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Experts Brief Doctors on Radiation Safety for Heart Patients

Cardiologists at briefing

Cardiologists are briefed about radiation risks. (Credit: D. Calma/IAEA)

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The IAEA is raising awareness among cardiologists about radiation risks, following continued incidences of radiation induced injuries (burns) in patients from a common medical procedure known as angioplasty and other interventional cardiological procedures.

From 6-7 May 2004 cardiologists from 25 countries are being briefed by experts at IAEA headquarters in Vienna about simple but very effective ways to help prevent, recognise and treat radiation burns.

"Most cardiologists have no idea the procedures they perform can cause severe and extremely painful radiation injuries. If a severe radiation burn is caused, more often than not it is then misdiagnosed," Professor of Radiological Physics at the University of Texas, Louis Wagner, told participants.

Cardiologists are now using angioplasty instead of open-heart surgery to unblock clogged arteries in the heart. It means patients do not have to undergo a major operation and can leave the hospital the next day. The procedure involves passing a catheter through the blood vessel to open the blocked artery, under fluoroscopic guidance using X-Rays.

Historically cardiologists have not been taught and trained in radiation protection. So as accessibility to this technology has increased, so has the chances of erythema, or radiation burns from the X-Rays used, says IAEA Radiation Safety Specialist, Dr. Madan Rehani. There are no worldwide statistics on the numbers of injuries caused from this procedure but about one case per month is turning up in the United States courts. "It is reasonable to assume that these injuries are occurring in other parts of the world," Dr. Rehani said. Dr. Wagner agrees that numbers are difficult to pin-down because often the injury goes unreported. "A gut-wrenching guess is about one patient per 10,000 receives a severe radiation injury," he said. One of the most common factors in injuries reported so far is the more obese or muscular the patient, the more the chances of injury as exposure factors are automatically hiked by the X-Ray machine.

Cardiologists attending the IAEA workshop were told that one means to reduce radiation burns, is to ensure unnecessary body parts, such as a patientís arm or breast, are not inadvertently exposed to the X-Ray beam.

"It is important doctors recognise the symptoms of an X-Ray injury," Dr Wagner told cardiologists attending the IAEA workshop. Usually a rash will appear a few days or weeks at the exact spot where the X-Ray beam was most directed. "There have been many cases where a patient is told to apply a cream or that it is only an allergic reaction. Doctors are confused and befuddled because the progression of an X-Ray injury is not understood," Dr. Wagner said.

Depending on the severity of the radiation dose, hair loss could occur or the rash can develop into a painfully sore ulcer, which requires surgical intervention such as skin grafts. "There is also a definite increase in the probability of radiation-induced cancer particularly when such procedures are performed on small children," Dr. Rehani said.

The IAEA workshop will teach cardiologists to respond, prevent and minimise radiation risks to their patients. "As use of the technology spreads, so must awareness about using it safely," IAEA Unit Head of Radiation Safety, Dr. Pedro Ortiz-Lopez, said.

The IAEA has launched an International Action Plan on Radiological Protection of Patients. "The objective is to achieve a high level of safety for the patient undergoing cardiac interventions. The IAEAís efforts to educate cardiologists, is a key step toward preventing such injuries from occurring," Dr. Ortiz-Lopez said.

It is expected the two-day workshop will identify specific issues in different countries and ways to address them.