The recent publication of several reports on risk of cataract, left sided brain tumors, subclinical atherosclerosis and chromosome damage among interventional cardiologists has raised increasing concerns about radiation exposure in the cath lab.

Recognizing these risks has created a demand of these new forms of protection. Unfortunately, these have mainly been focused on the main operator, when it is pretty obvious the whole team is exposed.

Read also: “Nearly half of interventional cardiologists may have pre-cataract lesions”.

The present study assessed the use of accessory lead shields to protect circulating staff in the cath lab, such as radiology technicians and nurses.

To find out about the impact of these accessory lead shields, researchers used real time dosimetry in nurses and technicians participating in 764 consecutive procedures. 

The study was divided in two phases: the first (n=401) used standard protection (which included protection shields for the main operator); phase 2 (n=363) two accessory shields located between patient and each of the staff members were added to standard protection. Radiation exposure was reported as the effective dose normalized to dose area product.

Read also: “Effects of Cerebral Radiation on Interventional Cardiologists”.

Use of accessory shields saw a 62.5% reduction per case among technologists (phase I: 2.4 [4.3] μSv/[mGy × cm²] × 10^-5; phase II: 0.9 [2.8] μSv/[mGy × cm²] × 10^-5; p < 0.001) and a 63.6% reduction per case among nurses (phase I: 1.1 [3.1] μSv/[mGy × cm²] × 10^-5; phase II: 0.4 [1.8] μSv/[mGy × cm²] × 10^-5; p < 0.001).

By multivariate analysis, accessory shields remained independently associated with a dose reduction among both technicians and nurses.

Conclusion

With a nearly two thirds reduction in radiation exposure in nurses and technicians, the use of accessory lead shields is relatively simple and offers effective protection to all staff in the cath lab. 

Editorial Comment

Protection shields had already been shown to reduce radiation exposure in main operators, but this is the first study to observe a similar benefit in the rest of the cath lab staff, which could have huge implications as regards occupational safety. 

There were specific differences in radiation exposure among nurses and technicians, which could be attributed to their different roles in the cath lab:

• On one side, the technicians generally stand beside the main operator and at a relatively fixed distance from the radiation source. Given their position, the dose they receive directly depends on the dose used in the procedure, and the lead shield was the only game changer.
• On the other hand, nurses move around the cath lab and change their distance from the source. Procedures requiring nurses to stand closer to patients to administer drugs or antiplatelet agents, or to place an oxygen mask (among other tasks), were associated to higher radiation exposure.

Read also: “Important Study Detects Radiation-Induced DNA Damage in Operators After an Endovascular Procedure”.

In a diagnostic position followed by PCI, nurses will necessarily approach patients to carry out the above-mentioned tasks while main operators continue to step on the fluoroscopy pedal. This can increase radiation exposure for nurses as much as 425%. These specific activities dramatically raise nurse radiation exposure. Lead shields protect all members involved and should be used by all cath lab staff, regardless their role.

Original title: Radiation Exposure Among Scrub Technologists and Nurse Circulators During Cardiac Catheterization. The Impact of Accessory Lead Shields.

Reference: Ryan D. Madder et al. J Am Coll Cardiol Intv 2017, Article in press.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.