Ryan D. Madder
The use of a dedicated accessory lead shield was associated with a significant reduction in radiation exposure among nurses and technologists working in the cath lab, according to a study.
Data have shown an increased risk for certain cancers, stroke and cataracts not only among cardiologists but also among other cath lab personnel, Ryan D. Madder, MD, from the Frederik Meijer Heart and Vascular Institute of Spectrum Health in Grand Rapids, Michigan, and colleagues wrote in JACC: Cardiovascular Interventions.
During the past few years, Madder and colleagues have worked diligently to improve the culture of radiation safety in their cath lab. After the purchase of their first robotic system for PCI in 2013, they noted 99% reductions in radiation doses to physicians performing robotic PCI vs. manual PCI.
“Simultaneously, we were expanding our use of a suspended lead suit worn by physicians for nearly all diagnostic and therapeutic catheterizations. It occurred to me that with these new technologies, we were achieving remarkably low radiation doses among physicians, but we were not focusing enough on protecting our staff members from radiation. This study was born out of a desire to identify methods to improve radiation safety practices for all members of the cath lab team, not just physicians,” Madder told Cardiology Today’s Intervention.
To determine whether an accessory lead shield reduced radiation exposure for cath lab staff, Madder and colleagues conducted a single-center observational study in which they collected real-time radiation exposure data among nurses and technologists during consecutive cardiac catheterizations in two phases. In the first phase, which included 401 cases, only standard radiation protection measures were used. In the second phase, which included 363 cases, standard protection measures were used with an accessory lead shield placed between the staff member and the patient.
The effective dose was normalized to the dose-area product (EDAP) for reporting of radiation exposure to control for the amount of radiation used in each case.
Reduced radiation exposure
Results showed that the EDAP per case was 62.5% lower among technologists and 63.6% lower among nurses with the use of an accessory lead shield.
In multivariate analysis, EDAP was independently associated with only the use of the lead shield (dose reduction, 34.2%) and radiation-absorbing pads (dose reduction, 47%) among technologists. However, among nurses, the use of the lead shield was the only variable independently associated with a reduction in EDAP (dose reduction, 36.4%), with PCI (dose increase, 112%) and fractional flow reserve (dose increase, 41.9%) being independently associated with increases in EDAP.
“Whereas it was encouraging to see that the shields were associated with a [reduction of nearly two-thirds] in the radiation doses among nurses and technologists, we were surprised to see the dramatic impact of PCI on nurse radiation doses. Even after normalizing the effective dose per case to the dose-area product, cases involving PCI were associated with a 425% increase in the nurse radiation dose by univariate analysis,” he told Cardiology Today’s Intervention.
This difference, Madder noted, is likely related to occupational differences. He and his colleagues speculated that the increased radiation exposure may have been attributable to nurses approaching the patient during PCI to administer oral or IV medications while fluoroscopy was in use.
“This finding underscores the need for additional methods to reduce nurse radiation doses during PCI. Based on this finding, we have now made it standard practice at our institution that nurses verbally notify the physician if they need to approach the patient. This enables the physician to get off the pedal and cease radiation use in order to prevent the nurse from getting irradiated as they care for the patient,” Madder said.
A ‘simple’ measure
These study results are encouraging and demonstrate the effectiveness of a fairly straightforward safety measure, according to Madder.
“The use of accessory lead shields is a simple and relatively inexpensive means by which nurses and technologists may significantly reduce their occupational radiation exposure,” he said. “Based on the results of our study, Spectrum Health has purchased a dedicated accessory lead shield for use by staff members in each of our cath lab rooms. It has now been over a year since these additional shields were purchased and we have seen a dramatic reduction in radiation exposure among our staff members.”
In light of these findings, Madder said he hopes that other institutions will take similar steps in an attempt to protect nurses and technologists. – by Melissa Foster
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Ryan D. Madder, MD, can be reached at email@example.com.
Disclosures: The study was partially funded by a research grant from Corindus Vascular Robotics. Madder reports he has received research support from and served on the advisory board of Corindus Vascular Robotics. All other authors report no relevant financial disclosures.
Editor’s note: This article was updated on Jan. 30 with quotes from Dr. Madder.