Efficacy of a Protective Sheet for Reducing Ocular Radiation Exposure During Transcatheter Aortic Valve Implantation

Abstract

Background:The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use X-ray fluoroscopy is a fundamental problem not only for patients but also for surgeons and interventional cardiologists, increasing the risk of cataracts among operators. We investigated the efficacy of leaded glasses and protective sheets for ocular radiation protection. Methods and Results:Between January 2020 and February 2021 we enrolled 54 TAVI procedures using the transfemoral approach. The subjects were divided into a curtain protection group (Group C, n=20), glass protection group (Group G, n=17), and sheet protection group (Group S, n=17). The cumulative dose (CD) of the operators showed a decreasing trend in Group S compared with the other two groups. The CD normalized by dose area product (CD/DAP) of the operators was significantly reduced in Group S compared with Group C. However, Group G showed no significant difference compared with Group C. Regarding the distribution of CD/DAP, Group S had a significantly lower distribution than that in groups C and G. Conclusions:Protective sheets provide more stable radiation protection than conventional curtains or leaded glasses.

Hybrid Operating Room Suites

“…34 Fidalgo Domingos and colleagues (2018) 35 measured values of absorbed radiation before the installation of a hybrid OR, after installation but before administration of a radioprotection seminar, and after administration of a radioprotection seminar� The highest average amount of absorbed radiation was observed in the hybrid OR before the radioprotection seminar was administered� The average radiation exposure for patients was significantly lower in the hybrid OR after the seminar. 35 After the implementation of a radiation dose protection program in a hybrid OR, researchers found the mean unprotected eye lens dose measured outside of the operator's lead glasses was reduced by between 55% and 79% for EVAR procedures� 36 The average interoperative radiation exposure for surgeons and assistants was significantly reduced when a protection sheet (a sterile, disposable drape that does not contain lead) was placed over the pelvis after surgical exposure of the femoral artery� 37 The protection sheet is meant to protect the operator from the surgery's scatter radiation.…”