Effect of protective devices on the radiation dose received by the brains of interventional cardiologists

Silva, Edilaine Honório da; Vanhavere, F.; Struelens, Lara; Covens, Peter; Buls, Nico

doi:10.4244/eij-d-17-00759

Cited by 14 publications

(19 citation statements)

References 30 publications

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“…6 During the cardiovascular intervention, the person subject to the highest radiation dose is the performing physician. 7 Accessory lead shields, 8 leaded glasses 9 and lead cap 9 have been used for protection of the eye lens and the brain, but may be considerably less efficient than commonly accepted. 9,10 The Zero-Gravity (Biotronik; Berlin, Germany) suspended radiation protection system (ZG) has recently been introduced by the manufacturer as a tool to enhance radiation protection and to improve ergonomics while also eliminating physical stress for the operator.…”

Section: Introductionmentioning

confidence: 99%

“…7 Accessory lead shields, 8 leaded glasses 9 and lead cap 9 have been used for protection of the eye lens and the brain, but may be considerably less efficient than commonly accepted. 9,10 The Zero-Gravity (Biotronik; Berlin, Germany) suspended radiation protection system (ZG) has recently been introduced by the manufacturer as a tool to enhance radiation protection and to improve ergonomics while also eliminating physical stress for the operator. In terms of radiation protection, it is meant to replace the lead apron and thyroid shield and, in addition, to protect the head region.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a suspended radiation protection system to reduce operator exposure in cardiology interventional procedures

Zanca¹,

Dabin

Collard

et al. 2021

Cathet Cardio Intervent

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a suspended radiation protection system to reduce operator exposure in cardiology interventional procedures

Zanca¹,

Dabin

Collard

et al. 2021

Cathet Cardio Intervent

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“…Some of them, except one which reports no effect [25], demonstrate its advantage over the ceiling-suspended protective screen, but authors anticipate the effect of lead cap on the head or brain based on the measurements performed on the skin [23][24][25]. The remaining papers, relying on simulations or measurements performed inside phantom head give consistent conclusions and show rather minimal influence of the lead cap on the doses to the head [22,26,27]. The aim of this study is to provide a deeper insight into the influence of the lead free cap on the dose to the skin, the head and the brain of interventional cardiologists by carrying out measurements in both the clinic during real procedures and laboratory in exposure conditions that mimic the real practice.…”

Section: Clinical Measurementsmentioning

confidence: 96%

“…They can differ in terms of shape, weight and lead equivalence. Few papers present the results on protective capabilities of lead or lead free caps but their conclusions, due to different methodologies used, are inconsistent [22][23][24][25][26][27]. Some of them, except one which reports no effect [25], demonstrate its advantage over the ceiling-suspended protective screen, but authors anticipate the effect of lead cap on the head or brain based on the measurements performed on the skin [23][24][25].…”

Section: Clinical Measurementsmentioning

confidence: 99%

The effect of lead free cap on the doses of ionizing radiation to the head of interventional cardiologists working in haemodynamic room

Grabowicz¹,

Masiarek²,

Górnik³

et al. 2022

Int J Occup Med Environ Health

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Objectives:The study aim was to analyse the influence of the lead free cap on doses received by interventional cardiologists. The impact of lead free cap on doses to the head were evaluated in number of studies. As different methods used to assess the attenuation properties of protective cap can lead to ambiguous results, a detailed study was performed. Material and Methods: The effectiveness of a lead free cap in reducing the doses to the skin was assessed in clinic by performing measurements with thermoluminescent dosimeters attached inside and outside the cap first during individual coronary angiography (CA) or CA/percutaneous transluminal coronary angioplasty (CA/PTCA) procedures and then cumulated during few procedures of the same type. In order to investigate the effect of the cap on reducing the doses to the brain additional measurements were performed with a male Alderson Rando and polymethyl methacrylate (PMMA) phantoms representing the physician and the patient, respectively for different projections. The brain dose per procedure, annual and cumulated during entire working practice were estimated for both cases working with and without the cap. Results: The dose reduction factor (RF) for the skin (the quotient of doses outside and inside the cap) vary from 1.1 up to 4.0 in clinical conditions; on average 2.3-fold reduction is observed in the most exposed left temple. The RFs determined for the part of the head covered by the cap range from 1.4 to 1.8 while for the brain from 1.0 to 1.1 depending on the projection. The estimated annual brain dose for interventional cardiologist performing yearly 550 CA/PTCA procedures without any protective shields is 7.2 mGy and it is reduced with the lead free cap by an average factor of 1.1. Conclusions: The study results proved the considerable effectiveness of lead free cap to protect the skin but very limited to protect the brain.

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“…However, information of the net benefit for the patient and professionals in real practice is scarce 3‐7 . This is important as actual figures of radiation exposure may deviate strongly from bench values due to real‐life factors, such as high‐body mass index, number of treated lesions, complex procedures like CTO PCI, 8 operator's experience and implementation of radiation protection strategies (fluoroscopy vs. cine acquisition, collimation, gantry position, and ancillary protection devices 9 ). These considerations are equally relevant for patient safety, as reliable data on radiation reduction is required in planning and performing complex interventions 10 …”

Section: Introductionmentioning

confidence: 99%

Dose‐reducing fluoroscopic system decreases patient but not occupational radiation exposure in chronic total occlusion intervention

Salinas

Sanchez

Gonzalo

et al. 2020

Cathet Cardio Intervent

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Aims Several novel low‐dose fluoroscopic systems (LDS) developed recently, but real practice information of the net benefit for the patient and professionals is scarce. We evaluated separately patient and operator radiation exposure during percutaneous interventions of chronic total occlusions (CTO). Methods A total of 116 consecutive CTOs were analyzed (60 in LDS and 56 in standard‐dose fluoroscopic system [SDS]). Digital dosimetry of patient and occupational (operator and scatter dose) exposure was prospectively recorded. Results Biometrics, demographics, CTO variables, and operators were distributed evenly. Patient radiation exposure was effectively decreased in LDS (dose area product [DAP] by 36%, Air Kerma [AK] by 47%). However, occupational data showed no statistical differences between LDS and SDS. The LDS uses less radiation amount but with higher energy (due to additional filtration) compared to SDS, therefore increasing the scatter dose. When comparing the C‐arm scatter dose to the DAP we found higher scatter dose with the LDS (0.0139 mSv/gray (Gy)*cm2 vs. 0.0082 mSv/Gy*cm2, p < .001). This was confirmed in a larger dataset comprising 5,221 coronary procedures. Conclusions LDS was safer for patients reducing DAP and AK compared to SDS. However, occupational doses were not lower and scatter dose higher. Radiological protection measures must be kept maximized even in LDS.

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Effect of protective devices on the radiation dose received by the brains of interventional cardiologists

Cited by 14 publications

References 30 publications

Evaluation of a suspended radiation protection system to reduce operator exposure in cardiology interventional procedures

Evaluation of a suspended radiation protection system to reduce operator exposure in cardiology interventional procedures

The effect of lead free cap on the doses of ionizing radiation to the head of interventional cardiologists working in haemodynamic room

Dose‐reducing fluoroscopic system decreases patient but not occupational radiation exposure in chronic total occlusion intervention

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