Author + information
Cardiac catheterization is associated with significant radiation exposure to the operator. Radiation safety employing the As Low As Reasonably Achievable (ALARA) principle includes use of lead shielding to reduce operator exposure. Furthermore, radial approach is now preferred and may be associated with more radiation exposure compared with femoral approach. We sought to evaluate whether use of a novel lead-based arm-board will result in lower radiation exposure to the operator versus usual practice.
In this proof-of-concept pilot study we evaluated radiation exposure to the primary operator in 72 patients undergoing cardiac catheterization and/or percutaneous coronary intervention (PCI) with or without the lead-based arm-board. Radiation was measured using a personal dosimeter at the level of the chest and left arm. The primary outcome was the radiation dose to operator at the chest and arm level, external to worn lead. Secondary outcomes included radiation dose to the patient, number of cine acquisitions and total fluoroscopy time.
We analyzed radiation data to operator and patient during 72 procedures (37 investigation; 35 control). The mean age of patients was 64 and most were male (75%). The majority of procedures were by radial approach (82%) and 40% had PCI. There were no significant differences in measured baseline or procedural characteristics between the two groups. The lead-based arm-board significantly reduced the radiation dose to operator at the chest level (1.1 vs. 2.1 mrem, p=0.0015) with a trend towards reduction at the arm level (2.6 vs. 4.7 mrem, p=0.06). There was no significant difference in the patient dose (8841 vs. 6762, p=0.14).
In this pilot study, radiation dose to primary operator was significantly reduced with a lead-based arm-board. A larger, randomized trial is underway to evaluate this further.
IMAGING: Cath Lab of the Future