Rizik David G, Burke Robert F, Klassen Sabrina R, Nigoghosian Ariana M, Riley Robert D, Gosselin Kevin P, Goldstein James A
Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona.
J Soc Cardiovasc Angiogr Interv. 2023 Oct 19;3(1):101110. doi: 10.1016/j.jscai.2023.101110. eCollection 2024 Jan.
This study of radiation exposure (RE) to physicians performing structural heart procedures evaluated the efficacy of a novel comprehensive radiation shield compared to those of traditional shielding methods. A novel comprehensive shielding system (Protego, Image Diagnostics Inc) has been documented to provide superior RE protection during coronary procedures compared to that provided by a standard "drop down" shield. The purpose of this study was to assess the efficacy of this shield in transcatheter aortic valve replacement (TAVR) procedures, which are associated with disproportionate RE to operators.
This single-center, 2-group cohort, observational analysis compared RE to the primary physician operator performing TAVR using the Protego shield (n = 25) with that using a standard drop-down shield with personal leaded apparel (n = 25). RE was measured at both thyroid and waist levels with a real-time dosimetry system (RaySafe i3, RaySafe) and was calculated on a mean per case basis. Data were collected on additional procedural parameters, including access site(s) for device implantation, per case fluoroscopy time, air kerma, and patient factors, including body mass index. Between-group comparisons were conducted to evaluate RE by group and measurement sites.
The Protego system reduced operator RE by 99% compared to that using standard protection. RE was significantly lower at both the thyroid level (0.08 ± 0.27 vs 79.2 ± 62.4 μSv; < .001) and the waist level (0.70 ± 1.50 vs 162.0 ± 91.0 μSv, < .001). "Zero" total RE was documented by RaySafe in 60% (n = 15) of TAVR cases using Protego. In contrast, standard protection did not achieve zero exposure in a single case.
The Protego shield system provides superior operator RE protection during TAVR procedures. This shield allows operators to work without the need for personal lead aprons and has potential to reduce catheterization laboratory occupational health hazards.
本项针对进行结构性心脏病手术的医生的辐射暴露（RE）研究，评估了一种新型综合辐射防护装置相较于传统防护方法的效果。与标准的“下拉式”防护装置相比，一种新型综合防护系统（Protego，影像诊断公司）已被证明在冠状动脉手术期间能提供更好的辐射暴露防护。本研究的目的是评估这种防护装置在经导管主动脉瓣置换术（TAVR）中的效果，该手术会使术者受到不成比例的辐射暴露。
本单中心、两组队列观察性分析，比较了使用Protego防护装置（n = 25）与使用带有个人铅制防护服的标准下拉式防护装置（n = 25）进行TAVR手术时术者的辐射暴露情况。使用实时剂量测定系统（RaySafe i3，RaySafe）在甲状腺和腰部水平测量辐射暴露，并按每例平均计算。收集了其他手术参数的数据，包括装置植入的穿刺部位、每例的透视时间、空气比释动能，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。
与使用标准防护相比，Protego系统使术者的辐射暴露降低了99%。在甲状腺水平（0.08±0.27对79.
