title: Radiation protection during hybrid procedures: innovation creates new challenges.
abstract: BACKGROUND
  The cooperation between interventional cardiologists and cardiothoracic surgeons has expanded the spectrum of treatment modalities for patients with congenital heart disease. These hybrid techniques have created new challenges, one of which being the provision of adequate but practical radiation protection. This study evaluates the use of a lightweight radiation protection drape (RADPAD) that may be suitable for shielding during hybrid procedures.
  
  
  METHODS
  To simulate a pediatric patient, an 8.7 liter water-filled tub was placed on an X-ray table and exposed to 10-second cine acquisition runs. Radiation exposure was measured at twelve specified locations around the table using a model with three different levels of radiation protection: no shielding, shielding using a traditional 0.35 mm lead-equivalent apron, and shielding using the 0.25 mm lead-equivalent RADPAD.
  
  
  RESULTS
  The traditional lead apron and the RADPAD significantly reduced the amount of radiation dose when compared with no shielding. The standard lead apron provided slightly greater radiation protection than the RADPAD (0.000064 radiation absorbed dose [rad] vs. 0.000091 rad; p = 0.012). The measured rad was significantly higher on the right side of the table, and the measured radiation dose decreased significantly with increasing distance from the table.
  
  
  CONCLUSIONS
  The RADPAD has been shown to function as an efficient shielding device, even though it does not quite match the protection that can be expected from a standard lead apron. It complies with regulatory radiation protection requirements and its lightweight and sterile use make it particularly useful during hybrid procedures in the operating room.
authors.affiliation: Cardiac Catheterization and Interventional Therapy, Cardiology Division, The Ohio State University, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA. Ralf.Holzer@NationwideChildrens.org
authors.forename: Jaclynn M
authors.initials: JM
authors.lastname: Sawdy
authors.forename: Mark D
authors.initials: MD
authors.lastname: Gocha
authors.forename: Vincent
authors.initials: V
authors.lastname: Olshove
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Chisolm
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hill
authors.forename: Alistair
authors.initials: A
authors.lastname: Phillips
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.forename: John P
authors.initials: JP
authors.lastname: Cheatham
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Holzer
mesh_terms: D000792:Angiography / Q000379:methods*; D013504:Cardiovascular Surgical Procedures / Q000295:instrumentation / Q000379:methods; D002404:Catheterization / Q000379:methods*; D004059:Diffusion of Innovation; D006801:Humans; D008422:Materials Testing; D008954:Models, Biological; D010166:Palliative Care / Q000379:methods*; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation* / Q000379:methods; D015607:Stents