Relative Contribution of High-Dose Outliers to Cumulative Occupational Radiation Dose in the Catheterization Laboratory

<h2>ABSTRACT</h2><h3>Background</h3> The contribution of high radiation dose outliers to cumulative occupational radiation dose is understudied. <h3>Methods</h3> Physician radiation data were collected during consecutive coronary cases and per case doses were ranked by magnitude. The relationship between the per case rank and relative contribution to cumulative dose was summed for cases ≤50^th percentile and for cases >90^th percentile. Similar methodology was applied for radiation doses among structural interventionalists, interventional echocardiographers, scrub technologists, and nurse circulators. Multivariable logistic regression was fit to identify independent predictors of physician radiation dose >90^th percentile during coronary cases. <h3>Results</h3> Across 363 coronary cases, median physician radiation dose per case was 10.2 [3.2, 35.5] μSv and cumulative radiation dose was 13,230 μSv. Coronary cases ≤50^th percentile accounted for only 5.0% of cumulative radiation dose. Cases >90^th percentile accounted for 60.3% of cumulative dose. Cases >90^th percentile accounted for 51.3%, 39.9%, 45.8%, and 64.8% of the cumulative dose among structural interventionalists, interventional echocardiographers, scrub technologists, and nurse circulators, respectively. ST-segment elevation myocardial infarction (OR 6.2 [1.5, 26.3], p=0.01), percutaneous coronary intervention (OR 5.6 [2.2, 14.2], p < 0.001), right heart catheterization (OR 4.4 [1.7, 11.7], p=0.003), and male sex (OR 3.2 [1.3, 8.0], p=0.01) were independently associated physician radiation dose > 90^th percentile. <h3>Conclusions</h3> Physician radiation dose outliers contribute disproportionately to the cumulative radiation dose, with cases above the 90^th percentile accounting for 60% of the cumulative dose. High radiation dose outliers are an important target for future radiation mitigation efforts.