# Eye Lens Radiation Exposure During TAVI: Current Evidence and Imaging-Based Strategies for Dose Reduction

## TL;DR

This review discusses how medical staff are exposed to eye radiation during TAVI procedures and suggests ways to reduce this risk through imaging optimization and protective measures.

## Contribution

The paper provides a comprehensive review of strategies to reduce eye lens radiation exposure during TAVI procedures.

## Key findings

- Operator eye lens doses typically range from 30 to 110 µSv per TAVI procedure.
- Shielding and lead-free drapes can reduce normalized eye dose by 25–40%.
- RADPAD® use significantly lowers operator eye-level dose during TAVI.

## Abstract

Transcatheter aortic valve implantation (TAVI) relies heavily on X-ray imaging, which exposes medical staff to scattered radiation, particularly to the sensitive lens of the eye. Recent evidence shows that eye damage can occur at lower radiation doses than previously thought, prompting stricter dose limits. This review summarizes current knowledge on eye lens exposure during these procedures and highlights how imaging settings, beam angles, shielding, and staff positioning strongly influence dose. Optimizing imaging practices alongside eye protection can meaningfully reduce risk and support safer clinical radiology practice while guiding future research.

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 µSv 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® use reduced operator eye-level dose from 24.3 to 14.8 µSv 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).