title: Impact of robotics and a suspended lead suit on physician radiation exposure during percutaneous coronary intervention.
abstract: BACKGROUND
  Reports of left-sided brain malignancies among interventional cardiologists have heightened concerns regarding physician radiation exposure. This study evaluated the impact of a suspended lead suit and robotic system on physician radiation exposure during percutaneous coronary intervention (PCI).
  
  
  METHODS
  Real-time radiation exposure data were prospectively collected from dosimeters worn by operating physicians at the head- and chest-level during consecutive PCI cases. Exposures were compared in three study groups: 1) manual PCI performed with traditional lead apparel; 2) manual PCI performed using suspended lead; and 3) robotic PCI performed in combination with suspended lead.
  
  
  RESULTS
  Among 336 cases (86.6% manual, 13.4% robotic) performed over 30weeks, use of suspended lead during manual PCI was associated with significantly less radiation exposure to the chest and head of operating physicians than traditional lead apparel (chest: 0.0 [0.1] μSv vs 0.4 [4.0] μSv, p<0.001; head: 0.5 [1.9] μSv vs 14.9 [51.5] μSv, p<0.001). Chest-level radiation exposure during robotic PCI performed in combination with suspended lead was 0.0 [0.0] μSv, which was significantly less chest exposure than manual PCI performed with traditional lead (p<0.001) or suspended lead (p=0.046). In robotic PCI the median head-level exposure was 0.1 [0.2] μSv, which was 99.3% less than manual PCI performed with traditional lead (p<0.001) and 80.0% less than manual PCI performed with suspended lead (p<0.001).
  
  
  CONCLUSIONS
  Utilization of suspended lead and robotics were observed to result in significantly less radiation exposure to the chest and head of operating physicians during PCI.
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI. Electronic address: ryan.madder@spectrumhealth.org.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI.
authors.forename: Stacie
authors.initials: S
authors.lastname: VanOosterhout
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI.
authors.forename: Abbey
authors.initials: A
authors.lastname: Mulder
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI.
authors.forename: Matthew
authors.initials: M
authors.lastname: Elmore
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI.
authors.forename: Jessica
authors.initials: J
authors.lastname: Campbell
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI.
authors.forename: Andrew
authors.initials: A
authors.lastname: Borgman
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI.
authors.forename: Jessica
authors.initials: J
authors.lastname: Parker
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI.
authors.forename: David
authors.initials: D
authors.lastname: Wohns
mesh_terms: D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D004867:Equipment Design; D006257:Head / Q000528:radiation effects; D006801:Humans; D007854:Lead; D016014:Linear Models; D016015:Logistic Models; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D010820:Physicians; D011446:Prospective Studies; D011481:Protective Clothing; D011829:Radiation Dosage; D000072232:Radiation Dosimeters; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011834:Radiation Monitoring / Q000295:instrumentation; D011835:Radiation Protection / Q000295:instrumentation*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D013909:Thorax / Q000528:radiation effects; D013997:Time Factors
chemical_list: D007854:Lead
keywords: Occupational hazard; Percutaneous coronary intervention; Radiation safety; Robotic PCI