Cardiac catheterization laboratories should rou- tinely record relevant available patient procedural radiation dose data (eg, total air kerma at the international reference point [Ka,r], air kerma air product [PKA], fluoroscopy time, number of cine images), and should define thresholds with corre- sponding follow-up protocols for patients who re- ceive a high procedural radiation dose. (Level of Evidence: C) The issue of radiation exposure during imaging procedures has received increased attention, and the writing committee believes that radiation safety should be addressed in this guideline. Current standards for cardiac catheterization labo- ratories include the following: Specific procedures and policies are in place to mini mize patient (and operator) risk. A radiation safety officer coordinates all radiation safety issues and works conjointly with the medical or health physicist. Patient radiation exposure is reduced to as low a level as reasonably can be achieved. Patients at increased risk for high procedural radiation exposure are identified. Informed consent includes radiation safety informa tion, particularly for the high-risk patient. A basic primer on the physics of x-ray imaging, essential to the safe practice of radiation dose management, has been published in an ACCF/AHA/Heart Rhythm Society/SCAI clinical competence statement.316 Appendix 4C summarizes strategies to minimize patient and operator radiation expo- sure. Adverse radiation effects are now well recognized as infrequent but potentially serious complications of prolonged interventional procedures.317 Fluoroscopic time does not in- clude cine acquisition imaging and is therefore not an accurate measure of patient radiation dose. Total air kerma at the interventional reference point (Ka,r, in Gy) and air kerma area product (PKA, in Gycm2 ) are required to be reported on interventional x-ray systems since 2006. 