ABC | Volume 114, Nº1, January 2019

Statement Position Statement of the Brazilian Cardiology Society and the Brazilian Society of Hemodynamics and Interventional Cardiology on Training Centers and Professional Certification in Hemodynamics and Interventional Cardiology – 2020 Arq Bras Cardiol. 2020; 114(1):137-193 Annex 1 RADIATION PROTECTION Technological advances over the past decades have made it possible for interventional cardiology to expand visibly, promoting diagnosis and therapy of numerous diseases in a less invasive manner and with minimal risks for patients. This area of practice has gone from having a diagnostic perspective to intensely acting to treat cardiovascular conditions, encompassing complex coronary interventions, extracardiac vascular diseases, and congenital and structural heart diseases. In addition, the type and complexity of interventions, as well as the clinical severity of patients have significantly increased. 65 What is thus observed is an increasing radiation dose used for interventional procedures over the past years. Biological Risk of Exposure to Ionizing Radiation in Interventional Cardiology Exposure to ionizing radiation in a routine and continuous manner may lead to harmful biological effects on the human body, by direct or indirect action on the cells, causing physiological and/or functional effects on the organs. Studies have shown that exposed professionals have increased risks of cataracts, 66,67 brain tumors, skin lesions, and hereditary genetic alterations. 68 Radiation protection measures, both for individuals and for institutional requirements, are thus essential for everyone who works with these agents. Institutional Requirements It is necessary for the institution where the hemodynamics and interventional cardiology laboratory functions to have the following: a. A medical technician responsible for ensuring all service licensing norms, in compliance with federal and state health legislation. b. A physician specialist in radiodiagnostics, as required by current legislation. c. Personal protective equipment (PPE) in sufficient quantity for the whole team, such as a 0.5 mm lead-equivalent apron, lead glasses with side shields, and thyroid shields. d. Barrier measures, such as lower (“skirt”) and upper (“shield”) screens are also requisites for protection. e. Upkeep of PPE and its respective integrity tests, also on an annual basis (carried out and registered). f. Individual dosimeter. Technical Responsibility The managing technician has the following responsibilities: a. Be duly qualified and capacitated to exercise this function and ensure the service’s proper functioning. b. Establish a radiation protection program that includes service routines, technique standardization, and specific radiation protection measures. c. Ensure that annual training and qualification of medical, care, and technical teams take place, including radiation protection measures, correct use of PPE, correct use of individual dosimeter, and correct equipment use. d. Nominate subordinate people to assist in the construction and execution of activities that involve the radiation protection program, such as other physicians, physician specialists in radiodiagnostics, radiology technicians, and work safety technicians, i.e., encourage a culture of protection. e. Guarantee preventative maintenance and dosimetry of equipment and a specific quality program for cinefluoroscopic equipment, including performance tests that evaluate precepts of image quality and radiological safety, with the frequency recommended by current legislation. Individual Protection Measures Individual protection measures include the following: a. All individuals who work with radiation must use the aforementioned PPE (apron, lead glasses with side shield, and thyroid shield). b. The operators, in addition to PPE, must use protective barriers (upper and lower screens) during all procedures. c. No employee should exceed individual dose limits stipulated by current legislation: 69 • The average annual effective dose must not exceed 20 mSv during any period of five consecutive years, and it must not exceed 50 mSv during any year. • The equivalent annual dose must not exceed 500 mSv for any extremity and 150 mSv for the lens of the eye. 158