Letter to the Editor
Training of interventional cardiologists in radiation protection—the IAEA's initiatives

https://doi.org/10.1016/j.ijcard.2005.11.061Get rights and content

Abstract

The International Atomic Energy Agency (IAEA) has initiated a major international initiative to train interventional cardiologists in radiation protection as a part of its International Action Plan on the radiological protection of patients. A simple programme of two days' training has been developed, covering possible and observed radiation effects among patients and staff, international standards, dose management techniques, examples of good and bad practice and examples indicating prevention of possible injuries as a result of good practice of radiation protection. The training material is freely available on CD from the IAEA. The IAEA has conducted two events in 2004 and 2005 and number of events are planned in 2006. The survey conducted among the cardiologists participating in these programmes indicates that over 80% of them were attending such a structured programme on radiation protection for the first time. As the magnitude of X-ray usage in cardiology grows to match that in interventional radiology, the standards of training on radiation effects, radiation physics and radiation protection in interventional cardiology should also match those in interventional radiology.

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).

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