Radiation Exposure Among Cath Lab Staff

Nov 08, 2017
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Authors:
Madder RD, LaCombe A, VanOosterhout S, et al.
Citation:
Radiation Exposure Among Scrub Technologists and Nurse Circulators During Cardiac Catheterization: The Impact of Accessory Lead Shields. JACC Cardiovasc Interv 2017;Nov 1:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the impact of an accessory lead shield on radiation exposure among staff members during cardiac catheterization?

Methods:

The investigators prospectively collected real-time radiation exposure data among nurses and technologists during 764 consecutive catheterizations. The study had two phases: in phase I (n = 401), standard radiation protection measures were used, and in phase II (n = 363), standard radiation protection measures were combined with an accessory lead shield placed between the staff member and patient. Radiation exposure was reported as the effective dose normalized to dose-area product (EDAP). Multivariate linear regression modeling with backward selection was performed to identify procedural variables independently associated with log of EDAP.

Results:

Use of an accessory lead shield in phase II was associated with a 62.5% lower EDAP per case among technologists (phase I: 2.4 [4.3] µSv/[mGy x cm2] x 10-5; phase II: 0.9 [2.8] µSv/[mGy x cm2] x 10-5; p < 0.001) and a 63.6% lower EDAP per case among nurses (phase I: 1.1 [3.1] µSv/[mGy x cm2] x 10-5; phase II: 0.4 [1.8] µSv/[mGy x cm2] x 10-5; p < 0.001). By multivariate analysis, accessory shielding remained independently associated with a lower EDAP among both technologists (34.2% reduction; 95% confidence interval, 20.1-45.8%; p < 0.001) and nurses (36.4% reduction; 95% confidence interval, 19.7-49.6%; p < 0.001).

Conclusions:

The authors concluded that a relatively simple approach of using accessory lead shields was associated with a nearly two-thirds reduction in radiation exposure among nurses and technologists.

Perspective:

This study reports that a simple and relatively inexpensive approach of providing staff members with a dedicated accessory lead shield during cardiac catheterization was associated with a nearly two-thirds reduction in radiation exposure among both nurses and technologists. Since, unlike physicians, who typically control the amount of radiation administered during a case, nurses and technologists may have no control over radiation use, use of accessory shields may have important implications for occupational safety in the cardiac catheterization or interventional radiology laboratory.

Clinical Topics: Prevention

Keywords: Cardiac Catheterization, Occupational Health, Primary Prevention, Protective Devices, Radiation Effects, Radiation Protection, Radiology, Interventional


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