Effect of a Real-Time Radiation Monitoring Device on Operator Radiation Exposure During Cardiac Catheterization

Abstract

Background— The Radiation Reduction During Cardiac Catheterization Using Real-Time Monitoring study sought to examine the effect of a radiation detection device that provides real-time operator dose reporting through auditory feedback (Bleeper Sv; Vertec Scientific Ltd; Berkshire, UK) on patient dose and operator exposure during cardiac catheterization. Methods and Results— Between January 2012 and May 2014, 505 patients undergoing coronary angiography, percutaneous coronary intervention, or both were randomized to use (n=253) or no use (n=252) of the Bleeper Sv radiation monitor. Operator radiation exposure was measured in both groups using a second, silent radiation exposure monitoring device. Mean patient age was 65±8 years, most patients (99%) were men, and 30% had prior coronary artery bypass graft surgery. Baseline clinical characteristics were similar in the 2 study groups. Radial access was used in 18% and chronic total occlusion percutaneous coronary intervention constituted 7% of the total procedures. Median procedure time was 17 (12–27) minutes for diagnostic angiography, 42 (28–70) minutes for percutaneous coronary intervention, and 27 (14–51) minutes in the overall study population, with similar distribution between the study groups. First (9 [4–17] versus 14 [7–25] μSv; P <0.001) and second (5 [2–10] versus 7 [4–14] μSv; P <0.001) operator radiation exposure was significantly lower in the Bleeper Sv group. Use of the device did not result in a significant reduction in patient radiation dose. The effect of the Bleeper Sv device on operator radiation exposure was consistent among various study subgroups. Conclusions— Use of a real-time radiation monitoring device that provides auditory feedback can significantly reduce operator radiation exposure during cardiac catheterization. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01510353.

Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry

“…Operator experience can significantly enhance radiation safety, 14 because it directly affects fluoroscopy time and patient dose, as shown in an analysis of the National Cardiovascular Data Registry. 15 The RadiCure trial 1 also showed remarkable variation of first operator radiation exposure among the 18 different operators that participated in the study. Our study suggests that addressing site-specific factors (e.g.…”

“…16 Similarly, there are guidelines for reducing radiation exposure in the cardiac catheterization laboratory. 17 In our opinion, best practices for reducing operator radiation dose include: (a) low frame per second fluoroscopy (7.5 frames per sec or lower); 24 (b) using the fluoro-store function of the X-ray equipment instead of cine-angiography whenever possible; (c) optimizing patient and equipment positioning, by maximizing the distance between the patient and the X-ray tube, minimizing the distance between image intensifier and the patient 18-20,32 and avoiding extreme angulations 22,23 ; (d) collimation; 18-20 (e) shielding, both fixed and disposable (such as the Radpad, Worldwide Innovations & Technologies, Inc), 33 thyroid collar, leaded glasses for eye protection as well as radiation protective hats; 25-28 (f) using radiation monitors that provide real time feedback; 1 and (g) using newer X-ray systems that reduce patient (and operator) radiation dose. 31 …”

“…1-3 Every effort needs to be made to reduce radiation exposure, following the principle of “as low as reasonably achievable” (ALARA).…”

The Economic Imperatives Underlying the Occupational Health Hazards of the Cardiac Catheterization Laboratory

“…One study 1 demonstrated that many physicians do not routinely wear their radiation badge, so that their exposure is unmeasured or falsely low, lest they be banished from the laboratory, although there is a clear evidence showing that wearing the dosimeter leads to lower operator and patient exposure. 13 Adoption of radiation safety protocols 14 and improved radiation equipment and imaging 10 to decrease dose have been effective, but the major motivation is to allow longer procedures without the patient being exposed to dangerous levels. Newer ideas, such as ceiling suspended aprons, and shielded gloves and caps, continue the concept of individual protection, rather than propose a new paradigm.…”

Comparative test of radiological exposure between femoral and radial techniques, development of a protective device and clinical trial design

“…Stochastic effects are caused by random cell damage where probability is proportional to received radiation dose without any threshold. Of these effects, the oncological risk11 is of concern as the latency period after exposure can be over 40 years,12 and ways to minimise radiation have been afforded increasing attention 13 14…”