title: Significant reduction of radiation exposure to operator and staff during cardiac interventions by analysis of radiation leakage and improved lead shielding.
abstract: The objectives of this study were to disclose and to reduce occupational radiation leakage in invasive cardiology. Prospectively, we analyzed various dose parameters for 330 coronary procedures. We used a Rando phantom to measure scatter entrance skin air kerma to the operator (S-ESAK-O) during fluoroscopy for all standard tube angulations, and to plot isodose lines for 0 degrees /0 degrees -posterior anterior angulation. The patient's measured dose area product due to diagnostic catheterization and elective percutaneous transluminal coronary angioplasty was 6.2 and 10.4 Gycm(2), which represents 11% and 13% of currently typical values, respectively. With use of 0.5- and 1.0-mm overcouch and undercouch shielding, it was possible to reduce the mean of 4,686 nSv/Gycm(2) to 677 and 277 nSv/Gycm(2), respectively. Closure of radiation leakage up to 897 microSv/hour at the operator's gonadal height (80 to 105 cm), not heretofore described, was achieved by an additional 1.0-mm, lead-equivalent undercouch-top and overcouch-flap adjacent to the table, down to a S-ESAK-O/dose area product level of 47.5 nSv/Gycm(2). With use of a 0.5-mm lead apron, collar, glasses, foot-switch shield and 1.0-mm lead cover around the patient's thighs, the operator received a mean S-ESAK-O of 8.5, while his forehead, eyes, thyroid, chest, gonads, and hands were exposed to 68.2, 1.2, 1.2, 1.2, 0.8, and 58.2 nSv/Gycm(2), respectively. In conclusion, radiation-attenuating intervention techniques and improved lead protection can effectively contribute to a new state of the art in invasive cardiology, with reduction of operator radiation exposure to 0.8% of typical S-ESAK-O levels in advanced catheterization laboratories.
authors.affiliation: Department of Cardiology, Clinic Franconia Switzerland, Ebermannstad, Germany. kfs.ebs@t-online.de
authors.forename: Eberhard
authors.initials: E
authors.lastname: Kuon
authors.forename: Moritz
authors.initials: M
authors.lastname: Schmitt
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Dahm
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D002932:Cineangiography / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation; D006282:Health Personnel; D006801:Humans; D008297:Male; D016273:Occupational Exposure; D010361:Patients; D011446:Prospective Studies; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation*; D012542:Scattering, Radiation