Relative Contribution of High-Dose Outliers to Cumulative Occupational Radiation Dose in the Catheterization Laboratory

Ryan D Madder; Michael Abiragi; Luai Madanat; Stacie VanOosterhout; Jessica L Parker; Devraj Sukul; David A McNamara

doi:10.1016/j.jscai.2025.104054

Relative Contribution of High-Dose Outliers to Cumulative Occupational Radiation Dose in the Catheterization Laboratory

J Soc Cardiovasc Angiogr Interv. 2025 Oct 28;5(1):104054. doi: 10.1016/j.jscai.2025.104054. eCollection 2026 Jan.

Authors

Ryan D Madder¹, Michael Abiragi², Luai Madanat¹, Stacie VanOosterhout², Jessica L Parker², Devraj Sukul², David A McNamara²

Affiliations

¹ Department of Cardiovascular Medicine, William Beaumont University Hospital, Corewell Health East, Royal Oak, Michigan.
² Frederik Meijer Heart & Vascular Institute, Corewell Health West, Grand Rapids, Michigan.

Abstract

Background: The contribution of high radiation dose outliers to cumulative occupational radiation dose is understudied.

Methods: Physician radiation data were collected during consecutive coronary cases, and per case doses were ranked by magnitude. The relationship between the per case rank and relative contribution to cumulative dose was summed for cases ≤50th percentile and for cases >90th percentile. A similar methodology was applied for radiation doses among structural interventionalists, interventional echocardiographers, scrub technologists, and nurse circulators. Multivariable logistic regression was fit to identify independent predictors of physician radiation dose >90th percentile during coronary cases.

Results: Across 363 coronary cases, the median physician radiation dose per case was 10.2 (3.2, 35.5) μSv, and the cumulative radiation dose was 13,230 μSv. Coronary cases ≤50th percentile accounted for only 5.0% of the cumulative radiation dose. Cases >90th percentile accounted for 60.3% of the cumulative dose. Cases >90th percentile accounted for 51.3%, 39.9%, 45.8%, and 64.8% of the cumulative dose among structural interventionalists, interventional echocardiographers, scrub technologists, and nurse circulators, respectively. ST-segment elevation myocardial infarction (OR, 6.2; 95% CI, 1.5-26.3; P = .01), percutaneous coronary intervention (OR, 5.6; 95% CI, 2.2-14.2; P < .001), right heart catheterization (OR, 4.4; 95% CI, 1.7-11.7; P = .003), and male sex (OR, 3.2; 95% CI, 1.3-8.0; P = .01) were independently associated with physician radiation dose >90th percentile.

Conclusions: Physician radiation dose outliers contribute disproportionately to the cumulative radiation dose, with cases above the 90th percentile accounting for 60% of the cumulative dose. High radiation dose outliers are an important target for future radiation mitigation efforts.

Keywords: cardiac catheterization; catheterization laboratory; radiation safety.