Interventional Cardiology Unit, "Santa Maria" University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy.
Unit of Internal Medicine, "Santa Maria" University Hospital, Terni, Italy.
Cardiovasc Interv Ther. 2020 Oct;35(4):379-384. doi: 10.1007/s12928-020-00646-6. Epub 2020 Feb 7.
Cardiac catheterization through radial access is associated with significant ionizing radiation exposure for the operator. We aimed at evaluating whether a removable shield placed upon the patient could impact favorably on annual radiation exposure for the operator. We designed a pre-post study comparing radiation exposure in a total of five operators under standard protection procedures (first period) and after applying a removable shield (second period). Each period included all the procedures performed in 1 year. Radiation exposure was measured through three dosimeters on each operator. A total of 1610 procedures were performed during the first period, and 1670 during the second period. For each operator, Fluoroscopy Time (FT) per exam did not differ between the two periods (13.1 ± 1 vs 12.9 ± 2 min/exam, p = 0.73), whereas Dose-Area Product (DAP) per procedure was slightly higher in the second period (5.247 ± 651 vs 6.374 ± 967 mGy/cm, p < 0.01). The use of a removable shield significantly reduced operators' radiation dose at the left bracelet (64.3 ± 13.3 μSv/exam vs 23.8 ± 6.0 μSv/exam, p = 0.003). This remained significant even after adjustment for DAP per procedure (p = 0.015) and number of operators participating to each procedure (p = 0.013), whereas no significant difference was observed for card (5.6 ± 10.5 μSv/exam vs 0.9 ± 0.3 μSv/exam, p = 0.36) and neck bands (3.3 ± 4.5 μSv/exam vs 2.0 ± 2.0 μSv/exam, p = 0.36) dosimeters. The use of a removable shield during cardiac catheterization reduces radiation exposure at the level of the operator's upper limb, whereas no difference was found for other body parts. This may help in reducing radiation exposure of operator's hand. DAP increase merits further investigation.
经桡动脉入路行心导管术会使术者受到大量电离辐射。我们旨在评估在患者身上放置可移除的屏蔽是否会对术者的年辐射暴露产生有利影响。我们设计了一项前瞻性研究，比较了在标准防护程序下（第一期）和应用可移除屏蔽后（第二期）的 5 名术者的辐射暴露情况。每个阶段都包括 1 年内进行的所有操作。通过每个术者的三个剂量计测量辐射暴露。第一期共进行了 1610 次操作，第二期共进行了 1670 次操作。对于每个术者，两次检查的透视时间（FT）没有差异（13.1±1 与 12.9±2 分钟/检查，p=0.73），而每次操作的剂量面积乘积（DAP）在第二期略高（5.247±651 与 6.374±967 mGy/cm，p<0.01）。使用可移除屏蔽可显著降低术者左手链部位的辐射剂量（64.3±13.3 μSv/检查与 23.8±6.0 μSv/检查，p=0.003）。即使在考虑到每次操作的 DAP（p=0.015）和每个操作的术者数量（p=0.013）后，这一结果仍然显著，而对于卡（5.6±10.5 μSv/检查与 0.9±0.3 μSv/检查，p=0.36）和颈部带（3.3±4.5 μSv/检查与 2.0±2.0 μSv/检查，p=0.36）剂量计，未观察到显著差异。在心脏导管术中使用可移除屏蔽可降低术者上肢的辐射暴露，而其他身体部位则无差异。这可能有助于减少术者手部的辐射暴露。DAP 的增加需要进一步研究。
