Radiation protection in electrophysiology is essential to all patients and personnel in order to minimize the cumulative effects to the bone marrow and other radiation-sensitive tissue as well as the possible risk of cancer. The electrophysiology laboratory (including all associated operating rooms) should strive for the ALARA principle, defined as minimizing radiation exposure to “As Low as Reasonably Achievable.”
In order to minimize radiation exposure, there are three factors that need to be considered: 1) time, 2) distance, and 3) shielding. The amount of radiation exposure is directly related to the exposure time of the procedure. In particular, the current needed to generate x-rays, milliampere- seconds (mAs), should be maintained as low as possible. The image intensifier to object (patient) distance must be kept to a minimum at all times to reduce exposure from scattered radiation to both the operator and assisting personnel. The further the image intensifier is from the patient, the greater the radiation required to produce a diagnostic image with subsequent increase of scatter and radiation exposure to the staff. All non-essential personnel should be at least six feet from the source of the scattered radiation—the patient—during fluoroscopy. In addition, the duration of fluoroscopy exposure for long and complex electrophysiology procedures (e.g., catheter ablations and biventricular implants) should be less than 60 minutes in order to minimize the potential for a radiation burn to the patient’s skin.