Usefulness of Pelvic Radiation Protection Shields During Transfemoral Procedures—Operator and Patient Considerations

Marcusohn, Erez; Postnikov, Maria; Musallam, Anees; Yalonetsky, Sergey; Mishra, Snehil; Kerner, Arthur; Поляков, А С; Roguin, Ariel

doi:10.1016/j.amjcard.2018.06.003

Cited by 21 publications

(25 citation statements)

References 23 publications

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“…There were three review articles found that met the inclusion criteria [16][17][18]. Analysis of these reviews in combination with cross references from the national guidelines [6][7][8][9][10]19] revealed twelve more publications that were also included in the full text analysis [2,3,[20][21][22][23][24][25][26][27][28][29].…”

Section: Resultsmentioning

confidence: 99%

“…The difficulty in positioning correctly the shielding to guarantee that it will stay outside the X-ray field, while X-ray tube constantly moves around the patient; the fact that the shielding is not visible under the sterile drape, and that the procedures are particularly long increasing the risk that the patient moves, make shielding use complicated. On the other hand, special shielding during fluoroscopy and interventional procedures is often used to decrease the radiation exposure of the operator and not that of the patient [21,23,26]. If this kind of shielding is correctly placed, outside the primary beam, the patient exposure remains the same, while in some cases the dose to the operator may decrease or remain the same [21,26].…”

Section: Fluoroscopy Guided Proceduresmentioning

confidence: 99%

“…On the other hand, special shielding during fluoroscopy and interventional procedures is often used to decrease the radiation exposure of the operator and not that of the patient [21,23,26]. If this kind of shielding is correctly placed, outside the primary beam, the patient exposure remains the same, while in some cases the dose to the operator may decrease or remain the same [21,26]. However, there are bad practice when applying patient shielding was proven to increase the dose to the patient and personnel [23], hide important anatomical details [21], and increase the risk of infection [53].…”

Section: Fluoroscopy Guided Proceduresmentioning

confidence: 99%

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Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

et al. 2022

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Patient shielding during medical X-ray imaging has been increasingly criticized in the last years due to growing evidence that it often provides minimal benefit and may even compromise image quality. In Europe, and as also shown in a short assessment in Switzerland, the use of patient shielding is inhomogeneous. The aim of this study was to systematically review recent literature in order to assess benefits and appraise disadvantages related to the routine use of patient shielding. Methods: To evaluate benefits and disadvantages related to the application of patient shielding in radiological procedures, a systematic literature review was performed for CT, radiography, mammography and fluoroscopyguided medical X-ray imaging. In addition, reports from medical physics societies and authorities of different countries were considered in the evaluation. Results: The literature review revealed 479 papers and reports on the topic, from which 87 qualified for closer analysis. The review considered in-and out-of-plane patient shielding as well as shielding for pregnant and pediatric patients. Dose savings and other dose and non-dose related effects of patient shielding were considered in the evaluation. Conclusions: Although patient shielding has been used in radiological practice for many years, its use is no longer undisputed. The evaluation of the systematic literature review of recent studies and reports shows that dose savings are rather minimal while significant dose-and non-dose-related detrimental effects are present. Consequently, the routine usage of patient protection shielding in medical X-ray imaging can be safely discontinued for all modalities and patient groups.

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Section: Resultsmentioning

confidence: 99%

Section: Fluoroscopy Guided Proceduresmentioning

confidence: 99%

Section: Fluoroscopy Guided Proceduresmentioning

confidence: 99%

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Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

et al. 2022

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“…Several studies have demonstrated that operator radiation can be significantly reduced when using a lead or leadequivalent drape over the pelvis of the patient [2,3,9]. However, there are very few data regarding the effectiveness of these devices in reduction of radiation for CTO operators.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of MAVIG X-Ray Protective Drapes in Reducing CTO Operator Radiation

McCutcheon

Vanhaverbeke

Dabin

et al. 2021

Journal of Interventional Cardiology

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Background. The MAVIG X-ray protective drape (MXPD) has been shown to reduce operator radiation dose during percutaneous coronary interventions (PCI). Whether MXPDs are also effective in reducing operator radiation during chronic total occlusion (CTO) PCI, often with dual access, is unknown. Methods. We performed a prospective, randomized-controlled study comparing operator radiation dose during CTO PCI (n = 60) with or without pelvic MXPDs. The primary outcomes were the difference in first operator radiation dose (μSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the two groups. The effectiveness of MXPD in CTO PCI was compared with non-CTO PCI using a patient-level pooled analysis with a previously published non-CTO PCI randomized study. Results. The use of the MXPD was associated with a 37% reduction in operator dose (weighted median dose 26.0 (IQR 10.00–29.47) μSv in the drape group versus 41.8 (IQR 30.82–60.59) μSv in the no drape group; P < 0.001 ) and a 60% reduction in relative operator dose (median dose 3.5 (IQR 2.5–5.4) E/DAPx10−3 in the drape group versus 8.6 (IQR 4.2–12.5) E/DAPx10−3 in the no drape group; P = 0.001 ). MXPD was equally effective in reducing operator dose in CTO PCI compared with non-CTO PCI ( P value for interaction 0.963). Conclusions. The pelvic MAVIG X-ray protective drape significantly reduced CTO operator radiation dose. This trial is clinically registered with https://www.clinicaltrials.gov (unique identifier: NCT04285944).

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“…Traditional lead personal protective equipment (LPPE) with lead aprons, thyroid shields and lead glasses are only partially effective. This protection equipment leaves body parts such as arms, hands and the head unprotected 8‐10 . New concepts in individual or semi‐individual radioprotection are now being marketed to reduce scatter radiation.…”

Section: Introductionmentioning

confidence: 99%

The radioprotective effect of the Cathpax® AIR cabin during interventional cardiology procedures

Gutierrez-Barrios

Angulo-Pain

Noval-Morillas

et al. 2021

Catheter Cardiovasc Interv

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Background The use of ionizing radiation during cardiac catheterization interventions adversely impacts the medical staff. Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has proven to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real‐world procedures. Methods and Results In this nonrandomized all‐comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n = 59) and the non‐RPC group (n = 60). No significant changes in the characteristics of patients and procedures, average contrast volume, air kerma (AK), dose area‐product (DAP) and fluoroscopy time between both groups were apparent. In the RPC group, the first‐operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures. Conclusions Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real‐world setting.

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Usefulness of Pelvic Radiation Protection Shields During Transfemoral Procedures—Operator and Patient Considerations

Cited by 21 publications

References 23 publications

Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

Efficacy of MAVIG X-Ray Protective Drapes in Reducing CTO Operator Radiation

The radioprotective effect of the Cathpax® AIR cabin during interventional cardiology procedures

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