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Cammann VL, Schweiger V, Cieslik M, Seifert B, Gilhofer T, Koleva I, Würdinger M, Candreva A, Gajic M, Michel J, Jakob P, Stehli J, Stähli B, Templin C, Gotschy A. Effectiveness of radiation protection systems in the cardiac catheterization laboratory: a comparative study. Clin Res Cardiol 2023; 112:605-613. [PMID: 36646858 PMCID: PMC10160176 DOI: 10.1007/s00392-022-02142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND As numbers and complexity of percutaneous coronary interventions are constantly increasing, optimal radiation protection is required to ensure operator safety. Suspended radiation protection systems (SRPS) and protective scatter-radiation absorbing drapes (PAD) are novel methods to mitigate fluoroscopic scattered radiation exposure. The aim of the study was to investigate the effectiveness regarding radiation protection of a SRPS and a PAD in comparison with conventional protection. METHODS A total of 229 cardiac catheterization procedures with SRPS (N = 73), PAD (N = 82) and standard radiation protection (N = 74) were prospectively included. Real-time dosimeter data were collected from the first operator and the assistant. Endpoints were the cumulative operator exposure relative to the dose area product [standardized operator exposure (SOE)] for the first operator and the assistant. RESULTS For the first operator, the SRPS and the PAD significantly decreased the overall SOE compared to conventional shielding by 93.9% and 66.4%, respectively (P < 0.001). The protective effect of the SRPS was significantly higher compared to the PAD (P < 0.001). For the assistant, the SRPS and the PAD provided a not statistically significant reduction compared to conventional shielding in the overall SOE by 38.0% and 30.6%, respectively. CONCLUSIONS The SRPS and the PAD enhance radiation protection significantly compared to conventional protection. In most clinical scenarios, the protective effect of SRPS is significantly higher than the additional protection provided by the PAD. Comparison of the additional radiation protection provided by protective scatter-radiation absorbing drapes (PAD) and the suspended radiation protection system (SRPS) system over standard protection with lead aprons.
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Affiliation(s)
- Victoria L Cammann
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Victor Schweiger
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Maciej Cieslik
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Gilhofer
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Iva Koleva
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alessandro Candreva
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,PolitoBIO Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Marko Gajic
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Jonathan Michel
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp Jakob
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Julia Stehli
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Barbara Stähli
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland. .,University of Zurich, Zurich, Switzerland.
| | - Alexander Gotschy
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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Domienik-Andrzejewska J, Mirowski M, Jastrzębski M, Górnik T, Masiarek K, Warchoł I, Grabowicz W. Occupational exposure to physicians working with a Zero-Gravity™ protection system in haemodynamic and electrophysiology labs and the assessment of its performance against a standard ceiling suspended shield. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:293-300. [PMID: 35218403 PMCID: PMC8881893 DOI: 10.1007/s00411-022-00968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
A two centre clinical study was performed to analyse exposure levels of cardiac physicians performing electrophysiology and haemodynamic procedures with the use of state of the art Zero-Gravity™ radiation protective system (ZG). The effectiveness of ZG was compared against the commonly used ceiling suspended lead shield (CSS) in a haemodynamic lab. The operator's exposure was assessed using thermoluminescent dosimeters (TLDs) during both ablation (radiofrequency ablation (RFA) and cryoablation (CRYA)) and angiography and angioplasty procedures (CA/PCI). The dosimeters were placed in multiple body regions: near the left eye, on the left side of the neck, waist and chest, on both hands and ankles during each measurement performed with the use of ZG. In total 29 measurements were performed during 105 procedures. To compare the effectiveness of ZG against CSS an extra 80 measurements were performed with the standard lead apron, thyroid collar and ceiling suspended lead shield during CA/PCI procedures. For ZG, the upper values for the average eye lens and whole body doses per procedure were 4 µSv and 16 µSv for the left eye lens in electrophysiology lab (with additionally used CSS) and haemodynamic lab (without CSS), respectively, and about 10 µSv for the remaining body parts (neck, chest and waist) in both labs. The skin doses to hands and ankles non-protected by the ZG were 5 µSv for the most exposed left finger and left ankle in electrophysiology lab, while in haemodynamic lab 150 µSv and 17 µSv, respectively. The ZG performance was 3 times (p < 0.05) and at least 15 times (p < 0.05) higher for the eye lenses and thoracic region, respectively, compared to CSS (with dosimeters on the apron/collar). However, when only ZG was used slightly higher normalised doses were observed for the left finger compared to CSS (5.88e - 2 Sv/Gym2 vs. 4.31 e - 2 Sv/Gym2, p = 0.016). The study results indicate that ZG performance is superior to CSS. It can be simultaneously used with the ceiling suspended lead shield to ensure the protection to the hands as long as this is not obstructive for the work.
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Affiliation(s)
| | - Mateusz Mirowski
- Radiation Protection Department, Nofer Institute of Occupational Medicine in Lodz, Łódź, Poland
| | - Marek Jastrzębski
- Medical College, 1St Department of Cardiology, Jagiellonian University, Interventional Electrocardiology and Hypertension, Kraków, Poland
| | - Tomasz Górnik
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Łódź, Poland
| | - Konrad Masiarek
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Łódź, Poland
| | - Izabela Warchoł
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Łódź, Poland
| | - Włodzimierz Grabowicz
- Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Łódź, Poland
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Salcido-Rios J, McNamara DA, VanOosterhout S, VanLoo L, Redmond M, Parker JL, Madder RD. Suspended lead suit and physician radiation doses during coronary angiography. Catheter Cardiovasc Interv 2021; 99:981-988. [PMID: 34967086 DOI: 10.1002/ccd.30047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study was performed to evaluate physician radiation doses with the use of a suspended lead suit. BACKGROUND Interventional cardiologists face substantial occupational risks from chronic radiation exposure and wearing heavy lead aprons. METHODS Head-level physician radiation doses, collected using real-time dosimeters during consecutive coronary angiography procedures, were compared with the use of a suspended lead suit versus conventional lead aprons. Multiple linear regression analyses were completed using physician radiation doses as the response and testing patient variables (body mass index, age, sex), procedural variables (right heart catheterization, fractional flow reserve, percutaneous coronary intervention, radial access), and shielding variables (radiation-absorbing pad, accessory lead shield, suspended lead suit) as the predictors. RESULTS Among 1054 coronary angiography procedures, 691 (65.6%) were performed with a suspended lead suit and 363 (34.4%) with lead aprons. There was no significant difference in dose area product between groups (61.7 [41.0, 94.9] mGy·cm2 vs. 64.6 [42.9, 96.9] mGy·cm2 , p = 0.20). Median head-level physician radiation doses were 10.2 [3.2, 35.5] μSv with lead aprons and 0.2 [0.1, 0.9] μSv with a suspended lead suit (p < 0.001), representing a 98.0% reduced dose with suspended lead. In the fully adjusted regression model, the use of a suspended lead suit was independently associated with a 93.8% reduction (95% confidence interval: -95.0, -92.3; p < 0.001) in physician radiation dose. CONCLUSION Compared to conventional lead aprons, the use of a suspended lead suit during coronary angiography was associated with marked reductions in head-level physician radiation doses.
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Affiliation(s)
- Jose Salcido-Rios
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - David A McNamara
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Stacie VanOosterhout
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Lisa VanLoo
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Meaghan Redmond
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Jessica L Parker
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Ryan D Madder
- Division of Cardiology, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
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Zanca F, Dabin J, Collard C, Alexandre N, De Groote A, Salembier JP, Henry M, Rombaut E, Sghaier S, Massart PE. Evaluation of a suspended radiation protection system to reduce operator exposure in cardiology interventional procedures. Catheter Cardiovasc Interv 2021; 98:E687-E694. [PMID: 34347935 DOI: 10.1002/ccd.29894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/02/2021] [Accepted: 07/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate a novel suspended radiation shield (ZG), in reducing operator radiation exposure during cardiology interventions. BACKGROUND Radiation exposure to the operator remains an occupational health hazard in the cardiac catheterization laboratory. METHODS An anthropomorphic mannequin simulating an operator was placed near a phantom, simulating a patient. To measure the operator dose reduction, thermoluminescent detectors (TLDs) were inserted into the head and into the eye bulbs of the mannequin, while electronic dosimeters were positioned on the temple and at the level of the thyroid. Measurements were performed without and with the ZG system in place. Physician exposure was subsequently prospectively measured on the torso, on the left eye and on upper arm using the same electronic dosimeters, during clinical procedures (coronary angiography (CA) and percutaneous coronary intervention (PCI)). The physicians dose reduction was assessed by comparing operator dose when using traditional radioprotection garments (Phase 0) versus using the ZG system (Phase 1). RESULTS Dose reductions as measured on the mannequin ranged from 66% to the head, to 100% to the torso. No dose was detected at the level of the torso and thyroid with ZG. When comparing CA and PCI procedures between Phase 0 and Phase 1, a significant difference (p < 0.001) was found for the left eye and the left wrist. Dose reduction as measured during clinical procedures for left eye/upper arm were on average 78.9%/95.6% for CA and 83.0%/93.0% for PCI, respectively (p < 0.001 for both). CONCLUSIONS The ZG systems has a great potential to significantly reduce operator dose through the creation of a nearly zero-radiation work environment.
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Affiliation(s)
| | - Jérémie Dabin
- Research in Dosimetric Applications, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Celine Collard
- CHU UCL Namur site Sainte Elisabeth, Department of Cardiology, Namur, Belgium
| | | | | | - Jean Paul Salembier
- CHU UCL Namur site Sainte Elisabeth, Department of Cardiology, Namur, Belgium
| | - Michel Henry
- CHU UCL Namur site Sainte Elisabeth, Department of Cardiology, Namur, Belgium
| | - Emmanuel Rombaut
- CHU UCL Namur site Sainte Elisabeth, Department of Cardiology, Namur, Belgium
| | - Sonia Sghaier
- CHU UCL Namur site Sainte Elisabeth, Department of Cardiology, Namur, Belgium
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