Interventional-related radiation exposure skyrockets in developing world

The booming growth of fluoro-guided minimally invasive interventional procedures in developing countries is exposing the adults and children receiving treatment to extraordinary levels of ionizing radiation, according to the International Atomic Energy Agency.

"We found that a substantial number of coronary angioplasty procedures performed in the developing countries in this study are above the currently known dose reference level," said IAEA senior investigator and study coordinator Madan M. Rehani, Ph.D.

Following up on its pledge to protect patients from unnecessary radiation exposure from medical procedures, the organization, which is based in Vienna, Austria, launched a program in 2005 focused on patient protection in all regions of the world. The program included a survey of interventional procedures aimed at identifying and fixing substandard radiation protection measures.

From 2006 to 2008, Rehani and colleagues collected information on radiation protection tools and radiation dose measurement from 55 hospitals in five African, six Asian, and nine mostly European countries Eastern. Researchers included one developed European country (Greece) as a reference.

The investigators found that interventional procedures, particularly coronary angioplasties, have expanded dramatically in these countries. Annual procedure volumes resemble or even sharply surpass those in the developed world, while the procedure workload involving pediatric patients reaches adult levels.

Radiation protection measures involving the medical staff were considered generally acceptable compared with international standards. However, most facilities proved unfamiliar with dose-estimation and -management techniques and thus expose patients, especially younger ones, to a higher risk of radiation-induced injuries and complications. About 20% of patients monitored for peak skin dose measurements were above the accepted 2-Gy threshold. Findings appeared in the August issue of the American Journal of Roentgenology (2009;193:559-569).

There is a significant lack of awareness about patient dose estimations and dose management among interventional radiologists and cardiologists in developing countries, Rehani said. Some findings were sobering. Although nearly half the facilities had kerma-area product meters available for dose estimations, they lacked staff trained in their use.

In addition to radiation protection programs for residents, most training centers need to establish a culture of dose assessment and dose management with the proper monitoring devices to improve patient safety, Rehani said.

"Our goal is to introduce these concepts to them and achieve effective implementation," he said.