Anesthesiologists in the cath lab are exposed to more radiation than in the operating room

An anesthesiologist in the cath lab usually works at the head of the table, beside the patient, for the whole case. Two studies measured what that position receives, and a review explains why it is hard to shield.

The cath lab against the operating room

Henderson and colleagues gave radiation badges to the anesthesia fellows at a pediatric hospital. In the operating rooms their monthly readings stayed below 10 mrem, the lowest dose the badges record. In the cath lab they ranged from 20 to 180 mrem a month, and often exceeded the guidelines for workers who are not radiation workers.¹ The authors recommended badging anesthesiologists who work often in fluoroscopy areas such as the cath lab.

Beside the anesthesia machine

Mohapatra and colleagues measured staff doses with real-time dosimeters in 39 fenestrated endovascular aortic repairs, in an operating room rather than a cath lab. The dosimeter on the anesthesia equipment recorded the highest doses in the room: 143 µSv more per case than the average operator (range 38 to 247). The authors put it down to ineffective shielding at that position.²

Why the position is hard to protect

A 2020 review by Biso and Vidovich gives the reasons. Anesthesiologists often need direct contact with the patient during the procedure, they stay in a relatively fixed position, and the room rarely lets them keep a safe distance from the source. Their place on the patient’s left, the review adds, may expose them to more radiation than interventional cardiologists on the right.³

Shielding the head of the table

In a phantom study of EggNest^® Complete, scatter at the anesthesia or jugular access position was 85% lower than with standard cath lab shielding, averaged over five C-arm angulations. The study was sponsored by Egg Medical, and its authors note the results need confirming in clinical studies.⁴ See the study on the Evidence page.