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

Abstract

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.

Occupational exposure to physicians working with a Zero-Gravity™ protection system in haemodynamic and electrophysiology labs and the assessment of its performance against a standard ceiling suspended shield

“…The measurements exhibited high attenuation of doses in the areas, where dosimeters were shielded by the ZG system; in particular, in the region of chest and the eye lens where at least 15-fold and threefold reduction of doses, respectively, is predicted. The effectiveness of the ZG system in reducing the exposure to the eye lens found in this study is lower than that reported by Savage et al ( 2013 ) (66% vs. 87% reduction for eye &head region) and Zanca et al ( 2021 ) (66% vs. 79%/83% reduction for the left eye in CA/PCI procedures) while higher than that reported by Haussen et al ( 2016 ) (66% vs. 50%). In quoted studies, except for the Zanca et al ( 2021 ), the operators performed different non-cardiac interventional radiology procedures.…”

“…The effectiveness of the ZG system in reducing the exposure to the eye lens found in this study is lower than that reported by Savage et al ( 2013 ) (66% vs. 87% reduction for eye &head region) and Zanca et al ( 2021 ) (66% vs. 79%/83% reduction for the left eye in CA/PCI procedures) while higher than that reported by Haussen et al ( 2016 ) (66% vs. 50%). In quoted studies, except for the Zanca et al ( 2021 ), the operators performed different non-cardiac interventional radiology procedures. The difference suggests that the performance of the ZG system might depend on dynamic factors related to clinical practice, such as the projection types used, the physician’s position with respect to the center of X-ray field, exposure parameters depending on patient size and the treatment area etc.…”

“…which are, to some extent, characteristic for procedure type but may also differ for procedures of the same type. According to results of the measurements performed on the phantoms presented in the report Dabin et al ( 2021 ) and published in the paper by Zanca et al ( 2021 ) the effectiveness of ZG system on the level of the eye lens is high and only slightly depends on the projection type at least for analysed in this study projections (PA, LAO 30, LAO 90); the dose reduction for the left eye lens ranges from 84% for PA projection to 96% for LAO 90 and for the right one from 75 to 92%, respectively. These values were also consistent with the results of computational simulations (Dabin et al 2021 ).…”

Effectiveness of a Real-Time X-ray Dosimetry Monitor in Reducing Radiation Exposure in Coronary Procedures: The ESPRESSO-Raysafe Randomized Trial

“…Cardiac catheterization procedures account for about 40% of total medical radiation exposure [2,21]. Despite the progress in X-ray instrumentation, protection devices, the introduction of robotic PCI, and foremost the increased awareness, the progressively increasing complexity of the procedures performed (including structural and valvular procedures) leads to a constant increase in operator exposure [22][23][24]. This increase was recently quantified in a 54% higher average fluoroscopy time when procedures performed in the year 2016 were compared to those performed 10 years before [25].…”

Suspended lead suit and physician radiation doses during coronary angiography

“…The body of the suit is composed of materials having a thicker lead equivalency than conventional lead aprons and has a transparent acrylic shield extending upward to protect the operator's head and neck. Although these design elements may theoretically offer superior radiation protection compared to lead aprons, studies evaluating the suspended lead suit have been limited to ex vivo investigations, 6–8 to small studies in noncardiac fluoroscopically guided procedures, 9–11 to its use exclusively during the percutaneous coronary intervention (PCI), 12 or did not account for important procedural variables known to impact physician radiation doses when evaluating the impact of suspended lead 13 . Furthermore, none of the prior studies investigated whether the suspended lead suit, when worn by the primary operator, impacted the radiation doses of other members of the catheterization laboratory team.…”