Effect of an optimized X-ray blanket design on operator radiation dose in cardiac catheterization based on real-world angiography

Abstract

Background There is increasing concern and focus in the interventional cardiology community on potential long term health issues related to radiation exposure and heavy wearable protection. Optimized shielding measures may reduce operator dose to levels where lighter radioprotective garments can safely be used, or even omitted. X-ray blankets (XRB) are commercially available but suffer from small size and lack of stability. A larger XRB may reduce operator dose but could hamper vascular access and visualization. The aim of this study is to assess shielding effect of an optimized XRB during cardiac catheterization and estimate the potential reduction in annual operator dose based on DICOM Radiation Dose Structured Report (RDSR) data reflecting everyday clinical practice. Methods Data accumulated from 7681 procedures over three years in our RDSR repository was used to identify projection angles and radiation doses during cardiac catheterization. Using an anthropomorphic phantom and a scatter radiation detector, radiation dose to the operator (mSv) and patient (dose area product—DAP) was measured for each angiographic projection for three different shielding setups. Relative operator dose (mSv/DAP) was calculated and multiplied by DAP per projection to estimate effect on operator dose. Results Adding an optimized XRB to a standard shielding setup comprising a table- and ceiling-mounted shield resulted in a 94.9% reduction in estimated operator dose. The largest shielding effect was observed in left and cranial projections where the ceiling-mounted shield offered less protection. Conclusions An optimized XRB is a simple shielding measure that has the potential to reduce operator dose.

Efficacy and User Experience of a Novel X-Ray Shield on Operator Radiation Exposure During Cardiac Catheterization: A Randomized Controlled Trial

“…19 We have previously shown that openings between the shielding elements may cause a large increase in operator exposure. 14 The FMX was specifically designed to offer a more continuous shielding solution independently of different access and visualization needs. Our results indicate promising shielding effect.…”

“…Based on clinical experience and extensive bench testing with an anthropomorphic phantom in the cath laboratory, 14,16 we developed the reusable FMX to be placed on the patient to shield the operator from scatter radiation (Figure 1B). Pilot investigations indicated the importance of optimal positioning with a shield covering both cranially and caudally to the vascular access site and laterally to make contact with the table-mounted shield.…”

“…A model based on real-world cardiac catheterization radiation data indicated that an FMX could dramatically reduce operator dose. 14 To further validate the concept, a pilot randomized controlled trial was conducted to evaluate clinical relevance based on shielding efficacy and user feedback in routine use.…”