title: Redundant protective barriers: minimizing operator occupational risk.
abstract: BACKGROUND
  The ubiquitous use of less invasive therapeutic angiographic procedures has created the milieu for long-term occupational risk of cancer and genetic defects. This study set out to determine the relative effectiveness of redundant radiation protective barriers and their impact on operator total-body-ionizing radiation exposure in the catheterization suite.
  
  
  METHODS
  Thermolucent dosimeter x-irradiation was measured inside and outside personal and movable protective barriers used concurrently during 50 consecutive procedures by a single operator. Additionally, the entrance/exit doses were recorded on the back and chest for all patients to provide insight into radiation scatter patterns.
  
  
  RESULTS
  The x-ray beam had an average 90.8% decrement in energy traversing the patient's chest when entrance and exit doses were compared, suggesting a 3.3-fold greater operator scatter radiation exposure below the table compared with that above the table. All 0.5-mm lead equivalent personal barriers reduced operator exposure by 72-95%, whereas the 1.0-mm leaded personal barrier (overlapping gown) reduced exposure by 96%. The 0.75-mm leaded glasses reduced exposure to the left eye by 67%. A leaded left-hand glove reduced exposure by only 20%. The effective calculated operator radiation exposure risk reduction provided by the use of personal and movable barriers reduced the theoretical risk of fatal or nonfatal cancer by 22-fold while decreasing potential severe genetic effect by 25-fold in comparison to movable barriers alone.
  
  
  CONCLUSIONS
  The optimal use of combined personal and movable (redundant) lead barriers results in a significant reduction in total-body operator radiation exposure in the catheterization laboratory. The use of redundant barriers in the catheterization suite is associated with a dramatic theoretical long-term occupational risk reduction and should be encouraged.
authors.affiliation: Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine Charleston Division, Charleston, West Virginia, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Challa
authors.forename: Stafford G
authors.initials: SG
authors.lastname: Warren
authors.forename: Subhash
authors.initials: S
authors.lastname: Danak
authors.forename: Mark C
authors.initials: MC
authors.lastname: Bates
mesh_terms: D001822:Body Burden; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control*; D016273:Occupational Exposure / Q000517:prevention & control*; D016272:Occupational Health; D011481:Protective Clothing; D011835:Radiation Protection / Q000379:methods*; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014903:West Virginia / Q000453:epidemiology