Operators' radiation exposure reduction during cardiac catheterization using a removable shield

Radiation dose to the eye of physicians during radio frequency catheter ablation: a small-scale study

BACKGROUND

Radio frequency catheter ablation (RFCA), a treatment for arrhythmia, requires a long fluoroscopy time that increases the radiation exposure dose to the physician, particularly to the lens of the eye. It is recommended that a lens-specific dosimeter such as DOSIRIS® is used to measure the dose to the lens.

AIMS

In this study, we investigated whether conventional glass badges can be used as an alternative to lens dosimeters.

METHODS

The doses to the lenses of two physicians (physician A, main operator; physician B, assistant; physician B was further away from the patient than physician A) were measured for 126 RFCA procedures performed over a 6-month period (fluoroscopy rate of 3.0 p/s with use of a ceiling-hanging shield).

RESULTS

The cumulative value measured by a lens dosimeter attached to the inside of Pb glasses (0.07-mm dose equivalent) next to the left eye was 4.7 mSv for physician A, and 0.8 mSv for physician B. The reading on the glass badge worn on the left side of the neck was 4.7 mSv for physician A and 1.3 mSv for physician B. Lens dosimeter and glass badge values showed a good correlation for the left eye and left neck (r = 0.86, p < 0.01).

CONCLUSIONS

We show that glass badges may be a viable alternative to lens-equivalent dosimetry when using low-pulse fluoroscopy and a ceiling-hanging shield.

A contemporary review of clinical significances of percutaneous coronary intervention for chronic total occlusions, with some Japanese insights

The clinical "significance" of percutaneous coronary intervention for coronary chronic total occlusion (CTO-PCI) has been evaluated. In the beginning, the effects on clinical endpoints were investigated by comparisons between cases of success and failure of CTO-PCI, which mostly demonstrated better long-term outcomes in the successful cases. Similarly, improvement of cardiac function or wall motion was proven by serial observational studies. Accordingly, several prospective randomized trials (RCTs), which should confirm such accumulated potential benefits, were recently conducted by comparison with studies of patients that had received optical medical therapy (OMT) alone. While they mostly demonstrated significant improvement of angina symptoms and quality of life (QOL) in the CTO-PCI group, they failed to prove a reduction of clinical events or improvement of left ventricle wall motion, compared with OMT. Concurrent guidelines or consensus documents emphasize that the principal indication for CTO-PCI is to improve symptoms. To determine strategy, the following must be discussed in each individual case: the probability of procedural success, the expectation of long-term patency, and an assessment of the balance between procedure-related complications and overall benefits. In essence, we believe the following facts to be the current sincere appraisal of CTO-PCI: (1) improvements of symptoms and QOL are established, but the others remain inconclusive, and; (2) their margins for improvement are narrowing and numbers of candidates are shrinking. Precision medicine or individualization may be the right directions to take, to enhance the potential of this treatment. This course of action demands discrimination of those candidates who will truly receive benefits from invasive treatment, and that still requires further clinical studies or actions.

Efficacy of MAVIG X-Ray Protective Drapes in Reducing Operator Radiation Dose in the Cardiac Catheterization Laboratory: A Randomized Controlled Trial

BACKGROUND

Interventional cardiologists are occupationally exposed to high doses of ionizing radiation. The MAVIG X-ray protective drape (MXPD) is a commercially available light weight, lead-free shield placed over the pelvic area of patients to minimize operator radiation dose. The aim of this study was to examine the efficacy of the MXPD during routine cardiac catheterization, including percutaneous coronary interventions.

METHODS

We performed a prospective, randomized controlled study comparing operator radiation dose during cardiac catheterization and percutaneous coronary intervention (n=632) with or without pelvic MXPD. We measured operator radiation dose at 4 sites: left eye, chest, left ring finger, and right ring finger. The primary outcomes were the difference in first operator radiation dose (µSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the 2 groups.

RESULTS

The use of the MXPD was associated with a 50% reduction in operator radiation dose (median dose 30.5 [interquartile range, 23.0-39.7] µSv in no drape group versus 15.3 [interquartile range, 11.1-20.0] µSv in the drape group; P<0.001) and a 57% reduction in relative operator dose (P<0.001). The largest absolute reduction in dose was observed at the left finger (median left finger dose for the no drape group was 104.9 [75.7-137.4] µSv versus 41.9 [32.6-70.6] µSv in the drape group; P<0.001).

CONCLUSIONS

The pelvic MXPD significantly reduces first operator radiation dose during routine cardiac catheterization and percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04285944.