Rizik David G, Riley Robert D, Burke Robert F, Klassen Sabrina R, Nigoghosian Ariana M, Gosselin Kevin P, Goldstein James A
Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona.
University of Michigan, Ann Arbor, Michigan.
J Soc Cardiovasc Angiogr Interv. 2023 Mar 21;2(3):100603. doi: 10.1016/j.jscai.2023.100603. eCollection 2023 May-Jun.
The catheterization laboratory predisposes to occupational health hazards. Chronic radiation exposure (RE) direct injuries include a predilection to cataracts and concerns for cancers. Indirectly adverse effects underly the prevalence of orthopedic maladies in interventionists, linked to the burden of mandatory protective lead aprons. A novel comprehensive shielding system (Protego, Image Diagnostics Inc) has been validated in early studies to provide excellent radiation protection. The system is designed to reduce operator RE sufficient to eliminate the need for personal lead aprons. Recent system refinements offer potentially even greater degrees of protection. This clinical study evaluated the efficacy of this system.
This single-center 2-group cohort study compared physician operator RE utilizing the latest iteration of the Protego shield (n = 25 cases) or standard protection (personal leaded apparel and drop-down shield, n = 25 cases) during routine cardiac catheterization procedures. RE at both thyroid and waist levels were measured with a real-time dosimetry system (Raysafe) and calculated on a mean per case basis at both thyroid and waist levels. Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index. Between-group comparisons were conducted to evaluate RE by group and measurement sites.
Protection with Protego was superior to standard methods. Protego showed markedly lower RE at both the thyroid level (0.36 ± 0.86 vs 58.5 ± 50.2 μSv; < .001) and the waist level (0.84 ± 2.99 vs 121.4 ± 171.2 μSv; < .001. "Zero" total RE was documented in 68% (n = 17) of Protego cases; in contrast, standard protection did not achieve "zero" exposure in a single case.
The Protego shield system provides excellent RE protection to the physician operator, achieving "zero" RE in two-thirds of cases. RE was superior to standard protection methods. The magnitude of protection achieves state regulatory standards sufficient to allow operators to perform procedures without orthopedically burdensome lead aprons. This shield system has the potential to reduce occupational health hazards.
导管室易引发职业健康危害。长期辐射暴露（RE）导致的直接损伤包括易患白内障以及对癌症的担忧。间接不良影响是导致介入医生骨科疾病高发的原因，这与强制使用防护铅围裙的负担有关。一种新型综合屏蔽系统（Protego，影像诊断公司）在早期研究中已得到验证，可提供出色的辐射防护。该系统旨在将操作人员的辐射暴露降低到足以无需使用个人铅围裙的程度。最近对该系统的改进可能提供更高程度的防护。本临床研究评估了该系统的有效性。
这项单中心两组队列研究比较了在常规心脏导管插入术过程中，使用最新版Protego屏蔽装置的医生操作人员（n = 25例）与使用标准防护措施（个人铅制服装和下拉式屏蔽，n = 25例）的辐射暴露情况。使用实时剂量测定系统（Raysafe）测量甲状腺和腰部水平的辐射暴露，并计算每例患者甲状腺和腰部水平的平均辐射量。收集的其他参数包括手术类型、穿刺部位、每例患者的透视时间以及患者因素，包括体重指数。进行组间比较以评估不同组和测量部位的辐射暴露情况。
Protego防护优于标准方法。Protego在甲状腺水平（0.36 ± 0.86 vs 58.5 ± 50.2 μSv；P <.001）和腰部水平（0.84 ± 2.99 vs 121.4 ± 171.2 μSv；P <.001）的辐射暴露均显著更低。在68%（n = 17）的Protego病例中记录到“零”总辐射暴露；相比之下，标准防护措施在任何一例中都未实现“零”暴露。
Protego屏蔽系统为医生操作人员提供了出色的辐射暴露防护，三分之二的病例实现了“零”辐射暴露。其辐射防护优于标准防护方法。防护程度达到了国家监管标准，足以使操作人员在不穿戴对骨科造成负担的铅围裙的情况下进行手术。这种屏蔽系统有可能减少职业健康危害。
