Radiation hazards for cardiologists.

Sir, The Editorial by Raphael and Tomlinson (1986;55:421-2) was an interesting review of some specific aspects of radiation dosage to cardiologists. The authors advised, quite correctly, that those performing catheterisations should be instructed in radiation safety practice before or early in their training. They did not point out, however, the complete absence of structured tuition in radiation physics and radiation protection for cardiology trainees. A trainee radiologist in his first year of training must attend a formal course of instruction in radiation physics (including radiation protection) and must pass an examination (Fellowship of the Royal College of Radiologists part I) before being allowed to continue and complete his or her training as a radiologist. Similarly, a student radiographer must undergo full formal training and examination before being allowed to expose a single radiograph without supervision. In sharp contrast with this, most cardiologists in the United Kingdom perform cardiac angiography without any formal training or an examination. While the clinical skills of cardiology are probably best learned informally during the course of clinical duties, the same cannot be said for the study of radiation physics; particularly when seniors are usually also untrained. The subject of radiation exposure is especially topical and cardiologists will leave themselves increasingly open to criticism if they continue their close involvement with ionising radiation without taking sensible action to institute proper training. The imminent Euratom directive from the European Economic Community may well make such training a legal necessity. A final related point is that the radiologist learns radiation physics not only to protect himself and others but also to ensure optimal function of equipment and thus optimal diagnostic accuracy. If a cardiologist without such training works in an institution which also has no integrated cardiac radiological involvement (as happens in many centres) it is a matter for speculation as to how adequate standards of equipment operation and angiographic quality are maintained.