Letter to the EditorTraining of interventional cardiologists in radiation protection—the IAEA's initiatives
Introduction
A number of radiation-induced skin injuries have been reported in patients undergoing cardiac angioplasty and other interventions [1]. When radiation injuries were detected, invariably the cardiologist indicated no knowledge about the possibility of such injuries, as his training had not covered radiation effects and radiation protection (RP). Despite being among the most active users of X-rays, interventional cardiologists have either no training or inadequate training in RP. Traditionally, RP is hardly taught in medical schools during undergraduate studies. Medical professionals who undertake further education in radiological specialties such as diagnostic radiology, nuclear medicine and radiotherapy are taught radiological physics and RP during their graduate or postgraduate studies. However, resident doctors in clinical specialties such as medicine and cardiology do not have the opportunity to undergo such training. In the past, training in radiological physics and RP was not necessary for such clinical residents, as X-rays and radiation sources were employed in radiological departments by staff reasonably trained in RP. When fluoroscopic guided interventions began, specialist clinicians such as cardiologists became increasingly involved in performing such procedures together with radiologists and in radiology departments. Over the years, a trend emerged of having X ray machines installed in clinical departments; however, adequate training in radiological physics and RP as applied to radiological specialties was not implemented. Thus there is a need for specific guidance for cardiology.
Section snippets
Requirements of radiation protection training
The International Basic Safety Standards (known as BSS) for Protection against Ionising Radiation and for the Safety of Radiation Sources, published by the International Atomic Energy Agency (IAEA) and jointly sponsored by FAO, ILO, PAHO and WHO [2], require that all personnel on whom protection and safety depend be appropriately trained and qualified so that they understand their responsibilities and perform their duties with appropriate judgment and according to defined procedure and also
Training guidelines, curriculum and material
Recommendations on training requirements have started to emerge from a number of organizations. Initially, most guidelines on training were directed at all interventionalists, but in recent years specific recommendations from cardiological societies have started to emerge. The International Commission on Radiological Protection (ICRP), which provides principles and recommendations on radiation protection in the use of radiation in its publication 85 [4], states that interventional procedures
IAEA experience
The first international programme on RP exclusively for interventional cardiologists was organized by the IAEA and held at its Headquarters in Vienna in May 2004. Interventional cardiologists from 25 countries participated. The second programme was held in Singapore in April 2005 for interventional cardiologists from the Asian region and the participants were from 9 countries. The experience from these two programmes is presented here based on the response to a questionnaire provided to
How much training is adequate?
Since the intensity of radiation employed by interventional cardiologists per patient, and collectively based on workload, is no less than that employed by interventional radiologists, the training standards of radiation effects, radiation physics and RP in interventional cardiology should also match those in interventional radiology. However, this may be practically impossible to achieve, much as it is desired. Attempts should be made to begin at least with what is practicable and achievable.
Acknowledgement
The preparation of the curricula required review and inputs from following members whose help is gratefully acknowledged: Pedro Ortiz-Lopez (IAEA), Louis Wagner (USA), Eliseo Vañó (Spain), Guglielmo Bernardi and Renato Padovani (Italy).
References (13)
- Rehani MM, Ortiz-Lopez P. Radiation effects in fluoroscopically guided cardiac interventions—keeping them under...
- IAEA, International Atomic Energy Agency. International Basic Safety Standards for Protection against Ionizing...
- European Union. Council Directive 97/43 Euratom, on health protection of individuals against the dangers of ionizing...
- ICRP. Avoidance of radiation injuries from medical interventional procedures. ICRP Publication 85, Annals of the ICRP...
Avoidance of serious X-ray-induced skin injuries to patients during fluoroscopically-guided procedures. Statement 9 Sept. 1994
(1994)Use of radiographic devices by cardiologists. American College of Cardiology Cardiac Catheterization Committee
J Am Coll Cardiol
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