Reduction of Operator Radiation Dose by a Pelvic Lead Shield During Cardiac Catheterization by Radial Access: Comparison With Femoral Access

Apr 16, 2012
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Authors:
Lange HW, von Boetticher H.
Citation:
JACC Cardiovasc Interv 2012;5:445-449.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the efficacy of patient pelvic lead shielding for the reduction of operator radiation exposure during cardiac catheterization via the radial access in comparison with the femoral access?

Methods:

The investigators randomly assigned 210 patients undergoing elective coronary angiography by the same operator to a radial and femoral access with and without pelvic lead shielding of the patient. Operator radiation dose was measured by a radiation dosimeter attached to the outside breast pocket of the lead apron. Comparisons between groups were done with the Mann-Whitney U-test and the chi-square test.

Results:

For radial access, operator dose decreased from 20.9 ± 13.8 to 9.0 ± 5.4 µSv, p < 0.0001 with pelvic lead shielding. For femoral access, it decreased from 15.3 ± 10.4 to 2.9 ± 2.7 µSv, p < 0.0001. Pelvic lead shielding significantly decreased the dose-area product–normalized operator dose (operator dose divided by the dose-area product) by the same amount for radial and femoral access (0.94 ± 0.28 to 0.39 ± 0.19 µSv x Gy-1 x cm-2 and 0.70 ± 0.26 to 0.16 ± 0.13 µSv x Gy-1 x cm-2, respectively).

Conclusions:

The authors concluded that pelvic lead shielding is highly effective in reducing operator radiation exposure for radial as well as femoral procedures.

Perspective:

This study suggests that pelvic lead shielding offers effective radiation protection to the operator working from a transradial access. The absolute amount of dose reduction is similar for radial and femoral procedures, although despite the use of the pelvic shield, the operator radiation dose for radial diagnostic coronary angiograms remains higher compared with the femoral route. Further reductions in radiation exposure for radial operators are possible and should be aimed for, such as a combination of the pelvic lead shield and the protection board. These measures may attenuate or eventually eliminate the difference in operator radiation exposure associated with the radial approach, which exists today.

Keywords: Chi-Square Distribution, Coronary Angiography, Protective Devices, Cardiac Catheterization, Radiation Dosage, Radiation Protection


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