In this episode, Daniel Ambinder (CardioNerds Co-Founder), Dr. Gurleen Kaur (Director of CardioNerds Internship and medicine resident at Brigham and Women’s Hospital), Dr. Eunice Dugan (Cardiology fellow at Cleveland Clinic) and Dr. Zarina Sharalaya (Interventional and Structural Cardiologist at North Texas Heart) learn from the Dr. Sheila Sahni (Interventional Cardiologist and Director of The Women’s Heart Program at The Sahni Heart Center) regarding radiation safety in the cath lab and methods of reducing radiation exposure to the operator. She also discusses radiation safety for the pregnant interventional cardiologist and how to safely manage pregnancy during the gestational period. We hear her inspirational journey as a female interventional cardiologist and her experience in starting the Women’s Heart Program at Sahni Heart Center. Special message by Dr. Jeff Lander, New Jersey ACC Chapter Governor. Audio editing by CardioNerds Academy Intern, Pace Wetstein.

The PA-ACC & CardioNerds Narratives in Cardiology is a multimedia educational series jointly developed by the Pennsylvania Chapter ACC, the ACC Fellows in Training Section, and the CardioNerds Platform with the goal to promote diversity, equity, and inclusion in cardiology. In this series, we host inspiring faculty and fellows from various ACC chapters to discuss their areas of expertise and their individual narratives. Join us for these captivating conversations as we celebrate our differences and share our joy for practicing cardiovascular medicine. We thank our project mentors Dr. Katie Berlacher and Dr. Nosheen Reza.

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1/ Episode 228: @PaChapterACC & @CardioNerds Narratives in Cardiology episode featured a discussion w/ @DrSheilaSahni, @ZSharalayaMD, @EuniceDuganMD, & @Dr_DanMD

Follow this #CardsNarratives🧵on Radiation Safety & Women in Interventional Cardiology pic.twitter.com/YounyfIl8a

“Having anyone who can believe in you when you are really passionate about something is really all you need… the passion is what’s going to carry you through. It’s not about being male or female or pregnant or not pregnant, it’s about what you love to do and how can you master it.”

“Our careers can wait, but family planning cannot. If you are fortunate enough to have the opportunity to start a family even if it’s during your training, you should”.

What are procedural techniques to utilize during a heart catheterization to reduce radiation exposure to the operator?

• Decrease number and length of cine acquisitions and fluoroscopy time
• Decrease the frame rate – halving the frame rate reduces radiation dose by 50%
• Decrease the distance between the image intensifier and the patient
• Limit steep LAO angulations
• Apply collimation as much as possible which reduces overall patient dose and scatter radiation
• Limit digital magnification which can increase skin dose exposure by 50%

What are the important dose limits to consider for a pregnant female and her fetus in the cath lab?

• The US Nuclear Regulatory Commission (NRC) regulatory equivalent dose limit is 5mSv during the entire pregnancy of the declared pregnant woman.
• The annual natural background radiation dose in the US is 3mSv.
• The average under-lead dose to a working pregnant interventionalist over the entire gestation is ~0.3mSv.
• The fetus of a working pregnant interventionalist is estimated to receive ~0.09mSv over an entire gestation.

What are the ways in which pregnant women can protect themselves and the fetus from radiation exposure in the cath lab?

• Disclose (confidentially if desired) pregnancy to the radiation safety office to ensure fetal protection
• Wear an additional dosimeter underneath the lead apron at waist level to track fetal radiation dose
• Decrease occupational exposure via radiation protection measures as summarized below

What are important considerations for lead apron use in the cath lab to maximize radiation protection?

• Make sure your lead fits!
• Do not sit in your lead- sitting in lead can lead to cracks which can decrease protection
• Hang up your lead when not being used
• Consider shoulder pads/arm sleeve addition to lead apron to protect breast tissue
• Ensure that your lead apron is undergoing periodic screening to monitor for defects
• Consider lead thickness – 0.5mm thickness attenuates 98-99.5% of scattered radiation, 0.35mm thickness attenuates 95-96% of scattered radiation

1. Sahni S, Chieffo A, Balter S. Women as one. Radiation Safety in the Practice of Cardiology. https://rad.womenasone.org/. Accessed March 31, 2022.