Efficiency of the RADPAD Surgical Cap in Reducing Brain Exposure During Pacemaker and Defibrillator Implantation

Lemesre, Camille; Graf, Denis; Bisch, Laurence; Carroz, Patrice; Cherbuin, Nicolas; Damet, J.; Desorgher, L.; Siklódy, Claudia Herrera; Bloa, Mathieu Le; Pascale, Patrizio; Pruvot, Étienne

doi:10.1016/j.jacep.2020.08.007

Cited by 16 publications

(24 citation statements)

References 14 publications

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“…Therefore, reduction of scatter radiation at the level of the head is of particular importance. While radiation protection glasses are an effective way to reduce the risk of cataracts, cranial radioprotective surgical caps designed to specifically reducing brain exposure showed no impact on brain dose distribution [14,15] because of upward scatter radiation that enters the skull through the neck. Therefore, there is a clinical need for improved radiation protection for the head.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of radiation protection systems in the cardiac catheterization laboratory: a comparative study

et al. 2023

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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. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Effectiveness of radiation protection systems in the cardiac catheterization laboratory: a comparative study

et al. 2023

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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: 98%

“…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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“…Operators reported that the comfort level with the cap on during the procedure was 9 on a 1–10-point scale 31 . Interestingly, however, when tested in left subpectoral device implant procedures, with the right half of the operator's front head as the most exposed region, the Radpad cap attenuated the skin fronthead exposure but did not provide protection to the brain 10 . The exposure of the anterior part of the brain is decreased by the skull by 4.5-fold compared with the fronthead skin value; however, this study confirms previous evidence that most of the radiation to a interventionalist's brain originates from scatter radiation from angles not shadowed by a protection cap 26 .…”

Section: Head Protectionmentioning

confidence: 99%

“…Further, brain irradiation can have direct radiation effects on the thyroid and pituitary glands. The use of lead-based cranial dedicated shields may help reduce operator exposure but upward scattered radiation coming from the patient may challenge protection 10 …”

Section: Introductionmentioning

confidence: 99%

Interventional cardiology and X-ray exposure of the head: overview of clinical evidence and practical implications

Anselmino¹,

Marcantoni²,

Agresta³

et al. 2022

Journal of Cardiovascular Medicine

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Interventional cardiologists are significantly exposed to X-rays and no dose of radiation may be considered well tolerated or harmless. Leaded aprons protect the trunk and the thyroid gland, leaded glasses protect the eyes. The operator's legs, arms, neck and head are, instead, not fully protected. In fact, the operator's brain remains the closest part to the primary X-ray beam and scatter in most interventional procedures and specifically the physician's front head is the most exposed region during device implantation performed at the patient's side. After the initial description of cases of brain and neck tumours, additional reports on head and neck malignancies have been published. Although a direct link between operator radiation exposure and brain cancer has not been established, these reports have heightened awareness of a potential association. The use of lead-based cranial dedicated shields may help reduce operator exposure but upward scattered radiation, weight and poor tolerability have raised concerns and hindered widespread acceptance.The purpose of this review is to describe current knowledge on occupational X-ray exposure of interventional cardiologists, with a special focus on the potential risks for the head and neck and efficacy of available protection devices.

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Efficiency of the RADPAD Surgical Cap in Reducing Brain Exposure During Pacemaker and Defibrillator Implantation

Abstract: During device implantation the RADPAD ® cap decreased the skin front head exposure but had no impact on brain dose distribution as the exposure comes from upwards scattered radiation.

Cited by 16 publications

References 14 publications

Effectiveness of radiation protection systems in the cardiac catheterization laboratory: a comparative study

Effectiveness of radiation protection systems in the cardiac catheterization laboratory: a comparative study

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

Interventional cardiology and X-ray exposure of the head: overview of clinical evidence and practical implications

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