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Eye Lens Radiation Exposure During TAVI: Current Evidence and Imaging-Based Strategies for Dose Reduction
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DOI：10.3390/tomography12030036.png)
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Abstract
En 中文
Background: Transcatheter aortic valve implantation (TAVI) is increasingly performed in fluoroscopy-intensive environments, raising concerns about occupational eye lens dose (equivalent dose to the eye lens, Hp (3)) and the risk of radiation-induced cataract, particularly after the reduction of recommended annual eye lens dose limits to 20 mSv. Purpose: To summarize evidence on eye lens radiation exposure during TAVI, identify procedural and occupational determinants, and review strategies to reduce exposure with a focus on imaging optimization. Methods: We performed a narrative review of observational and prospective studies reporting direct eye-level dose measurements or validated surrogate eye lens dose estimates (head-level, chest-level, or DAP-normalized) during TAVI and related structural heart procedures. This approach was chosen to provide a qualitative synthesis of the available evidence rather than a formal systematic review. Results: Reported operator eye lens doses typically ranged from 30 to 110 & micro;Sv per procedure, with higher exposure during transapical/transaortal access and among staff working close to the patient (e.g., anesthesiologists and circulating nurses). Additional shielding and lead-free drapes reduced normalized eye dose by approximately 25-40%, and RADPAD (R) use reduced operator eye-level dose from 24.3 to 14.8 & micro;Sv per procedure (p = 0.008). At these levels, cumulative exposure may approach recommended regulatory limits after approximately 150-300 procedures, depending on role, access route, and shielding practices. Conclusion: In conclusion, Occupational eye lens exposure during TAVI is clinically relevant and strongly influenced by access route, staff positioning, and imaging-system use. Dose reduction should combine routine eye protection and dedicated eye-level dosimetry with imaging optimization (low pulse-rate fluoroscopy, minimized Digital-Subtraction-Angiography (DSA)/cine acquisitions, tight collimation, avoidance of unnecessary magnification, and correct positioning of ceiling-suspended shields and table skirts).
Keywords:
transcatheter aortic valve implantation
TAVI
eye lens dose
occupational radiation
cataract
fluoroscopy
imaging optimization
shielding
dosimetry
structural heart interventions
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