Introduction:
Occupational radiation exposure is of concern for many physicians, especially female cardiologists in training and during pregnancy. Many national societies recommend a radiation dose limit of 1 mSv on the uterus during the entire pregnancy, while the cutoff in the United States is up to 5 mSv. However, there is a lack of real-world data quantifying occupational radiation doses on the uterus during cardiac procedures. Thus, uncertainty remains regarding the occupational safety of radiation exposure during pregnancy leading to widely divergent and restrictive maternity protection practices. On the other hand, discontinuation of invasive training during pregnancy is a limiting factor in the pursuit of an invasive career path.
Methods:
To simulate a pregnant physician performing invasive procedures on a daily basis, any primary operator in the catheterization laboratory of Hannover Heart Rhythm Center wore two continuously turned-on electronic personal dosimeters measuring the personal equivalent dose Hp(10), which was used as a conservative surrogate of organ dose of the uterus, throughout the procedure (EPD TruDose, Thermo Scientific, Waltham, MA, USA): One was installed underneath the radiation protection apron at the level of the lower abdomen/uterus. The second was worn above the apron. In between procedures, the EPDs were kept in the control room turned-on. A third EPD was continuously left in the control room as a reference measuring background radiation. The study duration was 2x40 weeks (the duration of a typical pregnancy), from January 2024 to August 2025.
Results:
During the first 40-week period, a total of 320 procedures were recorded: 238 catheter ablations and 82 device implantations. During the second 40-week period, a total of 368 procedures were recorded: 267 catheter ablations and 101 device implantations. The cumulative radiation dose assessed during the 40 weeks of the first study period was 1.926 mSv for the EPD installed above the apron during procedures, 0.402 mSv for the EPD installed underneath the apron during procedures and 0.345 mSv for the background radiation. The cumulative radiation dose assessed during the 40 weeks of the second study period was 1.797 mSv for the EPD installed above the apron during procedures, 0.355 mSv for the EPD installed underneath the apron during procedures and 0.339 mSv for the EPD that remained in the control room during procedures. The overall mean weekly radiation doses registered by the EPD above the apron, underneath the apron and the reference EPD were 0.047 ± 0.039 mSv, 0.010 ± 0.003 mSv and 0.009 ± 0.001, respectively; p<0.001 for all comparisons.
Conclusion:
During a pregnancy, the cumulative radiation exposure on the uterus while performing catheter ablations and device implantations in a modern electrophysiology laboratory on a daily basis is safe and far below official limits while adhering to standard radiation protection measures.
