Reduced radiation exposure in the cardiac catheterization laboratory with a novel vertical radiation shield

• Published in: Catheterization and cardiovascular interventions Vol. 95; no. 1; pp. 7 - 12
• Main Authors: Panetta, Carmelo J., Galbraith, Erin M., Yanavitski, Marat, Koller, Patrick K., Shah, Binita, Iqbal, Sohah, Cigarroa, Joaquin E., Gordon, Gregory, Rao, Sunil V.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.01.2020; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Air Kerma; Background radiation; Cardiac Catheterization - adverse effects; Catheterization; Computer applications; Computer simulation; distance; dose equivalent; Dosimeters; Equipment Design; Female; Health hazards; Heart; horizontal radiation absorbing pad; Humans; Intubation; Laboratories; Lead; magnification; Male; Manikins; Mannequins; Middle Aged; Non‐invasive Angiography; Occupational exposure; Occupational Exposure - adverse effects; Occupational Exposure - prevention & control; Occupational health; Prospective Studies; Protective Devices; Radiation; Radiation Dosage; Radiation Exposure - adverse effects; Radiation Exposure - prevention & control; Radiation Protection - instrumentation; Radiography, Interventional - adverse effects; Risk Assessment; Risk Factors; Scattering, Radiation; horizontal radiation absorbing pad; dose equivalent; magnification; Air Kerma; distance
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28629

Objectives Investigation of novel vertical radiation shield (VRS) in reducing operator radiation exposure. Background Radiation exposure to the operator remains an occupational health hazard in the cardiac catheterization laboratory (CCL). Methods A mannequin simulating an operator was placed near a computational phantom, simulating a patient. Measurement of dose equivalent and Air Kerma located the angle with the highest radiation, followed by a common magnification (8 in.) and comparison of horizontal radiation absorbing pads (HRAP) with or without VRS with two different: CCL, phantoms, and dosimeters. Physician exposure was subsequently measured prospectively with or without VRS during clinical procedures. Results Dose equivalent and Air Kerma to the mannequin was highest at left anterior oblique (LAO)‐caudal angle (p < .005). Eight‐inch magnification increased mGray by 86.5% and μSv/min by 12.2% compared to 10‐in. (p < .005). Moving 40 cm from the access site lowered μSv/min by 30% (p < .005). With LAO‐caudal angle and 8‐in. magnification, VRS reduced μSv/min by 59%, (p < .005) in one CCL and μSv by 100% (p = .016) in second CCL in addition to HRAP. Prospective study of 177 procedures with HRAP, found VRS lowered μSv by 41.9% (μSv: 15.2 ± 13.4 vs. 26.2 ± 31.4, p = .001) with no difference in mGray. The difference was significant after multivariate adjustment for specified variables (p < .001). Conclusions Operator radiation exposure is significantly reduced utilizing a novel VRS, HRAP, and distance from the X‐ray tube, and consideration of lower magnification and avoiding LAO‐caudal angles to lower radiation for both operator and patient.