘As Low As Reasonably Achievable’), making radiation reduction an ethical issue. In electrophysiology, thanks to the recent development of electroanatomic navigation systems, we are witnessing the birth of a new era in which almost all arrhythmias may be treated without the use of fluoroscopy. In the present review, we start by describing risks to health due to radiation exposure for conventional transcatheter ablations and we continue by reporting the current state of art of the zero fluoroscopy approach.

Alejo L, Koren C, Corredoira E, et al. Eye lens dose correlations with personal dose equivalent and patient exposure in paediatric interventional cardiology performed with a fluoroscopic biplane system. Phys Med. 2017 Apr;36:81-90.

To analyse the correlations between the eye lens dose estimates performed with dosimeters placed next to the eyes of paediatric interventional cardiologists working with a biplane system, the personal dose equivalent measured on the thorax and the patient dose.

Aizer A, Qiu J, Cheng A, et al. Utilization of a Radiation Safety Time-Out Reduces Radiation Exposure During Electrophysiology Procedures. JACC: Clinical Electrophysiology. 2019;5(5):626-634.

This study sought to determine whether a radiation safety time-out reduces radiation exposure in electrophysiology procedures. Results of 1,040 patient cases were included. The median dose area product prior to time-out was 18.7 Gy∙cm2, and the median during the time-out was 14.7 Gy∙cm2, representing a 21% reduction (p = 0.007). The median reference point dose prior to time-out was 163 mGy, and during the time-out was 122 mGy (p = 0.011). The use of sterile disposable protective shields and ultrasound imaging for access increased significantly during the time-out.


In transcatheter aortic valve implantation, the operators’ positions and use of radiation shielding are particularly related to the entry choice on the patient’s heart. This study evaluates how occupational doses depend on operator positioning during transfemoral and transaortal access. Occupational dosimetric readings were collected with electronic dosemeters on two cardiothoracic surgeons and one cardiologist during 31 procedures. The findings were significantly higher body doses and eye lens doses to the surgeons during transaortal access compared to transfemoral access.